|
LEVEL I PERCUTANEOUS CORONARY AND INTRACARDIAC INTERVENTIONAL PROCEDURES
|
Facility
|
OP
|
$1,842.51
|
|
|
Service Code
|
EAPG 00099
|
| Min. Negotiated Rate |
$1,771.64 |
| Max. Negotiated Rate |
$1,842.51 |
| Rate for Payer: Anthem Medicaid |
$1,771.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$1,771.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,771.64
|
| Rate for Payer: Dean Health Medicaid |
$1,771.64
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$1,771.64
|
| Rate for Payer: Managed Health Services Medicaid |
$1,842.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,771.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$1,771.64
|
| Rate for Payer: United Healthcare Medicaid |
$1,771.64
|
|
|
LEVEL I PERINEAL AND VAGINAL GYNECOLOGICAL PROCEDURES
|
Facility
|
OP
|
$549.30
|
|
|
Service Code
|
EAPG 00188
|
| Min. Negotiated Rate |
$528.17 |
| Max. Negotiated Rate |
$549.30 |
| Rate for Payer: Anthem Medicaid |
$528.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$528.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$528.17
|
| Rate for Payer: Dean Health Medicaid |
$528.17
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$528.17
|
| Rate for Payer: Managed Health Services Medicaid |
$549.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$528.17
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$528.17
|
| Rate for Payer: United Healthcare Medicaid |
$528.17
|
|
|
LEVEL I PERIODONTICS
|
Facility
|
OP
|
$200.45
|
|
|
Service Code
|
EAPG 00352
|
| Min. Negotiated Rate |
$192.74 |
| Max. Negotiated Rate |
$200.45 |
| Rate for Payer: Anthem Medicaid |
$192.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$192.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$192.74
|
| Rate for Payer: Dean Health Medicaid |
$192.74
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$192.74
|
| Rate for Payer: Managed Health Services Medicaid |
$200.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$192.74
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$192.74
|
| Rate for Payer: United Healthcare Medicaid |
$192.74
|
|
|
LEVEL I PERIPHERAL ENDOVASCULAR AND TRANSCATHETER PROCEDURES
|
Facility
|
OP
|
$826.80
|
|
|
Service Code
|
EAPG 00077
|
| Min. Negotiated Rate |
$794.99 |
| Max. Negotiated Rate |
$826.80 |
| Rate for Payer: Anthem Medicaid |
$794.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$794.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$794.99
|
| Rate for Payer: Dean Health Medicaid |
$794.99
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$794.99
|
| Rate for Payer: Managed Health Services Medicaid |
$826.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$794.99
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$794.99
|
| Rate for Payer: United Healthcare Medicaid |
$794.99
|
|
|
LEVEL I PERIPHERAL VASCULAR REPAIR, LIGATION OR RECONSTRUCTION
|
Facility
|
OP
|
$458.76
|
|
|
Service Code
|
EAPG 00078
|
| Min. Negotiated Rate |
$441.11 |
| Max. Negotiated Rate |
$458.76 |
| Rate for Payer: Anthem Medicaid |
$441.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$441.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$441.11
|
| Rate for Payer: Dean Health Medicaid |
$441.11
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$441.11
|
| Rate for Payer: Managed Health Services Medicaid |
$458.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$441.11
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$441.11
|
| Rate for Payer: United Healthcare Medicaid |
$441.11
|
|
|
LEVEL I POSTERIOR SEGMENT EYE PROCEDURES
|
Facility
|
OP
|
$221.27
|
|
|
Service Code
|
EAPG 00237
|
| Min. Negotiated Rate |
$212.76 |
| Max. Negotiated Rate |
$221.27 |
| Rate for Payer: Anthem Medicaid |
$212.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$212.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$212.76
|
| Rate for Payer: Dean Health Medicaid |
$212.76
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$212.76
|
| Rate for Payer: Managed Health Services Medicaid |
$221.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$212.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$212.76
|
| Rate for Payer: United Healthcare Medicaid |
$212.76
|
|
|
LEVEL I PROSTATE PROCEDURES
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
EAPG 00176
|
| Min. Negotiated Rate |
$355.77 |
| Max. Negotiated Rate |
$370.00 |
| Rate for Payer: Anthem Medicaid |
$355.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$355.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$355.77
|
| Rate for Payer: Dean Health Medicaid |
$355.77
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$355.77
|
| Rate for Payer: Managed Health Services Medicaid |
$370.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$355.77
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$355.77
|
| Rate for Payer: United Healthcare Medicaid |
$355.77
|
|
|
LEVEL I PROSTHODONTICS, FIXED
|
Facility
|
OP
|
$22.59
|
|
|
Service Code
|
EAPG 00353
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$22.59 |
| Rate for Payer: Anthem Medicaid |
$21.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$21.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21.72
|
| Rate for Payer: Dean Health Medicaid |
$21.72
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$21.72
|
| Rate for Payer: Managed Health Services Medicaid |
$22.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$21.72
|
| Rate for Payer: United Healthcare Medicaid |
$21.72
|
|
|
LEVEL I PROSTHODONTICS, REMOVABLE
|
Facility
|
OP
|
$45.78
|
|
|
Service Code
|
EAPG 00356
|
| Min. Negotiated Rate |
$44.02 |
| Max. Negotiated Rate |
$45.78 |
| Rate for Payer: Anthem Medicaid |
$44.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$44.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.02
|
| Rate for Payer: Dean Health Medicaid |
$44.02
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$44.02
|
| Rate for Payer: Managed Health Services Medicaid |
$45.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$44.02
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$44.02
|
| Rate for Payer: United Healthcare Medicaid |
$44.02
|
|
|
LEVEL I RADIATION THERAPY
|
Facility
|
OP
|
$38.66
|
|
|
Service Code
|
EAPG 00343
|
| Min. Negotiated Rate |
$37.17 |
| Max. Negotiated Rate |
$38.66 |
| Rate for Payer: Anthem Medicaid |
$37.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$37.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$37.17
|
| Rate for Payer: Dean Health Medicaid |
$37.17
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$37.17
|
| Rate for Payer: Managed Health Services Medicaid |
$38.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$37.17
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$37.17
|
| Rate for Payer: United Healthcare Medicaid |
$37.17
|
|
|
LEVEL I RADIATION TREATMENT PREPARATION & PLANNING
|
Facility
|
OP
|
$25.76
|
|
|
Service Code
|
EAPG 00476
|
| Min. Negotiated Rate |
$24.76 |
| Max. Negotiated Rate |
$25.76 |
| Rate for Payer: Anthem Medicaid |
$24.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$24.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.76
|
| Rate for Payer: Dean Health Medicaid |
$24.76
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$24.76
|
| Rate for Payer: Managed Health Services Medicaid |
$25.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$24.76
|
| Rate for Payer: United Healthcare Medicaid |
$24.76
|
|
|
LEVEL I SKIN EXCISIONS, BIOPSIES, AND REPAIRS
|
Facility
|
OP
|
$93.05
|
|
|
Service Code
|
EAPG 00009
|
| Min. Negotiated Rate |
$89.47 |
| Max. Negotiated Rate |
$93.05 |
| Rate for Payer: Anthem Medicaid |
$89.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$89.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$89.47
|
| Rate for Payer: Dean Health Medicaid |
$89.47
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$89.47
|
| Rate for Payer: Managed Health Services Medicaid |
$93.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$89.47
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$89.47
|
| Rate for Payer: United Healthcare Medicaid |
$89.47
|
|
|
LEVEL I SKIN INCISION AND DRAINAGE, DEBRIDEMENT, DESTRUCTION, OTHER RELATED PX
|
Facility
|
OP
|
$37.63
|
|
|
Service Code
|
EAPG 00003
|
| Min. Negotiated Rate |
$36.19 |
| Max. Negotiated Rate |
$37.63 |
| Rate for Payer: Anthem Medicaid |
$36.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$36.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.19
|
| Rate for Payer: Dean Health Medicaid |
$36.19
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36.19
|
| Rate for Payer: Managed Health Services Medicaid |
$37.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$36.19
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36.19
|
| Rate for Payer: United Healthcare Medicaid |
$36.19
|
|
|
LEVEL I SMALL AND LARGE INTESTINE SURGICAL PROCEDURES
|
Facility
|
OP
|
$443.41
|
|
|
Service Code
|
EAPG 00127
|
| Min. Negotiated Rate |
$426.35 |
| Max. Negotiated Rate |
$443.41 |
| Rate for Payer: Anthem Medicaid |
$426.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$426.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$426.35
|
| Rate for Payer: Dean Health Medicaid |
$426.35
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$426.35
|
| Rate for Payer: Managed Health Services Medicaid |
$443.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$426.35
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$426.35
|
| Rate for Payer: United Healthcare Medicaid |
$426.35
|
|
|
LEVEL I SPINE PROCEDURES
|
Facility
|
OP
|
$1,080.54
|
|
|
Service Code
|
EAPG 00028
|
| Min. Negotiated Rate |
$1,038.97 |
| Max. Negotiated Rate |
$1,080.54 |
| Rate for Payer: Anthem Medicaid |
$1,038.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$1,038.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,038.97
|
| Rate for Payer: Dean Health Medicaid |
$1,038.97
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$1,038.97
|
| Rate for Payer: Managed Health Services Medicaid |
$1,080.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,038.97
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$1,038.97
|
| Rate for Payer: United Healthcare Medicaid |
$1,038.97
|
|
|
LEVEL I SURGICAL PATHOLOGY TESTS
|
Facility
|
OP
|
$7.02
|
|
|
Service Code
|
EAPG 00305
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$7.02 |
| Rate for Payer: Anthem Medicaid |
$6.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.75
|
| Rate for Payer: Dean Health Medicaid |
$6.75
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6.75
|
| Rate for Payer: Managed Health Services Medicaid |
$7.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.75
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6.75
|
| Rate for Payer: United Healthcare Medicaid |
$6.75
|
|
|
LEVEL I THORACIC AND CHEST PROCEDURES
|
Facility
|
OP
|
$498.51
|
|
|
Service Code
|
EAPG 00069
|
| Min. Negotiated Rate |
$479.33 |
| Max. Negotiated Rate |
$498.51 |
| Rate for Payer: Anthem Medicaid |
$479.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$479.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$479.33
|
| Rate for Payer: Dean Health Medicaid |
$479.33
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$479.33
|
| Rate for Payer: Managed Health Services Medicaid |
$498.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$479.33
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$479.33
|
| Rate for Payer: United Healthcare Medicaid |
$479.33
|
|
|
LEVEL I UPPER GI ENDOSCOPY
|
Facility
|
OP
|
$216.66
|
|
|
Service Code
|
EAPG 00134
|
| Min. Negotiated Rate |
$208.32 |
| Max. Negotiated Rate |
$216.66 |
| Rate for Payer: Anthem Medicaid |
$208.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$208.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$208.32
|
| Rate for Payer: Dean Health Medicaid |
$208.32
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$208.32
|
| Rate for Payer: Managed Health Services Medicaid |
$216.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$208.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$208.32
|
| Rate for Payer: United Healthcare Medicaid |
$208.32
|
|
|
LEVEL I URETHRAL PROCEDURES
|
Facility
|
OP
|
$649.87
|
|
|
Service Code
|
EAPG 00166
|
| Min. Negotiated Rate |
$624.87 |
| Max. Negotiated Rate |
$649.87 |
| Rate for Payer: Anthem Medicaid |
$624.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$624.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$624.87
|
| Rate for Payer: Dean Health Medicaid |
$624.87
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$624.87
|
| Rate for Payer: Managed Health Services Medicaid |
$649.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$624.87
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$624.87
|
| Rate for Payer: United Healthcare Medicaid |
$624.87
|
|
|
LEVEL I VARICOSE VEIN AND RELATED PROCEDURES
|
Facility
|
OP
|
$133.75
|
|
|
Service Code
|
EAPG 00090
|
| Min. Negotiated Rate |
$128.61 |
| Max. Negotiated Rate |
$133.75 |
| Rate for Payer: Anthem Medicaid |
$128.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$128.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$128.61
|
| Rate for Payer: Dean Health Medicaid |
$128.61
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$128.61
|
| Rate for Payer: Managed Health Services Medicaid |
$133.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$128.61
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$128.61
|
| Rate for Payer: United Healthcare Medicaid |
$128.61
|
|
|
LEVEL I VASCULAR RADIOLOGICAL PROCEDURES
|
Facility
|
OP
|
$243.39
|
|
|
Service Code
|
EAPG 00277
|
| Min. Negotiated Rate |
$234.02 |
| Max. Negotiated Rate |
$243.39 |
| Rate for Payer: Anthem Medicaid |
$234.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$234.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$234.02
|
| Rate for Payer: Dean Health Medicaid |
$234.02
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$234.02
|
| Rate for Payer: Managed Health Services Medicaid |
$243.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$234.02
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$234.02
|
| Rate for Payer: United Healthcare Medicaid |
$234.02
|
|
|
LEVEL IV EAR, NOSE, MOUTH AND THROAT PROCEDURES
|
Facility
|
OP
|
$961.64
|
|
|
Service Code
|
EAPG 00255
|
| Min. Negotiated Rate |
$924.65 |
| Max. Negotiated Rate |
$961.64 |
| Rate for Payer: Anthem Medicaid |
$924.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$924.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$924.65
|
| Rate for Payer: Dean Health Medicaid |
$924.65
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$924.65
|
| Rate for Payer: Managed Health Services Medicaid |
$961.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$924.65
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$924.65
|
| Rate for Payer: United Healthcare Medicaid |
$924.65
|
|
|
LEVEL IV NERVE PROCEDURE W OR W/O NEUROLOGICAL DEVICE
|
Facility
|
OP
|
$4,178.09
|
|
|
Service Code
|
EAPG 00224
|
| Min. Negotiated Rate |
$4,017.38 |
| Max. Negotiated Rate |
$4,178.09 |
| Rate for Payer: Anthem Medicaid |
$4,017.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,017.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,017.38
|
| Rate for Payer: Dean Health Medicaid |
$4,017.38
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,017.38
|
| Rate for Payer: Managed Health Services Medicaid |
$4,178.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,017.38
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,017.38
|
| Rate for Payer: United Healthcare Medicaid |
$4,017.38
|
|
|
Level IV - surgical pathology, gross and microscopic examination abortion - spontaneous/missed artery, biopsy bone marrow, biopsy bone exostosis brain/meninges, other than for tumor resection breast, biopsy, not requiring microscopic evaluation of surgical margins breast, reduction mammoplasty bronchus, biopsy cell block, any source cervix, biopsy colon, biopsy duodenum, biopsy endocervix, curettings/biopsy endometrium, curettings/biopsy esophagus, biopsy extremity, amputation, traumatic Fallopian tube, biopsy Fallopian tube, ectopic pregnancy femoral head, fracture fingers/toes, amputation, non-traumatic gingiva/oral mucosa, biopsy heart valve joint, resection kidney, biopsy larynx, biopsy leiomyoma(s), uterine myomectomy - without uterus lip, biopsy/wedge resection lung, transbronchial biopsy lymph node, biopsy muscle, biopsy nasal mucosa, biopsy nasopharynx/oropharynx, biopsy nerve, biopsy odontogenic/dental cyst omentum, biopsy ovary with or without tube, non-neoplastic ovary, biopsy/wedge resection parat
|
Facility
|
OP
|
$219.36
|
|
|
Service Code
|
CPT 88305
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$54.84 |
| Max. Negotiated Rate |
$219.36 |
| Rate for Payer: Aetna Managed Medicare |
$54.84
|
| Rate for Payer: Anthem Medicare Advantage |
$54.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$54.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$54.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$54.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$54.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$204.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$54.84
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$54.84
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$54.84
|
| Rate for Payer: NAPHCARE Commercial |
$82.26
|
| Rate for Payer: Quartz Medicare Advantage |
$54.84
|
| Rate for Payer: The Alliance Commercial |
$219.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.84
|
| Rate for Payer: Wellcare Medicare |
$54.84
|
|
|
Level IV - surgical pathology, gross and microscopic examination abortion - spontaneous/missed artery, biopsy bone marrow, biopsy bone exostosis brain/meninges, other than for tumor resection breast, biopsy, not requiring microscopic evaluation of surgical margins breast, reduction mammoplasty bronchus, biopsy cell block, any source cervix, biopsy colon, biopsy duodenum, biopsy endocervix, curettings/biopsy endometrium, curettings/biopsy esophagus, biopsy extremity, amputation, traumatic Fallopian tube, biopsy Fallopian tube, ectopic pregnancy femoral head, fracture fingers/toes, amputation, non-traumatic gingiva/oral mucosa, biopsy heart valve joint, resection kidney, biopsy larynx, biopsy leiomyoma(s), uterine myomectomy - without uterus lip, biopsy/wedge resection lung, transbronchial biopsy lymph node, biopsy muscle, biopsy nasal mucosa, biopsy nasopharynx/oropharynx, biopsy nerve, biopsy odontogenic/dental cyst omentum, biopsy ovary with or without tube, non-neoplastic ovary, biopsy/wedge resection parat
|
Facility
|
OP
|
$219.36
|
|
|
Service Code
|
CPT 88305
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$54.84 |
| Max. Negotiated Rate |
$219.36 |
| Rate for Payer: Aetna Managed Medicare |
$54.84
|
| Rate for Payer: Anthem Medicare Advantage |
$54.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$54.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$54.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$54.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$54.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$204.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$54.84
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$54.84
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$54.84
|
| Rate for Payer: NAPHCARE Commercial |
$82.26
|
| Rate for Payer: Quartz Medicare Advantage |
$54.84
|
| Rate for Payer: The Alliance Commercial |
$219.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.84
|
| Rate for Payer: Wellcare Medicare |
$54.84
|
|
