|
OT WRIST EXTENSION STATIC
|
Facility
|
OP
|
$154.86
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
41809290
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.32 |
| Max. Negotiated Rate |
$162.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$85.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38.32
|
| Rate for Payer: Aetna Government |
$38.32
|
| Rate for Payer: Brighton Health Commercial |
$92.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$77.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$89.04
|
| Rate for Payer: EmblemHealth Commercial |
$77.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$162.60
|
| Rate for Payer: Group Health Inc Commercial |
$77.43
|
| Rate for Payer: Group Health Inc Medicare |
$54.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$100.66
|
|
|
OT WRIST SPLINT
|
Facility
|
OP
|
$247.71
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
41808068
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.32 |
| Max. Negotiated Rate |
$260.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$136.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38.32
|
| Rate for Payer: Aetna Government |
$38.32
|
| Rate for Payer: Brighton Health Commercial |
$148.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$123.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$142.43
|
| Rate for Payer: EmblemHealth Commercial |
$123.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$260.10
|
| Rate for Payer: Group Health Inc Commercial |
$123.86
|
| Rate for Payer: Group Health Inc Medicare |
$86.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$123.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$123.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$161.01
|
|
|
OUTER HEAD
|
Facility
|
OP
|
$1,181.13
|
|
| Hospital Charge Code |
40202180
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$413.40 |
| Max. Negotiated Rate |
$944.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$649.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$590.56
|
| Rate for Payer: Aetna Government |
$590.56
|
| Rate for Payer: Brighton Health Commercial |
$885.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$944.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$803.17
|
| Rate for Payer: Group Health Inc Commercial |
$590.56
|
| Rate for Payer: Group Health Inc Medicare |
$413.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$590.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$590.56
|
|
|
OUTFLOW FMS A
|
Facility
|
OP
|
$162.29
|
|
| Hospital Charge Code |
64904942
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$56.80 |
| Max. Negotiated Rate |
$129.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$89.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$81.14
|
| Rate for Payer: Aetna Government |
$81.14
|
| Rate for Payer: Brighton Health Commercial |
$121.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$129.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$110.36
|
| Rate for Payer: Group Health Inc Commercial |
$81.14
|
| Rate for Payer: Group Health Inc Medicare |
$56.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.14
|
|
|
OUTFLOW FMS B
|
Facility
|
OP
|
$3,420.00
|
|
| Hospital Charge Code |
64905827
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,197.00 |
| Max. Negotiated Rate |
$2,736.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,881.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,710.00
|
| Rate for Payer: Aetna Government |
$1,710.00
|
| Rate for Payer: Brighton Health Commercial |
$2,565.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,736.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,325.60
|
| Rate for Payer: Group Health Inc Commercial |
$1,710.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,197.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,710.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,710.00
|
|
|
OUTPATIENT EAPG 00001: PHOTOCHEMOTHERAPY
|
Facility
|
OP
|
$176.15
|
|
|
Service Code
|
EAPG 00001
|
| Hospital Charge Code |
EAPG 00001
|
| Min. Negotiated Rate |
$176.15 |
| Max. Negotiated Rate |
$176.15 |
| Rate for Payer: Healthfirst Commercial |
$176.15
|
|
|
OUTPATIENT EAPG 00002: SUPERFICIAL NEEDLE BIOPSY AND ASPIRATION
|
Facility
|
OP
|
$1,308.24
|
|
|
Service Code
|
EAPG 00002
|
| Hospital Charge Code |
EAPG 00002
|
| Min. Negotiated Rate |
$581.44 |
| Max. Negotiated Rate |
$1,308.24 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,308.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,308.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$581.44
|
| Rate for Payer: Amida Care Medicaid |
$581.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$581.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,308.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,308.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$610.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$581.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$581.44
|
| Rate for Payer: Healthfirst Commercial |
$881.08
|
| Rate for Payer: Healthfirst Essential Plan |
$1,308.24
|
| Rate for Payer: Healthfirst QHP |
$581.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$581.44
|
| Rate for Payer: SOMOS Essential |
$1,308.24
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$1,308.24
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$639.58
|
| Rate for Payer: United Healthcare Medicaid |
$581.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$581.44
|
|
|
OUTPATIENT EAPG 00003: LEVEL I SKIN INCISION AND DRAINAGE
|
Facility
|
OP
|
$831.49
|
|
|
Service Code
|
EAPG 00003
|
| Hospital Charge Code |
EAPG 00003
|
| Min. Negotiated Rate |
$369.55 |
| Max. Negotiated Rate |
$831.49 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$831.49
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$831.49
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$369.55
|
| Rate for Payer: Amida Care Medicaid |
$369.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$369.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$831.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$831.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$388.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$369.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$369.55
|
| Rate for Payer: Healthfirst Commercial |
$559.99
|
| Rate for Payer: Healthfirst Essential Plan |
$831.49
|
| Rate for Payer: Healthfirst QHP |
$369.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$369.55
|
| Rate for Payer: SOMOS Essential |
$831.49
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$831.49
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$406.50
|
| Rate for Payer: United Healthcare Medicaid |
$369.55
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$369.55
|
|
|
OUTPATIENT EAPG 00004: LEVEL II SKIN INCISION AND DRAINAGE
|
Facility
|
OP
|
$1,573.74
|
|
|
Service Code
|
EAPG 00004
|
| Hospital Charge Code |
EAPG 00004
|
| Min. Negotiated Rate |
$699.44 |
| Max. Negotiated Rate |
$1,573.74 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,573.74
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,573.74
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$699.44
|
| Rate for Payer: Amida Care Medicaid |
$699.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$699.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,573.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,573.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$734.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$699.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$699.44
|
| Rate for Payer: Healthfirst Commercial |
$1,059.89
|
| Rate for Payer: Healthfirst Essential Plan |
$1,573.74
|
| Rate for Payer: Healthfirst QHP |
$699.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$699.44
|
| Rate for Payer: SOMOS Essential |
$1,573.74
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$1,573.74
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$769.38
|
| Rate for Payer: United Healthcare Medicaid |
$699.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$699.44
|
|
|
OUTPATIENT EAPG 00005: NAIL PROCEDURES
|
Facility
|
OP
|
$237.10
|
|
|
Service Code
|
EAPG 00005
|
| Hospital Charge Code |
EAPG 00005
|
| Min. Negotiated Rate |
$105.38 |
| Max. Negotiated Rate |
$237.10 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$237.10
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$237.10
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$105.38
|
| Rate for Payer: Amida Care Medicaid |
$105.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$105.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$237.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$237.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$110.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$105.38
|
| Rate for Payer: Healthfirst Commercial |
$159.67
|
| Rate for Payer: Healthfirst Essential Plan |
$237.10
|
| Rate for Payer: Healthfirst QHP |
$105.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$105.38
|
| Rate for Payer: SOMOS Essential |
$237.10
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$237.10
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$115.92
|
| Rate for Payer: United Healthcare Medicaid |
$105.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$105.38
|
|
|
OUTPATIENT EAPG 00006: LEVEL I SKIN DEBRIDEMENT AND DESTRUCTION
|
Facility
|
OP
|
$414.39
|
|
|
Service Code
|
EAPG 00006
|
| Hospital Charge Code |
EAPG 00006
|
| Min. Negotiated Rate |
$414.39 |
| Max. Negotiated Rate |
$414.39 |
| Rate for Payer: Healthfirst Commercial |
$414.39
|
|
|
OUTPATIENT EAPG 00007: LEVEL II SKIN DEBRIDEMENT AND DESTRUCTION
|
Facility
|
OP
|
$1,395.88
|
|
|
Service Code
|
EAPG 00007
|
| Hospital Charge Code |
EAPG 00007
|
| Min. Negotiated Rate |
$1,395.88 |
| Max. Negotiated Rate |
$1,395.88 |
| Rate for Payer: Healthfirst Commercial |
$1,395.88
|
|
|
OUTPATIENT EAPG 00008: LEVEL III SKIN DEBRIDEMENT AND DESTRUCTION
|
Facility
|
OP
|
$1,831.06
|
|
|
Service Code
|
EAPG 00008
|
| Hospital Charge Code |
EAPG 00008
|
| Min. Negotiated Rate |
$1,831.06 |
| Max. Negotiated Rate |
$1,831.06 |
| Rate for Payer: Healthfirst Commercial |
$1,831.06
|
|
|
OUTPATIENT EAPG 00009: LEVEL I EXCISION AND BIOPSY OF SKIN AND SOFT TISSUE
|
Facility
|
OP
|
$1,626.57
|
|
|
Service Code
|
EAPG 00009
|
| Hospital Charge Code |
EAPG 00009
|
| Min. Negotiated Rate |
$722.92 |
| Max. Negotiated Rate |
$1,626.57 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,626.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,626.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$722.92
|
| Rate for Payer: Amida Care Medicaid |
$722.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$722.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,626.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,626.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$759.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$722.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$722.92
|
| Rate for Payer: Healthfirst Commercial |
$1,095.46
|
| Rate for Payer: Healthfirst Essential Plan |
$1,626.57
|
| Rate for Payer: Healthfirst QHP |
$722.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$722.92
|
| Rate for Payer: SOMOS Essential |
$1,626.57
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$1,626.57
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$795.21
|
| Rate for Payer: United Healthcare Medicaid |
$722.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$722.92
|
|
|
OUTPATIENT EAPG 00010: LEVEL II EXCISION AND BIOPSY OF SKIN AND SOFT TISSUE
|
Facility
|
OP
|
$3,194.14
|
|
|
Service Code
|
EAPG 00010
|
| Hospital Charge Code |
EAPG 00010
|
| Min. Negotiated Rate |
$1,419.62 |
| Max. Negotiated Rate |
$3,194.14 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,194.14
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,194.14
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,419.62
|
| Rate for Payer: Amida Care Medicaid |
$1,419.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,419.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,194.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,194.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,490.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,419.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,419.62
|
| Rate for Payer: Healthfirst Commercial |
$2,151.21
|
| Rate for Payer: Healthfirst Essential Plan |
$3,194.14
|
| Rate for Payer: Healthfirst QHP |
$1,419.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,419.62
|
| Rate for Payer: SOMOS Essential |
$3,194.14
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$3,194.14
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$1,561.58
|
| Rate for Payer: United Healthcare Medicaid |
$1,419.62
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,419.62
|
|
|
OUTPATIENT EAPG 00011: LEVEL III EXCISION AND BIOPSY OF SKIN AND SOFT TISSUE
|
Facility
|
OP
|
$5,355.09
|
|
|
Service Code
|
EAPG 00011
|
| Hospital Charge Code |
EAPG 00011
|
| Min. Negotiated Rate |
$2,380.04 |
| Max. Negotiated Rate |
$5,355.09 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$5,355.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5,355.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,380.04
|
| Rate for Payer: Amida Care Medicaid |
$2,380.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,380.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,355.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,355.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,499.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,380.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,380.04
|
| Rate for Payer: Healthfirst Commercial |
$3,606.55
|
| Rate for Payer: Healthfirst Essential Plan |
$5,355.09
|
| Rate for Payer: Healthfirst QHP |
$2,380.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,380.04
|
| Rate for Payer: SOMOS Essential |
$5,355.09
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$5,355.09
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$2,618.04
|
| Rate for Payer: United Healthcare Medicaid |
$2,380.04
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,380.04
|
|
|
OUTPATIENT EAPG 00012: LEVEL I SKIN REPAIR
|
Facility
|
OP
|
$541.70
|
|
|
Service Code
|
EAPG 00012
|
| Hospital Charge Code |
EAPG 00012
|
| Min. Negotiated Rate |
$541.70 |
| Max. Negotiated Rate |
$541.70 |
| Rate for Payer: Healthfirst Commercial |
$541.70
|
|
|
OUTPATIENT EAPG 00013: LEVEL II SKIN REPAIR
|
Facility
|
OP
|
$1,319.48
|
|
|
Service Code
|
EAPG 00013
|
| Hospital Charge Code |
EAPG 00013
|
| Min. Negotiated Rate |
$1,319.48 |
| Max. Negotiated Rate |
$1,319.48 |
| Rate for Payer: Healthfirst Commercial |
$1,319.48
|
|
|
OUTPATIENT EAPG 00014: LEVEL III SKIN REPAIR
|
Facility
|
OP
|
$2,242.44
|
|
|
Service Code
|
EAPG 00014
|
| Hospital Charge Code |
EAPG 00014
|
| Min. Negotiated Rate |
$2,242.44 |
| Max. Negotiated Rate |
$2,242.44 |
| Rate for Payer: Healthfirst Commercial |
$2,242.44
|
|
|
OUTPATIENT EAPG 00015: LEVEL IV SKIN REPAIR
|
Facility
|
OP
|
$2,749.74
|
|
|
Service Code
|
EAPG 00015
|
| Hospital Charge Code |
EAPG 00015
|
| Min. Negotiated Rate |
$2,749.74 |
| Max. Negotiated Rate |
$2,749.74 |
| Rate for Payer: Healthfirst Commercial |
$2,749.74
|
|
|
OUTPATIENT EAPG 00020: LEVEL I BREAST PROCEDURES
|
Facility
|
OP
|
$4,057.85
|
|
|
Service Code
|
EAPG 00020
|
| Hospital Charge Code |
EAPG 00020
|
| Min. Negotiated Rate |
$1,803.49 |
| Max. Negotiated Rate |
$4,057.85 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,057.85
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,057.85
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,803.49
|
| Rate for Payer: Amida Care Medicaid |
$1,803.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,803.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4,057.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4,057.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,893.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,803.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,803.49
|
| Rate for Payer: Healthfirst Commercial |
$2,732.89
|
| Rate for Payer: Healthfirst Essential Plan |
$4,057.85
|
| Rate for Payer: Healthfirst QHP |
$1,803.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,803.49
|
| Rate for Payer: SOMOS Essential |
$4,057.85
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$4,057.85
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$1,983.84
|
| Rate for Payer: United Healthcare Medicaid |
$1,803.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,803.49
|
|
|
OUTPATIENT EAPG 00021: LEVEL II BREAST PROCEDURES
|
Facility
|
OP
|
$5,730.05
|
|
|
Service Code
|
EAPG 00021
|
| Hospital Charge Code |
EAPG 00021
|
| Min. Negotiated Rate |
$2,546.69 |
| Max. Negotiated Rate |
$5,730.05 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$5,730.05
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5,730.05
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,546.69
|
| Rate for Payer: Amida Care Medicaid |
$2,546.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,546.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,730.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,730.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,674.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,546.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,546.69
|
| Rate for Payer: Healthfirst Commercial |
$3,859.09
|
| Rate for Payer: Healthfirst Essential Plan |
$5,730.05
|
| Rate for Payer: Healthfirst QHP |
$2,546.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,546.69
|
| Rate for Payer: SOMOS Essential |
$5,730.05
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$5,730.05
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$2,801.36
|
| Rate for Payer: United Healthcare Medicaid |
$2,546.69
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,546.69
|
|
|
OUTPATIENT EAPG 00022: LEVEL III BREAST PROCEDURES
|
Facility
|
OP
|
$8,206.65
|
|
|
Service Code
|
EAPG 00022
|
| Hospital Charge Code |
EAPG 00022
|
| Min. Negotiated Rate |
$3,647.40 |
| Max. Negotiated Rate |
$8,206.65 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$8,206.65
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8,206.65
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,647.40
|
| Rate for Payer: Amida Care Medicaid |
$3,647.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,647.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8,206.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8,206.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,829.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,647.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,647.40
|
| Rate for Payer: Healthfirst Commercial |
$5,527.04
|
| Rate for Payer: Healthfirst Essential Plan |
$8,206.65
|
| Rate for Payer: Healthfirst QHP |
$3,647.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,647.40
|
| Rate for Payer: SOMOS Essential |
$8,206.65
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$8,206.65
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$4,012.14
|
| Rate for Payer: United Healthcare Medicaid |
$3,647.40
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,647.40
|
|
|
OUTPATIENT EAPG 00023: LEVEL I FOREARM AND WRIST PROCEDURES
|
Facility
|
OP
|
$5,132.45
|
|
|
Service Code
|
EAPG 00023
|
| Hospital Charge Code |
EAPG 00023
|
| Min. Negotiated Rate |
$2,281.09 |
| Max. Negotiated Rate |
$5,132.45 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$5,132.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5,132.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,281.09
|
| Rate for Payer: Amida Care Medicaid |
$2,281.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,281.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,132.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,132.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,395.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,281.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,281.09
|
| Rate for Payer: Healthfirst Essential Plan |
$5,132.45
|
| Rate for Payer: Healthfirst QHP |
$2,281.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,281.09
|
| Rate for Payer: SOMOS Essential |
$5,132.45
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$5,132.45
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$2,509.20
|
| Rate for Payer: United Healthcare Medicaid |
$2,281.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,281.09
|
|
|
OUTPATIENT EAPG 00024: LEVEL II FOREARM AND WRIST PROCEDURES
|
Facility
|
OP
|
$5,849.06
|
|
|
Service Code
|
EAPG 00024
|
| Hospital Charge Code |
EAPG 00024
|
| Min. Negotiated Rate |
$2,599.58 |
| Max. Negotiated Rate |
$5,849.06 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$5,849.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5,849.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,599.58
|
| Rate for Payer: Amida Care Medicaid |
$2,599.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,599.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,849.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,849.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,729.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,599.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,599.58
|
| Rate for Payer: Healthfirst Essential Plan |
$5,849.06
|
| Rate for Payer: Healthfirst QHP |
$2,599.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,599.58
|
| Rate for Payer: SOMOS Essential |
$5,849.06
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$5,849.06
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$2,859.54
|
| Rate for Payer: United Healthcare Medicaid |
$2,599.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,599.58
|
|
