OUTPATIENT EAPG 00025: SHOULDER AND UPPER ARM PROCEDURES
|
Facility
|
OP
|
$5,885.64
|
|
Service Code
|
EAPG 00025
|
Hospital Charge Code |
EAPG 00025
|
Min. Negotiated Rate |
$2,615.84 |
Max. Negotiated Rate |
$5,885.64 |
Rate for Payer: Affinity Essential Plan 1&2 |
$5,885.64
|
Rate for Payer: Affinity Essential Plan 3&4 |
$5,885.64
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,615.84
|
Rate for Payer: Amida Care Medicaid |
$2,615.84
|
Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,615.84
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$5,885.64
|
Rate for Payer: Fidelis Essential Plan QHP |
$5,885.64
|
Rate for Payer: Fidelis Qualified Health Plan |
$2,746.63
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,615.84
|
Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,615.84
|
Rate for Payer: Healthfirst Essential Plan |
$5,885.64
|
Rate for Payer: Healthfirst QHP |
$2,615.84
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,615.84
|
Rate for Payer: SOMOS Essential |
$5,885.64
|
Rate for Payer: United Healthcare Essential Plan 1&2 |
$5,885.64
|
Rate for Payer: United Healthcare Essential Plan 3&4 |
$2,877.42
|
Rate for Payer: United Healthcare Medicaid |
$2,615.84
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,615.84
|
|
OUTPATIENT EAPG 00026: LEVEL I KNEE AND LOWER LEG PROCEDURES
|
Facility
|
OP
|
$4,533.73
|
|
Service Code
|
EAPG 00026
|
Hospital Charge Code |
EAPG 00026
|
Min. Negotiated Rate |
$2,014.99 |
Max. Negotiated Rate |
$4,533.73 |
Rate for Payer: Affinity Essential Plan 1&2 |
$4,533.73
|
Rate for Payer: Affinity Essential Plan 3&4 |
$4,533.73
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,014.99
|
Rate for Payer: Amida Care Medicaid |
$2,014.99
|
Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,014.99
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$4,533.73
|
Rate for Payer: Fidelis Essential Plan QHP |
$4,533.73
|
Rate for Payer: Fidelis Qualified Health Plan |
$2,115.74
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,014.99
|
Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,014.99
|
Rate for Payer: Healthfirst Essential Plan |
$4,533.73
|
Rate for Payer: Healthfirst QHP |
$2,014.99
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,014.99
|
Rate for Payer: SOMOS Essential |
$4,533.73
|
Rate for Payer: United Healthcare Essential Plan 1&2 |
$4,533.73
|
Rate for Payer: United Healthcare Essential Plan 3&4 |
$2,216.49
|
Rate for Payer: United Healthcare Medicaid |
$2,014.99
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,014.99
|
|
OUTPATIENT EAPG 00027: PELVIS, FEMUR AND UPPER LEG PROCEDURES
|
Facility
|
OP
|
$5,662.12
|
|
Service Code
|
EAPG 00027
|
Hospital Charge Code |
EAPG 00027
|
Min. Negotiated Rate |
$2,516.50 |
Max. Negotiated Rate |
$5,662.12 |
Rate for Payer: Affinity Essential Plan 1&2 |
$5,662.12
|
Rate for Payer: Affinity Essential Plan 3&4 |
$5,662.12
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,516.50
|
Rate for Payer: Amida Care Medicaid |
$2,516.50
|
Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,516.50
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$5,662.12
|
Rate for Payer: Fidelis Essential Plan QHP |
$5,662.12
|
Rate for Payer: Fidelis Qualified Health Plan |
$2,642.32
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,516.50
|
Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,516.50
|
Rate for Payer: Healthfirst Essential Plan |
$5,662.12
|
Rate for Payer: Healthfirst QHP |
$2,516.50
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,516.50
|
Rate for Payer: SOMOS Essential |
$5,662.12
|
Rate for Payer: United Healthcare Essential Plan 1&2 |
$5,662.12
|
Rate for Payer: United Healthcare Essential Plan 3&4 |
$2,768.15
|
Rate for Payer: United Healthcare Medicaid |
$2,516.50
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,516.50
|
|
OUTPATIENT EAPG 00028: LEVEL I SPINE PROCEDURES
|
Facility
|
OP
|
$8,336.27
|
|
Service Code
|
EAPG 00028
|
Hospital Charge Code |
EAPG 00028
|
Min. Negotiated Rate |
$3,705.01 |
Max. Negotiated Rate |
$8,336.27 |
Rate for Payer: Affinity Essential Plan 1&2 |
$8,336.27
|
Rate for Payer: Affinity Essential Plan 3&4 |
$8,336.27
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,705.01
|
Rate for Payer: Amida Care Medicaid |
$3,705.01
|
Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,705.01
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$8,336.27
|
Rate for Payer: Fidelis Essential Plan QHP |
$8,336.27
|
Rate for Payer: Fidelis Qualified Health Plan |
$3,890.26
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,705.01
|
Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,705.01
|
Rate for Payer: Healthfirst Essential Plan |
$8,336.27
|
Rate for Payer: Healthfirst QHP |
$3,705.01
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,705.01
|
Rate for Payer: SOMOS Essential |
$8,336.27
|
Rate for Payer: United Healthcare Essential Plan 1&2 |
$8,336.27
|
Rate for Payer: United Healthcare Essential Plan 3&4 |
$4,075.51
|
Rate for Payer: United Healthcare Medicaid |
$3,705.01
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,705.01
|
|
OUTPATIENT EAPG 00029: LEVEL II SPINE PROCEDURES
|
Facility
|
OP
|
$10,110.35
|
|
Service Code
|
EAPG 00029
|
Hospital Charge Code |
EAPG 00029
|
Min. Negotiated Rate |
$4,493.49 |
Max. Negotiated Rate |
$10,110.35 |
Rate for Payer: Affinity Essential Plan 1&2 |
$10,110.35
|
Rate for Payer: Affinity Essential Plan 3&4 |
$10,110.35
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,493.49
|
Rate for Payer: Amida Care Medicaid |
$4,493.49
|
Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,493.49
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$10,110.35
|
Rate for Payer: Fidelis Essential Plan QHP |
$10,110.35
|
Rate for Payer: Fidelis Qualified Health Plan |
$4,718.16
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,493.49
|
Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4,493.49
|
Rate for Payer: Healthfirst Essential Plan |
$10,110.35
|
Rate for Payer: Healthfirst QHP |
$4,493.49
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4,493.49
|
Rate for Payer: SOMOS Essential |
$10,110.35
|
Rate for Payer: United Healthcare Essential Plan 1&2 |
$10,110.35
|
Rate for Payer: United Healthcare Essential Plan 3&4 |
$4,942.84
|
Rate for Payer: United Healthcare Medicaid |
$4,493.49
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4,493.49
|
|
OUTPATIENT EAPG 00030: GENERAL MUSCULOSKELETAL PROCEDURES
|
Facility
|
OP
|
$3,002.82
|
|
Service Code
|
EAPG 00030
|
Hospital Charge Code |
EAPG 00030
|
Min. Negotiated Rate |
$3,002.82 |
Max. Negotiated Rate |
$3,002.82 |
Rate for Payer: Healthfirst Commercial |
$3,002.82
|
|
OUTPATIENT EAPG 00033: LEVEL I HAND PROCEDURES
|
Facility
|
OP
|
$3,269.00
|
|
Service Code
|
EAPG 00033
|
Hospital Charge Code |
EAPG 00033
|
Min. Negotiated Rate |
$1,452.89 |
Max. Negotiated Rate |
$3,269.00 |
Rate for Payer: Affinity Essential Plan 1&2 |
$3,269.00
|
Rate for Payer: Affinity Essential Plan 3&4 |
$3,269.00
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,452.89
|
Rate for Payer: Amida Care Medicaid |
$1,452.89
|
Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,452.89
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$3,269.00
|
Rate for Payer: Fidelis Essential Plan QHP |
$3,269.00
|
Rate for Payer: Fidelis Qualified Health Plan |
$1,525.53
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,452.89
|
Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,452.89
|
Rate for Payer: Healthfirst Commercial |
$2,201.62
|
Rate for Payer: Healthfirst Essential Plan |
$3,269.00
|
Rate for Payer: Healthfirst QHP |
$1,452.89
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,452.89
|
Rate for Payer: SOMOS Essential |
$3,269.00
|
Rate for Payer: United Healthcare Essential Plan 1&2 |
$3,269.00
|
Rate for Payer: United Healthcare Essential Plan 3&4 |
$1,598.18
|
Rate for Payer: United Healthcare Medicaid |
$1,452.89
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,452.89
|
|
OUTPATIENT EAPG 00034: LEVEL II HAND PROCEDURES
|
Facility
|
OP
|
$5,406.98
|
|
Service Code
|
EAPG 00034
|
Hospital Charge Code |
EAPG 00034
|
Min. Negotiated Rate |
$2,403.10 |
Max. Negotiated Rate |
$5,406.98 |
Rate for Payer: Affinity Essential Plan 1&2 |
$5,406.98
|
Rate for Payer: Affinity Essential Plan 3&4 |
$5,406.98
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,403.10
|
Rate for Payer: Amida Care Medicaid |
$2,403.10
|
Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,403.10
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$5,406.98
|
Rate for Payer: Fidelis Essential Plan QHP |
$5,406.98
|
Rate for Payer: Fidelis Qualified Health Plan |
$2,523.26
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,403.10
|
Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,403.10
|
Rate for Payer: Healthfirst Commercial |
$3,641.50
|
Rate for Payer: Healthfirst Essential Plan |
$5,406.98
|
Rate for Payer: Healthfirst QHP |
$2,403.10
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,403.10
|
Rate for Payer: SOMOS Essential |
$5,406.98
|
Rate for Payer: United Healthcare Essential Plan 1&2 |
$5,406.98
|
Rate for Payer: United Healthcare Essential Plan 3&4 |
$2,643.41
|
Rate for Payer: United Healthcare Medicaid |
$2,403.10
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,403.10
|
|
OUTPATIENT EAPG 00035: LEVEL I FOOT PROCEDURES
|
Facility
|
OP
|
$4,210.94
|
|
Service Code
|
EAPG 00035
|
Hospital Charge Code |
EAPG 00035
|
Min. Negotiated Rate |
$1,871.53 |
Max. Negotiated Rate |
$4,210.94 |
Rate for Payer: Affinity Essential Plan 1&2 |
$4,210.94
|
Rate for Payer: Affinity Essential Plan 3&4 |
$4,210.94
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,871.53
|
Rate for Payer: Amida Care Medicaid |
$1,871.53
|
Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,871.53
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$4,210.94
|
Rate for Payer: Fidelis Essential Plan QHP |
$4,210.94
|
Rate for Payer: Fidelis Qualified Health Plan |
$1,965.11
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,871.53
|
Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,871.53
|
Rate for Payer: Healthfirst Commercial |
$2,836.00
|
Rate for Payer: Healthfirst Essential Plan |
$4,210.94
|
Rate for Payer: Healthfirst QHP |
$1,871.53
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,871.53
|
Rate for Payer: SOMOS Essential |
$4,210.94
|
Rate for Payer: United Healthcare Essential Plan 1&2 |
$4,210.94
|
Rate for Payer: United Healthcare Essential Plan 3&4 |
$2,058.68
|
Rate for Payer: United Healthcare Medicaid |
$1,871.53
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,871.53
|
|
OUTPATIENT EAPG 00036: LEVEL II FOOT PROCEDURES
|
Facility
|
OP
|
$5,388.10
|
|
Service Code
|
EAPG 00036
|
Hospital Charge Code |
EAPG 00036
|
Min. Negotiated Rate |
$2,394.71 |
Max. Negotiated Rate |
$5,388.10 |
Rate for Payer: Affinity Essential Plan 1&2 |
$5,388.10
|
Rate for Payer: Affinity Essential Plan 3&4 |
$5,388.10
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,394.71
|
Rate for Payer: Amida Care Medicaid |
$2,394.71
|
Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,394.71
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$5,388.10
|
Rate for Payer: Fidelis Essential Plan QHP |
$5,388.10
|
Rate for Payer: Fidelis Qualified Health Plan |
$2,514.45
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,394.71
|
Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,394.71
|
Rate for Payer: Healthfirst Commercial |
$3,628.80
|
Rate for Payer: Healthfirst Essential Plan |
$5,388.10
|
Rate for Payer: Healthfirst QHP |
$2,394.71
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,394.71
|
Rate for Payer: SOMOS Essential |
$5,388.10
|
Rate for Payer: United Healthcare Essential Plan 1&2 |
$5,388.10
|
Rate for Payer: United Healthcare Essential Plan 3&4 |
$2,634.18
|
Rate for Payer: United Healthcare Medicaid |
$2,394.71
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,394.71
|
|
OUTPATIENT EAPG 00037: LEVEL I ARTHROSCOPY
|
Facility
|
OP
|
$4,710.53
|
|
Service Code
|
EAPG 00037
|
Hospital Charge Code |
EAPG 00037
|
Min. Negotiated Rate |
$2,093.57 |
Max. Negotiated Rate |
$4,710.53 |
Rate for Payer: Affinity Essential Plan 1&2 |
$4,710.53
|
Rate for Payer: Affinity Essential Plan 3&4 |
$4,710.53
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,093.57
|
Rate for Payer: Amida Care Medicaid |
$2,093.57
|
Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,093.57
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$4,710.53
|
Rate for Payer: Fidelis Essential Plan QHP |
$4,710.53
|
Rate for Payer: Fidelis Qualified Health Plan |
$2,198.25
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,093.57
|
Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,093.57
|
Rate for Payer: Healthfirst Commercial |
$3,172.45
|
Rate for Payer: Healthfirst Essential Plan |
$4,710.53
|
Rate for Payer: Healthfirst QHP |
$2,093.57
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,093.57
|
Rate for Payer: SOMOS Essential |
$4,710.53
|
Rate for Payer: United Healthcare Essential Plan 1&2 |
$4,710.53
|
Rate for Payer: United Healthcare Essential Plan 3&4 |
$2,302.93
|
Rate for Payer: United Healthcare Medicaid |
$2,093.57
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,093.57
|
|
OUTPATIENT EAPG 00038: LEVEL II ARTHROSCOPY
|
Facility
|
OP
|
$8,951.85
|
|
Service Code
|
EAPG 00038
|
Hospital Charge Code |
EAPG 00038
|
Min. Negotiated Rate |
$3,978.60 |
Max. Negotiated Rate |
$8,951.85 |
Rate for Payer: Affinity Essential Plan 1&2 |
$8,951.85
|
Rate for Payer: Affinity Essential Plan 3&4 |
$8,951.85
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,978.60
|
Rate for Payer: Amida Care Medicaid |
$3,978.60
|
Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,978.60
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$8,951.85
|
Rate for Payer: Fidelis Essential Plan QHP |
$8,951.85
|
Rate for Payer: Fidelis Qualified Health Plan |
$4,177.53
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,978.60
|
Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,978.60
|
Rate for Payer: Healthfirst Commercial |
$6,028.93
|
Rate for Payer: Healthfirst Essential Plan |
$8,951.85
|
Rate for Payer: Healthfirst QHP |
$3,978.60
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,978.60
|
Rate for Payer: SOMOS Essential |
$8,951.85
|
Rate for Payer: United Healthcare Essential Plan 1&2 |
$8,951.85
|
Rate for Payer: United Healthcare Essential Plan 3&4 |
$4,376.46
|
Rate for Payer: United Healthcare Medicaid |
$3,978.60
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,978.60
|
|
OUTPATIENT EAPG 00039: CAST APPLICATION OR REPLACEMENT
|
Facility
|
OP
|
$748.64
|
|
Service Code
|
EAPG 00039
|
Hospital Charge Code |
EAPG 00039
|
Min. Negotiated Rate |
$332.73 |
Max. Negotiated Rate |
$748.64 |
Rate for Payer: Affinity Essential Plan 1&2 |
$748.64
|
Rate for Payer: Affinity Essential Plan 3&4 |
$748.64
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$332.73
|
Rate for Payer: Amida Care Medicaid |
$332.73
|
Rate for Payer: Fidelis CHP/HARP/Medicaid |
$332.73
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$748.64
|
Rate for Payer: Fidelis Essential Plan QHP |
$748.64
|
Rate for Payer: Fidelis Qualified Health Plan |
$349.37
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$332.73
|
Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$332.73
|
Rate for Payer: Healthfirst Commercial |
$504.21
|
Rate for Payer: Healthfirst Essential Plan |
$748.64
|
Rate for Payer: Healthfirst QHP |
$332.73
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$332.73
|
Rate for Payer: SOMOS Essential |
$748.64
|
Rate for Payer: United Healthcare Essential Plan 1&2 |
$748.64
|
Rate for Payer: United Healthcare Essential Plan 3&4 |
$366.00
|
Rate for Payer: United Healthcare Medicaid |
$332.73
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$332.73
|
|
OUTPATIENT EAPG 00040: MINOR SPLINT AND STRAPPING APPLICATION
|
Facility
|
OP
|
$547.78
|
|
Service Code
|
EAPG 00040
|
Hospital Charge Code |
EAPG 00040
|
Min. Negotiated Rate |
$243.46 |
Max. Negotiated Rate |
$547.78 |
Rate for Payer: Affinity Essential Plan 1&2 |
$547.78
|
Rate for Payer: Affinity Essential Plan 3&4 |
$547.78
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$243.46
|
Rate for Payer: Amida Care Medicaid |
$243.46
|
Rate for Payer: Fidelis CHP/HARP/Medicaid |
$243.46
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$547.78
|
Rate for Payer: Fidelis Essential Plan QHP |
$547.78
|
Rate for Payer: Fidelis Qualified Health Plan |
$255.63
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$243.46
|
Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$243.46
|
Rate for Payer: Healthfirst Commercial |
$368.92
|
Rate for Payer: Healthfirst Essential Plan |
$547.78
|
Rate for Payer: Healthfirst QHP |
$243.46
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$243.46
|
Rate for Payer: SOMOS Essential |
$547.78
|
Rate for Payer: United Healthcare Essential Plan 1&2 |
$547.78
|
Rate for Payer: United Healthcare Essential Plan 3&4 |
$267.81
|
Rate for Payer: United Healthcare Medicaid |
$243.46
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$243.46
|
|
OUTPATIENT EAPG 00041: CLOSED TREATMENT FX & DISCLOCATION
|
Facility
|
OP
|
$1,298.66
|
|
Service Code
|
EAPG 00041
|
Hospital Charge Code |
EAPG 00041
|
Min. Negotiated Rate |
$577.18 |
Max. Negotiated Rate |
$1,298.66 |
Rate for Payer: Affinity Essential Plan 1&2 |
$1,298.66
|
Rate for Payer: Affinity Essential Plan 3&4 |
$1,298.66
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$577.18
|
Rate for Payer: Amida Care Medicaid |
$577.18
|
Rate for Payer: Fidelis CHP/HARP/Medicaid |
$577.18
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$1,298.66
|
Rate for Payer: Fidelis Essential Plan QHP |
$1,298.66
|
Rate for Payer: Fidelis Qualified Health Plan |
$606.04
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$577.18
|
Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$577.18
|
Rate for Payer: Healthfirst Commercial |
$874.61
|
Rate for Payer: Healthfirst Essential Plan |
$1,298.66
|
Rate for Payer: Healthfirst QHP |
$577.18
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$577.18
|
Rate for Payer: SOMOS Essential |
$1,298.66
|
Rate for Payer: United Healthcare Essential Plan 1&2 |
$1,298.66
|
Rate for Payer: United Healthcare Essential Plan 3&4 |
$634.90
|
Rate for Payer: United Healthcare Medicaid |
$577.18
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$577.18
|
|
OUTPATIENT EAPG 00043: OPEN OR PERCUTANEOUS TREATMENT OF FRACTURES
|
Facility
|
OP
|
$7,658.24
|
|
Service Code
|
EAPG 00043
|
Hospital Charge Code |
EAPG 00043
|
Min. Negotiated Rate |
$3,403.66 |
Max. Negotiated Rate |
$7,658.24 |
Rate for Payer: Affinity Essential Plan 1&2 |
$7,658.24
|
Rate for Payer: Affinity Essential Plan 3&4 |
$7,658.24
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,403.66
|
Rate for Payer: Amida Care Medicaid |
$3,403.66
|
Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,403.66
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$7,658.24
|
Rate for Payer: Fidelis Essential Plan QHP |
$7,658.24
|
Rate for Payer: Fidelis Qualified Health Plan |
$3,573.84
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,403.66
|
Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,403.66
|
Rate for Payer: Healthfirst Commercial |
$5,157.69
|
Rate for Payer: Healthfirst Essential Plan |
$7,658.24
|
Rate for Payer: Healthfirst QHP |
$3,403.66
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,403.66
|
Rate for Payer: SOMOS Essential |
$7,658.24
|
Rate for Payer: United Healthcare Essential Plan 1&2 |
$7,658.24
|
Rate for Payer: United Healthcare Essential Plan 3&4 |
$3,744.03
|
Rate for Payer: United Healthcare Medicaid |
$3,403.66
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,403.66
|
|
OUTPATIENT EAPG 00044: BONE OR JOINT MANIPULATION UNDER ANESTHESIA
|
Facility
|
OP
|
$2,393.21
|
|
Service Code
|
EAPG 00044
|
Hospital Charge Code |
EAPG 00044
|
Min. Negotiated Rate |
$1,063.65 |
Max. Negotiated Rate |
$2,393.21 |
Rate for Payer: Affinity Essential Plan 1&2 |
$2,393.21
|
Rate for Payer: Affinity Essential Plan 3&4 |
$2,393.21
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,063.65
|
Rate for Payer: Amida Care Medicaid |
$1,063.65
|
Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,063.65
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$2,393.21
|
Rate for Payer: Fidelis Essential Plan QHP |
$2,393.21
|
Rate for Payer: Fidelis Qualified Health Plan |
$1,116.83
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,063.65
|
Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,063.65
|
Rate for Payer: Healthfirst Commercial |
$1,611.78
|
Rate for Payer: Healthfirst Essential Plan |
$2,393.21
|
Rate for Payer: Healthfirst QHP |
$1,063.65
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,063.65
|
Rate for Payer: SOMOS Essential |
$2,393.21
|
Rate for Payer: United Healthcare Essential Plan 1&2 |
$2,393.21
|
Rate for Payer: United Healthcare Essential Plan 3&4 |
$1,170.02
|
Rate for Payer: United Healthcare Medicaid |
$1,063.65
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,063.65
|
|
OUTPATIENT EAPG 00046: LEVEL I ARTHROPLASTY
|
Facility
|
OP
|
$7,855.65
|
|
Service Code
|
EAPG 00046
|
Hospital Charge Code |
EAPG 00046
|
Min. Negotiated Rate |
$3,491.40 |
Max. Negotiated Rate |
$7,855.65 |
Rate for Payer: Affinity Essential Plan 1&2 |
$7,855.65
|
Rate for Payer: Affinity Essential Plan 3&4 |
$7,855.65
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,491.40
|
Rate for Payer: Amida Care Medicaid |
$3,491.40
|
Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,491.40
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$7,855.65
|
Rate for Payer: Fidelis Essential Plan QHP |
$7,855.65
|
Rate for Payer: Fidelis Qualified Health Plan |
$3,665.97
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,491.40
|
Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,491.40
|
Rate for Payer: Healthfirst Commercial |
$5,290.65
|
Rate for Payer: Healthfirst Essential Plan |
$7,855.65
|
Rate for Payer: Healthfirst QHP |
$3,491.40
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,491.40
|
Rate for Payer: SOMOS Essential |
$7,855.65
|
Rate for Payer: United Healthcare Essential Plan 1&2 |
$7,855.65
|
Rate for Payer: United Healthcare Essential Plan 3&4 |
$3,840.54
|
Rate for Payer: United Healthcare Medicaid |
$3,491.40
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,491.40
|
|
OUTPATIENT EAPG 00047: LEVEL II ARTHROPLASTY
|
Facility
|
OP
|
$9,024.95
|
|
Service Code
|
EAPG 00047
|
Hospital Charge Code |
EAPG 00047
|
Min. Negotiated Rate |
$4,011.09 |
Max. Negotiated Rate |
$9,024.95 |
Rate for Payer: Affinity Essential Plan 1&2 |
$9,024.95
|
Rate for Payer: Affinity Essential Plan 3&4 |
$9,024.95
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,011.09
|
Rate for Payer: Amida Care Medicaid |
$4,011.09
|
Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,011.09
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$9,024.95
|
Rate for Payer: Fidelis Essential Plan QHP |
$9,024.95
|
Rate for Payer: Fidelis Qualified Health Plan |
$4,211.64
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,011.09
|
Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4,011.09
|
Rate for Payer: Healthfirst Commercial |
$6,078.16
|
Rate for Payer: Healthfirst Essential Plan |
$9,024.95
|
Rate for Payer: Healthfirst QHP |
$4,011.09
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4,011.09
|
Rate for Payer: SOMOS Essential |
$9,024.95
|
Rate for Payer: United Healthcare Essential Plan 1&2 |
$9,024.95
|
Rate for Payer: United Healthcare Essential Plan 3&4 |
$4,412.20
|
Rate for Payer: United Healthcare Medicaid |
$4,011.09
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4,011.09
|
|
OUTPATIENT EAPG 00049: LEVEL I JOINT, TENDON, OR LIGAMENT INJECTION PROCEDURES
|
Facility
|
OP
|
$757.19
|
|
Service Code
|
EAPG 00049
|
Hospital Charge Code |
EAPG 00049
|
Min. Negotiated Rate |
$336.53 |
Max. Negotiated Rate |
$757.19 |
Rate for Payer: Affinity Essential Plan 1&2 |
$757.19
|
Rate for Payer: Affinity Essential Plan 3&4 |
$757.19
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$336.53
|
Rate for Payer: Amida Care Medicaid |
$336.53
|
Rate for Payer: Fidelis CHP/HARP/Medicaid |
$336.53
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$757.19
|
Rate for Payer: Fidelis Essential Plan QHP |
$757.19
|
Rate for Payer: Fidelis Qualified Health Plan |
$353.36
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$336.53
|
Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$336.53
|
Rate for Payer: Healthfirst Commercial |
$509.96
|
Rate for Payer: Healthfirst Essential Plan |
$757.19
|
Rate for Payer: Healthfirst QHP |
$336.53
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$336.53
|
Rate for Payer: SOMOS Essential |
$757.19
|
Rate for Payer: United Healthcare Essential Plan 1&2 |
$757.19
|
Rate for Payer: United Healthcare Essential Plan 3&4 |
$370.18
|
Rate for Payer: United Healthcare Medicaid |
$336.53
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$336.53
|
|
OUTPATIENT EAPG 00050: LEVEL II JOINT, TENDON, OR LIGAMENT INJECTION PROCEDURES
|
Facility
|
OP
|
$1,374.12
|
|
Service Code
|
EAPG 00050
|
Hospital Charge Code |
EAPG 00050
|
Min. Negotiated Rate |
$610.72 |
Max. Negotiated Rate |
$1,374.12 |
Rate for Payer: Affinity Essential Plan 1&2 |
$1,374.12
|
Rate for Payer: Affinity Essential Plan 3&4 |
$1,374.12
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$610.72
|
Rate for Payer: Amida Care Medicaid |
$610.72
|
Rate for Payer: Fidelis CHP/HARP/Medicaid |
$610.72
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$1,374.12
|
Rate for Payer: Fidelis Essential Plan QHP |
$1,374.12
|
Rate for Payer: Fidelis Qualified Health Plan |
$641.26
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$610.72
|
Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$610.72
|
Rate for Payer: Healthfirst Essential Plan |
$1,374.12
|
Rate for Payer: Healthfirst QHP |
$610.72
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$610.72
|
Rate for Payer: SOMOS Essential |
$1,374.12
|
Rate for Payer: United Healthcare Essential Plan 1&2 |
$1,374.12
|
Rate for Payer: United Healthcare Essential Plan 3&4 |
$671.79
|
Rate for Payer: United Healthcare Medicaid |
$610.72
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$610.72
|
|
OUTPATIENT EAPG 00052: LEVEL II KNEE AND LOWER LEG PROCEDURES
|
Facility
|
OP
|
$5,167.58
|
|
Service Code
|
EAPG 00052
|
Hospital Charge Code |
EAPG 00052
|
Min. Negotiated Rate |
$2,296.70 |
Max. Negotiated Rate |
$5,167.58 |
Rate for Payer: Affinity Essential Plan 1&2 |
$5,167.58
|
Rate for Payer: Affinity Essential Plan 3&4 |
$5,167.58
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,296.70
|
Rate for Payer: Amida Care Medicaid |
$2,296.70
|
Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,296.70
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$5,167.58
|
Rate for Payer: Fidelis Essential Plan QHP |
$5,167.58
|
Rate for Payer: Fidelis Qualified Health Plan |
$2,411.54
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,296.70
|
Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,296.70
|
Rate for Payer: Healthfirst Essential Plan |
$5,167.58
|
Rate for Payer: Healthfirst QHP |
$2,296.70
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,296.70
|
Rate for Payer: SOMOS Essential |
$5,167.58
|
Rate for Payer: United Healthcare Essential Plan 1&2 |
$5,167.58
|
Rate for Payer: United Healthcare Essential Plan 3&4 |
$2,526.37
|
Rate for Payer: United Healthcare Medicaid |
$2,296.70
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,296.70
|
|
OUTPATIENT EAPG 00053: SPINE INJECTIONS AND OTHER RELATED PROCEDURES
|
Facility
|
OP
|
$1,431.63
|
|
Service Code
|
EAPG 00053
|
Hospital Charge Code |
EAPG 00053
|
Min. Negotiated Rate |
$636.28 |
Max. Negotiated Rate |
$1,431.63 |
Rate for Payer: Affinity Essential Plan 1&2 |
$1,431.63
|
Rate for Payer: Affinity Essential Plan 3&4 |
$1,431.63
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$636.28
|
Rate for Payer: Amida Care Medicaid |
$636.28
|
Rate for Payer: Fidelis CHP/HARP/Medicaid |
$636.28
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$1,431.63
|
Rate for Payer: Fidelis Essential Plan QHP |
$1,431.63
|
Rate for Payer: Fidelis Qualified Health Plan |
$668.09
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$636.28
|
Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$636.28
|
Rate for Payer: Healthfirst Essential Plan |
$1,431.63
|
Rate for Payer: Healthfirst QHP |
$636.28
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$636.28
|
Rate for Payer: SOMOS Essential |
$1,431.63
|
Rate for Payer: United Healthcare Essential Plan 1&2 |
$1,431.63
|
Rate for Payer: United Healthcare Essential Plan 3&4 |
$699.91
|
Rate for Payer: United Healthcare Medicaid |
$636.28
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$636.28
|
|
OUTPATIENT EAPG 00060: PULMONARY TESTS
|
Facility
|
OP
|
$705.92
|
|
Service Code
|
EAPG 00060
|
Hospital Charge Code |
EAPG 00060
|
Min. Negotiated Rate |
$313.74 |
Max. Negotiated Rate |
$705.92 |
Rate for Payer: Affinity Essential Plan 1&2 |
$705.92
|
Rate for Payer: Affinity Essential Plan 3&4 |
$705.92
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$313.74
|
Rate for Payer: Amida Care Medicaid |
$313.74
|
Rate for Payer: Fidelis CHP/HARP/Medicaid |
$313.74
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$705.92
|
Rate for Payer: Fidelis Essential Plan QHP |
$705.92
|
Rate for Payer: Fidelis Qualified Health Plan |
$329.43
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$313.74
|
Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$313.74
|
Rate for Payer: Healthfirst Commercial |
$475.42
|
Rate for Payer: Healthfirst Essential Plan |
$705.92
|
Rate for Payer: Healthfirst QHP |
$313.74
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$313.74
|
Rate for Payer: SOMOS Essential |
$705.92
|
Rate for Payer: United Healthcare Essential Plan 1&2 |
$705.92
|
Rate for Payer: United Healthcare Essential Plan 3&4 |
$345.11
|
Rate for Payer: United Healthcare Medicaid |
$313.74
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$313.74
|
|
OUTPATIENT EAPG 00062: LEVEL I ENDOSCOPY OF THE UPPER AIRWAY
|
Facility
|
OP
|
$985.70
|
|
Service Code
|
EAPG 00062
|
Hospital Charge Code |
EAPG 00062
|
Min. Negotiated Rate |
$438.09 |
Max. Negotiated Rate |
$985.70 |
Rate for Payer: Affinity Essential Plan 1&2 |
$985.70
|
Rate for Payer: Affinity Essential Plan 3&4 |
$985.70
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$438.09
|
Rate for Payer: Amida Care Medicaid |
$438.09
|
Rate for Payer: Fidelis CHP/HARP/Medicaid |
$438.09
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$985.70
|
Rate for Payer: Fidelis Essential Plan QHP |
$985.70
|
Rate for Payer: Fidelis Qualified Health Plan |
$459.99
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$438.09
|
Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$438.09
|
Rate for Payer: Healthfirst Commercial |
$663.85
|
Rate for Payer: Healthfirst Essential Plan |
$985.70
|
Rate for Payer: Healthfirst QHP |
$438.09
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$438.09
|
Rate for Payer: SOMOS Essential |
$985.70
|
Rate for Payer: United Healthcare Essential Plan 1&2 |
$985.70
|
Rate for Payer: United Healthcare Essential Plan 3&4 |
$481.90
|
Rate for Payer: United Healthcare Medicaid |
$438.09
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$438.09
|
|