|
OUTPATIENT EAPG 00234: LEVEL I ANTERIOR SEGMENT EYE PROCEDURES
|
Facility
|
OP
|
$4,227.70
|
|
|
Service Code
|
EAPG 00234
|
| Hospital Charge Code |
EAPG 00234
|
| Min. Negotiated Rate |
$1,878.98 |
| Max. Negotiated Rate |
$4,227.70 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,227.70
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,227.70
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,878.98
|
| Rate for Payer: Amida Care Medicaid |
$1,878.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,878.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4,227.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4,227.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,972.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,878.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,878.98
|
| Rate for Payer: Healthfirst Commercial |
$2,847.30
|
| Rate for Payer: Healthfirst Essential Plan |
$4,227.70
|
| Rate for Payer: Healthfirst QHP |
$1,878.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,878.98
|
| Rate for Payer: SOMOS Essential |
$4,227.70
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$4,227.70
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$2,066.88
|
| Rate for Payer: United Healthcare Medicaid |
$1,878.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,878.98
|
|
|
OUTPATIENT EAPG 00235: LEVEL II ANTERIOR SEGMENT EYE PROCEDURES
|
Facility
|
OP
|
$5,665.34
|
|
|
Service Code
|
EAPG 00235
|
| Hospital Charge Code |
EAPG 00235
|
| Min. Negotiated Rate |
$2,517.93 |
| Max. Negotiated Rate |
$5,665.34 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$5,665.34
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5,665.34
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,517.93
|
| Rate for Payer: Amida Care Medicaid |
$2,517.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,517.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,665.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,665.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,643.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,517.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,517.93
|
| Rate for Payer: Healthfirst Commercial |
$3,815.52
|
| Rate for Payer: Healthfirst Essential Plan |
$5,665.34
|
| Rate for Payer: Healthfirst QHP |
$2,517.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,517.93
|
| Rate for Payer: SOMOS Essential |
$5,665.34
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$5,665.34
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$2,769.72
|
| Rate for Payer: United Healthcare Medicaid |
$2,517.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,517.93
|
|
|
OUTPATIENT EAPG 00236: LEVEL III ANTERIOR SEGMENT EYE PROCEDURES
|
Facility
|
OP
|
$8,164.22
|
|
|
Service Code
|
EAPG 00236
|
| Hospital Charge Code |
EAPG 00236
|
| Min. Negotiated Rate |
$3,628.54 |
| Max. Negotiated Rate |
$8,164.22 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$8,164.22
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8,164.22
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,628.54
|
| Rate for Payer: Amida Care Medicaid |
$3,628.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,628.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8,164.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8,164.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,809.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,628.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,628.54
|
| Rate for Payer: Healthfirst Commercial |
$5,498.46
|
| Rate for Payer: Healthfirst Essential Plan |
$8,164.22
|
| Rate for Payer: Healthfirst QHP |
$3,628.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,628.54
|
| Rate for Payer: SOMOS Essential |
$8,164.22
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$8,164.22
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$3,991.39
|
| Rate for Payer: United Healthcare Medicaid |
$3,628.54
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,628.54
|
|
|
OUTPATIENT EAPG 00237: LEVEL I POSTERIOR SEGMENT EYE PROCEDURES
|
Facility
|
OP
|
$1,500.95
|
|
|
Service Code
|
EAPG 00237
|
| Hospital Charge Code |
EAPG 00237
|
| Min. Negotiated Rate |
$667.09 |
| Max. Negotiated Rate |
$1,500.95 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,500.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,500.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$667.09
|
| Rate for Payer: Amida Care Medicaid |
$667.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$667.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,500.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,500.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$700.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$667.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$667.09
|
| Rate for Payer: Healthfirst Commercial |
$1,010.86
|
| Rate for Payer: Healthfirst Essential Plan |
$1,500.95
|
| Rate for Payer: Healthfirst QHP |
$667.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$667.09
|
| Rate for Payer: SOMOS Essential |
$1,500.95
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$1,500.95
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$733.80
|
| Rate for Payer: United Healthcare Medicaid |
$667.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$667.09
|
|
|
OUTPATIENT EAPG 00238: LEVEL II POSTERIOR SEGMENT EYE PROCEDURES
|
Facility
|
OP
|
$7,174.17
|
|
|
Service Code
|
EAPG 00238
|
| Hospital Charge Code |
EAPG 00238
|
| Min. Negotiated Rate |
$3,188.52 |
| Max. Negotiated Rate |
$7,174.17 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$7,174.17
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7,174.17
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,188.52
|
| Rate for Payer: Amida Care Medicaid |
$3,188.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,188.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7,174.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7,174.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,347.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,188.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,188.52
|
| Rate for Payer: Healthfirst Commercial |
$4,831.69
|
| Rate for Payer: Healthfirst Essential Plan |
$7,174.17
|
| Rate for Payer: Healthfirst QHP |
$3,188.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,188.52
|
| Rate for Payer: SOMOS Essential |
$7,174.17
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$7,174.17
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$3,507.37
|
| Rate for Payer: United Healthcare Medicaid |
$3,188.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,188.52
|
|
|
OUTPATIENT EAPG 00239: STRABISMUS AND MUSCLE EYE PROCEDURES
|
Facility
|
OP
|
$4,490.55
|
|
|
Service Code
|
EAPG 00239
|
| Hospital Charge Code |
EAPG 00239
|
| Min. Negotiated Rate |
$1,995.80 |
| Max. Negotiated Rate |
$4,490.55 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,490.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,490.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,995.80
|
| Rate for Payer: Amida Care Medicaid |
$1,995.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,995.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4,490.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4,490.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,095.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,995.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,995.80
|
| Rate for Payer: Healthfirst Commercial |
$3,024.30
|
| Rate for Payer: Healthfirst Essential Plan |
$4,490.55
|
| Rate for Payer: Healthfirst QHP |
$1,995.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,995.80
|
| Rate for Payer: SOMOS Essential |
$4,490.55
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$4,490.55
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$2,195.38
|
| Rate for Payer: United Healthcare Medicaid |
$1,995.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,995.80
|
|
|
OUTPATIENT EAPG 00240: LEVEL I REPAIR AND PLASTIC PROCEDURES OF EYE
|
Facility
|
OP
|
$1,977.10
|
|
|
Service Code
|
EAPG 00240
|
| Hospital Charge Code |
EAPG 00240
|
| Min. Negotiated Rate |
$878.71 |
| Max. Negotiated Rate |
$1,977.10 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,977.10
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,977.10
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$878.71
|
| Rate for Payer: Amida Care Medicaid |
$878.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$878.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,977.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,977.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$922.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$878.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$878.71
|
| Rate for Payer: Healthfirst Commercial |
$1,331.55
|
| Rate for Payer: Healthfirst Essential Plan |
$1,977.10
|
| Rate for Payer: Healthfirst QHP |
$878.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$878.71
|
| Rate for Payer: SOMOS Essential |
$1,977.10
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$1,977.10
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$966.58
|
| Rate for Payer: United Healthcare Medicaid |
$878.71
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$878.71
|
|
|
OUTPATIENT EAPG 00241: LEVEL II REPAIR AND PLASTIC PROCEDURES OF EYE
|
Facility
|
OP
|
$4,928.33
|
|
|
Service Code
|
EAPG 00241
|
| Hospital Charge Code |
EAPG 00241
|
| Min. Negotiated Rate |
$2,190.37 |
| Max. Negotiated Rate |
$4,928.33 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,928.33
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,928.33
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,190.37
|
| Rate for Payer: Amida Care Medicaid |
$2,190.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,190.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4,928.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4,928.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,299.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,190.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,190.37
|
| Rate for Payer: Healthfirst Commercial |
$3,319.15
|
| Rate for Payer: Healthfirst Essential Plan |
$4,928.33
|
| Rate for Payer: Healthfirst QHP |
$2,190.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,190.37
|
| Rate for Payer: SOMOS Essential |
$4,928.33
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$4,928.33
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$2,409.41
|
| Rate for Payer: United Healthcare Medicaid |
$2,190.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,190.37
|
|
|
OUTPATIENT EAPG 00249: MINOR ENT PROCEDURES
|
Facility
|
OP
|
$345.94
|
|
|
Service Code
|
EAPG 00249
|
| Hospital Charge Code |
EAPG 00249
|
| Min. Negotiated Rate |
$153.75 |
| Max. Negotiated Rate |
$345.94 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$345.94
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$345.94
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$153.75
|
| Rate for Payer: Amida Care Medicaid |
$153.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$153.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$345.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$345.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$161.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$153.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$153.75
|
| Rate for Payer: Healthfirst Essential Plan |
$345.94
|
| Rate for Payer: Healthfirst QHP |
$153.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$153.75
|
| Rate for Payer: SOMOS Essential |
$345.94
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$345.94
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$169.12
|
| Rate for Payer: United Healthcare Medicaid |
$153.75
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$153.75
|
|
|
OUTPATIENT EAPG 00250: COCHLEAR DEVICE IMPLANTATION
|
Facility
|
OP
|
$79,733.99
|
|
|
Service Code
|
EAPG 00250
|
| Hospital Charge Code |
EAPG 00250
|
| Min. Negotiated Rate |
$35,437.33 |
| Max. Negotiated Rate |
$79,733.99 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$79,733.99
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$79,733.99
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$35,437.33
|
| Rate for Payer: Amida Care Medicaid |
$35,437.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35,437.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$79,733.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$79,733.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37,209.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35,437.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35,437.33
|
| Rate for Payer: Healthfirst Commercial |
$53,699.49
|
| Rate for Payer: Healthfirst Essential Plan |
$79,733.99
|
| Rate for Payer: Healthfirst QHP |
$35,437.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35,437.33
|
| Rate for Payer: SOMOS Essential |
$79,733.99
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$79,733.99
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$38,981.06
|
| Rate for Payer: United Healthcare Medicaid |
$35,437.33
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$35,437.33
|
|
|
OUTPATIENT EAPG 00251: OTORHINOLARYNGOLOGIC FUNCTION TESTS
|
Facility
|
OP
|
$349.34
|
|
|
Service Code
|
EAPG 00251
|
| Hospital Charge Code |
EAPG 00251
|
| Min. Negotiated Rate |
$155.26 |
| Max. Negotiated Rate |
$349.34 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$349.34
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$349.34
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$155.26
|
| Rate for Payer: Amida Care Medicaid |
$155.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$155.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$349.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$349.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$163.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$155.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$155.26
|
| Rate for Payer: Healthfirst Commercial |
$235.27
|
| Rate for Payer: Healthfirst Essential Plan |
$349.34
|
| Rate for Payer: Healthfirst QHP |
$155.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$155.26
|
| Rate for Payer: SOMOS Essential |
$349.34
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$349.34
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$170.79
|
| Rate for Payer: United Healthcare Medicaid |
$155.26
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$155.26
|
|
|
OUTPATIENT EAPG 00252: LEVEL I FACIAL AND ENT PROCEDURES
|
Facility
|
OP
|
$3,217.18
|
|
|
Service Code
|
EAPG 00252
|
| Hospital Charge Code |
EAPG 00252
|
| Min. Negotiated Rate |
$1,429.86 |
| Max. Negotiated Rate |
$3,217.18 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,217.18
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,217.18
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,429.86
|
| Rate for Payer: Amida Care Medicaid |
$1,429.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,429.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,217.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,217.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,501.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,429.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,429.86
|
| Rate for Payer: Healthfirst Commercial |
$2,166.73
|
| Rate for Payer: Healthfirst Essential Plan |
$3,217.18
|
| Rate for Payer: Healthfirst QHP |
$1,429.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,429.86
|
| Rate for Payer: SOMOS Essential |
$3,217.18
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$3,217.18
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$1,572.85
|
| Rate for Payer: United Healthcare Medicaid |
$1,429.86
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,429.86
|
|
|
OUTPATIENT EAPG 00253: LEVEL II FACIAL AND ENT PROCEDURES
|
Facility
|
OP
|
$4,327.90
|
|
|
Service Code
|
EAPG 00253
|
| Hospital Charge Code |
EAPG 00253
|
| Min. Negotiated Rate |
$1,923.51 |
| Max. Negotiated Rate |
$4,327.90 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,327.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,327.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,923.51
|
| Rate for Payer: Amida Care Medicaid |
$1,923.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,923.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4,327.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4,327.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,019.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,923.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,923.51
|
| Rate for Payer: Healthfirst Commercial |
$2,914.77
|
| Rate for Payer: Healthfirst Essential Plan |
$4,327.90
|
| Rate for Payer: Healthfirst QHP |
$1,923.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,923.51
|
| Rate for Payer: SOMOS Essential |
$4,327.90
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$4,327.90
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$2,115.86
|
| Rate for Payer: United Healthcare Medicaid |
$1,923.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,923.51
|
|
|
OUTPATIENT EAPG 00254: LEVEL III FACIAL AND ENT PROCEDURES
|
Facility
|
OP
|
$6,134.18
|
|
|
Service Code
|
EAPG 00254
|
| Hospital Charge Code |
EAPG 00254
|
| Min. Negotiated Rate |
$2,726.30 |
| Max. Negotiated Rate |
$6,134.18 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$6,134.18
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6,134.18
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,726.30
|
| Rate for Payer: Amida Care Medicaid |
$2,726.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,726.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6,134.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6,134.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,862.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,726.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,726.30
|
| Rate for Payer: Healthfirst Commercial |
$4,131.27
|
| Rate for Payer: Healthfirst Essential Plan |
$6,134.18
|
| Rate for Payer: Healthfirst QHP |
$2,726.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,726.30
|
| Rate for Payer: SOMOS Essential |
$6,134.18
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$6,134.18
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$2,998.93
|
| Rate for Payer: United Healthcare Medicaid |
$2,726.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,726.30
|
|
|
OUTPATIENT EAPG 00255: LEVEL IV FACIAL AND ENT PROCEDURES
|
Facility
|
OP
|
$8,831.52
|
|
|
Service Code
|
EAPG 00255
|
| Hospital Charge Code |
EAPG 00255
|
| Min. Negotiated Rate |
$3,925.12 |
| Max. Negotiated Rate |
$8,831.52 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$8,831.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8,831.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,925.12
|
| Rate for Payer: Amida Care Medicaid |
$3,925.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,925.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8,831.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8,831.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,121.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,925.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,925.12
|
| Rate for Payer: Healthfirst Commercial |
$5,947.89
|
| Rate for Payer: Healthfirst Essential Plan |
$8,831.52
|
| Rate for Payer: Healthfirst QHP |
$3,925.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,925.12
|
| Rate for Payer: SOMOS Essential |
$8,831.52
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$8,831.52
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$4,317.63
|
| Rate for Payer: United Healthcare Medicaid |
$3,925.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,925.12
|
|
|
OUTPATIENT EAPG 00256: TONSIL AND ADENOID PROCEDURES
|
Facility
|
OP
|
$3,726.20
|
|
|
Service Code
|
EAPG 00256
|
| Hospital Charge Code |
EAPG 00256
|
| Min. Negotiated Rate |
$1,656.09 |
| Max. Negotiated Rate |
$3,726.20 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,726.20
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,726.20
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,656.09
|
| Rate for Payer: Amida Care Medicaid |
$1,656.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,656.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,726.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,726.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,738.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,656.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,656.09
|
| Rate for Payer: Healthfirst Commercial |
$2,509.53
|
| Rate for Payer: Healthfirst Essential Plan |
$3,726.20
|
| Rate for Payer: Healthfirst QHP |
$1,656.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,656.09
|
| Rate for Payer: SOMOS Essential |
$3,726.20
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$3,726.20
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$1,821.70
|
| Rate for Payer: United Healthcare Medicaid |
$1,656.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,656.09
|
|
|
OUTPATIENT EAPG 00257: AUDIOMETRY
|
Facility
|
OP
|
$199.33
|
|
|
Service Code
|
EAPG 00257
|
| Hospital Charge Code |
EAPG 00257
|
| Min. Negotiated Rate |
$88.59 |
| Max. Negotiated Rate |
$199.33 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$199.33
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$199.33
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$88.59
|
| Rate for Payer: Amida Care Medicaid |
$88.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$88.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$199.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$199.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$93.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$88.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.59
|
| Rate for Payer: Healthfirst Commercial |
$134.25
|
| Rate for Payer: Healthfirst Essential Plan |
$199.33
|
| Rate for Payer: Healthfirst QHP |
$88.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$88.59
|
| Rate for Payer: SOMOS Essential |
$199.33
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$199.33
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$97.45
|
| Rate for Payer: United Healthcare Medicaid |
$88.59
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$88.59
|
|
|
OUTPATIENT EAPG 00270: OCCUPATIONAL THERAPY
|
Facility
|
OP
|
$342.76
|
|
|
Service Code
|
EAPG 00270
|
| Hospital Charge Code |
EAPG 00270
|
| Min. Negotiated Rate |
$152.34 |
| Max. Negotiated Rate |
$342.76 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$342.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$342.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$152.34
|
| Rate for Payer: Amida Care Medicaid |
$152.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$152.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$342.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$342.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$159.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$152.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$152.34
|
| Rate for Payer: Healthfirst Commercial |
$230.84
|
| Rate for Payer: Healthfirst Essential Plan |
$342.76
|
| Rate for Payer: Healthfirst QHP |
$152.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$152.34
|
| Rate for Payer: SOMOS Essential |
$342.76
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$342.76
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$167.57
|
| Rate for Payer: United Healthcare Medicaid |
$152.34
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$152.34
|
|
|
OUTPATIENT EAPG 00271: PHYSICAL THERAPY
|
Facility
|
OP
|
$323.19
|
|
|
Service Code
|
EAPG 00271
|
| Hospital Charge Code |
EAPG 00271
|
| Min. Negotiated Rate |
$143.64 |
| Max. Negotiated Rate |
$323.19 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$323.19
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$323.19
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$143.64
|
| Rate for Payer: Amida Care Medicaid |
$143.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$143.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$323.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$323.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$150.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$143.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$143.64
|
| Rate for Payer: Healthfirst Commercial |
$217.65
|
| Rate for Payer: Healthfirst Essential Plan |
$323.19
|
| Rate for Payer: Healthfirst QHP |
$143.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$143.64
|
| Rate for Payer: SOMOS Essential |
$323.19
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$323.19
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$158.00
|
| Rate for Payer: United Healthcare Medicaid |
$143.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$143.64
|
|
|
OUTPATIENT EAPG 00272: SPEECH THERAPY AND EVALUATION
|
Facility
|
OP
|
$313.38
|
|
|
Service Code
|
EAPG 00272
|
| Hospital Charge Code |
EAPG 00272
|
| Min. Negotiated Rate |
$139.28 |
| Max. Negotiated Rate |
$313.38 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$313.38
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$313.38
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$139.28
|
| Rate for Payer: Amida Care Medicaid |
$139.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$139.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$313.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$313.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$146.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$139.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$139.28
|
| Rate for Payer: Healthfirst Commercial |
$211.07
|
| Rate for Payer: Healthfirst Essential Plan |
$313.38
|
| Rate for Payer: Healthfirst QHP |
$139.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$139.28
|
| Rate for Payer: SOMOS Essential |
$313.38
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$313.38
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$153.21
|
| Rate for Payer: United Healthcare Medicaid |
$139.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$139.28
|
|
|
OUTPATIENT EAPG 00273: MANIPULATION THERAPY
|
Facility
|
OP
|
$88.15
|
|
|
Service Code
|
EAPG 00273
|
| Hospital Charge Code |
EAPG 00273
|
| Min. Negotiated Rate |
$88.15 |
| Max. Negotiated Rate |
$88.15 |
| Rate for Payer: Healthfirst Commercial |
$88.15
|
|
|
OUTPATIENT EAPG 00274: OCCUPATIONAL/PHYSICAL THERAPY, GROUP
|
Facility
|
OP
|
$76.95
|
|
|
Service Code
|
EAPG 00274
|
| Hospital Charge Code |
EAPG 00274
|
| Min. Negotiated Rate |
$76.95 |
| Max. Negotiated Rate |
$76.95 |
| Rate for Payer: Healthfirst Commercial |
$76.95
|
|
|
OUTPATIENT EAPG 00275: SPEECH THERAPY & EVALUATION, GROUP
|
Facility
|
OP
|
$61.57
|
|
|
Service Code
|
EAPG 00275
|
| Hospital Charge Code |
EAPG 00275
|
| Min. Negotiated Rate |
$61.57 |
| Max. Negotiated Rate |
$61.57 |
| Rate for Payer: Healthfirst Commercial |
$61.57
|
|
|
OUTPATIENT EAPG 00278: INJECTION(S) FOR RADIOLOGICAL IMAGING
|
Facility
|
OP
|
$1,197.65
|
|
|
Service Code
|
EAPG 00278
|
| Hospital Charge Code |
EAPG 00278
|
| Min. Negotiated Rate |
$532.29 |
| Max. Negotiated Rate |
$1,197.65 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,197.65
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,197.65
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$532.29
|
| Rate for Payer: Amida Care Medicaid |
$532.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$532.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,197.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,197.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$558.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$532.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$532.29
|
| Rate for Payer: Healthfirst Essential Plan |
$1,197.65
|
| Rate for Payer: Healthfirst QHP |
$532.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$532.29
|
| Rate for Payer: SOMOS Essential |
$1,197.65
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$1,197.65
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$585.52
|
| Rate for Payer: United Healthcare Medicaid |
$532.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$532.29
|
|
|
OUTPATIENT EAPG 00279: LEVEL I VASCULAR RADIOLOGICAL PROCEDURES
|
Facility
|
OP
|
$915.80
|
|
|
Service Code
|
EAPG 00279
|
| Hospital Charge Code |
EAPG 00279
|
| Min. Negotiated Rate |
$407.02 |
| Max. Negotiated Rate |
$915.80 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$915.80
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$915.80
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$407.02
|
| Rate for Payer: Amida Care Medicaid |
$407.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$407.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$915.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$915.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$427.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$407.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$407.02
|
| Rate for Payer: Healthfirst Essential Plan |
$915.80
|
| Rate for Payer: Healthfirst QHP |
$407.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$407.02
|
| Rate for Payer: SOMOS Essential |
$915.80
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$915.80
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$447.72
|
| Rate for Payer: United Healthcare Medicaid |
$407.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$407.02
|
|
