|
OUTPATIENT EAPG 00396: LEVEL I MICROBIOLOGY TESTS
|
Facility
|
OP
|
$28.62
|
|
|
Service Code
|
EAPG 00396
|
| Hospital Charge Code |
EAPG 00396
|
| Min. Negotiated Rate |
$12.72 |
| Max. Negotiated Rate |
$28.62 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$28.62
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$28.62
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.72
|
| Rate for Payer: Amida Care Medicaid |
$12.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$28.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.72
|
| Rate for Payer: Healthfirst Commercial |
$19.27
|
| Rate for Payer: Healthfirst Essential Plan |
$28.62
|
| Rate for Payer: Healthfirst QHP |
$12.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.72
|
| Rate for Payer: SOMOS Essential |
$28.62
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$28.62
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$13.99
|
| Rate for Payer: United Healthcare Medicaid |
$12.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.72
|
|
|
OUTPATIENT EAPG 00397: LEVEL II MICROBIOLOGY TESTS
|
Facility
|
OP
|
$113.26
|
|
|
Service Code
|
EAPG 00397
|
| Hospital Charge Code |
EAPG 00397
|
| Min. Negotiated Rate |
$50.34 |
| Max. Negotiated Rate |
$113.26 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$113.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$113.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$50.34
|
| Rate for Payer: Amida Care Medicaid |
$50.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$50.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$113.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$52.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$50.34
|
| Rate for Payer: Healthfirst Commercial |
$76.28
|
| Rate for Payer: Healthfirst Essential Plan |
$113.26
|
| Rate for Payer: Healthfirst QHP |
$50.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$50.34
|
| Rate for Payer: SOMOS Essential |
$113.26
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$113.26
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$55.37
|
| Rate for Payer: United Healthcare Medicaid |
$50.34
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$50.34
|
|
|
OUTPATIENT EAPG 00398: LEVEL I ENDOCRINOLOGY TESTS
|
Facility
|
OP
|
$74.66
|
|
|
Service Code
|
EAPG 00398
|
| Hospital Charge Code |
EAPG 00398
|
| Min. Negotiated Rate |
$33.18 |
| Max. Negotiated Rate |
$74.66 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$74.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$74.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$33.18
|
| Rate for Payer: Amida Care Medicaid |
$33.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$74.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$74.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.18
|
| Rate for Payer: Healthfirst Commercial |
$50.29
|
| Rate for Payer: Healthfirst Essential Plan |
$74.66
|
| Rate for Payer: Healthfirst QHP |
$33.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$33.18
|
| Rate for Payer: SOMOS Essential |
$74.66
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$74.66
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$36.50
|
| Rate for Payer: United Healthcare Medicaid |
$33.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$33.18
|
|
|
OUTPATIENT EAPG 00399: LEVEL II ENDOCRINOLOGY TESTS
|
Facility
|
OP
|
$105.12
|
|
|
Service Code
|
EAPG 00399
|
| Hospital Charge Code |
EAPG 00399
|
| Min. Negotiated Rate |
$46.72 |
| Max. Negotiated Rate |
$105.12 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$105.12
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$105.12
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$46.72
|
| Rate for Payer: Amida Care Medicaid |
$46.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$46.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$105.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$105.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$46.72
|
| Rate for Payer: Healthfirst Commercial |
$70.79
|
| Rate for Payer: Healthfirst Essential Plan |
$105.12
|
| Rate for Payer: Healthfirst QHP |
$46.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$46.72
|
| Rate for Payer: SOMOS Essential |
$105.12
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$105.12
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$51.39
|
| Rate for Payer: United Healthcare Medicaid |
$46.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$46.72
|
|
|
OUTPATIENT EAPG 00400: LEVEL I CHEMISTRY TESTS
|
Facility
|
OP
|
$31.79
|
|
|
Service Code
|
EAPG 00400
|
| Hospital Charge Code |
EAPG 00400
|
| Min. Negotiated Rate |
$14.13 |
| Max. Negotiated Rate |
$31.79 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$31.79
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$31.79
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$14.13
|
| Rate for Payer: Amida Care Medicaid |
$14.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.13
|
| Rate for Payer: Healthfirst Commercial |
$21.42
|
| Rate for Payer: Healthfirst Essential Plan |
$31.79
|
| Rate for Payer: Healthfirst QHP |
$14.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$14.13
|
| Rate for Payer: SOMOS Essential |
$31.79
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$31.79
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$15.54
|
| Rate for Payer: United Healthcare Medicaid |
$14.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.13
|
|
|
OUTPATIENT EAPG 00401: LEVEL II CHEMISTRY TESTS
|
Facility
|
OP
|
$99.29
|
|
|
Service Code
|
EAPG 00401
|
| Hospital Charge Code |
EAPG 00401
|
| Min. Negotiated Rate |
$44.13 |
| Max. Negotiated Rate |
$99.29 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$99.29
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$99.29
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$44.13
|
| Rate for Payer: Amida Care Medicaid |
$44.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$44.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$99.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$99.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$46.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.13
|
| Rate for Payer: Healthfirst Commercial |
$66.86
|
| Rate for Payer: Healthfirst Essential Plan |
$99.29
|
| Rate for Payer: Healthfirst QHP |
$44.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$44.13
|
| Rate for Payer: SOMOS Essential |
$99.29
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$99.29
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$48.54
|
| Rate for Payer: United Healthcare Medicaid |
$44.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$44.13
|
|
|
OUTPATIENT EAPG 00402: BASIC CHEMISTRY TESTS
|
Facility
|
OP
|
$19.76
|
|
|
Service Code
|
EAPG 00402
|
| Hospital Charge Code |
EAPG 00402
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$19.76 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$19.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$19.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.78
|
| Rate for Payer: Amida Care Medicaid |
$8.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$19.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.78
|
| Rate for Payer: Healthfirst Commercial |
$13.32
|
| Rate for Payer: Healthfirst Essential Plan |
$19.76
|
| Rate for Payer: Healthfirst QHP |
$8.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.78
|
| Rate for Payer: SOMOS Essential |
$19.76
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$19.76
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$9.66
|
| Rate for Payer: United Healthcare Medicaid |
$8.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.78
|
|
|
OUTPATIENT EAPG 00403: ORGAN OR DISEASE ORIENTED PANELS
|
Facility
|
OP
|
$76.41
|
|
|
Service Code
|
EAPG 00403
|
| Hospital Charge Code |
EAPG 00403
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$76.41 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$76.41
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$76.41
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$33.96
|
| Rate for Payer: Amida Care Medicaid |
$33.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$76.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$76.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.96
|
| Rate for Payer: Healthfirst Commercial |
$51.46
|
| Rate for Payer: Healthfirst Essential Plan |
$76.41
|
| Rate for Payer: Healthfirst QHP |
$33.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$33.96
|
| Rate for Payer: SOMOS Essential |
$76.41
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$76.41
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$37.36
|
| Rate for Payer: United Healthcare Medicaid |
$33.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$33.96
|
|
|
OUTPATIENT EAPG 00404: TOXICOLOGY TESTS
|
Facility
|
OP
|
$55.94
|
|
|
Service Code
|
EAPG 00404
|
| Hospital Charge Code |
EAPG 00404
|
| Min. Negotiated Rate |
$24.86 |
| Max. Negotiated Rate |
$55.94 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$55.94
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$55.94
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$24.86
|
| Rate for Payer: Amida Care Medicaid |
$24.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$55.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$55.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.86
|
| Rate for Payer: Healthfirst Commercial |
$37.69
|
| Rate for Payer: Healthfirst Essential Plan |
$55.94
|
| Rate for Payer: Healthfirst QHP |
$24.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.86
|
| Rate for Payer: SOMOS Essential |
$55.94
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$55.94
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$27.35
|
| Rate for Payer: United Healthcare Medicaid |
$24.86
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$24.86
|
|
|
OUTPATIENT EAPG 00405: THERAPEUTIC DRUG MONITORING
|
Facility
|
OP
|
$50.18
|
|
|
Service Code
|
EAPG 00405
|
| Hospital Charge Code |
EAPG 00405
|
| Min. Negotiated Rate |
$22.30 |
| Max. Negotiated Rate |
$50.18 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$50.18
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$50.18
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$22.30
|
| Rate for Payer: Amida Care Medicaid |
$22.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$50.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.30
|
| Rate for Payer: Healthfirst Commercial |
$33.79
|
| Rate for Payer: Healthfirst Essential Plan |
$50.18
|
| Rate for Payer: Healthfirst QHP |
$22.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.30
|
| Rate for Payer: SOMOS Essential |
$50.18
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$50.18
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$24.53
|
| Rate for Payer: United Healthcare Medicaid |
$22.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$22.30
|
|
|
OUTPATIENT EAPG 00406: LEVEL I CLOTTING TESTS
|
Facility
|
OP
|
$39.35
|
|
|
Service Code
|
EAPG 00406
|
| Hospital Charge Code |
EAPG 00406
|
| Min. Negotiated Rate |
$17.49 |
| Max. Negotiated Rate |
$39.35 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$39.35
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$39.35
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$17.49
|
| Rate for Payer: Amida Care Medicaid |
$17.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$39.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.49
|
| Rate for Payer: Healthfirst Commercial |
$26.50
|
| Rate for Payer: Healthfirst Essential Plan |
$39.35
|
| Rate for Payer: Healthfirst QHP |
$17.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$17.49
|
| Rate for Payer: SOMOS Essential |
$39.35
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$39.35
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$19.24
|
| Rate for Payer: United Healthcare Medicaid |
$17.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.49
|
|
|
OUTPATIENT EAPG 00407: LEVEL II CLOTTING TESTS
|
Facility
|
OP
|
$117.94
|
|
|
Service Code
|
EAPG 00407
|
| Hospital Charge Code |
EAPG 00407
|
| Min. Negotiated Rate |
$52.42 |
| Max. Negotiated Rate |
$117.94 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$117.94
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$117.94
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$52.42
|
| Rate for Payer: Amida Care Medicaid |
$52.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$52.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$117.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$117.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$55.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$52.42
|
| Rate for Payer: Healthfirst Commercial |
$79.43
|
| Rate for Payer: Healthfirst Essential Plan |
$117.94
|
| Rate for Payer: Healthfirst QHP |
$52.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$52.42
|
| Rate for Payer: SOMOS Essential |
$117.94
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$117.94
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$57.66
|
| Rate for Payer: United Healthcare Medicaid |
$52.42
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$52.42
|
|
|
OUTPATIENT EAPG 00408: LEVEL I HEMATOLOGY TESTS
|
Facility
|
OP
|
$32.72
|
|
|
Service Code
|
EAPG 00408
|
| Hospital Charge Code |
EAPG 00408
|
| Min. Negotiated Rate |
$14.54 |
| Max. Negotiated Rate |
$32.72 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$32.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$32.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$14.54
|
| Rate for Payer: Amida Care Medicaid |
$14.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.54
|
| Rate for Payer: Healthfirst Commercial |
$22.04
|
| Rate for Payer: Healthfirst Essential Plan |
$32.72
|
| Rate for Payer: Healthfirst QHP |
$14.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$14.54
|
| Rate for Payer: SOMOS Essential |
$32.72
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$32.72
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$15.99
|
| Rate for Payer: United Healthcare Medicaid |
$14.54
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.54
|
|
|
OUTPATIENT EAPG 00409: LEVEL II HEMATOLOGY TESTS
|
Facility
|
OP
|
$79.76
|
|
|
Service Code
|
EAPG 00409
|
| Hospital Charge Code |
EAPG 00409
|
| Min. Negotiated Rate |
$35.45 |
| Max. Negotiated Rate |
$79.76 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$79.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$79.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$35.45
|
| Rate for Payer: Amida Care Medicaid |
$35.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$79.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$79.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.45
|
| Rate for Payer: Healthfirst Commercial |
$53.71
|
| Rate for Payer: Healthfirst Essential Plan |
$79.76
|
| Rate for Payer: Healthfirst QHP |
$35.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35.45
|
| Rate for Payer: SOMOS Essential |
$79.76
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$79.76
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$39.00
|
| Rate for Payer: United Healthcare Medicaid |
$35.45
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$35.45
|
|
|
OUTPATIENT EAPG 00410: URINALYSIS
|
Facility
|
OP
|
$31.18
|
|
|
Service Code
|
EAPG 00410
|
| Hospital Charge Code |
EAPG 00410
|
| Min. Negotiated Rate |
$13.86 |
| Max. Negotiated Rate |
$31.18 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$31.18
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$31.18
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.86
|
| Rate for Payer: Amida Care Medicaid |
$13.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.86
|
| Rate for Payer: Healthfirst Commercial |
$20.99
|
| Rate for Payer: Healthfirst Essential Plan |
$31.18
|
| Rate for Payer: Healthfirst QHP |
$13.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$13.86
|
| Rate for Payer: SOMOS Essential |
$31.18
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$31.18
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$15.25
|
| Rate for Payer: United Healthcare Medicaid |
$13.86
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.86
|
|
|
OUTPATIENT EAPG 00412: SIMPLE PULMONARY FUNCTION TESTS
|
Facility
|
OP
|
$191.02
|
|
|
Service Code
|
EAPG 00412
|
| Hospital Charge Code |
EAPG 00412
|
| Min. Negotiated Rate |
$84.90 |
| Max. Negotiated Rate |
$191.02 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$191.02
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$191.02
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$84.90
|
| Rate for Payer: Amida Care Medicaid |
$84.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$84.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$191.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$191.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$89.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$84.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$84.90
|
| Rate for Payer: Healthfirst Commercial |
$128.64
|
| Rate for Payer: Healthfirst Essential Plan |
$191.02
|
| Rate for Payer: Healthfirst QHP |
$84.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$84.90
|
| Rate for Payer: SOMOS Essential |
$191.02
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$191.02
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$93.39
|
| Rate for Payer: United Healthcare Medicaid |
$84.90
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$84.90
|
|
|
OUTPATIENT EAPG 00413: CARDIOGRAM
|
Facility
|
OP
|
$108.36
|
|
|
Service Code
|
EAPG 00413
|
| Hospital Charge Code |
EAPG 00413
|
| Min. Negotiated Rate |
$48.16 |
| Max. Negotiated Rate |
$108.36 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$108.36
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$108.36
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$48.16
|
| Rate for Payer: Amida Care Medicaid |
$48.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$48.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$108.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.16
|
| Rate for Payer: Healthfirst Commercial |
$72.98
|
| Rate for Payer: Healthfirst Essential Plan |
$108.36
|
| Rate for Payer: Healthfirst QHP |
$48.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$48.16
|
| Rate for Payer: SOMOS Essential |
$108.36
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$108.36
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$52.98
|
| Rate for Payer: United Healthcare Medicaid |
$48.16
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$48.16
|
|
|
OUTPATIENT EAPG 00414: LEVEL I IMMUNIZATION
|
Facility
|
OP
|
$84.89
|
|
|
Service Code
|
EAPG 00414
|
| Hospital Charge Code |
EAPG 00414
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$84.89 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$84.89
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$84.89
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$37.73
|
| Rate for Payer: Amida Care Medicaid |
$37.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$84.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$37.73
|
| Rate for Payer: Healthfirst Commercial |
$57.16
|
| Rate for Payer: Healthfirst Essential Plan |
$84.89
|
| Rate for Payer: Healthfirst QHP |
$37.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$37.73
|
| Rate for Payer: SOMOS Essential |
$84.89
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$84.89
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$41.50
|
| Rate for Payer: United Healthcare Medicaid |
$37.73
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$37.73
|
|
|
OUTPATIENT EAPG 00415: LEVEL II IMMUNIZATION
|
Facility
|
OP
|
$176.04
|
|
|
Service Code
|
EAPG 00415
|
| Hospital Charge Code |
EAPG 00415
|
| Min. Negotiated Rate |
$78.24 |
| Max. Negotiated Rate |
$176.04 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$176.04
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$176.04
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$78.24
|
| Rate for Payer: Amida Care Medicaid |
$78.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$78.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$176.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$176.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$82.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$78.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$78.24
|
| Rate for Payer: Healthfirst Commercial |
$118.57
|
| Rate for Payer: Healthfirst Essential Plan |
$176.04
|
| Rate for Payer: Healthfirst QHP |
$78.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$78.24
|
| Rate for Payer: SOMOS Essential |
$176.04
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$176.04
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$86.06
|
| Rate for Payer: United Healthcare Medicaid |
$78.24
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$78.24
|
|
|
OUTPATIENT EAPG 00416: LEVEL III IMMUNIZATION
|
Facility
|
OP
|
$241.13
|
|
|
Service Code
|
EAPG 00416
|
| Hospital Charge Code |
EAPG 00416
|
| Min. Negotiated Rate |
$241.13 |
| Max. Negotiated Rate |
$241.13 |
| Rate for Payer: Healthfirst Commercial |
$241.13
|
|
|
OUTPATIENT EAPG 00417: MINOR REPRODUCTIVE PROCEDURES
|
Facility
|
OP
|
$380.63
|
|
|
Service Code
|
EAPG 00417
|
| Hospital Charge Code |
EAPG 00417
|
| Min. Negotiated Rate |
$169.17 |
| Max. Negotiated Rate |
$380.63 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$380.63
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$380.63
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$169.17
|
| Rate for Payer: Amida Care Medicaid |
$169.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$169.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$380.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$380.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$177.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$169.17
|
| Rate for Payer: Healthfirst Commercial |
$256.35
|
| Rate for Payer: Healthfirst Essential Plan |
$380.63
|
| Rate for Payer: Healthfirst QHP |
$169.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$169.17
|
| Rate for Payer: SOMOS Essential |
$380.63
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$380.63
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$186.09
|
| Rate for Payer: United Healthcare Medicaid |
$169.17
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$169.17
|
|
|
OUTPATIENT EAPG 00418: AMBULATORY PATIENT MONITORING AND RELATED ASSESSMENTS
|
Facility
|
OP
|
$479.48
|
|
|
Service Code
|
EAPG 00418
|
| Hospital Charge Code |
EAPG 00418
|
| Min. Negotiated Rate |
$213.10 |
| Max. Negotiated Rate |
$479.48 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$479.48
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$479.48
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$213.10
|
| Rate for Payer: Amida Care Medicaid |
$213.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$213.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$479.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$479.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$223.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$213.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$213.10
|
| Rate for Payer: Healthfirst Commercial |
$322.92
|
| Rate for Payer: Healthfirst Essential Plan |
$479.48
|
| Rate for Payer: Healthfirst QHP |
$213.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$213.10
|
| Rate for Payer: SOMOS Essential |
$479.48
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$479.48
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$234.41
|
| Rate for Payer: United Healthcare Medicaid |
$213.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$213.10
|
|
|
OUTPATIENT EAPG 00419: MINOR OPHTHALMOLOGICAL INJECTION, SCRAPING AND TESTS
|
Facility
|
OP
|
$234.43
|
|
|
Service Code
|
EAPG 00419
|
| Hospital Charge Code |
EAPG 00419
|
| Min. Negotiated Rate |
$104.19 |
| Max. Negotiated Rate |
$234.43 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$234.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$234.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$104.19
|
| Rate for Payer: Amida Care Medicaid |
$104.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$104.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$234.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$234.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$109.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$104.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$104.19
|
| Rate for Payer: Healthfirst Commercial |
$157.88
|
| Rate for Payer: Healthfirst Essential Plan |
$234.43
|
| Rate for Payer: Healthfirst QHP |
$104.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$104.19
|
| Rate for Payer: SOMOS Essential |
$234.43
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$234.43
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$114.61
|
| Rate for Payer: United Healthcare Medicaid |
$104.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$104.19
|
|
|
OUTPATIENT EAPG 00420: ELECTRONIC ANALYSIS FOR PACEMAKERS AND OTHER DEVICES
|
Facility
|
OP
|
$215.12
|
|
|
Service Code
|
EAPG 00420
|
| Hospital Charge Code |
EAPG 00420
|
| Min. Negotiated Rate |
$95.61 |
| Max. Negotiated Rate |
$215.12 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$215.12
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$215.12
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$95.61
|
| Rate for Payer: Amida Care Medicaid |
$95.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$95.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$215.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$215.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$100.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$95.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$95.61
|
| Rate for Payer: Healthfirst Commercial |
$144.87
|
| Rate for Payer: Healthfirst Essential Plan |
$215.12
|
| Rate for Payer: Healthfirst QHP |
$95.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$95.61
|
| Rate for Payer: SOMOS Essential |
$215.12
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$215.12
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$105.17
|
| Rate for Payer: United Healthcare Medicaid |
$95.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$95.61
|
|
|
OUTPATIENT EAPG 00421: TUBE REPLACEMENT, REVISION OR REMOVAL
|
Facility
|
OP
|
$926.84
|
|
|
Service Code
|
EAPG 00421
|
| Hospital Charge Code |
EAPG 00421
|
| Min. Negotiated Rate |
$411.93 |
| Max. Negotiated Rate |
$926.84 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$926.84
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$926.84
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$411.93
|
| Rate for Payer: Amida Care Medicaid |
$411.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$411.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$926.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$926.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$432.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$411.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$411.93
|
| Rate for Payer: Healthfirst Commercial |
$624.22
|
| Rate for Payer: Healthfirst Essential Plan |
$926.84
|
| Rate for Payer: Healthfirst QHP |
$411.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$411.93
|
| Rate for Payer: SOMOS Essential |
$926.84
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$926.84
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$453.12
|
| Rate for Payer: United Healthcare Medicaid |
$411.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$411.93
|
|
