|
OUTPATIENT EAPG 00531: MIGRAINE
|
Facility
|
OP
|
$379.19
|
|
|
Service Code
|
EAPG 00531
|
| Hospital Charge Code |
EAPG 00531
|
| Min. Negotiated Rate |
$168.53 |
| Max. Negotiated Rate |
$379.19 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$379.19
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$379.19
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$168.53
|
| Rate for Payer: Amida Care Medicaid |
$168.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$168.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$379.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$379.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$176.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$168.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$168.53
|
| Rate for Payer: Healthfirst Commercial |
$255.39
|
| Rate for Payer: Healthfirst Essential Plan |
$379.19
|
| Rate for Payer: Healthfirst QHP |
$168.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$168.53
|
| Rate for Payer: SOMOS Essential |
$379.19
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$379.19
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$185.38
|
| Rate for Payer: United Healthcare Medicaid |
$168.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$168.53
|
|
|
OUTPATIENT EAPG 00532: HEAD TRAUMA
|
Facility
|
OP
|
$351.47
|
|
|
Service Code
|
EAPG 00532
|
| Hospital Charge Code |
EAPG 00532
|
| Min. Negotiated Rate |
$156.21 |
| Max. Negotiated Rate |
$351.47 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$351.47
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$351.47
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$156.21
|
| Rate for Payer: Amida Care Medicaid |
$156.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$156.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$351.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$351.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$164.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$156.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$156.21
|
| Rate for Payer: Healthfirst Commercial |
$236.71
|
| Rate for Payer: Healthfirst Essential Plan |
$351.47
|
| Rate for Payer: Healthfirst QHP |
$156.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$156.21
|
| Rate for Payer: SOMOS Essential |
$351.47
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$351.47
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$171.83
|
| Rate for Payer: United Healthcare Medicaid |
$156.21
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$156.21
|
|
|
OUTPATIENT EAPG 00533: AFTEREFFECTS OF CEREBROVASCULAR ACCIDENT
|
Facility
|
OP
|
$324.52
|
|
|
Service Code
|
EAPG 00533
|
| Hospital Charge Code |
EAPG 00533
|
| Min. Negotiated Rate |
$144.23 |
| Max. Negotiated Rate |
$324.52 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$324.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$324.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$144.23
|
| Rate for Payer: Amida Care Medicaid |
$144.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$144.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$324.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$324.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$151.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$144.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$144.23
|
| Rate for Payer: Healthfirst Commercial |
$218.55
|
| Rate for Payer: Healthfirst Essential Plan |
$324.52
|
| Rate for Payer: Healthfirst QHP |
$144.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$144.23
|
| Rate for Payer: SOMOS Essential |
$324.52
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$324.52
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$158.65
|
| Rate for Payer: United Healthcare Medicaid |
$144.23
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$144.23
|
|
|
OUTPATIENT EAPG 00534: NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARC
|
Facility
|
OP
|
$323.19
|
|
|
Service Code
|
EAPG 00534
|
| Hospital Charge Code |
EAPG 00534
|
| 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 |
$217.67
|
| 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 00535: CVA & PRECEREBRAL OCCLUSION W INFARCT
|
Facility
|
OP
|
$322.52
|
|
|
Service Code
|
EAPG 00535
|
| Hospital Charge Code |
EAPG 00535
|
| Min. Negotiated Rate |
$143.34 |
| Max. Negotiated Rate |
$322.52 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$322.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$322.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$143.34
|
| Rate for Payer: Amida Care Medicaid |
$143.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$143.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$322.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$322.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$150.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$143.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$143.34
|
| Rate for Payer: Healthfirst Commercial |
$217.21
|
| Rate for Payer: Healthfirst Essential Plan |
$322.52
|
| Rate for Payer: Healthfirst QHP |
$143.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$143.34
|
| Rate for Payer: SOMOS Essential |
$322.52
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$322.52
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$157.67
|
| Rate for Payer: United Healthcare Medicaid |
$143.34
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$143.34
|
|
|
OUTPATIENT EAPG 00536: CEREBRAL PALSY
|
Facility
|
OP
|
$389.23
|
|
|
Service Code
|
EAPG 00536
|
| Hospital Charge Code |
EAPG 00536
|
| Min. Negotiated Rate |
$172.99 |
| Max. Negotiated Rate |
$389.23 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$389.23
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$389.23
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$172.99
|
| Rate for Payer: Amida Care Medicaid |
$172.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$172.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$389.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$389.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$181.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$172.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$172.99
|
| Rate for Payer: Healthfirst Commercial |
$262.14
|
| Rate for Payer: Healthfirst Essential Plan |
$389.23
|
| Rate for Payer: Healthfirst QHP |
$172.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$172.99
|
| Rate for Payer: SOMOS Essential |
$389.23
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$389.23
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$190.29
|
| Rate for Payer: United Healthcare Medicaid |
$172.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$172.99
|
|
|
OUTPATIENT EAPG 00550: ACUTE MAJOR EYE INFECTIONS
|
Facility
|
OP
|
$308.72
|
|
|
Service Code
|
EAPG 00550
|
| Hospital Charge Code |
EAPG 00550
|
| Min. Negotiated Rate |
$137.21 |
| Max. Negotiated Rate |
$308.72 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$308.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$308.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$137.21
|
| Rate for Payer: Amida Care Medicaid |
$137.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$137.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$308.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$308.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$144.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$137.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$137.21
|
| Rate for Payer: Healthfirst Commercial |
$207.92
|
| Rate for Payer: Healthfirst Essential Plan |
$308.72
|
| Rate for Payer: Healthfirst QHP |
$137.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$137.21
|
| Rate for Payer: SOMOS Essential |
$308.72
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$308.72
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$150.93
|
| Rate for Payer: United Healthcare Medicaid |
$137.21
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$137.21
|
|
|
OUTPATIENT EAPG 00551: CATARACTS
|
Facility
|
OP
|
$323.46
|
|
|
Service Code
|
EAPG 00551
|
| Hospital Charge Code |
EAPG 00551
|
| Min. Negotiated Rate |
$143.76 |
| Max. Negotiated Rate |
$323.46 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$323.46
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$323.46
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$143.76
|
| Rate for Payer: Amida Care Medicaid |
$143.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$143.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$323.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$323.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$150.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$143.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$143.76
|
| Rate for Payer: Healthfirst Commercial |
$217.85
|
| Rate for Payer: Healthfirst Essential Plan |
$323.46
|
| Rate for Payer: Healthfirst QHP |
$143.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$143.76
|
| Rate for Payer: SOMOS Essential |
$323.46
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$323.46
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$158.14
|
| Rate for Payer: United Healthcare Medicaid |
$143.76
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$143.76
|
|
|
OUTPATIENT EAPG 00552: GLAUCOMA
|
Facility
|
OP
|
$320.06
|
|
|
Service Code
|
EAPG 00552
|
| Hospital Charge Code |
EAPG 00552
|
| Min. Negotiated Rate |
$142.25 |
| Max. Negotiated Rate |
$320.06 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$320.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$320.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$142.25
|
| Rate for Payer: Amida Care Medicaid |
$142.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$142.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$320.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$320.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$149.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$142.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$142.25
|
| Rate for Payer: Healthfirst Commercial |
$215.55
|
| Rate for Payer: Healthfirst Essential Plan |
$320.06
|
| Rate for Payer: Healthfirst QHP |
$142.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$142.25
|
| Rate for Payer: SOMOS Essential |
$320.06
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$320.06
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$156.48
|
| Rate for Payer: United Healthcare Medicaid |
$142.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$142.25
|
|
|
OUTPATIENT EAPG 00553: LEVEL I OTHER OPHTHALMIC DIAGNOSES
|
Facility
|
OP
|
$356.06
|
|
|
Service Code
|
EAPG 00553
|
| Hospital Charge Code |
EAPG 00553
|
| Min. Negotiated Rate |
$158.25 |
| Max. Negotiated Rate |
$356.06 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$356.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$356.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$158.25
|
| Rate for Payer: Amida Care Medicaid |
$158.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$158.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$356.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$356.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$166.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$158.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$158.25
|
| Rate for Payer: Healthfirst Commercial |
$239.81
|
| Rate for Payer: Healthfirst Essential Plan |
$356.06
|
| Rate for Payer: Healthfirst QHP |
$158.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$158.25
|
| Rate for Payer: SOMOS Essential |
$356.06
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$356.06
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$174.08
|
| Rate for Payer: United Healthcare Medicaid |
$158.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$158.25
|
|
|
OUTPATIENT EAPG 00554: LEVEL II OTHER OPHTHALMIC DIAGNOSES
|
Facility
|
OP
|
$240.16
|
|
|
Service Code
|
EAPG 00554
|
| Hospital Charge Code |
EAPG 00554
|
| Min. Negotiated Rate |
$240.16 |
| Max. Negotiated Rate |
$240.16 |
| Rate for Payer: Healthfirst Commercial |
$240.16
|
|
|
OUTPATIENT EAPG 00555: CONJUNCTIVITIS
|
Facility
|
OP
|
$300.51
|
|
|
Service Code
|
EAPG 00555
|
| Hospital Charge Code |
EAPG 00555
|
| Min. Negotiated Rate |
$133.56 |
| Max. Negotiated Rate |
$300.51 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$300.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$300.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$133.56
|
| Rate for Payer: Amida Care Medicaid |
$133.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$133.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$300.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$300.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$133.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$133.56
|
| Rate for Payer: Healthfirst Commercial |
$202.38
|
| Rate for Payer: Healthfirst Essential Plan |
$300.51
|
| Rate for Payer: Healthfirst QHP |
$133.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$133.56
|
| Rate for Payer: SOMOS Essential |
$300.51
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$300.51
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$146.92
|
| Rate for Payer: United Healthcare Medicaid |
$133.56
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$133.56
|
|
|
OUTPATIENT EAPG 00560: EAR, NOSE, MOUTH, THROAT, CRANIAL/FACIAL MALIGNANCIES
|
Facility
|
OP
|
$355.68
|
|
|
Service Code
|
EAPG 00560
|
| Hospital Charge Code |
EAPG 00560
|
| Min. Negotiated Rate |
$158.08 |
| Max. Negotiated Rate |
$355.68 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$355.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$355.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$158.08
|
| Rate for Payer: Amida Care Medicaid |
$158.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$158.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$355.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$355.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$165.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$158.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$158.08
|
| Rate for Payer: Healthfirst Commercial |
$239.54
|
| Rate for Payer: Healthfirst Essential Plan |
$355.68
|
| Rate for Payer: Healthfirst QHP |
$158.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$158.08
|
| Rate for Payer: SOMOS Essential |
$355.68
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$355.68
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$173.89
|
| Rate for Payer: United Healthcare Medicaid |
$158.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$158.08
|
|
|
OUTPATIENT EAPG 00561: VERTIGINOUS DIAGNOSES EXCEPT FOR BENIGN VERTIGO
|
Facility
|
OP
|
$357.64
|
|
|
Service Code
|
EAPG 00561
|
| Hospital Charge Code |
EAPG 00561
|
| Min. Negotiated Rate |
$158.95 |
| Max. Negotiated Rate |
$357.64 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$357.64
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$357.64
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$158.95
|
| Rate for Payer: Amida Care Medicaid |
$158.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$158.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$357.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$357.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$166.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$158.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$158.95
|
| Rate for Payer: Healthfirst Commercial |
$240.87
|
| Rate for Payer: Healthfirst Essential Plan |
$357.64
|
| Rate for Payer: Healthfirst QHP |
$158.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$158.95
|
| Rate for Payer: SOMOS Essential |
$357.64
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$357.64
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$174.84
|
| Rate for Payer: United Healthcare Medicaid |
$158.95
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$158.95
|
|
|
OUTPATIENT EAPG 00562: INFECTIONS OF UPPER RESPIRATORY TRACT & OTITIS MEDIA
|
Facility
|
OP
|
$304.22
|
|
|
Service Code
|
EAPG 00562
|
| Hospital Charge Code |
EAPG 00562
|
| Min. Negotiated Rate |
$135.21 |
| Max. Negotiated Rate |
$304.22 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$304.22
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$304.22
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$135.21
|
| Rate for Payer: Amida Care Medicaid |
$135.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$135.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$304.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$304.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$141.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$135.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$135.21
|
| Rate for Payer: Healthfirst Commercial |
$204.89
|
| Rate for Payer: Healthfirst Essential Plan |
$304.22
|
| Rate for Payer: Healthfirst QHP |
$135.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$135.21
|
| Rate for Payer: SOMOS Essential |
$304.22
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$304.22
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$148.73
|
| Rate for Payer: United Healthcare Medicaid |
$135.21
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$135.21
|
|
|
OUTPATIENT EAPG 00563: DENTAL & ORAL DIAGNOSES & INJURIES
|
Facility
|
OP
|
$294.23
|
|
|
Service Code
|
EAPG 00563
|
| Hospital Charge Code |
EAPG 00563
|
| Min. Negotiated Rate |
$130.77 |
| Max. Negotiated Rate |
$294.23 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$294.23
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$294.23
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$130.77
|
| Rate for Payer: Amida Care Medicaid |
$130.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$130.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$294.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$137.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$130.77
|
| Rate for Payer: Healthfirst Commercial |
$198.16
|
| Rate for Payer: Healthfirst Essential Plan |
$294.23
|
| Rate for Payer: Healthfirst QHP |
$130.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$130.77
|
| Rate for Payer: SOMOS Essential |
$294.23
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$294.23
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$143.85
|
| Rate for Payer: United Healthcare Medicaid |
$130.77
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$130.77
|
|
|
OUTPATIENT EAPG 00564: LEVEL I OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES
|
Facility
|
OP
|
$332.24
|
|
|
Service Code
|
EAPG 00564
|
| Hospital Charge Code |
EAPG 00564
|
| Min. Negotiated Rate |
$147.66 |
| Max. Negotiated Rate |
$332.24 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$332.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$332.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$147.66
|
| Rate for Payer: Amida Care Medicaid |
$147.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$147.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$332.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$332.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$155.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$147.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$147.66
|
| Rate for Payer: Healthfirst Commercial |
$223.75
|
| Rate for Payer: Healthfirst Essential Plan |
$332.24
|
| Rate for Payer: Healthfirst QHP |
$147.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$147.66
|
| Rate for Payer: SOMOS Essential |
$332.24
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$332.24
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$162.43
|
| Rate for Payer: United Healthcare Medicaid |
$147.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$147.66
|
|
|
OUTPATIENT EAPG 00565: LEVEL II OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES
|
Facility
|
OP
|
$255.62
|
|
|
Service Code
|
EAPG 00565
|
| Hospital Charge Code |
EAPG 00565
|
| Min. Negotiated Rate |
$255.62 |
| Max. Negotiated Rate |
$255.62 |
| Rate for Payer: Healthfirst Commercial |
$255.62
|
|
|
OUTPATIENT EAPG 00570: CYSTIC FIBROSIS - PULMONARY DISEASE
|
Facility
|
OP
|
$456.98
|
|
|
Service Code
|
EAPG 00570
|
| Hospital Charge Code |
EAPG 00570
|
| Min. Negotiated Rate |
$203.10 |
| Max. Negotiated Rate |
$456.98 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$456.98
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$456.98
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$203.10
|
| Rate for Payer: Amida Care Medicaid |
$203.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$203.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$456.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$456.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$213.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$203.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$203.10
|
| Rate for Payer: Healthfirst Commercial |
$307.76
|
| Rate for Payer: Healthfirst Essential Plan |
$456.98
|
| Rate for Payer: Healthfirst QHP |
$203.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$203.10
|
| Rate for Payer: SOMOS Essential |
$456.98
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$456.98
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$223.41
|
| Rate for Payer: United Healthcare Medicaid |
$203.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$203.10
|
|
|
OUTPATIENT EAPG 00571: RESPIRATORY MALIGNANCY
|
Facility
|
OP
|
$324.68
|
|
|
Service Code
|
EAPG 00571
|
| Hospital Charge Code |
EAPG 00571
|
| Min. Negotiated Rate |
$144.30 |
| Max. Negotiated Rate |
$324.68 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$324.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$324.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$144.30
|
| Rate for Payer: Amida Care Medicaid |
$144.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$144.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$324.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$324.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$151.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$144.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$144.30
|
| Rate for Payer: Healthfirst Commercial |
$218.66
|
| Rate for Payer: Healthfirst Essential Plan |
$324.68
|
| Rate for Payer: Healthfirst QHP |
$144.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$144.30
|
| Rate for Payer: SOMOS Essential |
$324.68
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$324.68
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$158.73
|
| Rate for Payer: United Healthcare Medicaid |
$144.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$144.30
|
|
|
OUTPATIENT EAPG 00572: BRONCHIOLITIS & RSV PNEUMONIA
|
Facility
|
OP
|
$293.47
|
|
|
Service Code
|
EAPG 00572
|
| Hospital Charge Code |
EAPG 00572
|
| Min. Negotiated Rate |
$130.43 |
| Max. Negotiated Rate |
$293.47 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$293.47
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$293.47
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$130.43
|
| Rate for Payer: Amida Care Medicaid |
$130.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$130.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$293.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$293.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$136.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$130.43
|
| Rate for Payer: Healthfirst Commercial |
$197.64
|
| Rate for Payer: Healthfirst Essential Plan |
$293.47
|
| Rate for Payer: Healthfirst QHP |
$130.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$130.43
|
| Rate for Payer: SOMOS Essential |
$293.47
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$293.47
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$143.47
|
| Rate for Payer: United Healthcare Medicaid |
$130.43
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$130.43
|
|
|
OUTPATIENT EAPG 00573: COMMUNITY ACQUIRED PNUEMONIA
|
Facility
|
OP
|
$265.77
|
|
|
Service Code
|
EAPG 00573
|
| Hospital Charge Code |
EAPG 00573
|
| Min. Negotiated Rate |
$265.77 |
| Max. Negotiated Rate |
$265.77 |
| Rate for Payer: Healthfirst Commercial |
$265.77
|
|
|
OUTPATIENT EAPG 00574: CHRONIC OBSTRUCTIVE PULMONARY DISEASE
|
Facility
|
OP
|
$313.92
|
|
|
Service Code
|
EAPG 00574
|
| Hospital Charge Code |
EAPG 00574
|
| Min. Negotiated Rate |
$139.52 |
| Max. Negotiated Rate |
$313.92 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$313.92
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$313.92
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$139.52
|
| Rate for Payer: Amida Care Medicaid |
$139.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$139.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$313.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$313.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$146.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$139.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$139.52
|
| Rate for Payer: Healthfirst Commercial |
$211.41
|
| Rate for Payer: Healthfirst Essential Plan |
$313.92
|
| Rate for Payer: Healthfirst QHP |
$139.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$139.52
|
| Rate for Payer: SOMOS Essential |
$313.92
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$313.92
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$153.47
|
| Rate for Payer: United Healthcare Medicaid |
$139.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$139.52
|
|
|
OUTPATIENT EAPG 00575: ASTHMA
|
Facility
|
OP
|
$424.22
|
|
|
Service Code
|
EAPG 00575
|
| Hospital Charge Code |
EAPG 00575
|
| Min. Negotiated Rate |
$188.54 |
| Max. Negotiated Rate |
$424.22 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$424.22
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$424.22
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$188.54
|
| Rate for Payer: Amida Care Medicaid |
$188.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$188.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$424.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$424.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$197.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$188.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$188.54
|
| Rate for Payer: Healthfirst Commercial |
$285.71
|
| Rate for Payer: Healthfirst Essential Plan |
$424.22
|
| Rate for Payer: Healthfirst QHP |
$188.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$188.54
|
| Rate for Payer: SOMOS Essential |
$424.22
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$424.22
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$207.39
|
| Rate for Payer: United Healthcare Medicaid |
$188.54
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$188.54
|
|
|
OUTPATIENT EAPG 00576: LEVEL I OTHER RESPIRATORY DIAGNOSES
|
Facility
|
OP
|
$365.76
|
|
|
Service Code
|
EAPG 00576
|
| Hospital Charge Code |
EAPG 00576
|
| Min. Negotiated Rate |
$162.56 |
| Max. Negotiated Rate |
$365.76 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$365.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$365.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$162.56
|
| Rate for Payer: Amida Care Medicaid |
$162.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$162.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$365.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$365.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$170.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$162.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$162.56
|
| Rate for Payer: Healthfirst Commercial |
$246.33
|
| Rate for Payer: Healthfirst Essential Plan |
$365.76
|
| Rate for Payer: Healthfirst QHP |
$162.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$162.56
|
| Rate for Payer: SOMOS Essential |
$365.76
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$365.76
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$178.82
|
| Rate for Payer: United Healthcare Medicaid |
$162.56
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$162.56
|
|
