|
OUTPATIENT EAPG 00628: ABDOMINAL PAIN
|
Facility
|
OP
|
$365.92
|
|
|
Service Code
|
EAPG 00628
|
| Hospital Charge Code |
EAPG 00628
|
| Min. Negotiated Rate |
$162.63 |
| Max. Negotiated Rate |
$365.92 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$365.92
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$365.92
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$162.63
|
| Rate for Payer: Amida Care Medicaid |
$162.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$162.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$365.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$365.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$170.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$162.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$162.63
|
| Rate for Payer: Healthfirst Commercial |
$246.44
|
| Rate for Payer: Healthfirst Essential Plan |
$365.92
|
| Rate for Payer: Healthfirst QHP |
$162.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$162.63
|
| Rate for Payer: SOMOS Essential |
$365.92
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$365.92
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$178.89
|
| Rate for Payer: United Healthcare Medicaid |
$162.63
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$162.63
|
|
|
OUTPATIENT EAPG 00629: MALFUNCTION, REACTION & COMPLICATION OF GI DEVICE OR PROCEDURE
|
Facility
|
OP
|
$418.90
|
|
|
Service Code
|
EAPG 00629
|
| Hospital Charge Code |
EAPG 00629
|
| Min. Negotiated Rate |
$186.18 |
| Max. Negotiated Rate |
$418.90 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$418.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$418.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$186.18
|
| Rate for Payer: Amida Care Medicaid |
$186.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$186.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$418.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$418.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$195.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$186.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$186.18
|
| Rate for Payer: Healthfirst Commercial |
$282.14
|
| Rate for Payer: Healthfirst Essential Plan |
$418.90
|
| Rate for Payer: Healthfirst QHP |
$186.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$186.18
|
| Rate for Payer: SOMOS Essential |
$418.90
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$418.90
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$204.80
|
| Rate for Payer: United Healthcare Medicaid |
$186.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$186.18
|
|
|
OUTPATIENT EAPG 00630: CONSTIPATION
|
Facility
|
OP
|
$401.78
|
|
|
Service Code
|
EAPG 00630
|
| Hospital Charge Code |
EAPG 00630
|
| Min. Negotiated Rate |
$178.57 |
| Max. Negotiated Rate |
$401.78 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$401.78
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$401.78
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$178.57
|
| Rate for Payer: Amida Care Medicaid |
$178.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$178.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$401.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$401.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$187.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$178.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$178.57
|
| Rate for Payer: Healthfirst Commercial |
$270.60
|
| Rate for Payer: Healthfirst Essential Plan |
$401.78
|
| Rate for Payer: Healthfirst QHP |
$178.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$178.57
|
| Rate for Payer: SOMOS Essential |
$401.78
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$401.78
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$196.43
|
| Rate for Payer: United Healthcare Medicaid |
$178.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$178.57
|
|
|
OUTPATIENT EAPG 00631: HERNIA
|
Facility
|
OP
|
$313.47
|
|
|
Service Code
|
EAPG 00631
|
| Hospital Charge Code |
EAPG 00631
|
| Min. Negotiated Rate |
$139.32 |
| Max. Negotiated Rate |
$313.47 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$313.47
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$313.47
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$139.32
|
| Rate for Payer: Amida Care Medicaid |
$139.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$139.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$313.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$313.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$146.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$139.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$139.32
|
| Rate for Payer: Healthfirst Commercial |
$211.12
|
| Rate for Payer: Healthfirst Essential Plan |
$313.47
|
| Rate for Payer: Healthfirst QHP |
$139.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$139.32
|
| Rate for Payer: SOMOS Essential |
$313.47
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$313.47
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$153.25
|
| Rate for Payer: United Healthcare Medicaid |
$139.32
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$139.32
|
|
|
OUTPATIENT EAPG 00632: IRRITABLE BOWEL SYNDROME
|
Facility
|
OP
|
$270.11
|
|
|
Service Code
|
EAPG 00632
|
| Hospital Charge Code |
EAPG 00632
|
| Min. Negotiated Rate |
$120.05 |
| Max. Negotiated Rate |
$270.11 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$270.11
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$270.11
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$120.05
|
| Rate for Payer: Amida Care Medicaid |
$120.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$120.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$270.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$270.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$126.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$120.05
|
| Rate for Payer: Healthfirst Commercial |
$181.92
|
| Rate for Payer: Healthfirst Essential Plan |
$270.11
|
| Rate for Payer: Healthfirst QHP |
$120.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$120.05
|
| Rate for Payer: SOMOS Essential |
$270.11
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$270.11
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$132.06
|
| Rate for Payer: United Healthcare Medicaid |
$120.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$120.05
|
|
|
OUTPATIENT EAPG 00633: ALCOHOLIC LIVER DISEASE
|
Facility
|
OP
|
$331.22
|
|
|
Service Code
|
EAPG 00633
|
| Hospital Charge Code |
EAPG 00633
|
| Min. Negotiated Rate |
$147.21 |
| Max. Negotiated Rate |
$331.22 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$331.22
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$331.22
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$147.21
|
| Rate for Payer: Amida Care Medicaid |
$147.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$147.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$331.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$331.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$154.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$147.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$147.21
|
| Rate for Payer: Healthfirst Commercial |
$223.08
|
| Rate for Payer: Healthfirst Essential Plan |
$331.22
|
| Rate for Payer: Healthfirst QHP |
$147.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$147.21
|
| Rate for Payer: SOMOS Essential |
$331.22
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$331.22
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$161.93
|
| Rate for Payer: United Healthcare Medicaid |
$147.21
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$147.21
|
|
|
OUTPATIENT EAPG 00634: MALIGNANCY OF HEPATOBILIARY SYSTEM & PANCREAS
|
Facility
|
OP
|
$352.73
|
|
|
Service Code
|
EAPG 00634
|
| Hospital Charge Code |
EAPG 00634
|
| Min. Negotiated Rate |
$156.77 |
| Max. Negotiated Rate |
$352.73 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$352.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$352.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$156.77
|
| Rate for Payer: Amida Care Medicaid |
$156.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$156.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$352.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$352.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$164.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$156.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$156.77
|
| Rate for Payer: Healthfirst Commercial |
$237.56
|
| Rate for Payer: Healthfirst Essential Plan |
$352.73
|
| Rate for Payer: Healthfirst QHP |
$156.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$156.77
|
| Rate for Payer: SOMOS Essential |
$352.73
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$352.73
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$172.45
|
| Rate for Payer: United Healthcare Medicaid |
$156.77
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$156.77
|
|
|
OUTPATIENT EAPG 00635: PANCREAS DIAGNOSES EXCEPT MALIGNANCY
|
Facility
|
OP
|
$323.68
|
|
|
Service Code
|
EAPG 00635
|
| Hospital Charge Code |
EAPG 00635
|
| Min. Negotiated Rate |
$143.86 |
| Max. Negotiated Rate |
$323.68 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$323.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$323.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$143.86
|
| Rate for Payer: Amida Care Medicaid |
$143.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$143.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$323.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$323.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$151.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$143.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$143.86
|
| Rate for Payer: Healthfirst Commercial |
$218.00
|
| Rate for Payer: Healthfirst Essential Plan |
$323.68
|
| Rate for Payer: Healthfirst QHP |
$143.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$143.86
|
| Rate for Payer: SOMOS Essential |
$323.68
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$323.68
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$158.25
|
| Rate for Payer: United Healthcare Medicaid |
$143.86
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$143.86
|
|
|
OUTPATIENT EAPG 00636: HEPATITIS WITHOUT COMA
|
Facility
|
OP
|
$373.93
|
|
|
Service Code
|
EAPG 00636
|
| Hospital Charge Code |
EAPG 00636
|
| Min. Negotiated Rate |
$166.19 |
| Max. Negotiated Rate |
$373.93 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$373.93
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$373.93
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$166.19
|
| Rate for Payer: Amida Care Medicaid |
$166.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$166.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$373.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$373.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$174.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$166.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$166.19
|
| Rate for Payer: Healthfirst Commercial |
$251.84
|
| Rate for Payer: Healthfirst Essential Plan |
$373.93
|
| Rate for Payer: Healthfirst QHP |
$166.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$166.19
|
| Rate for Payer: SOMOS Essential |
$373.93
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$373.93
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$182.81
|
| Rate for Payer: United Healthcare Medicaid |
$166.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$166.19
|
|
|
OUTPATIENT EAPG 00637: GALLBLADDER & BILIARY TRACT DIAGNOSES
|
Facility
|
OP
|
$303.14
|
|
|
Service Code
|
EAPG 00637
|
| Hospital Charge Code |
EAPG 00637
|
| Min. Negotiated Rate |
$134.73 |
| Max. Negotiated Rate |
$303.14 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$303.14
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$303.14
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$134.73
|
| Rate for Payer: Amida Care Medicaid |
$134.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$134.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$303.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$303.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$141.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$134.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$134.73
|
| Rate for Payer: Healthfirst Commercial |
$204.16
|
| Rate for Payer: Healthfirst Essential Plan |
$303.14
|
| Rate for Payer: Healthfirst QHP |
$134.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$134.73
|
| Rate for Payer: SOMOS Essential |
$303.14
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$303.14
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$148.20
|
| Rate for Payer: United Healthcare Medicaid |
$134.73
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$134.73
|
|
|
OUTPATIENT EAPG 00638: CHOLECYSTITIS
|
Facility
|
OP
|
$297.07
|
|
|
Service Code
|
EAPG 00638
|
| Hospital Charge Code |
EAPG 00638
|
| Min. Negotiated Rate |
$132.03 |
| Max. Negotiated Rate |
$297.07 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$297.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$297.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$132.03
|
| Rate for Payer: Amida Care Medicaid |
$132.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$132.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$297.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$297.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$138.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$132.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$132.03
|
| Rate for Payer: Healthfirst Commercial |
$200.07
|
| Rate for Payer: Healthfirst Essential Plan |
$297.07
|
| Rate for Payer: Healthfirst QHP |
$132.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$132.03
|
| Rate for Payer: SOMOS Essential |
$297.07
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$297.07
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$145.23
|
| Rate for Payer: United Healthcare Medicaid |
$132.03
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$132.03
|
|
|
OUTPATIENT EAPG 00639: LEVEL I HEPATOBILIARY DIAGNOSES
|
Facility
|
OP
|
$341.50
|
|
|
Service Code
|
EAPG 00639
|
| Hospital Charge Code |
EAPG 00639
|
| Min. Negotiated Rate |
$151.78 |
| Max. Negotiated Rate |
$341.50 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$341.50
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$341.50
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$151.78
|
| Rate for Payer: Amida Care Medicaid |
$151.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$151.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$341.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$341.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$159.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$151.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$151.78
|
| Rate for Payer: Healthfirst Commercial |
$230.01
|
| Rate for Payer: Healthfirst Essential Plan |
$341.50
|
| Rate for Payer: Healthfirst QHP |
$151.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$151.78
|
| Rate for Payer: SOMOS Essential |
$341.50
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$341.50
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$166.96
|
| Rate for Payer: United Healthcare Medicaid |
$151.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$151.78
|
|
|
OUTPATIENT EAPG 00640: LEVEL II HEPATOBILIARY DIAGNOSES
|
Facility
|
OP
|
$220.70
|
|
|
Service Code
|
EAPG 00640
|
| Hospital Charge Code |
EAPG 00640
|
| Min. Negotiated Rate |
$220.70 |
| Max. Negotiated Rate |
$220.70 |
| Rate for Payer: Healthfirst Commercial |
$220.70
|
|
|
OUTPATIENT EAPG 00647: FRACTURES, DISLOCATIONS, SPRAINS & OTHER INJURIES OF THE SHOULDER AND UPPER ARM
|
Facility
|
OP
|
$438.34
|
|
|
Service Code
|
EAPG 00647
|
| Hospital Charge Code |
EAPG 00647
|
| Min. Negotiated Rate |
$194.82 |
| Max. Negotiated Rate |
$438.34 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$438.34
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$438.34
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$194.82
|
| Rate for Payer: Amida Care Medicaid |
$194.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$194.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$438.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$438.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$204.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$194.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$194.82
|
| Rate for Payer: Healthfirst Essential Plan |
$438.34
|
| Rate for Payer: Healthfirst QHP |
$194.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$194.82
|
| Rate for Payer: SOMOS Essential |
$438.34
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$438.34
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$214.30
|
| Rate for Payer: United Healthcare Medicaid |
$194.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$194.82
|
|
|
OUTPATIENT EAPG 00648: FRACTURES, DISLOCATIONS AND SPRAINS OF THE SKULL, CRANIUM AND FACE
|
Facility
|
OP
|
$366.73
|
|
|
Service Code
|
EAPG 00648
|
| Hospital Charge Code |
EAPG 00648
|
| Min. Negotiated Rate |
$162.99 |
| Max. Negotiated Rate |
$366.73 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$366.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$366.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$162.99
|
| Rate for Payer: Amida Care Medicaid |
$162.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$162.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$366.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$366.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$171.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$162.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$162.99
|
| Rate for Payer: Healthfirst Essential Plan |
$366.73
|
| Rate for Payer: Healthfirst QHP |
$162.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$162.99
|
| Rate for Payer: SOMOS Essential |
$366.73
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$366.73
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$179.29
|
| Rate for Payer: United Healthcare Medicaid |
$162.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$162.99
|
|
|
OUTPATIENT EAPG 00649: OTHER PATHOLOGICAL FRACTURES W/O MUSCULOSKELETAL MALIGNANCY
|
Facility
|
OP
|
$407.59
|
|
|
Service Code
|
EAPG 00649
|
| Hospital Charge Code |
EAPG 00649
|
| Min. Negotiated Rate |
$181.15 |
| Max. Negotiated Rate |
$407.59 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$407.59
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$407.59
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$181.15
|
| Rate for Payer: Amida Care Medicaid |
$181.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$181.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$407.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$407.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$190.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$181.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$181.15
|
| Rate for Payer: Healthfirst Essential Plan |
$407.59
|
| Rate for Payer: Healthfirst QHP |
$181.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$181.15
|
| Rate for Payer: SOMOS Essential |
$407.59
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$407.59
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$199.26
|
| Rate for Payer: United Healthcare Medicaid |
$181.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$181.15
|
|
|
OUTPATIENT EAPG 00650: FRACTURES, DISLOCATIONS & OTHER INJURIES - LOWER EXTREMITY INCLUDING FEMUR
|
Facility
|
OP
|
$538.94
|
|
|
Service Code
|
EAPG 00650
|
| Hospital Charge Code |
EAPG 00650
|
| Min. Negotiated Rate |
$239.53 |
| Max. Negotiated Rate |
$538.94 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$538.94
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$538.94
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$239.53
|
| Rate for Payer: Amida Care Medicaid |
$239.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$239.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$538.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$538.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$251.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$239.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$239.53
|
| Rate for Payer: Healthfirst Commercial |
$362.97
|
| Rate for Payer: Healthfirst Essential Plan |
$538.94
|
| Rate for Payer: Healthfirst QHP |
$239.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$239.53
|
| Rate for Payer: SOMOS Essential |
$538.94
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$538.94
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$263.48
|
| Rate for Payer: United Healthcare Medicaid |
$239.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$239.53
|
|
|
OUTPATIENT EAPG 00651: FRACTURES, DISLOCATIONS, SPRAINS AND OTHER INJURIES OF THE PELVIS AND HIP
|
Facility
|
OP
|
$494.64
|
|
|
Service Code
|
EAPG 00651
|
| Hospital Charge Code |
EAPG 00651
|
| Min. Negotiated Rate |
$219.84 |
| Max. Negotiated Rate |
$494.64 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$494.64
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$494.64
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$219.84
|
| Rate for Payer: Amida Care Medicaid |
$219.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$219.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$494.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$494.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$230.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$219.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$219.84
|
| Rate for Payer: Healthfirst Commercial |
$333.14
|
| Rate for Payer: Healthfirst Essential Plan |
$494.64
|
| Rate for Payer: Healthfirst QHP |
$219.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$219.84
|
| Rate for Payer: SOMOS Essential |
$494.64
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$494.64
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$241.82
|
| Rate for Payer: United Healthcare Medicaid |
$219.84
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$219.84
|
|
|
OUTPATIENT EAPG 00652: OTHER INJURIES AND DISORDERS OF THE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE
|
Facility
|
OP
|
$495.61
|
|
|
Service Code
|
EAPG 00652
|
| Hospital Charge Code |
EAPG 00652
|
| Min. Negotiated Rate |
$220.27 |
| Max. Negotiated Rate |
$495.61 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$495.61
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$495.61
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$220.27
|
| Rate for Payer: Amida Care Medicaid |
$220.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$220.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$495.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$495.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$231.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$220.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$220.27
|
| Rate for Payer: Healthfirst Commercial |
$333.78
|
| Rate for Payer: Healthfirst Essential Plan |
$495.61
|
| Rate for Payer: Healthfirst QHP |
$220.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$220.27
|
| Rate for Payer: SOMOS Essential |
$495.61
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$495.61
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$242.30
|
| Rate for Payer: United Healthcare Medicaid |
$220.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$220.27
|
|
|
OUTPATIENT EAPG 00653: MUSCULOSKELETAL MALIGNANCY & PATHOLOGICAL FRACTURES DUE TO MALIGNANCY
|
Facility
|
OP
|
$403.76
|
|
|
Service Code
|
EAPG 00653
|
| Hospital Charge Code |
EAPG 00653
|
| Min. Negotiated Rate |
$179.45 |
| Max. Negotiated Rate |
$403.76 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$403.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$403.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$179.45
|
| Rate for Payer: Amida Care Medicaid |
$179.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$179.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$403.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$403.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$188.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$179.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$179.45
|
| Rate for Payer: Healthfirst Commercial |
$271.92
|
| Rate for Payer: Healthfirst Essential Plan |
$403.76
|
| Rate for Payer: Healthfirst QHP |
$179.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$179.45
|
| Rate for Payer: SOMOS Essential |
$403.76
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$403.76
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$197.40
|
| Rate for Payer: United Healthcare Medicaid |
$179.45
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$179.45
|
|
|
OUTPATIENT EAPG 00654: OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTIONS
|
Facility
|
OP
|
$390.31
|
|
|
Service Code
|
EAPG 00654
|
| Hospital Charge Code |
EAPG 00654
|
| Min. Negotiated Rate |
$173.47 |
| Max. Negotiated Rate |
$390.31 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$390.31
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$390.31
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$173.47
|
| Rate for Payer: Amida Care Medicaid |
$173.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$173.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$390.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$390.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$182.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$173.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$173.47
|
| Rate for Payer: Healthfirst Commercial |
$262.87
|
| Rate for Payer: Healthfirst Essential Plan |
$390.31
|
| Rate for Payer: Healthfirst QHP |
$173.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$173.47
|
| Rate for Payer: SOMOS Essential |
$390.31
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$390.31
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$190.82
|
| Rate for Payer: United Healthcare Medicaid |
$173.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$173.47
|
|
|
OUTPATIENT EAPG 00655: CONNECTIVE TISSUE DIAGNOSES
|
Facility
|
OP
|
$325.94
|
|
|
Service Code
|
EAPG 00655
|
| Hospital Charge Code |
EAPG 00655
|
| Min. Negotiated Rate |
$144.86 |
| Max. Negotiated Rate |
$325.94 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$325.94
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$325.94
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$144.86
|
| Rate for Payer: Amida Care Medicaid |
$144.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$144.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$325.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$325.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$152.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$144.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$144.86
|
| Rate for Payer: Healthfirst Commercial |
$219.51
|
| Rate for Payer: Healthfirst Essential Plan |
$325.94
|
| Rate for Payer: Healthfirst QHP |
$144.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$144.86
|
| Rate for Payer: SOMOS Essential |
$325.94
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$325.94
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$159.35
|
| Rate for Payer: United Healthcare Medicaid |
$144.86
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$144.86
|
|
|
OUTPATIENT EAPG 00656: FRACTURES, DISLOCATIONS & OTHER INJURIES OF THE NECK, UPPER BACK AND CHEST
|
Facility
|
OP
|
$382.59
|
|
|
Service Code
|
EAPG 00656
|
| Hospital Charge Code |
EAPG 00656
|
| Min. Negotiated Rate |
$170.04 |
| Max. Negotiated Rate |
$382.59 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$382.59
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$382.59
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$170.04
|
| Rate for Payer: Amida Care Medicaid |
$170.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$170.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$382.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$382.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$178.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$170.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$170.04
|
| Rate for Payer: Healthfirst Commercial |
$257.67
|
| Rate for Payer: Healthfirst Essential Plan |
$382.59
|
| Rate for Payer: Healthfirst QHP |
$170.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$170.04
|
| Rate for Payer: SOMOS Essential |
$382.59
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$382.59
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$187.04
|
| Rate for Payer: United Healthcare Medicaid |
$170.04
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$170.04
|
|
|
OUTPATIENT EAPG 00657: FRACTURES, DISLOCATIONS, SPRAINS AND OTHER INJURIES OF THE LOWER BACK
|
Facility
|
OP
|
$376.18
|
|
|
Service Code
|
EAPG 00657
|
| Hospital Charge Code |
EAPG 00657
|
| Min. Negotiated Rate |
$167.19 |
| Max. Negotiated Rate |
$376.18 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$376.18
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$376.18
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$167.19
|
| Rate for Payer: Amida Care Medicaid |
$167.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$167.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$376.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$376.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$175.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$167.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$167.19
|
| Rate for Payer: Healthfirst Commercial |
$253.35
|
| Rate for Payer: Healthfirst Essential Plan |
$376.18
|
| Rate for Payer: Healthfirst QHP |
$167.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$167.19
|
| Rate for Payer: SOMOS Essential |
$376.18
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$376.18
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$183.91
|
| Rate for Payer: United Healthcare Medicaid |
$167.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$167.19
|
|
|
OUTPATIENT EAPG 00658: SCIATICA
|
Facility
|
OP
|
$397.69
|
|
|
Service Code
|
EAPG 00658
|
| Hospital Charge Code |
EAPG 00658
|
| Min. Negotiated Rate |
$176.75 |
| Max. Negotiated Rate |
$397.69 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$397.69
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$397.69
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$176.75
|
| Rate for Payer: Amida Care Medicaid |
$176.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$176.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$397.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$397.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$185.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$176.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$176.75
|
| Rate for Payer: Healthfirst Commercial |
$267.84
|
| Rate for Payer: Healthfirst Essential Plan |
$397.69
|
| Rate for Payer: Healthfirst QHP |
$176.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$176.75
|
| Rate for Payer: SOMOS Essential |
$397.69
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$397.69
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$194.42
|
| Rate for Payer: United Healthcare Medicaid |
$176.75
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$176.75
|
|
