EAPG Facility Outpatient Calculator

Prices a facility outpatient claim against your hospital's contracted SIG/MED and ANC rates — dual-rate methodology with Exhibit F consolidation and CPT / ICD-10 cross-reference.

Visit Settings

Plan Type

Date of Service

Contract Year

SIG / MED rate ($)

ANC rate ($)

Lesser of charges

Code Lookup

CPT / HCPCS Lookup

or search by name

Enter a CPT/HCPCS code to see EAPG, weight, type, and which rate applies.

ICD-10 Diagnosis Lookup

or search by name

Enter an ICD-10 code to see which medical visit EAPG it maps to.

How this plan prices SIG/MED rate — types S, M, Recurring ANC rate — types D, L, P, R, O Sig. procedure present → Med + Anc packaged Med visit present → Anc packaged Multiple-procedure discount 100 / 50 / 25% Medical visits: 1 paid Recurring services: no discount

Service Lines

CPT/HCPCS	ICD-10	EAPG	Description	Wt	Type	Units ⓘ	Charge ($)	Flags

Payment Breakdown

Code	EAPG & description	Type	Wt	Units	Disc	Facility Payment
Total facility payment

How each line type prices

Sig Proc (S): SIG/MED rate × weight × discount. Causes Med + Anc to package.

Medical Visit (M): SIG/MED rate × weight. Max 1 per claim. Packages if Sig Proc present.

Sig Diagnostic (D): ANC rate × weight × discount. Always separately reimbursable.

Ancillary (L,P,R,O): ANC rate × weight × discount. Packages when Sig Proc or Med Visit present.

Recurring (Exhibit J): SIG/MED rate × weight × units. No discounting. Always separately reimbursable.

Units expand the discount sequence: 2 units of discounted = 100%+50% = 150%. 2 units of recurring = 200%.

Patient Estimate

Fill in estimated cost-share, then print or save a PDF for the patient. Run "Calculate Payment" first.

This is a facility-only estimate. Physicians and other professionals involved in the visit (surgeon, ED physician, radiologist, pathologist, anesthesiologist, etc.) bill separately from the hospital and are not included. The printed estimate repeats this note.

Primary plan (BCBS OK)

Deductible remaining ($)

Coinsurance % — patient share after deductible

Copay ($)

OOP max remaining ($)

Secondary coverage (estimate)

For a Medigap, supplemental, or employer gap plan that pays a share of the patient's leftover balance. This is a projection — not from a loaded contract. The hospital files the secondary claim; the actual amount is set then.

Secondary covers % of the remaining patient balance