| 4810 |
EPS START OF CARE, CLIN A, FUNC E, AGE GRP 1 |
$1,643.24 |
$1,658.85 |
$1,821.70 |
$1,839.01 |
| 4811 |
EPS START OF CARE, CLIN A, FUNC E, AGE GRP 2 |
$1,829.04 |
$1,846.42 |
$2,027.67 |
$2,046.93 |
| 4812 |
EPS START OF CARE, CLIN A, FUNC E, AGE GRP 3 |
$1,829.04 |
$1,846.42 |
$2,027.67 |
$2,046.93 |
| 4813 |
EPS START OF CARE, CLIN A, FUNC E, AGE GRP 4 |
$2,126.31 |
$2,146.51 |
$2,357.23 |
$2,379.62 |
| 4814 |
EPS START OF CARE, CLIN A, FUNC E, AGE GRP 5 |
$2,126.31 |
$2,146.51 |
$2,357.23 |
$2,379.62 |
| 4815 |
EPS START OF CARE, CLIN A, FUNC E, AGE GRP 6 |
$2,241.22 |
$2,262.51 |
$2,484.62 |
$2,508.22 |
| 4816 |
EPS START OF CARE, CLIN A, FUNC F, AGE GRP 1 |
$2,551.01 |
$2,575.24 |
$2,828.05 |
$2,854.92 |
| 4817 |
EPS START OF CARE, CLIN A, FUNC F, AGE GRP 2 |
$2,975.46 |
$3,003.73 |
$3,298.59 |
$3,329.93 |
| 4818 |
EPS START OF CARE, CLIN A, FUNC F, AGE GRP 3 |
$2,975.46 |
$3,003.73 |
$3,298.59 |
$3,329.93 |
| 4819 |
EPS START OF CARE, CLIN A, FUNC F, AGE GRP 4 |
$3,291.89 |
$3,323.16 |
$3,649.39 |
$3,684.06 |
| 4820 |
EPS START OF CARE, CLIN A, FUNC F, AGE GRP 5 |
$3,291.89 |
$3,323.16 |
$3,649.39 |
$3,684.06 |
| 4821 |
EPS START OF CARE, CLIN A, FUNC F, AGE GRP 6 |
$3,657.65 |
$3,692.40 |
$4,054.87 |
$4,093.39 |
| 4822 |
EPS START OF CARE, CLIN A, FUNC G, AGE GRP 1 |
$3,082.57 |
$3,111.85 |
$3,417.34 |
$3,449.80 |
| 4823 |
EPS START OF CARE, CLIN A, FUNC G, AGE GRP 2 |
$3,311.22 |
$3,342.68 |
$3,670.82 |
$3,705.69 |
| 4824 |
EPS START OF CARE, CLIN A, FUNC G, AGE GRP 3 |
$3,311.22 |
$3,342.68 |
$3,670.82 |
$3,705.69 |
| 4825 |
EPS START OF CARE, CLIN A, FUNC G, AGE GRP 4 |
$4,002.30 |
$4,040.32 |
$4,436.95 |
$4,479.10 |
| 4826 |
EPS START OF CARE, CLIN A, FUNC G, AGE GRP 5 |
$4,002.30 |
$4,040.32 |
$4,436.95 |
$4,479.10 |
| 4827 |
EPS START OF CARE, CLIN A, FUNC G, AGE GRP 6 |
$5,131.81 |
$5,180.56 |
$5,689.12 |
$5,743.17 |
| 4828 |
EPS START OF CARE, CLIN B, FUNC E, AGE GRP 1 |
$1,848.50 |
$1,866.06 |
$2,049.25 |
$2,068.72 |
| 4829 |
EPS START OF CARE, CLIN B, FUNC E, AGE GRP 2 |
$2,006.97 |
$2,026.04 |
$2,224.93 |
$2,246.07 |
| 4830 |
EPS START OF CARE, CLIN B, FUNC E, AGE GRP 3 |
$2,006.97 |
$2,026.04 |
$2,224.93 |
$2,246.07 |
| 4831 |
EPS START OF CARE, CLIN B, FUNC E, AGE GRP 4 |
$2,076.06 |
$2,095.78 |
$2,301.52 |
$2,323.38 |
| 4832 |
EPS START OF CARE, CLIN B, FUNC E, AGE GRP 5 |
$2,076.06 |
$2,095.78 |
$2,301.52 |
$2,323.38 |
| 4833 |
EPS START OF CARE, CLIN B, FUNC E, AGE GRP 6 |
$2,259.73 |
$2,281.20 |
$2,505.14 |
$2,528.94 |
| 4834 |
EPS START OF CARE, CLIN B, FUNC F, AGE GRP 1 |
$2,833.83 |
$2,860.75 |
$3,141.58 |
$3,171.43 |
| 4835 |
EPS START OF CARE, CLIN B, FUNC F, AGE GRP 2 |
$3,048.44 |
$3,077.40 |
$3,379.50 |
$3,411.61 |
| 4836 |
EPS START OF CARE, CLIN B, FUNC F, AGE GRP 3 |
$3,048.44 |
$3,077.40 |
$3,379.50 |
$3,411.61 |
| 4837 |
EPS START OF CARE, CLIN B, FUNC F, AGE GRP 4 |
$3,401.74 |
$3,434.06 |
$3,771.17 |
$3,807.00 |
| 4838 |
EPS START OF CARE, CLIN B, FUNC F, AGE GRP 5 |
$3,401.74 |
$3,434.06 |
$3,771.17 |
$3,807.00 |
| 4839 |
EPS START OF CARE, CLIN B, FUNC F, AGE GRP 6 |
$3,733.32 |
$3,768.79 |
$4,138.76 |
$4,178.08 |
| 4840 |
EPS START OF CARE, CLIN B, FUNC G, AGE GRP 1 |
$3,965.99 |
$4,003.67 |
$4,396.70 |
$4,438.47 |
| 4841 |
EPS START OF CARE, CLIN B, FUNC G, AGE GRP 2 |
$4,472.38 |
$4,514.87 |
$4,958.08 |
$5,005.18 |
| 4842 |
EPS START OF CARE, CLIN B, FUNC G, AGE GRP 3 |
$4,472.38 |
$4,514.87 |
$4,958.08 |
$5,005.18 |
| 4843 |
EPS START OF CARE, CLIN B, FUNC G, AGE GRP 4 |
$5,310.92 |
$5,361.37 |
$5,887.69 |
$5,943.62 |
| 4844 |
EPS START OF CARE, CLIN B, FUNC G, AGE GRP 5 |
$5,310.92 |
$5,361.37 |
$5,887.69 |
$5,943.62 |
| 4845 |
EPS START OF CARE, CLIN B, FUNC G, AGE GRP 6 |
$5,799.49 |
$5,854.59 |
$6,429.31 |
$6,490.39 |
| 4846 |
EPS START OF CARE, CLIN C, FUNC E, AGE GRP 1 |
$2,026.11 |
$2,045.36 |
$2,246.15 |
$2,267.49 |
| 4847 |
EPS START OF CARE, CLIN C, FUNC E, AGE GRP 2 |
$2,298.87 |
$2,320.71 |
$2,548.53 |
$2,572.74 |
| 4848 |
EPS START OF CARE, CLIN C, FUNC E, AGE GRP 3 |
$2,298.87 |
$2,320.71 |
$2,548.53 |
$2,572.74 |
| 4849 |
EPS START OF CARE, CLIN C, FUNC E, AGE GRP 4 |
$2,490.12 |
$2,513.78 |
$2,760.55 |
$2,786.78 |
| 4850 |
EPS START OF CARE, CLIN C, FUNC E, AGE GRP 5 |
$2,490.12 |
$2,513.78 |
$2,760.55 |
$2,786.78 |
| 4851 |
EPS START OF CARE, CLIN C, FUNC E, AGE GRP 6 |
$3,051.70 |
$3,080.69 |
$3,383.11 |
$3,415.25 |
| 4852 |
EPS START OF CARE, CLIN C, FUNC F, AGE GRP 1 |
$3,639.87 |
$3,674.45 |
$4,035.16 |
$4,073.49 |
| 4853 |
EPS START OF CARE, CLIN C, FUNC F, AGE GRP 2 |
$4,204.17 |
$4,244.11 |
$4,660.74 |
$4,705.02 |
| 4854 |
EPS START OF CARE, CLIN C, FUNC F, AGE GRP 3 |
$4,204.17 |
$4,244.11 |
$4,660.74 |
$4,705.02 |
| 4855 |
EPS START OF CARE, CLIN C, FUNC F, AGE GRP 4 |
$4,674.59 |
$4,719.00 |
$5,182.25 |
$5,231.48 |
| 4856 |
EPS START OF CARE, CLIN C, FUNC F, AGE GRP 5 |
$4,674.59 |
$4,719.00 |
$5,182.25 |
$5,231.48 |
| 4857 |
EPS START OF CARE, CLIN C, FUNC F, AGE GRP 6 |
$4,913.00 |
$4,959.67 |
$5,446.55 |
$5,498.29 |
| 4858 |
EPS START OF CARE, CLIN C, FUNC G, AGE GRP 1 |
$4,556.38 |
$4,599.67 |
$5,051.20 |
$5,099.19 |
| 4859 |
EPS START OF CARE, CLIN C, FUNC G, AGE GRP 2 |
$6,408.75 |
$6,469.63 |
$7,104.74 |
$7,172.24 |
| 4860 |
EPS START OF CARE, CLIN C, FUNC G, AGE GRP 3 |
$6,408.75 |
$6,469.63 |
$7,104.74 |
$7,172.24 |
| 4861 |
EPS START OF CARE, CLIN C, FUNC G, AGE GRP 4 |
$6,430.41 |
$6,491.50 |
$7,128.75 |
$7,196.47 |
| 4862 |
EPS START OF CARE, CLIN C, FUNC G, AGE GRP 5 |
$6,430.41 |
$6,491.50 |
$7,128.75 |
$7,196.47 |
| 4863 |
EPS START OF CARE, CLIN C, FUNC G, AGE GRP 6 |
$7,452.31 |
$7,523.11 |
$8,261.63 |
$8,340.12 |
| 4864 |
EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 1 |
$1,207.59 |
$1,219.06 |
$1,338.73 |
$1,351.45 |
| 4865 |
EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 2 |
$1,319.90 |
$1,332.44 |
$1,463.24 |
$1,477.14 |
| 4866 |
EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 3 |
$1,319.90 |
$1,332.44 |
$1,463.24 |
$1,477.14 |
| 4867 |
EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 4 |
$1,926.31 |
$1,944.61 |
$2,135.51 |
$2,155.80 |
| 4868 |
EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 5 |
$1,926.31 |
$1,944.61 |
$2,135.51 |
$2,155.80 |
| 4869 |
EPS RECERTIFICATION, CLIN A, FUNC E, AGE GRP 6 |
$2,042.44 |
$2,061.84 |
$2,264.25 |
$2,285.76 |
| 4870 |
EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 1 |
$2,872.59 |
$2,899.88 |
$3,184.55 |
$3,214.80 |
| 4871 |
EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 2 |
$3,015.74 |
$3,044.39 |
$3,343.25 |
$3,375.01 |
| 4872 |
EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 3 |
$3,015.74 |
$3,044.39 |
$3,343.25 |
$3,375.01 |
| 4873 |
EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 4 |
$3,888.67 |
$3,925.61 |
$4,310.98 |
$4,351.93 |
| 4874 |
EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 5 |
$3,888.67 |
$3,925.61 |
$4,310.98 |
$4,351.93 |
| 4875 |
EPS RECERTIFICATION, CLIN A, FUNC F, AGE GRP 6 |
$4,280.26 |
$4,320.92 |
$4,745.10 |
$4,790.18 |
| 4876 |
EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 1 |
$3,560.23 |
$3,594.05 |
$3,946.87 |
$3,984.37 |
| 4877 |
EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 2 |
$3,392.04 |
$3,424.26 |
$3,760.42 |
$3,796.14 |
| 4878 |
EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 3 |
$3,392.04 |
$3,424.26 |
$3,760.42 |
$3,796.14 |
| 4879 |
EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 4 |
$4,909.18 |
$4,955.82 |
$5,442.32 |
$5,494.02 |
| 4880 |
EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 5 |
$4,909.18 |
$4,955.82 |
$5,442.32 |
$5,494.02 |
| 4881 |
EPS RECERTIFICATION, CLIN A, FUNC G, AGE GRP 6 |
$6,128.07 |
$6,186.29 |
$6,793.58 |
$6,858.12 |
| 4882 |
EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 1 |
$1,411.16 |
$1,424.57 |
$1,564.41 |
$1,579.27 |
| 4883 |
EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 2 |
$1,541.73 |
$1,556.38 |
$1,709.16 |
$1,725.40 |
| 4884 |
EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 3 |
$1,541.73 |
$1,556.38 |
$1,709.16 |
$1,725.40 |
| 4885 |
EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 4 |
$1,972.80 |
$1,991.54 |
$2,187.05 |
$2,207.83 |
| 4886 |
EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 5 |
$1,972.80 |
$1,991.54 |
$2,187.05 |
$2,207.83 |
| 4887 |
EPS RECERTIFICATION, CLIN B, FUNC E, AGE GRP 6 |
$2,194.83 |
$2,215.68 |
$2,433.19 |
$2,456.31 |
| 4888 |
EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 1 |
$2,979.26 |
$3,007.56 |
$3,302.81 |
$3,334.19 |
| 4889 |
EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 2 |
$3,460.08 |
$3,492.95 |
$3,835.84 |
$3,872.28 |
| 4890 |
EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 3 |
$3,460.08 |
$3,492.95 |
$3,835.84 |
$3,872.28 |
| 4891 |
EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 4 |
$4,283.53 |
$4,324.22 |
$4,748.72 |
$4,793.83 |
| 4892 |
EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 5 |
$4,283.53 |
$4,324.22 |
$4,748.72 |
$4,793.83 |
| 4893 |
EPS RECERTIFICATION, CLIN B, FUNC F, AGE GRP 6 |
$4,664.30 |
$4,708.61 |
$5,170.84 |
$5,219.96 |
| 4894 |
EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 1 |
$4,050.17 |
$4,088.65 |
$4,490.02 |
$4,532.68 |
| 4895 |
EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 2 |
$4,912.10 |
$4,958.76 |
$5,445.55 |
$5,497.28 |
| 4896 |
EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 3 |
$4,912.10 |
$4,958.76 |
$5,445.55 |
$5,497.28 |
| 4897 |
EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 4 |
$6,806.18 |
$6,870.84 |
$7,545.33 |
$7,617.01 |
| 4898 |
EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 5 |
$6,806.18 |
$6,870.84 |
$7,545.33 |
$7,617.01 |
| 4899 |
EPS RECERTIFICATION, CLIN B, FUNC G, AGE GRP 6 |
$7,470.39 |
$7,541.36 |
$8,281.67 |
$8,360.35 |
| 4900 |
EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 1 |
$1,439.31 |
$1,452.98 |
$1,595.62 |
$1,610.78 |
| 4901 |
EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 2 |
$1,987.68 |
$2,006.56 |
$2,203.54 |
$2,224.47 |
| 4902 |
EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 3 |
$1,987.68 |
$2,006.56 |
$2,203.54 |
$2,224.47 |
| 4903 |
EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 4 |
$2,967.72 |
$2,995.91 |
$3,290.01 |
$3,321.27 |
| 4904 |
EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 5 |
$2,967.72 |
$2,995.91 |
$3,290.01 |
$3,321.27 |
| 4905 |
EPS RECERTIFICATION, CLIN C, FUNC E, AGE GRP 6 |
$2,418.63 |
$2,441.61 |
$2,681.29 |
$2,706.76 |
| 4906 |
EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 1 |
$3,875.40 |
$3,912.22 |
$4,296.27 |
$4,337.08 |
| 4907 |
EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 2 |
$5,025.08 |
$5,072.82 |
$5,570.80 |
$5,623.72 |
| 4908 |
EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 3 |
$5,025.08 |
$5,072.82 |
$5,570.80 |
$5,623.72 |
| 4909 |
EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 4 |
$5,560.43 |
$5,613.25 |
$6,164.29 |
$6,222.85 |
| 4910 |
EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 5 |
$5,560.43 |
$5,613.25 |
$6,164.29 |
$6,222.85 |
| 4911 |
EPS RECERTIFICATION, CLIN C, FUNC F, AGE GRP 6 |
$6,396.94 |
$6,457.71 |
$7,091.65 |
$7,159.02 |
| 4912 |
EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 1 |
$5,980.41 |
$6,037.22 |
$6,629.88 |
$6,692.86 |
| 4913 |
EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 2 |
$9,376.84 |
$9,465.92 |
$10,395.16 |
$10,493.91 |
| 4914 |
EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 3 |
$9,376.84 |
$9,465.92 |
$10,395.16 |
$10,493.91 |
| 4915 |
EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 4 |
$8,174.59 |
$8,252.25 |
$9,062.35 |
$9,148.44 |
| 4916 |
EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 5 |
$8,174.59 |
$8,252.25 |
$9,062.35 |
$9,148.44 |
| 4917 |
EPS RECERTIFICATION, CLIN C, FUNC G, AGE GRP 6 |
$11,339.09 |
$11,446.81 |
$12,570.52 |
$12,689.94 |
| 4919 |
ASSESSMENTS - LUPA ONLY - NO CHANGE |
|
|
|
|
| 4920 |
EPS MATERNITY, NO OASIS, 18 AND OLDER |
$1,207.59 |
$1,219.06 |
$1,338.73 |
$1,351.45 |