St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

OUTPATIENT EAPG 00063: LEVEL II ENDOSCOPY OF THE UPPER AIRWAY

Facility

$4,353.70

Service Code	EAPG 00063
Hospital Charge Code	EAPG 00063
Min. Negotiated Rate	$1,934.98
Max. Negotiated Rate	$4,353.70
Rate for Payer: Affinity Essential Plan 1&2	$4,353.70
Rate for Payer: Affinity Essential Plan 3&4	$4,353.70
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,934.98
Rate for Payer: Amida Care Medicaid	$1,934.98
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,934.98
Rate for Payer: Fidelis Essential Plan Aliesa	$4,353.70
Rate for Payer: Fidelis Essential Plan QHP	$4,353.70
Rate for Payer: Fidelis Qualified Health Plan	$2,031.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,934.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,934.98
Rate for Payer: Healthfirst Commercial	$2,932.14
Rate for Payer: Healthfirst Essential Plan	$4,353.70
Rate for Payer: Healthfirst QHP	$1,934.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,934.98
Rate for Payer: SOMOS Essential	$4,353.70
Rate for Payer: United Healthcare Essential Plan 1&2	$4,353.70
Rate for Payer: United Healthcare Essential Plan 3&4	$2,128.48
Rate for Payer: United Healthcare Medicaid	$1,934.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,934.98

OUTPATIENT EAPG 00064: ENDOSCOPY OF THE LOWER AIRWAY

Facility

$3,027.06

Service Code	EAPG 00064
Hospital Charge Code	EAPG 00064
Min. Negotiated Rate	$1,345.36
Max. Negotiated Rate	$3,027.06
Rate for Payer: Affinity Essential Plan 1&2	$3,027.06
Rate for Payer: Affinity Essential Plan 3&4	$3,027.06
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,345.36
Rate for Payer: Amida Care Medicaid	$1,345.36
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,345.36
Rate for Payer: Fidelis Essential Plan Aliesa	$3,027.06
Rate for Payer: Fidelis Essential Plan QHP	$3,027.06
Rate for Payer: Fidelis Qualified Health Plan	$1,412.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,345.36
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,345.36
Rate for Payer: Healthfirst Commercial	$2,038.67
Rate for Payer: Healthfirst Essential Plan	$3,027.06
Rate for Payer: Healthfirst QHP	$1,345.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,345.36
Rate for Payer: SOMOS Essential	$3,027.06
Rate for Payer: United Healthcare Essential Plan 1&2	$3,027.06
Rate for Payer: United Healthcare Essential Plan 3&4	$1,479.90
Rate for Payer: United Healthcare Medicaid	$1,345.36
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,345.36

OUTPATIENT EAPG 00067: VENTILATION ASSISTANCE AND MANAGEMENT

Facility

$486.00

Service Code	EAPG 00067
Hospital Charge Code	EAPG 00067
Min. Negotiated Rate	$216.00
Max. Negotiated Rate	$486.00
Rate for Payer: Affinity Essential Plan 1&2	$486.00
Rate for Payer: Affinity Essential Plan 3&4	$486.00
Rate for Payer: Affinity Medicaid/CHP/HARP	$216.00
Rate for Payer: Amida Care Medicaid	$216.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$216.00
Rate for Payer: Fidelis Essential Plan Aliesa	$486.00
Rate for Payer: Fidelis Essential Plan QHP	$486.00
Rate for Payer: Fidelis Qualified Health Plan	$226.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$216.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$216.00
Rate for Payer: Healthfirst Commercial	$327.32
Rate for Payer: Healthfirst Essential Plan	$486.00
Rate for Payer: Healthfirst QHP	$216.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$216.00
Rate for Payer: SOMOS Essential	$486.00
Rate for Payer: United Healthcare Essential Plan 1&2	$486.00
Rate for Payer: United Healthcare Essential Plan 3&4	$237.60
Rate for Payer: United Healthcare Medicaid	$216.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$216.00

OUTPATIENT EAPG 00068: THORACENTESIS, RELATED BIOPSY AND PLEURAL DRAINAGE PROCEDURES

Facility

$1,557.36

Service Code	EAPG 00068
Hospital Charge Code	EAPG 00068
Min. Negotiated Rate	$692.16
Max. Negotiated Rate	$1,557.36
Rate for Payer: Affinity Essential Plan 1&2	$1,557.36
Rate for Payer: Affinity Essential Plan 3&4	$1,557.36
Rate for Payer: Affinity Medicaid/CHP/HARP	$692.16
Rate for Payer: Amida Care Medicaid	$692.16
Rate for Payer: Fidelis CHP/HARP/Medicaid	$692.16
Rate for Payer: Fidelis Essential Plan Aliesa	$1,557.36
Rate for Payer: Fidelis Essential Plan QHP	$1,557.36
Rate for Payer: Fidelis Qualified Health Plan	$726.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$692.16
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$692.16
Rate for Payer: Healthfirst Essential Plan	$1,557.36
Rate for Payer: Healthfirst QHP	$692.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$692.16
Rate for Payer: SOMOS Essential	$1,557.36
Rate for Payer: United Healthcare Essential Plan 1&2	$1,557.36
Rate for Payer: United Healthcare Essential Plan 3&4	$761.38
Rate for Payer: United Healthcare Medicaid	$692.16
Rate for Payer: Wellcare CHP/FHP/Medicaid	$692.16

OUTPATIENT EAPG 00075: LEVEL I CENTRAL VENOUS ACCESS PROCEDURES

Facility

$602.19

Service Code	EAPG 00075
Hospital Charge Code	EAPG 00075
Min. Negotiated Rate	$267.64
Max. Negotiated Rate	$602.19
Rate for Payer: Affinity Essential Plan 1&2	$602.19
Rate for Payer: Affinity Essential Plan 3&4	$602.19
Rate for Payer: Affinity Medicaid/CHP/HARP	$267.64
Rate for Payer: Amida Care Medicaid	$267.64
Rate for Payer: Fidelis CHP/HARP/Medicaid	$267.64
Rate for Payer: Fidelis Essential Plan Aliesa	$602.19
Rate for Payer: Fidelis Essential Plan QHP	$602.19
Rate for Payer: Fidelis Qualified Health Plan	$281.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$267.64
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$267.64
Rate for Payer: Healthfirst Essential Plan	$602.19
Rate for Payer: Healthfirst QHP	$267.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$267.64
Rate for Payer: SOMOS Essential	$602.19
Rate for Payer: United Healthcare Essential Plan 1&2	$602.19
Rate for Payer: United Healthcare Essential Plan 3&4	$294.40
Rate for Payer: United Healthcare Medicaid	$267.64
Rate for Payer: Wellcare CHP/FHP/Medicaid	$267.64

OUTPATIENT EAPG 00076: REVISION, REPAIR OR REMOVAL OF CENTRAL VENOUS ACCESS DEVICE

Facility

$2,121.26

Service Code	EAPG 00076
Hospital Charge Code	EAPG 00076
Min. Negotiated Rate	$942.78
Max. Negotiated Rate	$2,121.26
Rate for Payer: Affinity Essential Plan 1&2	$2,121.26
Rate for Payer: Affinity Essential Plan 3&4	$2,121.26
Rate for Payer: Affinity Medicaid/CHP/HARP	$942.78
Rate for Payer: Amida Care Medicaid	$942.78
Rate for Payer: Fidelis CHP/HARP/Medicaid	$942.78
Rate for Payer: Fidelis Essential Plan Aliesa	$2,121.26
Rate for Payer: Fidelis Essential Plan QHP	$2,121.26
Rate for Payer: Fidelis Qualified Health Plan	$989.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$942.78
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$942.78
Rate for Payer: Healthfirst Essential Plan	$2,121.26
Rate for Payer: Healthfirst QHP	$942.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$942.78
Rate for Payer: SOMOS Essential	$2,121.26
Rate for Payer: United Healthcare Essential Plan 1&2	$2,121.26
Rate for Payer: United Healthcare Essential Plan 3&4	$1,037.06
Rate for Payer: United Healthcare Medicaid	$942.78
Rate for Payer: Wellcare CHP/FHP/Medicaid	$942.78

OUTPATIENT EAPG 00077: LEVEL I PERIPHERAL ENDOVASCULAR AND TRANSCATHETER PROCEDURES

Facility

$5,717.88

Service Code	EAPG 00077
Hospital Charge Code	EAPG 00077
Min. Negotiated Rate	$2,541.28
Max. Negotiated Rate	$5,717.88
Rate for Payer: Affinity Essential Plan 1&2	$5,717.88
Rate for Payer: Affinity Essential Plan 3&4	$5,717.88
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,541.28
Rate for Payer: Amida Care Medicaid	$2,541.28
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2,541.28
Rate for Payer: Fidelis Essential Plan Aliesa	$5,717.88
Rate for Payer: Fidelis Essential Plan QHP	$5,717.88
Rate for Payer: Fidelis Qualified Health Plan	$2,668.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,541.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,541.28
Rate for Payer: Healthfirst Essential Plan	$5,717.88
Rate for Payer: Healthfirst QHP	$2,541.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,541.28
Rate for Payer: SOMOS Essential	$5,717.88
Rate for Payer: United Healthcare Essential Plan 1&2	$5,717.88
Rate for Payer: United Healthcare Essential Plan 3&4	$2,795.41
Rate for Payer: United Healthcare Medicaid	$2,541.28
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,541.28

OUTPATIENT EAPG 00078: LEVEL I VASCULAR LIGATION, REPAIR AND RECONSTRUCTION

Facility

$6,602.54

Service Code	EAPG 00078
Hospital Charge Code	EAPG 00078
Min. Negotiated Rate	$2,934.46
Max. Negotiated Rate	$6,602.54
Rate for Payer: Affinity Essential Plan 1&2	$6,602.54
Rate for Payer: Affinity Essential Plan 3&4	$6,602.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,934.46
Rate for Payer: Amida Care Medicaid	$2,934.46
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2,934.46
Rate for Payer: Fidelis Essential Plan Aliesa	$6,602.54
Rate for Payer: Fidelis Essential Plan QHP	$6,602.54
Rate for Payer: Fidelis Qualified Health Plan	$3,081.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,934.46
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,934.46
Rate for Payer: Healthfirst Essential Plan	$6,602.54
Rate for Payer: Healthfirst QHP	$2,934.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,934.46
Rate for Payer: SOMOS Essential	$6,602.54
Rate for Payer: United Healthcare Essential Plan 1&2	$6,602.54
Rate for Payer: United Healthcare Essential Plan 3&4	$3,227.91
Rate for Payer: United Healthcare Medicaid	$2,934.46
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,934.46

OUTPATIENT EAPG 00079: LEVEL II PERIPHERAL ENDOVASCULAR AND TRANSCATHETER PROCEDURES

Facility

$6,895.64

Service Code	EAPG 00079
Hospital Charge Code	EAPG 00079
Min. Negotiated Rate	$3,064.73
Max. Negotiated Rate	$6,895.64
Rate for Payer: Affinity Essential Plan 1&2	$6,895.64
Rate for Payer: Affinity Essential Plan 3&4	$6,895.64
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,064.73
Rate for Payer: Amida Care Medicaid	$3,064.73
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3,064.73
Rate for Payer: Fidelis Essential Plan Aliesa	$6,895.64
Rate for Payer: Fidelis Essential Plan QHP	$6,895.64
Rate for Payer: Fidelis Qualified Health Plan	$3,217.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,064.73
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,064.73
Rate for Payer: Healthfirst Essential Plan	$6,895.64
Rate for Payer: Healthfirst QHP	$3,064.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,064.73
Rate for Payer: SOMOS Essential	$6,895.64
Rate for Payer: United Healthcare Essential Plan 1&2	$6,895.64
Rate for Payer: United Healthcare Essential Plan 3&4	$3,371.20
Rate for Payer: United Healthcare Medicaid	$3,064.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3,064.73

OUTPATIENT EAPG 00080: EXERCISE TOLERANCE TESTS

Facility

$430.09

Service Code	EAPG 00080
Hospital Charge Code	EAPG 00080
Min. Negotiated Rate	$191.15
Max. Negotiated Rate	$430.09
Rate for Payer: Affinity Essential Plan 1&2	$430.09
Rate for Payer: Affinity Essential Plan 3&4	$430.09
Rate for Payer: Affinity Medicaid/CHP/HARP	$191.15
Rate for Payer: Amida Care Medicaid	$191.15
Rate for Payer: Fidelis CHP/HARP/Medicaid	$191.15
Rate for Payer: Fidelis Essential Plan Aliesa	$430.09
Rate for Payer: Fidelis Essential Plan QHP	$430.09
Rate for Payer: Fidelis Qualified Health Plan	$200.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$191.15
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$191.15
Rate for Payer: Healthfirst Commercial	$289.65
Rate for Payer: Healthfirst Essential Plan	$430.09
Rate for Payer: Healthfirst QHP	$191.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$191.15
Rate for Payer: SOMOS Essential	$430.09
Rate for Payer: United Healthcare Essential Plan 1&2	$430.09
Rate for Payer: United Healthcare Essential Plan 3&4	$210.26
Rate for Payer: United Healthcare Medicaid	$191.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$191.15

OUTPATIENT EAPG 00081: ECHOCARDIOGRAPHY

Facility

$837.27

Service Code	EAPG 00081
Hospital Charge Code	EAPG 00081
Min. Negotiated Rate	$372.12
Max. Negotiated Rate	$837.27
Rate for Payer: Affinity Essential Plan 1&2	$837.27
Rate for Payer: Affinity Essential Plan 3&4	$837.27
Rate for Payer: Affinity Medicaid/CHP/HARP	$372.12
Rate for Payer: Amida Care Medicaid	$372.12
Rate for Payer: Fidelis CHP/HARP/Medicaid	$372.12
Rate for Payer: Fidelis Essential Plan Aliesa	$837.27
Rate for Payer: Fidelis Essential Plan QHP	$837.27
Rate for Payer: Fidelis Qualified Health Plan	$390.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$372.12
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$372.12
Rate for Payer: Healthfirst Commercial	$563.88
Rate for Payer: Healthfirst Essential Plan	$837.27
Rate for Payer: Healthfirst QHP	$372.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$372.12
Rate for Payer: SOMOS Essential	$837.27
Rate for Payer: United Healthcare Essential Plan 1&2	$837.27
Rate for Payer: United Healthcare Essential Plan 3&4	$409.33
Rate for Payer: United Healthcare Medicaid	$372.12
Rate for Payer: Wellcare CHP/FHP/Medicaid	$372.12

OUTPATIENT EAPG 00082: CARDIAC ELECTROPHYSIOLOGIC TESTS AND MONITORING

Facility

$2,380.90

Service Code	EAPG 00082
Hospital Charge Code	EAPG 00082
Min. Negotiated Rate	$1,058.18
Max. Negotiated Rate	$2,380.90
Rate for Payer: Affinity Essential Plan 1&2	$2,380.90
Rate for Payer: Affinity Essential Plan 3&4	$2,380.90
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,058.18
Rate for Payer: Amida Care Medicaid	$1,058.18
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,058.18
Rate for Payer: Fidelis Essential Plan Aliesa	$2,380.90
Rate for Payer: Fidelis Essential Plan QHP	$2,380.90
Rate for Payer: Fidelis Qualified Health Plan	$1,111.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,058.18
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,058.18
Rate for Payer: Healthfirst Commercial	$1,603.50
Rate for Payer: Healthfirst Essential Plan	$2,380.90
Rate for Payer: Healthfirst QHP	$1,058.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,058.18
Rate for Payer: SOMOS Essential	$2,380.90
Rate for Payer: United Healthcare Essential Plan 1&2	$2,380.90
Rate for Payer: United Healthcare Essential Plan 3&4	$1,164.00
Rate for Payer: United Healthcare Medicaid	$1,058.18
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,058.18

OUTPATIENT EAPG 00083: LEVEL II CENTRAL VENOUS ACCESS PROCEDURES

Facility

$3,582.99

Service Code	EAPG 00083
Hospital Charge Code	EAPG 00083
Min. Negotiated Rate	$1,592.44
Max. Negotiated Rate	$3,582.99
Rate for Payer: Affinity Essential Plan 1&2	$3,582.99
Rate for Payer: Affinity Essential Plan 3&4	$3,582.99
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,592.44
Rate for Payer: Amida Care Medicaid	$1,592.44
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,592.44
Rate for Payer: Fidelis Essential Plan Aliesa	$3,582.99
Rate for Payer: Fidelis Essential Plan QHP	$3,582.99
Rate for Payer: Fidelis Qualified Health Plan	$1,672.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,592.44
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,592.44
Rate for Payer: Healthfirst Commercial	$2,413.08
Rate for Payer: Healthfirst Essential Plan	$3,582.99
Rate for Payer: Healthfirst QHP	$1,592.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,592.44
Rate for Payer: SOMOS Essential	$3,582.99
Rate for Payer: United Healthcare Essential Plan 1&2	$3,582.99
Rate for Payer: United Healthcare Essential Plan 3&4	$1,751.68
Rate for Payer: United Healthcare Medicaid	$1,592.44
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,592.44

OUTPATIENT EAPG 00084: DIAGNOSTIC CARDIAC CATHETERIZATION

Facility

$4,648.77

Service Code	EAPG 00084
Hospital Charge Code	EAPG 00084
Min. Negotiated Rate	$2,066.12
Max. Negotiated Rate	$4,648.77
Rate for Payer: Affinity Essential Plan 1&2	$4,648.77
Rate for Payer: Affinity Essential Plan 3&4	$4,648.77
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,066.12
Rate for Payer: Amida Care Medicaid	$2,066.12
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2,066.12
Rate for Payer: Fidelis Essential Plan Aliesa	$4,648.77
Rate for Payer: Fidelis Essential Plan QHP	$4,648.77
Rate for Payer: Fidelis Qualified Health Plan	$2,169.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,066.12
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,066.12
Rate for Payer: Healthfirst Commercial	$3,130.87
Rate for Payer: Healthfirst Essential Plan	$4,648.77
Rate for Payer: Healthfirst QHP	$2,066.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,066.12
Rate for Payer: SOMOS Essential	$4,648.77
Rate for Payer: United Healthcare Essential Plan 1&2	$4,648.77
Rate for Payer: United Healthcare Essential Plan 3&4	$2,272.73
Rate for Payer: United Healthcare Medicaid	$2,066.12
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,066.12

OUTPATIENT EAPG 00085: LEVEL III PERIPHERAL ENDOVASCULAR AND TRANSCATHETER PROCEDURES

Facility

$6,895.66

Service Code	EAPG 00085
Hospital Charge Code	EAPG 00085
Min. Negotiated Rate	$3,064.74
Max. Negotiated Rate	$6,895.66
Rate for Payer: Affinity Essential Plan 1&2	$6,895.66
Rate for Payer: Affinity Essential Plan 3&4	$6,895.66
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,064.74
Rate for Payer: Amida Care Medicaid	$3,064.74
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3,064.74
Rate for Payer: Fidelis Essential Plan Aliesa	$6,895.66
Rate for Payer: Fidelis Essential Plan QHP	$6,895.66
Rate for Payer: Fidelis Qualified Health Plan	$3,217.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,064.74
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,064.74
Rate for Payer: Healthfirst Commercial	$4,644.11
Rate for Payer: Healthfirst Essential Plan	$6,895.66
Rate for Payer: Healthfirst QHP	$3,064.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,064.74
Rate for Payer: SOMOS Essential	$6,895.66
Rate for Payer: United Healthcare Essential Plan 1&2	$6,895.66
Rate for Payer: United Healthcare Essential Plan 3&4	$3,371.21
Rate for Payer: United Healthcare Medicaid	$3,064.74
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3,064.74

OUTPATIENT EAPG 00086: PACEMAKER AND OTHER CARDIOVASCULAR DEVICE INSERTION AND REPLACEMENT

Facility

$16,414.04

Service Code	EAPG 00086
Hospital Charge Code	EAPG 00086
Min. Negotiated Rate	$7,295.13
Max. Negotiated Rate	$16,414.04
Rate for Payer: Affinity Essential Plan 1&2	$16,414.04
Rate for Payer: Affinity Essential Plan 3&4	$16,414.04
Rate for Payer: Affinity Medicaid/CHP/HARP	$7,295.13
Rate for Payer: Amida Care Medicaid	$7,295.13
Rate for Payer: Fidelis CHP/HARP/Medicaid	$7,295.13
Rate for Payer: Fidelis Essential Plan Aliesa	$16,414.04
Rate for Payer: Fidelis Essential Plan QHP	$16,414.04
Rate for Payer: Fidelis Qualified Health Plan	$7,659.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,295.13
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$7,295.13
Rate for Payer: Healthfirst Commercial	$11,054.58
Rate for Payer: Healthfirst Essential Plan	$16,414.04
Rate for Payer: Healthfirst QHP	$7,295.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7,295.13
Rate for Payer: SOMOS Essential	$16,414.04
Rate for Payer: United Healthcare Essential Plan 1&2	$16,414.04
Rate for Payer: United Healthcare Essential Plan 3&4	$8,024.64
Rate for Payer: United Healthcare Medicaid	$7,295.13
Rate for Payer: Wellcare CHP/FHP/Medicaid	$7,295.13

OUTPATIENT EAPG 00087: REMOVAL OR REVISION OF PACEMAKERS AND OTHER CARDIOVASCULAR DEVICES

Facility

$5,864.13

Service Code	EAPG 00087
Hospital Charge Code	EAPG 00087
Min. Negotiated Rate	$2,606.28
Max. Negotiated Rate	$5,864.13
Rate for Payer: Affinity Essential Plan 1&2	$5,864.13
Rate for Payer: Affinity Essential Plan 3&4	$5,864.13
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,606.28
Rate for Payer: Amida Care Medicaid	$2,606.28
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2,606.28
Rate for Payer: Fidelis Essential Plan Aliesa	$5,864.13
Rate for Payer: Fidelis Essential Plan QHP	$5,864.13
Rate for Payer: Fidelis Qualified Health Plan	$2,736.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,606.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,606.28
Rate for Payer: Healthfirst Commercial	$3,949.39
Rate for Payer: Healthfirst Essential Plan	$5,864.13
Rate for Payer: Healthfirst QHP	$2,606.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,606.28
Rate for Payer: SOMOS Essential	$5,864.13
Rate for Payer: United Healthcare Essential Plan 1&2	$5,864.13
Rate for Payer: United Healthcare Essential Plan 3&4	$2,866.91
Rate for Payer: United Healthcare Medicaid	$2,606.28
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,606.28

OUTPATIENT EAPG 00088: LEVEL I CARDIOTHORACIC PROCEDURES W OR W/O VASCULAR DEVICE

Facility

$3,686.83

Service Code	EAPG 00088
Hospital Charge Code	EAPG 00088
Min. Negotiated Rate	$3,686.83
Max. Negotiated Rate	$3,686.83
Rate for Payer: Healthfirst Commercial	$3,686.83

OUTPATIENT EAPG 00089: LEVEL II CARDIOTHORACIC PROCEDURES W OR W/O VASCULAR DEVICE

Facility

$5,014.87

Service Code	EAPG 00089
Hospital Charge Code	EAPG 00089
Min. Negotiated Rate	$5,014.87
Max. Negotiated Rate	$5,014.87
Rate for Payer: Healthfirst Commercial	$5,014.87

OUTPATIENT EAPG 00090: SECONDARY VARICOSE VEINS AND VASCULAR INJECTION

Facility

$2,706.14

Service Code	EAPG 00090
Hospital Charge Code	EAPG 00090
Min. Negotiated Rate	$1,202.73
Max. Negotiated Rate	$2,706.14
Rate for Payer: Affinity Essential Plan 1&2	$2,706.14
Rate for Payer: Affinity Essential Plan 3&4	$2,706.14
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,202.73
Rate for Payer: Amida Care Medicaid	$1,202.73
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,202.73
Rate for Payer: Fidelis Essential Plan Aliesa	$2,706.14
Rate for Payer: Fidelis Essential Plan QHP	$2,706.14
Rate for Payer: Fidelis Qualified Health Plan	$1,262.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,202.73
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,202.73
Rate for Payer: Healthfirst Commercial	$1,822.55
Rate for Payer: Healthfirst Essential Plan	$2,706.14
Rate for Payer: Healthfirst QHP	$1,202.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,202.73
Rate for Payer: SOMOS Essential	$2,706.14
Rate for Payer: United Healthcare Essential Plan 1&2	$2,706.14
Rate for Payer: United Healthcare Essential Plan 3&4	$1,323.00
Rate for Payer: United Healthcare Medicaid	$1,202.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,202.73

OUTPATIENT EAPG 00091: LEVEL II VASCULAR LIGATION, REPAIR AND RECONSTRUCTION

Facility

$6,602.54

Service Code	EAPG 00091
Hospital Charge Code	EAPG 00091
Min. Negotiated Rate	$2,934.46
Max. Negotiated Rate	$6,602.54
Rate for Payer: Affinity Essential Plan 1&2	$6,602.54
Rate for Payer: Affinity Essential Plan 3&4	$6,602.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,934.46
Rate for Payer: Amida Care Medicaid	$2,934.46
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2,934.46
Rate for Payer: Fidelis Essential Plan Aliesa	$6,602.54
Rate for Payer: Fidelis Essential Plan QHP	$6,602.54
Rate for Payer: Fidelis Qualified Health Plan	$3,081.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,934.46
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,934.46
Rate for Payer: Healthfirst Commercial	$4,446.69
Rate for Payer: Healthfirst Essential Plan	$6,602.54
Rate for Payer: Healthfirst QHP	$2,934.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,934.46
Rate for Payer: SOMOS Essential	$6,602.54
Rate for Payer: United Healthcare Essential Plan 1&2	$6,602.54
Rate for Payer: United Healthcare Essential Plan 3&4	$3,227.91
Rate for Payer: United Healthcare Medicaid	$2,934.46
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,934.46

OUTPATIENT EAPG 00092: RESUSCITATION

Facility

$1,480.97

Service Code	EAPG 00092
Hospital Charge Code	EAPG 00092
Min. Negotiated Rate	$658.21
Max. Negotiated Rate	$1,480.97
Rate for Payer: Affinity Essential Plan 1&2	$1,480.97
Rate for Payer: Affinity Essential Plan 3&4	$1,480.97
Rate for Payer: Affinity Medicaid/CHP/HARP	$658.21
Rate for Payer: Amida Care Medicaid	$658.21
Rate for Payer: Fidelis CHP/HARP/Medicaid	$658.21
Rate for Payer: Fidelis Essential Plan Aliesa	$1,480.97
Rate for Payer: Fidelis Essential Plan QHP	$1,480.97
Rate for Payer: Fidelis Qualified Health Plan	$691.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$658.21
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$658.21
Rate for Payer: Healthfirst Commercial	$997.41
Rate for Payer: Healthfirst Essential Plan	$1,480.97
Rate for Payer: Healthfirst QHP	$658.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$658.21
Rate for Payer: SOMOS Essential	$1,480.97
Rate for Payer: United Healthcare Essential Plan 1&2	$1,480.97
Rate for Payer: United Healthcare Essential Plan 3&4	$724.03
Rate for Payer: United Healthcare Medicaid	$658.21
Rate for Payer: Wellcare CHP/FHP/Medicaid	$658.21

OUTPATIENT EAPG 00093: CARDIOVERSION

Facility

$1,373.78

Service Code	EAPG 00093
Hospital Charge Code	EAPG 00093
Min. Negotiated Rate	$610.57
Max. Negotiated Rate	$1,373.78
Rate for Payer: Affinity Essential Plan 1&2	$1,373.78
Rate for Payer: Affinity Essential Plan 3&4	$1,373.78
Rate for Payer: Affinity Medicaid/CHP/HARP	$610.57
Rate for Payer: Amida Care Medicaid	$610.57
Rate for Payer: Fidelis CHP/HARP/Medicaid	$610.57
Rate for Payer: Fidelis Essential Plan Aliesa	$1,373.78
Rate for Payer: Fidelis Essential Plan QHP	$1,373.78
Rate for Payer: Fidelis Qualified Health Plan	$641.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$610.57
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$610.57
Rate for Payer: Healthfirst Commercial	$925.22
Rate for Payer: Healthfirst Essential Plan	$1,373.78
Rate for Payer: Healthfirst QHP	$610.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$610.57
Rate for Payer: SOMOS Essential	$1,373.78
Rate for Payer: United Healthcare Essential Plan 1&2	$1,373.78
Rate for Payer: United Healthcare Essential Plan 3&4	$671.63
Rate for Payer: United Healthcare Medicaid	$610.57
Rate for Payer: Wellcare CHP/FHP/Medicaid	$610.57

OUTPATIENT EAPG 00094: CARDIAC REHABILITATION

Facility

$98.24

Service Code	EAPG 00094
Hospital Charge Code	EAPG 00094
Min. Negotiated Rate	$43.66
Max. Negotiated Rate	$98.24
Rate for Payer: Affinity Essential Plan 1&2	$98.24
Rate for Payer: Affinity Essential Plan 3&4	$98.24
Rate for Payer: Affinity Medicaid/CHP/HARP	$43.66
Rate for Payer: Amida Care Medicaid	$43.66
Rate for Payer: Fidelis CHP/HARP/Medicaid	$43.66
Rate for Payer: Fidelis Essential Plan Aliesa	$98.24
Rate for Payer: Fidelis Essential Plan QHP	$98.24
Rate for Payer: Fidelis Qualified Health Plan	$45.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.66
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$43.66
Rate for Payer: Healthfirst Commercial	$66.16
Rate for Payer: Healthfirst Essential Plan	$98.24
Rate for Payer: Healthfirst QHP	$43.66
Rate for Payer: SOMOS CHP/HARP/Medicaid	$43.66
Rate for Payer: SOMOS Essential	$98.24
Rate for Payer: United Healthcare Essential Plan 1&2	$98.24
Rate for Payer: United Healthcare Essential Plan 3&4	$48.03
Rate for Payer: United Healthcare Medicaid	$43.66
Rate for Payer: Wellcare CHP/FHP/Medicaid	$43.66

OUTPATIENT EAPG 00096: ATRIAL AND VENTRICULAR RECORDING AND PACING

Facility

$1,384.92

Service Code	EAPG 00096
Hospital Charge Code	EAPG 00096
Min. Negotiated Rate	$615.52
Max. Negotiated Rate	$1,384.92
Rate for Payer: Affinity Essential Plan 1&2	$1,384.92
Rate for Payer: Affinity Essential Plan 3&4	$1,384.92
Rate for Payer: Affinity Medicaid/CHP/HARP	$615.52
Rate for Payer: Amida Care Medicaid	$615.52
Rate for Payer: Fidelis CHP/HARP/Medicaid	$615.52
Rate for Payer: Fidelis Essential Plan Aliesa	$1,384.92
Rate for Payer: Fidelis Essential Plan QHP	$1,384.92
Rate for Payer: Fidelis Qualified Health Plan	$646.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$615.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$615.52
Rate for Payer: Healthfirst Commercial	$932.72
Rate for Payer: Healthfirst Essential Plan	$1,384.92
Rate for Payer: Healthfirst QHP	$615.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$615.52
Rate for Payer: SOMOS Essential	$1,384.92
Rate for Payer: United Healthcare Essential Plan 1&2	$1,384.92
Rate for Payer: United Healthcare Essential Plan 3&4	$677.07
Rate for Payer: United Healthcare Medicaid	$615.52
Rate for Payer: Wellcare CHP/FHP/Medicaid	$615.52

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