St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

OUTPATIENT EAPG 00097: AICD IMPLANT

Facility

$38,994.10

Service Code	EAPG 00097
Hospital Charge Code	EAPG 00097
Min. Negotiated Rate	$17,330.71
Max. Negotiated Rate	$38,994.10
Rate for Payer: Affinity Essential Plan 1&2	$38,994.10
Rate for Payer: Affinity Essential Plan 3&4	$38,994.10
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,330.71
Rate for Payer: Amida Care Medicaid	$17,330.71
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,330.71
Rate for Payer: Fidelis Essential Plan Aliesa	$38,994.10
Rate for Payer: Fidelis Essential Plan QHP	$38,994.10
Rate for Payer: Fidelis Qualified Health Plan	$18,197.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,330.71
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,330.71
Rate for Payer: Healthfirst Commercial	$26,261.88
Rate for Payer: Healthfirst Essential Plan	$38,994.10
Rate for Payer: Healthfirst QHP	$17,330.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,330.71
Rate for Payer: SOMOS Essential	$38,994.10
Rate for Payer: United Healthcare Essential Plan 1&2	$38,994.10
Rate for Payer: United Healthcare Essential Plan 3&4	$19,063.78
Rate for Payer: United Healthcare Medicaid	$17,330.71
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,330.71

OUTPATIENT EAPG 00099: CORONARY ANGIOPLASTY AND RELATED PROCEDURES

Facility

$6,895.66

Service Code	EAPG 00099
Hospital Charge Code	EAPG 00099
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 00110: PHARMACOTHERAPY BY EXTENDED INFUSION

Facility

$1,848.42

Service Code	EAPG 00110
Hospital Charge Code	EAPG 00110
Min. Negotiated Rate	$821.52
Max. Negotiated Rate	$1,848.42
Rate for Payer: Affinity Essential Plan 1&2	$1,848.42
Rate for Payer: Affinity Essential Plan 3&4	$1,848.42
Rate for Payer: Affinity Medicaid/CHP/HARP	$821.52
Rate for Payer: Amida Care Medicaid	$821.52
Rate for Payer: Fidelis CHP/HARP/Medicaid	$821.52
Rate for Payer: Fidelis Essential Plan Aliesa	$1,848.42
Rate for Payer: Fidelis Essential Plan QHP	$1,848.42
Rate for Payer: Fidelis Qualified Health Plan	$862.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$821.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$821.52
Rate for Payer: Healthfirst Commercial	$1,244.88
Rate for Payer: Healthfirst Essential Plan	$1,848.42
Rate for Payer: Healthfirst QHP	$821.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$821.52
Rate for Payer: SOMOS Essential	$1,848.42
Rate for Payer: United Healthcare Essential Plan 1&2	$1,848.42
Rate for Payer: United Healthcare Essential Plan 3&4	$903.67
Rate for Payer: United Healthcare Medicaid	$821.52
Rate for Payer: Wellcare CHP/FHP/Medicaid	$821.52

OUTPATIENT EAPG 00111: PHARMACOTHERAPY EXCEPT BY EXTENDED INFUSION

Facility

$692.28

Service Code	EAPG 00111
Hospital Charge Code	EAPG 00111
Min. Negotiated Rate	$307.68
Max. Negotiated Rate	$692.28
Rate for Payer: Affinity Essential Plan 1&2	$692.28
Rate for Payer: Affinity Essential Plan 3&4	$692.28
Rate for Payer: Affinity Medicaid/CHP/HARP	$307.68
Rate for Payer: Amida Care Medicaid	$307.68
Rate for Payer: Fidelis CHP/HARP/Medicaid	$307.68
Rate for Payer: Fidelis Essential Plan Aliesa	$692.28
Rate for Payer: Fidelis Essential Plan QHP	$692.28
Rate for Payer: Fidelis Qualified Health Plan	$323.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$307.68
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$307.68
Rate for Payer: Healthfirst Commercial	$466.25
Rate for Payer: Healthfirst Essential Plan	$692.28
Rate for Payer: Healthfirst QHP	$307.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$307.68
Rate for Payer: SOMOS Essential	$692.28
Rate for Payer: United Healthcare Essential Plan 1&2	$692.28
Rate for Payer: United Healthcare Essential Plan 3&4	$338.45
Rate for Payer: United Healthcare Medicaid	$307.68
Rate for Payer: Wellcare CHP/FHP/Medicaid	$307.68

OUTPATIENT EAPG 00113: LEVEL I BLOOD AND BLOOD PRODUCT EXCHANGE

Facility

$1,401.10

Service Code	EAPG 00113
Hospital Charge Code	EAPG 00113
Min. Negotiated Rate	$622.71
Max. Negotiated Rate	$1,401.10
Rate for Payer: Affinity Essential Plan 1&2	$1,401.10
Rate for Payer: Affinity Essential Plan 3&4	$1,401.10
Rate for Payer: Affinity Medicaid/CHP/HARP	$622.71
Rate for Payer: Amida Care Medicaid	$622.71
Rate for Payer: Fidelis CHP/HARP/Medicaid	$622.71
Rate for Payer: Fidelis Essential Plan Aliesa	$1,401.10
Rate for Payer: Fidelis Essential Plan QHP	$1,401.10
Rate for Payer: Fidelis Qualified Health Plan	$653.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$622.71
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$622.71
Rate for Payer: Healthfirst Commercial	$943.61
Rate for Payer: Healthfirst Essential Plan	$1,401.10
Rate for Payer: Healthfirst QHP	$622.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$622.71
Rate for Payer: SOMOS Essential	$1,401.10
Rate for Payer: United Healthcare Essential Plan 1&2	$1,401.10
Rate for Payer: United Healthcare Essential Plan 3&4	$684.98
Rate for Payer: United Healthcare Medicaid	$622.71
Rate for Payer: Wellcare CHP/FHP/Medicaid	$622.71

OUTPATIENT EAPG 00114: LEVEL II BLOOD AND BLOOD PRODUCT EXCHANGE

Facility

$5,280.08

Service Code	EAPG 00114
Hospital Charge Code	EAPG 00114
Min. Negotiated Rate	$2,346.70
Max. Negotiated Rate	$5,280.08
Rate for Payer: Affinity Essential Plan 1&2	$5,280.08
Rate for Payer: Affinity Essential Plan 3&4	$5,280.08
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,346.70
Rate for Payer: Amida Care Medicaid	$2,346.70
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2,346.70
Rate for Payer: Fidelis Essential Plan Aliesa	$5,280.08
Rate for Payer: Fidelis Essential Plan QHP	$5,280.08
Rate for Payer: Fidelis Qualified Health Plan	$2,464.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,346.70
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,346.70
Rate for Payer: Healthfirst Commercial	$3,556.04
Rate for Payer: Healthfirst Essential Plan	$5,280.08
Rate for Payer: Healthfirst QHP	$2,346.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,346.70
Rate for Payer: SOMOS Essential	$5,280.08
Rate for Payer: United Healthcare Essential Plan 1&2	$5,280.08
Rate for Payer: United Healthcare Essential Plan 3&4	$2,581.37
Rate for Payer: United Healthcare Medicaid	$2,346.70
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,346.70

OUTPATIENT EAPG 00115: DEEP LYMPH STRUCTURE AND THYROID PROCEDURES

Facility

$3,712.00

Service Code	EAPG 00115
Hospital Charge Code	EAPG 00115
Min. Negotiated Rate	$1,649.78
Max. Negotiated Rate	$3,712.00
Rate for Payer: Affinity Essential Plan 1&2	$3,712.00
Rate for Payer: Affinity Essential Plan 3&4	$3,712.00
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,649.78
Rate for Payer: Amida Care Medicaid	$1,649.78
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,649.78
Rate for Payer: Fidelis Essential Plan Aliesa	$3,712.00
Rate for Payer: Fidelis Essential Plan QHP	$3,712.00
Rate for Payer: Fidelis Qualified Health Plan	$1,732.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,649.78
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,649.78
Rate for Payer: Healthfirst Commercial	$2,499.98
Rate for Payer: Healthfirst Essential Plan	$3,712.00
Rate for Payer: Healthfirst QHP	$1,649.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,649.78
Rate for Payer: SOMOS Essential	$3,712.00
Rate for Payer: United Healthcare Essential Plan 1&2	$3,712.00
Rate for Payer: United Healthcare Essential Plan 3&4	$1,814.76
Rate for Payer: United Healthcare Medicaid	$1,649.78
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,649.78

OUTPATIENT EAPG 00116: ALLERGY TESTS

Facility

$653.20

Service Code	EAPG 00116
Hospital Charge Code	EAPG 00116
Min. Negotiated Rate	$290.31
Max. Negotiated Rate	$653.20
Rate for Payer: Affinity Essential Plan 1&2	$653.20
Rate for Payer: Affinity Essential Plan 3&4	$653.20
Rate for Payer: Affinity Medicaid/CHP/HARP	$290.31
Rate for Payer: Amida Care Medicaid	$290.31
Rate for Payer: Fidelis CHP/HARP/Medicaid	$290.31
Rate for Payer: Fidelis Essential Plan Aliesa	$653.20
Rate for Payer: Fidelis Essential Plan QHP	$653.20
Rate for Payer: Fidelis Qualified Health Plan	$304.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$290.31
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$290.31
Rate for Payer: Healthfirst Commercial	$439.92
Rate for Payer: Healthfirst Essential Plan	$653.20
Rate for Payer: Healthfirst QHP	$290.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$290.31
Rate for Payer: SOMOS Essential	$653.20
Rate for Payer: United Healthcare Essential Plan 1&2	$653.20
Rate for Payer: United Healthcare Essential Plan 3&4	$319.34
Rate for Payer: United Healthcare Medicaid	$290.31
Rate for Payer: Wellcare CHP/FHP/Medicaid	$290.31

OUTPATIENT EAPG 00130: ALIMENTARY TESTS AND TUBE INSERTION OR PLACEMENT

Facility

$1,296.99

Service Code	EAPG 00130
Hospital Charge Code	EAPG 00130
Min. Negotiated Rate	$576.44
Max. Negotiated Rate	$1,296.99
Rate for Payer: Affinity Essential Plan 1&2	$1,296.99
Rate for Payer: Affinity Essential Plan 3&4	$1,296.99
Rate for Payer: Affinity Medicaid/CHP/HARP	$576.44
Rate for Payer: Amida Care Medicaid	$576.44
Rate for Payer: Fidelis CHP/HARP/Medicaid	$576.44
Rate for Payer: Fidelis Essential Plan Aliesa	$1,296.99
Rate for Payer: Fidelis Essential Plan QHP	$1,296.99
Rate for Payer: Fidelis Qualified Health Plan	$605.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$576.44
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$576.44
Rate for Payer: Healthfirst Commercial	$873.50
Rate for Payer: Healthfirst Essential Plan	$1,296.99
Rate for Payer: Healthfirst QHP	$576.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$576.44
Rate for Payer: SOMOS Essential	$1,296.99
Rate for Payer: United Healthcare Essential Plan 1&2	$1,296.99
Rate for Payer: United Healthcare Essential Plan 3&4	$634.08
Rate for Payer: United Healthcare Medicaid	$576.44
Rate for Payer: Wellcare CHP/FHP/Medicaid	$576.44

OUTPATIENT EAPG 00131: ESOPHAGEAL DILATION WITHOUT ENDOSCOPY

Facility

$1,064.02

Service Code	EAPG 00131
Hospital Charge Code	EAPG 00131
Min. Negotiated Rate	$1,064.02
Max. Negotiated Rate	$1,064.02
Rate for Payer: Healthfirst Commercial	$1,064.02

OUTPATIENT EAPG 00132: ANOSCOPY WITH BIOPSY AND DIAGNOSTIC PROCTOSIGMOIDOSCOPY

Facility

$959.12

Service Code	EAPG 00132
Hospital Charge Code	EAPG 00132
Min. Negotiated Rate	$959.12
Max. Negotiated Rate	$959.12
Rate for Payer: Healthfirst Commercial	$959.12

OUTPATIENT EAPG 00133: PROCTOSIGMOIDOSCOPY WITH EXCISION OR BIOPSY

Facility

$1,353.78

Service Code	EAPG 00133
Hospital Charge Code	EAPG 00133
Min. Negotiated Rate	$1,353.78
Max. Negotiated Rate	$1,353.78
Rate for Payer: Healthfirst Commercial	$1,353.78

OUTPATIENT EAPG 00134: LEVEL I UPPER GI ENDOSCOPY

Facility

$2,080.76

Service Code	EAPG 00134
Hospital Charge Code	EAPG 00134
Min. Negotiated Rate	$924.78
Max. Negotiated Rate	$2,080.76
Rate for Payer: Affinity Essential Plan 1&2	$2,080.76
Rate for Payer: Affinity Essential Plan 3&4	$2,080.76
Rate for Payer: Affinity Medicaid/CHP/HARP	$924.78
Rate for Payer: Amida Care Medicaid	$924.78
Rate for Payer: Fidelis CHP/HARP/Medicaid	$924.78
Rate for Payer: Fidelis Essential Plan Aliesa	$2,080.76
Rate for Payer: Fidelis Essential Plan QHP	$2,080.76
Rate for Payer: Fidelis Qualified Health Plan	$971.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$924.78
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$924.78
Rate for Payer: Healthfirst Commercial	$1,401.34
Rate for Payer: Healthfirst Essential Plan	$2,080.76
Rate for Payer: Healthfirst QHP	$924.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$924.78
Rate for Payer: SOMOS Essential	$2,080.76
Rate for Payer: United Healthcare Essential Plan 1&2	$2,080.76
Rate for Payer: United Healthcare Essential Plan 3&4	$1,017.26
Rate for Payer: United Healthcare Medicaid	$924.78
Rate for Payer: Wellcare CHP/FHP/Medicaid	$924.78

OUTPATIENT EAPG 00135: LEVEL II UPPER GI ENDOSCOPY

Facility

$2,379.87

Service Code	EAPG 00135
Hospital Charge Code	EAPG 00135
Min. Negotiated Rate	$1,057.72
Max. Negotiated Rate	$2,379.87
Rate for Payer: Affinity Essential Plan 1&2	$2,379.87
Rate for Payer: Affinity Essential Plan 3&4	$2,379.87
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,057.72
Rate for Payer: Amida Care Medicaid	$1,057.72
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,057.72
Rate for Payer: Fidelis Essential Plan Aliesa	$2,379.87
Rate for Payer: Fidelis Essential Plan QHP	$2,379.87
Rate for Payer: Fidelis Qualified Health Plan	$1,110.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,057.72
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,057.72
Rate for Payer: Healthfirst Commercial	$1,602.81
Rate for Payer: Healthfirst Essential Plan	$2,379.87
Rate for Payer: Healthfirst QHP	$1,057.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,057.72
Rate for Payer: SOMOS Essential	$2,379.87
Rate for Payer: United Healthcare Essential Plan 1&2	$2,379.87
Rate for Payer: United Healthcare Essential Plan 3&4	$1,163.49
Rate for Payer: United Healthcare Medicaid	$1,057.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,057.72

OUTPATIENT EAPG 00136: DIAGNOSTIC LOWER GASTROINTESTINAL ENDOSCOPY

Facility

$1,998.81

Service Code	EAPG 00136
Hospital Charge Code	EAPG 00136
Min. Negotiated Rate	$888.36
Max. Negotiated Rate	$1,998.81
Rate for Payer: Affinity Essential Plan 1&2	$1,998.81
Rate for Payer: Affinity Essential Plan 3&4	$1,998.81
Rate for Payer: Affinity Medicaid/CHP/HARP	$888.36
Rate for Payer: Amida Care Medicaid	$888.36
Rate for Payer: Fidelis CHP/HARP/Medicaid	$888.36
Rate for Payer: Fidelis Essential Plan Aliesa	$1,998.81
Rate for Payer: Fidelis Essential Plan QHP	$1,998.81
Rate for Payer: Fidelis Qualified Health Plan	$932.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$888.36
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$888.36
Rate for Payer: Healthfirst Commercial	$1,346.17
Rate for Payer: Healthfirst Essential Plan	$1,998.81
Rate for Payer: Healthfirst QHP	$888.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$888.36
Rate for Payer: SOMOS Essential	$1,998.81
Rate for Payer: United Healthcare Essential Plan 1&2	$1,998.81
Rate for Payer: United Healthcare Essential Plan 3&4	$977.20
Rate for Payer: United Healthcare Medicaid	$888.36
Rate for Payer: Wellcare CHP/FHP/Medicaid	$888.36

OUTPATIENT EAPG 00137: THERAPEUTIC COLONOSCOPY

Facility

$2,264.56

Service Code	EAPG 00137
Hospital Charge Code	EAPG 00137
Min. Negotiated Rate	$1,006.47
Max. Negotiated Rate	$2,264.56
Rate for Payer: Affinity Essential Plan 1&2	$2,264.56
Rate for Payer: Affinity Essential Plan 3&4	$2,264.56
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,006.47
Rate for Payer: Amida Care Medicaid	$1,006.47
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,006.47
Rate for Payer: Fidelis Essential Plan Aliesa	$2,264.56
Rate for Payer: Fidelis Essential Plan QHP	$2,264.56
Rate for Payer: Fidelis Qualified Health Plan	$1,056.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,006.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,006.47
Rate for Payer: Healthfirst Commercial	$1,525.14
Rate for Payer: Healthfirst Essential Plan	$2,264.56
Rate for Payer: Healthfirst QHP	$1,006.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,006.47
Rate for Payer: SOMOS Essential	$2,264.56
Rate for Payer: United Healthcare Essential Plan 1&2	$2,264.56
Rate for Payer: United Healthcare Essential Plan 3&4	$1,107.12
Rate for Payer: United Healthcare Medicaid	$1,006.47
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,006.47

OUTPATIENT EAPG 00138: LEVEL I ERCP AND RELATED ENDOSCOPIC PROCEDURES

Facility

$3,362.24

Service Code	EAPG 00138
Hospital Charge Code	EAPG 00138
Min. Negotiated Rate	$1,494.33
Max. Negotiated Rate	$3,362.24
Rate for Payer: Affinity Essential Plan 1&2	$3,362.24
Rate for Payer: Affinity Essential Plan 3&4	$3,362.24
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,494.33
Rate for Payer: Amida Care Medicaid	$1,494.33
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,494.33
Rate for Payer: Fidelis Essential Plan Aliesa	$3,362.24
Rate for Payer: Fidelis Essential Plan QHP	$3,362.24
Rate for Payer: Fidelis Qualified Health Plan	$1,569.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,494.33
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,494.33
Rate for Payer: Healthfirst Commercial	$2,264.41
Rate for Payer: Healthfirst Essential Plan	$3,362.24
Rate for Payer: Healthfirst QHP	$1,494.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,494.33
Rate for Payer: SOMOS Essential	$3,362.24
Rate for Payer: United Healthcare Essential Plan 1&2	$3,362.24
Rate for Payer: United Healthcare Essential Plan 3&4	$1,643.76
Rate for Payer: United Healthcare Medicaid	$1,494.33
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,494.33

OUTPATIENT EAPG 00139: LEVEL I HERNIA REPAIR

Facility

$5,275.53

Service Code	EAPG 00139
Hospital Charge Code	EAPG 00139
Min. Negotiated Rate	$2,344.68
Max. Negotiated Rate	$5,275.53
Rate for Payer: Affinity Essential Plan 1&2	$5,275.53
Rate for Payer: Affinity Essential Plan 3&4	$5,275.53
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,344.68
Rate for Payer: Amida Care Medicaid	$2,344.68
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2,344.68
Rate for Payer: Fidelis Essential Plan Aliesa	$5,275.53
Rate for Payer: Fidelis Essential Plan QHP	$5,275.53
Rate for Payer: Fidelis Qualified Health Plan	$2,461.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,344.68
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,344.68
Rate for Payer: Healthfirst Commercial	$3,552.99
Rate for Payer: Healthfirst Essential Plan	$5,275.53
Rate for Payer: Healthfirst QHP	$2,344.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,344.68
Rate for Payer: SOMOS Essential	$5,275.53
Rate for Payer: United Healthcare Essential Plan 1&2	$5,275.53
Rate for Payer: United Healthcare Essential Plan 3&4	$2,579.15
Rate for Payer: United Healthcare Medicaid	$2,344.68
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,344.68

OUTPATIENT EAPG 00140: LEVEL II HERNIA REPAIR

Facility

$4,352.20

Service Code	EAPG 00140
Hospital Charge Code	EAPG 00140
Min. Negotiated Rate	$4,352.20
Max. Negotiated Rate	$4,352.20
Rate for Payer: Healthfirst Commercial	$4,352.20

OUTPATIENT EAPG 00141: LEVEL I ANAL AND RECTAL PROCEDURES

Facility

$2,815.67

Service Code	EAPG 00141
Hospital Charge Code	EAPG 00141
Min. Negotiated Rate	$1,251.41
Max. Negotiated Rate	$2,815.67
Rate for Payer: Affinity Essential Plan 1&2	$2,815.67
Rate for Payer: Affinity Essential Plan 3&4	$2,815.67
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,251.41
Rate for Payer: Amida Care Medicaid	$1,251.41
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,251.41
Rate for Payer: Fidelis Essential Plan Aliesa	$2,815.67
Rate for Payer: Fidelis Essential Plan QHP	$2,815.67
Rate for Payer: Fidelis Qualified Health Plan	$1,313.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,251.41
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,251.41
Rate for Payer: Healthfirst Commercial	$1,896.31
Rate for Payer: Healthfirst Essential Plan	$2,815.67
Rate for Payer: Healthfirst QHP	$1,251.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,251.41
Rate for Payer: SOMOS Essential	$2,815.67
Rate for Payer: United Healthcare Essential Plan 1&2	$2,815.67
Rate for Payer: United Healthcare Essential Plan 3&4	$1,376.55
Rate for Payer: United Healthcare Medicaid	$1,251.41
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,251.41

OUTPATIENT EAPG 00142: LEVEL II ANAL AND RECTAL PROCEDURES

Facility

$3,962.90

Service Code	EAPG 00142
Hospital Charge Code	EAPG 00142
Min. Negotiated Rate	$1,761.29
Max. Negotiated Rate	$3,962.90
Rate for Payer: Affinity Essential Plan 1&2	$3,962.90
Rate for Payer: Affinity Essential Plan 3&4	$3,962.90
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,761.29
Rate for Payer: Amida Care Medicaid	$1,761.29
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,761.29
Rate for Payer: Fidelis Essential Plan Aliesa	$3,962.90
Rate for Payer: Fidelis Essential Plan QHP	$3,962.90
Rate for Payer: Fidelis Qualified Health Plan	$1,849.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,761.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,761.29
Rate for Payer: Healthfirst Commercial	$2,668.95
Rate for Payer: Healthfirst Essential Plan	$3,962.90
Rate for Payer: Healthfirst QHP	$1,761.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,761.29
Rate for Payer: SOMOS Essential	$3,962.90
Rate for Payer: United Healthcare Essential Plan 1&2	$3,962.90
Rate for Payer: United Healthcare Essential Plan 3&4	$1,937.42
Rate for Payer: United Healthcare Medicaid	$1,761.29
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,761.29

OUTPATIENT EAPG 00143: LEVEL I GASTROINTESTINAL PROCEDURES

Facility

$3,111.05

Service Code	EAPG 00143
Hospital Charge Code	EAPG 00143
Min. Negotiated Rate	$1,382.69
Max. Negotiated Rate	$3,111.05
Rate for Payer: Affinity Essential Plan 1&2	$3,111.05
Rate for Payer: Affinity Essential Plan 3&4	$3,111.05
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,382.69
Rate for Payer: Amida Care Medicaid	$1,382.69
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,382.69
Rate for Payer: Fidelis Essential Plan Aliesa	$3,111.05
Rate for Payer: Fidelis Essential Plan QHP	$3,111.05
Rate for Payer: Fidelis Qualified Health Plan	$1,451.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,382.69
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,382.69
Rate for Payer: Healthfirst Commercial	$2,095.23
Rate for Payer: Healthfirst Essential Plan	$3,111.05
Rate for Payer: Healthfirst QHP	$1,382.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,382.69
Rate for Payer: SOMOS Essential	$3,111.05
Rate for Payer: United Healthcare Essential Plan 1&2	$3,111.05
Rate for Payer: United Healthcare Essential Plan 3&4	$1,520.96
Rate for Payer: United Healthcare Medicaid	$1,382.69
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,382.69

OUTPATIENT EAPG 00144: LEVEL II GASTROINTESTINAL PROCEDURES

Facility

$6,244.06

Service Code	EAPG 00144
Hospital Charge Code	EAPG 00144
Min. Negotiated Rate	$2,775.14
Max. Negotiated Rate	$6,244.06
Rate for Payer: Affinity Essential Plan 1&2	$6,244.06
Rate for Payer: Affinity Essential Plan 3&4	$6,244.06
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,775.14
Rate for Payer: Amida Care Medicaid	$2,775.14
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2,775.14
Rate for Payer: Fidelis Essential Plan Aliesa	$6,244.06
Rate for Payer: Fidelis Essential Plan QHP	$6,244.06
Rate for Payer: Fidelis Qualified Health Plan	$2,913.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,775.14
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,775.14
Rate for Payer: Healthfirst Commercial	$4,205.27
Rate for Payer: Healthfirst Essential Plan	$6,244.06
Rate for Payer: Healthfirst QHP	$2,775.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,775.14
Rate for Payer: SOMOS Essential	$6,244.06
Rate for Payer: United Healthcare Essential Plan 1&2	$6,244.06
Rate for Payer: United Healthcare Essential Plan 3&4	$3,052.65
Rate for Payer: United Healthcare Medicaid	$2,775.14
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,775.14

OUTPATIENT EAPG 00145: LEVEL I LAPAROSCOPY

Facility

$4,801.16

Service Code	EAPG 00145
Hospital Charge Code	EAPG 00145
Min. Negotiated Rate	$2,133.85
Max. Negotiated Rate	$4,801.16
Rate for Payer: Affinity Essential Plan 1&2	$4,801.16
Rate for Payer: Affinity Essential Plan 3&4	$4,801.16
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,133.85
Rate for Payer: Amida Care Medicaid	$2,133.85
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2,133.85
Rate for Payer: Fidelis Essential Plan Aliesa	$4,801.16
Rate for Payer: Fidelis Essential Plan QHP	$4,801.16
Rate for Payer: Fidelis Qualified Health Plan	$2,240.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,133.85
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,133.85
Rate for Payer: Healthfirst Commercial	$3,233.50
Rate for Payer: Healthfirst Essential Plan	$4,801.16
Rate for Payer: Healthfirst QHP	$2,133.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,133.85
Rate for Payer: SOMOS Essential	$4,801.16
Rate for Payer: United Healthcare Essential Plan 1&2	$4,801.16
Rate for Payer: United Healthcare Essential Plan 3&4	$2,347.24
Rate for Payer: United Healthcare Medicaid	$2,133.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,133.85

OUTPATIENT EAPG 00146: LEVEL II LAPAROSCOPY

Facility

$6,506.84

Service Code	EAPG 00146
Hospital Charge Code	EAPG 00146
Min. Negotiated Rate	$2,891.93
Max. Negotiated Rate	$6,506.84
Rate for Payer: Affinity Essential Plan 1&2	$6,506.84
Rate for Payer: Affinity Essential Plan 3&4	$6,506.84
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,891.93
Rate for Payer: Amida Care Medicaid	$2,891.93
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2,891.93
Rate for Payer: Fidelis Essential Plan Aliesa	$6,506.84
Rate for Payer: Fidelis Essential Plan QHP	$6,506.84
Rate for Payer: Fidelis Qualified Health Plan	$3,036.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,891.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,891.93
Rate for Payer: Healthfirst Commercial	$4,382.26
Rate for Payer: Healthfirst Essential Plan	$6,506.84
Rate for Payer: Healthfirst QHP	$2,891.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,891.93
Rate for Payer: SOMOS Essential	$6,506.84
Rate for Payer: United Healthcare Essential Plan 1&2	$6,506.84
Rate for Payer: United Healthcare Essential Plan 3&4	$3,181.12
Rate for Payer: United Healthcare Medicaid	$2,891.93
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,891.93

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