St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

OUTPATIENT EAPG 00192: LEVEL II FETAL PROCEDURES

Facility

$1,839.38

Service Code	EAPG 00192
Hospital Charge Code	EAPG 00192
Min. Negotiated Rate	$817.50
Max. Negotiated Rate	$1,839.38
Rate for Payer: Affinity Essential Plan 1&2	$1,839.38
Rate for Payer: Affinity Essential Plan 3&4	$1,839.38
Rate for Payer: Affinity Medicaid/CHP/HARP	$817.50
Rate for Payer: Amida Care Medicaid	$817.50
Rate for Payer: Fidelis CHP/HARP/Medicaid	$817.50
Rate for Payer: Fidelis Essential Plan Aliesa	$1,839.38
Rate for Payer: Fidelis Essential Plan QHP	$1,839.38
Rate for Payer: Fidelis Qualified Health Plan	$858.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$817.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$817.50
Rate for Payer: Healthfirst Commercial	$1,238.78
Rate for Payer: Healthfirst Essential Plan	$1,839.38
Rate for Payer: Healthfirst QHP	$817.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$817.50
Rate for Payer: SOMOS Essential	$1,839.38
Rate for Payer: United Healthcare Essential Plan 1&2	$1,839.38
Rate for Payer: United Healthcare Essential Plan 3&4	$899.25
Rate for Payer: United Healthcare Medicaid	$817.50
Rate for Payer: Wellcare CHP/FHP/Medicaid	$817.50

OUTPATIENT EAPG 00193: TREATMENT OF INCOMPLETE ABORTION

Facility

$2,231.81

Service Code	EAPG 00193
Hospital Charge Code	EAPG 00193
Min. Negotiated Rate	$2,231.81
Max. Negotiated Rate	$2,231.81
Rate for Payer: Healthfirst Commercial	$2,231.81

OUTPATIENT EAPG 00194: THERAPEUTIC ABORTION

Facility

$1,963.40

Service Code	EAPG 00194
Hospital Charge Code	EAPG 00194
Min. Negotiated Rate	$872.62
Max. Negotiated Rate	$1,963.40
Rate for Payer: Affinity Essential Plan 1&2	$1,963.40
Rate for Payer: Affinity Essential Plan 3&4	$1,963.40
Rate for Payer: Affinity Medicaid/CHP/HARP	$872.62
Rate for Payer: Amida Care Medicaid	$872.62
Rate for Payer: Fidelis CHP/HARP/Medicaid	$872.62
Rate for Payer: Fidelis Essential Plan Aliesa	$1,963.40
Rate for Payer: Fidelis Essential Plan QHP	$1,963.40
Rate for Payer: Fidelis Qualified Health Plan	$916.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$872.62
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$872.62
Rate for Payer: Healthfirst Commercial	$1,322.30
Rate for Payer: Healthfirst Essential Plan	$1,963.40
Rate for Payer: Healthfirst QHP	$872.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$872.62
Rate for Payer: SOMOS Essential	$1,963.40
Rate for Payer: United Healthcare Essential Plan 1&2	$1,963.40
Rate for Payer: United Healthcare Essential Plan 3&4	$959.88
Rate for Payer: United Healthcare Medicaid	$872.62
Rate for Payer: Wellcare CHP/FHP/Medicaid	$872.62

OUTPATIENT EAPG 00195: VAGINAL DELIVERY

Facility

$5,164.13

Service Code	EAPG 00195
Hospital Charge Code	EAPG 00195
Min. Negotiated Rate	$2,295.17
Max. Negotiated Rate	$5,164.13
Rate for Payer: Affinity Essential Plan 1&2	$5,164.13
Rate for Payer: Affinity Essential Plan 3&4	$5,164.13
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,295.17
Rate for Payer: Amida Care Medicaid	$2,295.17
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2,295.17
Rate for Payer: Fidelis Essential Plan Aliesa	$5,164.13
Rate for Payer: Fidelis Essential Plan QHP	$5,164.13
Rate for Payer: Fidelis Qualified Health Plan	$2,409.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,295.17
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,295.17
Rate for Payer: Healthfirst Commercial	$3,477.95
Rate for Payer: Healthfirst Essential Plan	$5,164.13
Rate for Payer: Healthfirst QHP	$2,295.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,295.17
Rate for Payer: SOMOS Essential	$5,164.13
Rate for Payer: United Healthcare Essential Plan 1&2	$5,164.13
Rate for Payer: United Healthcare Essential Plan 3&4	$2,524.69
Rate for Payer: United Healthcare Medicaid	$2,295.17
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,295.17

OUTPATIENT EAPG 00196: LEVEL I FEMALE REPRODUCTIVE PROCEDURES

Facility

$1,764.80

Service Code	EAPG 00196
Hospital Charge Code	EAPG 00196
Min. Negotiated Rate	$1,764.80
Max. Negotiated Rate	$1,764.80
Rate for Payer: Healthfirst Commercial	$1,764.80

OUTPATIENT EAPG 00197: LEVEL II FEMALE REPRODUCTIVE PROCEDURES

Facility

$3,310.76

Service Code	EAPG 00197
Hospital Charge Code	EAPG 00197
Min. Negotiated Rate	$3,310.76
Max. Negotiated Rate	$3,310.76
Rate for Payer: Healthfirst Commercial	$3,310.76

OUTPATIENT EAPG 00198: LEVEL III FEMALE REPRODUCTIVE PROCEDURES

Facility

$4,079.11

Service Code	EAPG 00198
Hospital Charge Code	EAPG 00198
Min. Negotiated Rate	$4,079.11
Max. Negotiated Rate	$4,079.11
Rate for Payer: Healthfirst Commercial	$4,079.11

OUTPATIENT EAPG 00199: DILATION AND CURETTAGE

Facility

$2,008.63

Service Code	EAPG 00199
Hospital Charge Code	EAPG 00199
Min. Negotiated Rate	$2,008.63
Max. Negotiated Rate	$2,008.63
Rate for Payer: Healthfirst Commercial	$2,008.63

OUTPATIENT EAPG 00200: HYSTEROSCOPY

Facility

$2,846.86

Service Code	EAPG 00200
Hospital Charge Code	EAPG 00200
Min. Negotiated Rate	$2,846.86
Max. Negotiated Rate	$2,846.86
Rate for Payer: Healthfirst Commercial	$2,846.86

OUTPATIENT EAPG 00201: COLPOSCOPY

Facility

$609.34

Service Code	EAPG 00201
Hospital Charge Code	EAPG 00201
Min. Negotiated Rate	$609.34
Max. Negotiated Rate	$609.34
Rate for Payer: Healthfirst Commercial	$609.34

OUTPATIENT EAPG 00205: OBSTETRICAL PROCEDURES

Facility

$2,662.47

Service Code	EAPG 00205
Hospital Charge Code	EAPG 00205
Min. Negotiated Rate	$1,183.32
Max. Negotiated Rate	$2,662.47
Rate for Payer: Affinity Essential Plan 1&2	$2,662.47
Rate for Payer: Affinity Essential Plan 3&4	$2,662.47
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,183.32
Rate for Payer: Amida Care Medicaid	$1,183.32
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,183.32
Rate for Payer: Fidelis Essential Plan Aliesa	$2,662.47
Rate for Payer: Fidelis Essential Plan QHP	$2,662.47
Rate for Payer: Fidelis Qualified Health Plan	$1,242.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,183.32
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,183.32
Rate for Payer: Healthfirst Essential Plan	$2,662.47
Rate for Payer: Healthfirst QHP	$1,183.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,183.32
Rate for Payer: SOMOS Essential	$2,662.47
Rate for Payer: United Healthcare Essential Plan 1&2	$2,662.47
Rate for Payer: United Healthcare Essential Plan 3&4	$1,301.65
Rate for Payer: United Healthcare Medicaid	$1,183.32
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,183.32

OUTPATIENT EAPG 00210: EXTENDED EEG STUDIES

Facility

$832.61

Service Code	EAPG 00210
Hospital Charge Code	EAPG 00210
Min. Negotiated Rate	$370.05
Max. Negotiated Rate	$832.61
Rate for Payer: Affinity Essential Plan 1&2	$832.61
Rate for Payer: Affinity Essential Plan 3&4	$832.61
Rate for Payer: Affinity Medicaid/CHP/HARP	$370.05
Rate for Payer: Amida Care Medicaid	$370.05
Rate for Payer: Fidelis CHP/HARP/Medicaid	$370.05
Rate for Payer: Fidelis Essential Plan Aliesa	$832.61
Rate for Payer: Fidelis Essential Plan QHP	$832.61
Rate for Payer: Fidelis Qualified Health Plan	$388.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$370.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$370.05
Rate for Payer: Healthfirst Commercial	$560.75
Rate for Payer: Healthfirst Essential Plan	$832.61
Rate for Payer: Healthfirst QHP	$370.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$370.05
Rate for Payer: SOMOS Essential	$832.61
Rate for Payer: United Healthcare Essential Plan 1&2	$832.61
Rate for Payer: United Healthcare Essential Plan 3&4	$407.06
Rate for Payer: United Healthcare Medicaid	$370.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$370.05

OUTPATIENT EAPG 00211: ELECTROENCEPHALOGRAM

Facility

$459.86

Service Code	EAPG 00211
Hospital Charge Code	EAPG 00211
Min. Negotiated Rate	$204.38
Max. Negotiated Rate	$459.86
Rate for Payer: Affinity Essential Plan 1&2	$459.86
Rate for Payer: Affinity Essential Plan 3&4	$459.86
Rate for Payer: Affinity Medicaid/CHP/HARP	$204.38
Rate for Payer: Amida Care Medicaid	$204.38
Rate for Payer: Fidelis CHP/HARP/Medicaid	$204.38
Rate for Payer: Fidelis Essential Plan Aliesa	$459.86
Rate for Payer: Fidelis Essential Plan QHP	$459.86
Rate for Payer: Fidelis Qualified Health Plan	$214.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$204.38
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$204.38
Rate for Payer: Healthfirst Commercial	$309.70
Rate for Payer: Healthfirst Essential Plan	$459.86
Rate for Payer: Healthfirst QHP	$204.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$204.38
Rate for Payer: SOMOS Essential	$459.86
Rate for Payer: United Healthcare Essential Plan 1&2	$459.86
Rate for Payer: United Healthcare Essential Plan 3&4	$224.82
Rate for Payer: United Healthcare Medicaid	$204.38
Rate for Payer: Wellcare CHP/FHP/Medicaid	$204.38

OUTPATIENT EAPG 00212: ELECTROCONVULSIVE THERAPY

Facility

$993.51

Service Code	EAPG 00212
Hospital Charge Code	EAPG 00212
Min. Negotiated Rate	$441.56
Max. Negotiated Rate	$993.51
Rate for Payer: Affinity Essential Plan 1&2	$993.51
Rate for Payer: Affinity Essential Plan 3&4	$993.51
Rate for Payer: Affinity Medicaid/CHP/HARP	$441.56
Rate for Payer: Amida Care Medicaid	$441.56
Rate for Payer: Fidelis CHP/HARP/Medicaid	$441.56
Rate for Payer: Fidelis Essential Plan Aliesa	$993.51
Rate for Payer: Fidelis Essential Plan QHP	$993.51
Rate for Payer: Fidelis Qualified Health Plan	$463.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$441.56
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$441.56
Rate for Payer: Healthfirst Commercial	$669.12
Rate for Payer: Healthfirst Essential Plan	$993.51
Rate for Payer: Healthfirst QHP	$441.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$441.56
Rate for Payer: SOMOS Essential	$993.51
Rate for Payer: United Healthcare Essential Plan 1&2	$993.51
Rate for Payer: United Healthcare Essential Plan 3&4	$485.72
Rate for Payer: United Healthcare Medicaid	$441.56
Rate for Payer: Wellcare CHP/FHP/Medicaid	$441.56

OUTPATIENT EAPG 00213: NERVE AND MUSCLE TESTS

Facility

$353.95

Service Code	EAPG 00213
Hospital Charge Code	EAPG 00213
Min. Negotiated Rate	$157.31
Max. Negotiated Rate	$353.95
Rate for Payer: Affinity Essential Plan 1&2	$353.95
Rate for Payer: Affinity Essential Plan 3&4	$353.95
Rate for Payer: Affinity Medicaid/CHP/HARP	$157.31
Rate for Payer: Amida Care Medicaid	$157.31
Rate for Payer: Fidelis CHP/HARP/Medicaid	$157.31
Rate for Payer: Fidelis Essential Plan Aliesa	$353.95
Rate for Payer: Fidelis Essential Plan QHP	$353.95
Rate for Payer: Fidelis Qualified Health Plan	$165.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.31
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$157.31
Rate for Payer: Healthfirst Commercial	$238.37
Rate for Payer: Healthfirst Essential Plan	$353.95
Rate for Payer: Healthfirst QHP	$157.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$157.31
Rate for Payer: SOMOS Essential	$353.95
Rate for Payer: United Healthcare Essential Plan 1&2	$353.95
Rate for Payer: United Healthcare Essential Plan 3&4	$173.04
Rate for Payer: United Healthcare Medicaid	$157.31
Rate for Payer: Wellcare CHP/FHP/Medicaid	$157.31

OUTPATIENT EAPG 00214: LEVEL I NERVOUS SYSTEM INJECTIONS INCLUDING CRANIAL TAP

Facility

$1,196.37

Service Code	EAPG 00214
Hospital Charge Code	EAPG 00214
Min. Negotiated Rate	$531.72
Max. Negotiated Rate	$1,196.37
Rate for Payer: Affinity Essential Plan 1&2	$1,196.37
Rate for Payer: Affinity Essential Plan 3&4	$1,196.37
Rate for Payer: Affinity Medicaid/CHP/HARP	$531.72
Rate for Payer: Amida Care Medicaid	$531.72
Rate for Payer: Fidelis CHP/HARP/Medicaid	$531.72
Rate for Payer: Fidelis Essential Plan Aliesa	$1,196.37
Rate for Payer: Fidelis Essential Plan QHP	$1,196.37
Rate for Payer: Fidelis Qualified Health Plan	$558.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$531.72
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$531.72
Rate for Payer: Healthfirst Commercial	$805.73
Rate for Payer: Healthfirst Essential Plan	$1,196.37
Rate for Payer: Healthfirst QHP	$531.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$531.72
Rate for Payer: SOMOS Essential	$1,196.37
Rate for Payer: United Healthcare Essential Plan 1&2	$1,196.37
Rate for Payer: United Healthcare Essential Plan 3&4	$584.89
Rate for Payer: United Healthcare Medicaid	$531.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$531.72

OUTPATIENT EAPG 00217: LEVEL I NERVE PROCEDURE W OR W/O NEUROLOGICAL DEVICE

Facility

$3,428.03

Service Code	EAPG 00217
Hospital Charge Code	EAPG 00217
Min. Negotiated Rate	$1,523.57
Max. Negotiated Rate	$3,428.03
Rate for Payer: Affinity Essential Plan 1&2	$3,428.03
Rate for Payer: Affinity Essential Plan 3&4	$3,428.03
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,523.57
Rate for Payer: Amida Care Medicaid	$1,523.57
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,523.57
Rate for Payer: Fidelis Essential Plan Aliesa	$3,428.03
Rate for Payer: Fidelis Essential Plan QHP	$3,428.03
Rate for Payer: Fidelis Qualified Health Plan	$1,599.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,523.57
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,523.57
Rate for Payer: Healthfirst Commercial	$2,308.72
Rate for Payer: Healthfirst Essential Plan	$3,428.03
Rate for Payer: Healthfirst QHP	$1,523.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,523.57
Rate for Payer: SOMOS Essential	$3,428.03
Rate for Payer: United Healthcare Essential Plan 1&2	$3,428.03
Rate for Payer: United Healthcare Essential Plan 3&4	$1,675.93
Rate for Payer: United Healthcare Medicaid	$1,523.57
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,523.57

OUTPATIENT EAPG 00218: LEVEL II NERVE PROCEDURE W OR W/O NEUROLOGICAL DEVICE

Facility

$9,155.50

Service Code	EAPG 00218
Hospital Charge Code	EAPG 00218
Min. Negotiated Rate	$4,069.11
Max. Negotiated Rate	$9,155.50
Rate for Payer: Affinity Essential Plan 1&2	$9,155.50
Rate for Payer: Affinity Essential Plan 3&4	$9,155.50
Rate for Payer: Affinity Medicaid/CHP/HARP	$4,069.11
Rate for Payer: Amida Care Medicaid	$4,069.11
Rate for Payer: Fidelis CHP/HARP/Medicaid	$4,069.11
Rate for Payer: Fidelis Essential Plan Aliesa	$9,155.50
Rate for Payer: Fidelis Essential Plan QHP	$9,155.50
Rate for Payer: Fidelis Qualified Health Plan	$4,272.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,069.11
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$4,069.11
Rate for Payer: Healthfirst Commercial	$6,166.06
Rate for Payer: Healthfirst Essential Plan	$9,155.50
Rate for Payer: Healthfirst QHP	$4,069.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,069.11
Rate for Payer: SOMOS Essential	$9,155.50
Rate for Payer: United Healthcare Essential Plan 1&2	$9,155.50
Rate for Payer: United Healthcare Essential Plan 3&4	$4,476.02
Rate for Payer: United Healthcare Medicaid	$4,069.11
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4,069.11

OUTPATIENT EAPG 00220: LEVEL II NERVOUS SYSTEM INJECTIONS INCLUDING CRANIAL TAP

Facility

$1,437.10

Service Code	EAPG 00220
Hospital Charge Code	EAPG 00220
Min. Negotiated Rate	$638.71
Max. Negotiated Rate	$1,437.10
Rate for Payer: Affinity Essential Plan 1&2	$1,437.10
Rate for Payer: Affinity Essential Plan 3&4	$1,437.10
Rate for Payer: Affinity Medicaid/CHP/HARP	$638.71
Rate for Payer: Amida Care Medicaid	$638.71
Rate for Payer: Fidelis CHP/HARP/Medicaid	$638.71
Rate for Payer: Fidelis Essential Plan Aliesa	$1,437.10
Rate for Payer: Fidelis Essential Plan QHP	$1,437.10
Rate for Payer: Fidelis Qualified Health Plan	$670.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$638.71
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$638.71
Rate for Payer: Healthfirst Commercial	$967.86
Rate for Payer: Healthfirst Essential Plan	$1,437.10
Rate for Payer: Healthfirst QHP	$638.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$638.71
Rate for Payer: SOMOS Essential	$1,437.10
Rate for Payer: United Healthcare Essential Plan 1&2	$1,437.10
Rate for Payer: United Healthcare Essential Plan 3&4	$702.58
Rate for Payer: United Healthcare Medicaid	$638.71
Rate for Payer: Wellcare CHP/FHP/Medicaid	$638.71

OUTPATIENT EAPG 00222: SLEEP STUDIES

Facility

$2,214.90

Service Code	EAPG 00222
Hospital Charge Code	EAPG 00222
Min. Negotiated Rate	$984.40
Max. Negotiated Rate	$2,214.90
Rate for Payer: Affinity Essential Plan 1&2	$2,214.90
Rate for Payer: Affinity Essential Plan 3&4	$2,214.90
Rate for Payer: Affinity Medicaid/CHP/HARP	$984.40
Rate for Payer: Amida Care Medicaid	$984.40
Rate for Payer: Fidelis CHP/HARP/Medicaid	$984.40
Rate for Payer: Fidelis Essential Plan Aliesa	$2,214.90
Rate for Payer: Fidelis Essential Plan QHP	$2,214.90
Rate for Payer: Fidelis Qualified Health Plan	$1,033.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$984.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$984.40
Rate for Payer: Healthfirst Commercial	$1,491.69
Rate for Payer: Healthfirst Essential Plan	$2,214.90
Rate for Payer: Healthfirst QHP	$984.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$984.40
Rate for Payer: SOMOS Essential	$2,214.90
Rate for Payer: United Healthcare Essential Plan 1&2	$2,214.90
Rate for Payer: United Healthcare Essential Plan 3&4	$1,082.84
Rate for Payer: United Healthcare Medicaid	$984.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$984.40

OUTPATIENT EAPG 00223: LEVEL III NERVE PROCEDURE W OR W/O NEUROLOGICAL DEVICE

Facility

$36,648.40

Service Code	EAPG 00223
Hospital Charge Code	EAPG 00223
Min. Negotiated Rate	$16,288.18
Max. Negotiated Rate	$36,648.40
Rate for Payer: Affinity Essential Plan 1&2	$36,648.40
Rate for Payer: Affinity Essential Plan 3&4	$36,648.40
Rate for Payer: Affinity Medicaid/CHP/HARP	$16,288.18
Rate for Payer: Amida Care Medicaid	$16,288.18
Rate for Payer: Fidelis CHP/HARP/Medicaid	$16,288.18
Rate for Payer: Fidelis Essential Plan Aliesa	$36,648.40
Rate for Payer: Fidelis Essential Plan QHP	$36,648.40
Rate for Payer: Fidelis Qualified Health Plan	$17,102.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$16,288.18
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16,288.18
Rate for Payer: Healthfirst Commercial	$24,682.08
Rate for Payer: Healthfirst Essential Plan	$36,648.40
Rate for Payer: Healthfirst QHP	$16,288.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$16,288.18
Rate for Payer: SOMOS Essential	$36,648.40
Rate for Payer: United Healthcare Essential Plan 1&2	$36,648.40
Rate for Payer: United Healthcare Essential Plan 3&4	$17,917.00
Rate for Payer: United Healthcare Medicaid	$16,288.18
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,288.18

OUTPATIENT EAPG 00224: LEVEL IV NERVE PROCEDURE W OR W/O NEUROLOGICAL DEVICE

Facility

$48,817.06

Service Code	EAPG 00224
Hospital Charge Code	EAPG 00224
Min. Negotiated Rate	$21,696.47
Max. Negotiated Rate	$48,817.06
Rate for Payer: Affinity Essential Plan 1&2	$48,817.06
Rate for Payer: Affinity Essential Plan 3&4	$48,817.06
Rate for Payer: Affinity Medicaid/CHP/HARP	$21,696.47
Rate for Payer: Amida Care Medicaid	$21,696.47
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,696.47
Rate for Payer: Fidelis Essential Plan Aliesa	$48,817.06
Rate for Payer: Fidelis Essential Plan QHP	$48,817.06
Rate for Payer: Fidelis Qualified Health Plan	$22,781.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,696.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,696.47
Rate for Payer: Healthfirst Commercial	$24,682.08
Rate for Payer: Healthfirst Essential Plan	$48,817.06
Rate for Payer: Healthfirst QHP	$21,696.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,696.47
Rate for Payer: SOMOS Essential	$48,817.06
Rate for Payer: United Healthcare Essential Plan 1&2	$48,817.06
Rate for Payer: United Healthcare Essential Plan 3&4	$23,866.12
Rate for Payer: United Healthcare Medicaid	$21,696.47
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,696.47

OUTPATIENT EAPG 00230: OPHTHALMOLOGICAL TESTS AND PROCEDURES

Facility

$506.77

Service Code	EAPG 00230
Hospital Charge Code	EAPG 00230
Min. Negotiated Rate	$225.23
Max. Negotiated Rate	$506.77
Rate for Payer: Affinity Essential Plan 1&2	$506.77
Rate for Payer: Affinity Essential Plan 3&4	$506.77
Rate for Payer: Affinity Medicaid/CHP/HARP	$225.23
Rate for Payer: Amida Care Medicaid	$225.23
Rate for Payer: Fidelis CHP/HARP/Medicaid	$225.23
Rate for Payer: Fidelis Essential Plan Aliesa	$506.77
Rate for Payer: Fidelis Essential Plan QHP	$506.77
Rate for Payer: Fidelis Qualified Health Plan	$236.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$225.23
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$225.23
Rate for Payer: Healthfirst Commercial	$341.31
Rate for Payer: Healthfirst Essential Plan	$506.77
Rate for Payer: Healthfirst QHP	$225.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$225.23
Rate for Payer: SOMOS Essential	$506.77
Rate for Payer: United Healthcare Essential Plan 1&2	$506.77
Rate for Payer: United Healthcare Essential Plan 3&4	$247.75
Rate for Payer: United Healthcare Medicaid	$225.23
Rate for Payer: Wellcare CHP/FHP/Medicaid	$225.23

OUTPATIENT EAPG 00232: LASER EYE PROCEDURES

Facility

$1,396.87

Service Code	EAPG 00232
Hospital Charge Code	EAPG 00232
Min. Negotiated Rate	$620.83
Max. Negotiated Rate	$1,396.87
Rate for Payer: Affinity Essential Plan 1&2	$1,396.87
Rate for Payer: Affinity Essential Plan 3&4	$1,396.87
Rate for Payer: Affinity Medicaid/CHP/HARP	$620.83
Rate for Payer: Amida Care Medicaid	$620.83
Rate for Payer: Fidelis CHP/HARP/Medicaid	$620.83
Rate for Payer: Fidelis Essential Plan Aliesa	$1,396.87
Rate for Payer: Fidelis Essential Plan QHP	$1,396.87
Rate for Payer: Fidelis Qualified Health Plan	$651.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$620.83
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$620.83
Rate for Payer: Healthfirst Commercial	$940.77
Rate for Payer: Healthfirst Essential Plan	$1,396.87
Rate for Payer: Healthfirst QHP	$620.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$620.83
Rate for Payer: SOMOS Essential	$1,396.87
Rate for Payer: United Healthcare Essential Plan 1&2	$1,396.87
Rate for Payer: United Healthcare Essential Plan 3&4	$682.91
Rate for Payer: United Healthcare Medicaid	$620.83
Rate for Payer: Wellcare CHP/FHP/Medicaid	$620.83

OUTPATIENT EAPG 00233: CATARACT PROCEDURES

Facility

$5,264.75

Service Code	EAPG 00233
Hospital Charge Code	EAPG 00233
Min. Negotiated Rate	$2,339.89
Max. Negotiated Rate	$5,264.75
Rate for Payer: Affinity Essential Plan 1&2	$5,264.75
Rate for Payer: Affinity Essential Plan 3&4	$5,264.75
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,339.89
Rate for Payer: Amida Care Medicaid	$2,339.89
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2,339.89
Rate for Payer: Fidelis Essential Plan Aliesa	$5,264.75
Rate for Payer: Fidelis Essential Plan QHP	$5,264.75
Rate for Payer: Fidelis Qualified Health Plan	$2,456.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,339.89
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,339.89
Rate for Payer: Healthfirst Commercial	$3,545.72
Rate for Payer: Healthfirst Essential Plan	$5,264.75
Rate for Payer: Healthfirst QHP	$2,339.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,339.89
Rate for Payer: SOMOS Essential	$5,264.75
Rate for Payer: United Healthcare Essential Plan 1&2	$5,264.75
Rate for Payer: United Healthcare Essential Plan 3&4	$2,573.88
Rate for Payer: United Healthcare Medicaid	$2,339.89
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,339.89

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