St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

OUTPATIENT EAPG 00280: LEVEL II VASCULAR RADIOLOGICAL PROCEDURES

Facility

$2,391.75

Service Code	EAPG 00280
Hospital Charge Code	EAPG 00280
Min. Negotiated Rate	$1,063.00
Max. Negotiated Rate	$2,391.75
Rate for Payer: Affinity Essential Plan 1&2	$2,391.75
Rate for Payer: Affinity Essential Plan 3&4	$2,391.75
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,063.00
Rate for Payer: Amida Care Medicaid	$1,063.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,063.00
Rate for Payer: Fidelis Essential Plan Aliesa	$2,391.75
Rate for Payer: Fidelis Essential Plan QHP	$2,391.75
Rate for Payer: Fidelis Qualified Health Plan	$1,116.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,063.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,063.00
Rate for Payer: Healthfirst Commercial	$1,610.81
Rate for Payer: Healthfirst Essential Plan	$2,391.75
Rate for Payer: Healthfirst QHP	$1,063.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,063.00
Rate for Payer: SOMOS Essential	$2,391.75
Rate for Payer: United Healthcare Essential Plan 1&2	$2,391.75
Rate for Payer: United Healthcare Essential Plan 3&4	$1,169.30
Rate for Payer: United Healthcare Medicaid	$1,063.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,063.00

OUTPATIENT EAPG 00282: MAGNETIC RESONANCE ANGIOGRAPHY

Facility

$1,443.76

Service Code	EAPG 00282
Hospital Charge Code	EAPG 00282
Min. Negotiated Rate	$641.67
Max. Negotiated Rate	$1,443.76
Rate for Payer: Affinity Essential Plan 1&2	$1,443.76
Rate for Payer: Affinity Essential Plan 3&4	$1,443.76
Rate for Payer: Affinity Medicaid/CHP/HARP	$641.67
Rate for Payer: Amida Care Medicaid	$641.67
Rate for Payer: Fidelis CHP/HARP/Medicaid	$641.67
Rate for Payer: Fidelis Essential Plan Aliesa	$1,443.76
Rate for Payer: Fidelis Essential Plan QHP	$1,443.76
Rate for Payer: Fidelis Qualified Health Plan	$673.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$641.67
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$641.67
Rate for Payer: Healthfirst Commercial	$972.34
Rate for Payer: Healthfirst Essential Plan	$1,443.76
Rate for Payer: Healthfirst QHP	$641.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$641.67
Rate for Payer: SOMOS Essential	$1,443.76
Rate for Payer: United Healthcare Essential Plan 1&2	$1,443.76
Rate for Payer: United Healthcare Essential Plan 3&4	$705.84
Rate for Payer: United Healthcare Medicaid	$641.67
Rate for Payer: Wellcare CHP/FHP/Medicaid	$641.67

OUTPATIENT EAPG 00284: MYELOGRAPHY

Facility

$1,539.65

Service Code	EAPG 00284
Hospital Charge Code	EAPG 00284
Min. Negotiated Rate	$684.29
Max. Negotiated Rate	$1,539.65
Rate for Payer: Affinity Essential Plan 1&2	$1,539.65
Rate for Payer: Affinity Essential Plan 3&4	$1,539.65
Rate for Payer: Affinity Medicaid/CHP/HARP	$684.29
Rate for Payer: Amida Care Medicaid	$684.29
Rate for Payer: Fidelis CHP/HARP/Medicaid	$684.29
Rate for Payer: Fidelis Essential Plan Aliesa	$1,539.65
Rate for Payer: Fidelis Essential Plan QHP	$1,539.65
Rate for Payer: Fidelis Qualified Health Plan	$718.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$684.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$684.29
Rate for Payer: Healthfirst Commercial	$1,036.94
Rate for Payer: Healthfirst Essential Plan	$1,539.65
Rate for Payer: Healthfirst QHP	$684.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$684.29
Rate for Payer: SOMOS Essential	$1,539.65
Rate for Payer: United Healthcare Essential Plan 1&2	$1,539.65
Rate for Payer: United Healthcare Essential Plan 3&4	$752.72
Rate for Payer: United Healthcare Medicaid	$684.29
Rate for Payer: Wellcare CHP/FHP/Medicaid	$684.29

OUTPATIENT EAPG 00286: MAMMOGRAPHY & OTHER RELATED PROCEDURES

Facility

$316.58

Service Code	EAPG 00286
Hospital Charge Code	EAPG 00286
Min. Negotiated Rate	$140.70
Max. Negotiated Rate	$316.58
Rate for Payer: Affinity Essential Plan 1&2	$316.58
Rate for Payer: Affinity Essential Plan 3&4	$316.58
Rate for Payer: Affinity Medicaid/CHP/HARP	$140.70
Rate for Payer: Amida Care Medicaid	$140.70
Rate for Payer: Fidelis CHP/HARP/Medicaid	$140.70
Rate for Payer: Fidelis Essential Plan Aliesa	$316.58
Rate for Payer: Fidelis Essential Plan QHP	$316.58
Rate for Payer: Fidelis Qualified Health Plan	$147.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$140.70
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$140.70
Rate for Payer: Healthfirst Commercial	$213.22
Rate for Payer: Healthfirst Essential Plan	$316.58
Rate for Payer: Healthfirst QHP	$140.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$140.70
Rate for Payer: SOMOS Essential	$316.58
Rate for Payer: United Healthcare Essential Plan 1&2	$316.58
Rate for Payer: United Healthcare Essential Plan 3&4	$154.77
Rate for Payer: United Healthcare Medicaid	$140.70
Rate for Payer: Wellcare CHP/FHP/Medicaid	$140.70

OUTPATIENT EAPG 00288: LEVEL I DIAGNOSTIC ULTRASOUND

Facility

$381.06

Service Code	EAPG 00288
Hospital Charge Code	EAPG 00288
Min. Negotiated Rate	$169.36
Max. Negotiated Rate	$381.06
Rate for Payer: Affinity Essential Plan 1&2	$381.06
Rate for Payer: Affinity Essential Plan 3&4	$381.06
Rate for Payer: Affinity Medicaid/CHP/HARP	$169.36
Rate for Payer: Amida Care Medicaid	$169.36
Rate for Payer: Fidelis CHP/HARP/Medicaid	$169.36
Rate for Payer: Fidelis Essential Plan Aliesa	$381.06
Rate for Payer: Fidelis Essential Plan QHP	$381.06
Rate for Payer: Fidelis Qualified Health Plan	$177.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.36
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$169.36
Rate for Payer: Healthfirst Commercial	$256.64
Rate for Payer: Healthfirst Essential Plan	$381.06
Rate for Payer: Healthfirst QHP	$169.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$169.36
Rate for Payer: SOMOS Essential	$381.06
Rate for Payer: United Healthcare Essential Plan 1&2	$381.06
Rate for Payer: United Healthcare Essential Plan 3&4	$186.30
Rate for Payer: United Healthcare Medicaid	$169.36
Rate for Payer: Wellcare CHP/FHP/Medicaid	$169.36

OUTPATIENT EAPG 00289: LEVEL II DIAGNOSTIC ULTRASOUND

Facility

$1,652.96

Service Code	EAPG 00289
Hospital Charge Code	EAPG 00289
Min. Negotiated Rate	$734.65
Max. Negotiated Rate	$1,652.96
Rate for Payer: Affinity Essential Plan 1&2	$1,652.96
Rate for Payer: Affinity Essential Plan 3&4	$1,652.96
Rate for Payer: Affinity Medicaid/CHP/HARP	$734.65
Rate for Payer: Amida Care Medicaid	$734.65
Rate for Payer: Fidelis CHP/HARP/Medicaid	$734.65
Rate for Payer: Fidelis Essential Plan Aliesa	$1,652.96
Rate for Payer: Fidelis Essential Plan QHP	$1,652.96
Rate for Payer: Fidelis Qualified Health Plan	$771.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$734.65
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$734.65
Rate for Payer: Healthfirst Commercial	$1,113.24
Rate for Payer: Healthfirst Essential Plan	$1,652.96
Rate for Payer: Healthfirst QHP	$734.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$734.65
Rate for Payer: SOMOS Essential	$1,652.96
Rate for Payer: United Healthcare Essential Plan 1&2	$1,652.96
Rate for Payer: United Healthcare Essential Plan 3&4	$808.12
Rate for Payer: United Healthcare Medicaid	$734.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$734.65

OUTPATIENT EAPG 00290: PET SCANS

Facility

$3,927.67

Service Code	EAPG 00290
Hospital Charge Code	EAPG 00290
Min. Negotiated Rate	$1,745.63
Max. Negotiated Rate	$3,927.67
Rate for Payer: Affinity Essential Plan 1&2	$3,927.67
Rate for Payer: Affinity Essential Plan 3&4	$3,927.67
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,745.63
Rate for Payer: Amida Care Medicaid	$1,745.63
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,745.63
Rate for Payer: Fidelis Essential Plan Aliesa	$3,927.67
Rate for Payer: Fidelis Essential Plan QHP	$3,927.67
Rate for Payer: Fidelis Qualified Health Plan	$1,832.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,745.63
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,745.63
Rate for Payer: Healthfirst Commercial	$2,645.23
Rate for Payer: Healthfirst Essential Plan	$3,927.67
Rate for Payer: Healthfirst QHP	$1,745.63
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,745.63
Rate for Payer: SOMOS Essential	$3,927.67
Rate for Payer: United Healthcare Essential Plan 1&2	$3,927.67
Rate for Payer: United Healthcare Essential Plan 3&4	$1,920.19
Rate for Payer: United Healthcare Medicaid	$1,745.63
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,745.63

OUTPATIENT EAPG 00291: BONE DENSITOMETRY

Facility

$425.38

Service Code	EAPG 00291
Hospital Charge Code	EAPG 00291
Min. Negotiated Rate	$189.06
Max. Negotiated Rate	$425.38
Rate for Payer: Affinity Essential Plan 1&2	$425.38
Rate for Payer: Affinity Essential Plan 3&4	$425.38
Rate for Payer: Affinity Medicaid/CHP/HARP	$189.06
Rate for Payer: Amida Care Medicaid	$189.06
Rate for Payer: Fidelis CHP/HARP/Medicaid	$189.06
Rate for Payer: Fidelis Essential Plan Aliesa	$425.38
Rate for Payer: Fidelis Essential Plan QHP	$425.38
Rate for Payer: Fidelis Qualified Health Plan	$198.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$189.06
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$189.06
Rate for Payer: Healthfirst Commercial	$286.49
Rate for Payer: Healthfirst Essential Plan	$425.38
Rate for Payer: Healthfirst QHP	$189.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$189.06
Rate for Payer: SOMOS Essential	$425.38
Rate for Payer: United Healthcare Essential Plan 1&2	$425.38
Rate for Payer: United Healthcare Essential Plan 3&4	$207.97
Rate for Payer: United Healthcare Medicaid	$189.06
Rate for Payer: Wellcare CHP/FHP/Medicaid	$189.06

OUTPATIENT EAPG 00293: MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST

Facility

$1,127.43

Service Code	EAPG 00293
Hospital Charge Code	EAPG 00293
Min. Negotiated Rate	$501.08
Max. Negotiated Rate	$1,127.43
Rate for Payer: Affinity Essential Plan 1&2	$1,127.43
Rate for Payer: Affinity Essential Plan 3&4	$1,127.43
Rate for Payer: Affinity Medicaid/CHP/HARP	$501.08
Rate for Payer: Amida Care Medicaid	$501.08
Rate for Payer: Fidelis CHP/HARP/Medicaid	$501.08
Rate for Payer: Fidelis Essential Plan Aliesa	$1,127.43
Rate for Payer: Fidelis Essential Plan QHP	$1,127.43
Rate for Payer: Fidelis Qualified Health Plan	$526.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$501.08
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$501.08
Rate for Payer: Healthfirst Commercial	$759.30
Rate for Payer: Healthfirst Essential Plan	$1,127.43
Rate for Payer: Healthfirst QHP	$501.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$501.08
Rate for Payer: SOMOS Essential	$1,127.43
Rate for Payer: United Healthcare Essential Plan 1&2	$1,127.43
Rate for Payer: United Healthcare Essential Plan 3&4	$551.19
Rate for Payer: United Healthcare Medicaid	$501.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$501.08

OUTPATIENT EAPG 00295: MAGNETIC RESONANCE IMAGING WITH CONTRAST

Facility

$1,700.44

Service Code	EAPG 00295
Hospital Charge Code	EAPG 00295
Min. Negotiated Rate	$755.75
Max. Negotiated Rate	$1,700.44
Rate for Payer: Affinity Essential Plan 1&2	$1,700.44
Rate for Payer: Affinity Essential Plan 3&4	$1,700.44
Rate for Payer: Affinity Medicaid/CHP/HARP	$755.75
Rate for Payer: Amida Care Medicaid	$755.75
Rate for Payer: Fidelis CHP/HARP/Medicaid	$755.75
Rate for Payer: Fidelis Essential Plan Aliesa	$1,700.44
Rate for Payer: Fidelis Essential Plan QHP	$1,700.44
Rate for Payer: Fidelis Qualified Health Plan	$793.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$755.75
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$755.75
Rate for Payer: Healthfirst Commercial	$1,145.21
Rate for Payer: Healthfirst Essential Plan	$1,700.44
Rate for Payer: Healthfirst QHP	$755.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$755.75
Rate for Payer: SOMOS Essential	$1,700.44
Rate for Payer: United Healthcare Essential Plan 1&2	$1,700.44
Rate for Payer: United Healthcare Essential Plan 3&4	$831.32
Rate for Payer: United Healthcare Medicaid	$755.75
Rate for Payer: Wellcare CHP/FHP/Medicaid	$755.75

OUTPATIENT EAPG 00297: MAGNETOCEPHALOGRAPHY/CARDIOGRAPHY MCG

Facility

$1,529.86

Service Code	EAPG 00297
Hospital Charge Code	EAPG 00297
Min. Negotiated Rate	$679.94
Max. Negotiated Rate	$1,529.86
Rate for Payer: Affinity Essential Plan 1&2	$1,529.86
Rate for Payer: Affinity Essential Plan 3&4	$1,529.86
Rate for Payer: Affinity Medicaid/CHP/HARP	$679.94
Rate for Payer: Amida Care Medicaid	$679.94
Rate for Payer: Fidelis CHP/HARP/Medicaid	$679.94
Rate for Payer: Fidelis Essential Plan Aliesa	$1,529.86
Rate for Payer: Fidelis Essential Plan QHP	$1,529.86
Rate for Payer: Fidelis Qualified Health Plan	$713.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$679.94
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$679.94
Rate for Payer: Healthfirst Commercial	$1,030.34
Rate for Payer: Healthfirst Essential Plan	$1,529.86
Rate for Payer: Healthfirst QHP	$679.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$679.94
Rate for Payer: SOMOS Essential	$1,529.86
Rate for Payer: United Healthcare Essential Plan 1&2	$1,529.86
Rate for Payer: United Healthcare Essential Plan 3&4	$747.93
Rate for Payer: United Healthcare Medicaid	$679.94
Rate for Payer: Wellcare CHP/FHP/Medicaid	$679.94

OUTPATIENT EAPG 00299: LEVEL I COMPUTED TOMOGRAPHY

Facility

$770.38

Service Code	EAPG 00299
Hospital Charge Code	EAPG 00299
Min. Negotiated Rate	$342.39
Max. Negotiated Rate	$770.38
Rate for Payer: Affinity Essential Plan 1&2	$770.38
Rate for Payer: Affinity Essential Plan 3&4	$770.38
Rate for Payer: Affinity Medicaid/CHP/HARP	$342.39
Rate for Payer: Amida Care Medicaid	$342.39
Rate for Payer: Fidelis CHP/HARP/Medicaid	$342.39
Rate for Payer: Fidelis Essential Plan Aliesa	$770.38
Rate for Payer: Fidelis Essential Plan QHP	$770.38
Rate for Payer: Fidelis Qualified Health Plan	$359.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$342.39
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$342.39
Rate for Payer: Healthfirst Commercial	$518.83
Rate for Payer: Healthfirst Essential Plan	$770.38
Rate for Payer: Healthfirst QHP	$342.39
Rate for Payer: SOMOS CHP/HARP/Medicaid	$342.39
Rate for Payer: SOMOS Essential	$770.38
Rate for Payer: United Healthcare Essential Plan 1&2	$770.38
Rate for Payer: United Healthcare Essential Plan 3&4	$376.63
Rate for Payer: United Healthcare Medicaid	$342.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$342.39

OUTPATIENT EAPG 00300: LEVEL II COMPUTED TOMOGRAPHY

Facility

$920.68

Service Code	EAPG 00300
Hospital Charge Code	EAPG 00300
Min. Negotiated Rate	$409.19
Max. Negotiated Rate	$920.68
Rate for Payer: Affinity Essential Plan 1&2	$920.68
Rate for Payer: Affinity Essential Plan 3&4	$920.68
Rate for Payer: Affinity Medicaid/CHP/HARP	$409.19
Rate for Payer: Amida Care Medicaid	$409.19
Rate for Payer: Fidelis CHP/HARP/Medicaid	$409.19
Rate for Payer: Fidelis Essential Plan Aliesa	$920.68
Rate for Payer: Fidelis Essential Plan QHP	$920.68
Rate for Payer: Fidelis Qualified Health Plan	$429.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$409.19
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$409.19
Rate for Payer: Healthfirst Commercial	$620.07
Rate for Payer: Healthfirst Essential Plan	$920.68
Rate for Payer: Healthfirst QHP	$409.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$409.19
Rate for Payer: SOMOS Essential	$920.68
Rate for Payer: United Healthcare Essential Plan 1&2	$920.68
Rate for Payer: United Healthcare Essential Plan 3&4	$450.11
Rate for Payer: United Healthcare Medicaid	$409.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$409.19

OUTPATIENT EAPG 00301: COMPUTED TOMOGRAPHY- OTHER

Facility

$692.19

Service Code	EAPG 00301
Hospital Charge Code	EAPG 00301
Min. Negotiated Rate	$307.64
Max. Negotiated Rate	$692.19
Rate for Payer: Affinity Essential Plan 1&2	$692.19
Rate for Payer: Affinity Essential Plan 3&4	$692.19
Rate for Payer: Affinity Medicaid/CHP/HARP	$307.64
Rate for Payer: Amida Care Medicaid	$307.64
Rate for Payer: Fidelis CHP/HARP/Medicaid	$307.64
Rate for Payer: Fidelis Essential Plan Aliesa	$692.19
Rate for Payer: Fidelis Essential Plan QHP	$692.19
Rate for Payer: Fidelis Qualified Health Plan	$323.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$307.64
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$307.64
Rate for Payer: Healthfirst Commercial	$466.18
Rate for Payer: Healthfirst Essential Plan	$692.19
Rate for Payer: Healthfirst QHP	$307.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$307.64
Rate for Payer: SOMOS Essential	$692.19
Rate for Payer: United Healthcare Essential Plan 1&2	$692.19
Rate for Payer: United Healthcare Essential Plan 3&4	$338.40
Rate for Payer: United Healthcare Medicaid	$307.64
Rate for Payer: Wellcare CHP/FHP/Medicaid	$307.64

OUTPATIENT EAPG 00302: COMPUTED TOMOGRAPHIC ANGIOGRAPHY

Facility

$976.86

Service Code	EAPG 00302
Hospital Charge Code	EAPG 00302
Min. Negotiated Rate	$434.16
Max. Negotiated Rate	$976.86
Rate for Payer: Affinity Essential Plan 1&2	$976.86
Rate for Payer: Affinity Essential Plan 3&4	$976.86
Rate for Payer: Affinity Medicaid/CHP/HARP	$434.16
Rate for Payer: Amida Care Medicaid	$434.16
Rate for Payer: Fidelis CHP/HARP/Medicaid	$434.16
Rate for Payer: Fidelis Essential Plan Aliesa	$976.86
Rate for Payer: Fidelis Essential Plan QHP	$976.86
Rate for Payer: Fidelis Qualified Health Plan	$455.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$434.16
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$434.16
Rate for Payer: Healthfirst Commercial	$657.90
Rate for Payer: Healthfirst Essential Plan	$976.86
Rate for Payer: Healthfirst QHP	$434.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$434.16
Rate for Payer: SOMOS Essential	$976.86
Rate for Payer: United Healthcare Essential Plan 1&2	$976.86
Rate for Payer: United Healthcare Essential Plan 3&4	$477.58
Rate for Payer: United Healthcare Medicaid	$434.16
Rate for Payer: Wellcare CHP/FHP/Medicaid	$434.16

OUTPATIENT EAPG 00308: LEVEL III PATHOLOGY TESTS

Facility

$220.32

Service Code	EAPG 00308
Hospital Charge Code	EAPG 00308
Min. Negotiated Rate	$97.92
Max. Negotiated Rate	$220.32
Rate for Payer: Affinity Essential Plan 1&2	$220.32
Rate for Payer: Affinity Essential Plan 3&4	$220.32
Rate for Payer: Affinity Medicaid/CHP/HARP	$97.92
Rate for Payer: Amida Care Medicaid	$97.92
Rate for Payer: Fidelis CHP/HARP/Medicaid	$97.92
Rate for Payer: Fidelis Essential Plan Aliesa	$220.32
Rate for Payer: Fidelis Essential Plan QHP	$220.32
Rate for Payer: Fidelis Qualified Health Plan	$102.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$97.92
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$97.92
Rate for Payer: Healthfirst Essential Plan	$220.32
Rate for Payer: Healthfirst QHP	$97.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$97.92
Rate for Payer: SOMOS Essential	$220.32
Rate for Payer: United Healthcare Essential Plan 1&2	$220.32
Rate for Payer: United Healthcare Essential Plan 3&4	$107.71
Rate for Payer: United Healthcare Medicaid	$97.92
Rate for Payer: Wellcare CHP/FHP/Medicaid	$97.92

OUTPATIENT EAPG 00310: DEVELOPMENTAL & NEUROPSYCHOLOGICAL TESTING

Facility

$395.30

Service Code	EAPG 00310
Hospital Charge Code	EAPG 00310
Min. Negotiated Rate	$174.10
Max. Negotiated Rate	$395.30
Rate for Payer: Affinity Essential Plan 1&2	$391.72
Rate for Payer: Affinity Essential Plan 3&4	$391.72
Rate for Payer: Affinity Medicaid/CHP/HARP	$174.10
Rate for Payer: Amida Care Medicaid	$174.10
Rate for Payer: Carelon Behavioral Health HARP/QHP	$175.69
Rate for Payer: Fidelis CHP/HARP/Medicaid	$174.10
Rate for Payer: Fidelis Essential Plan Aliesa	$391.72
Rate for Payer: Fidelis Essential Plan QHP	$391.72
Rate for Payer: Fidelis Qualified Health Plan	$182.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$174.10
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$174.10
Rate for Payer: Healthfirst Commercial	$263.83
Rate for Payer: Healthfirst Essential Plan	$391.72
Rate for Payer: Healthfirst QHP	$174.10
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$175.69
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$395.30
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$395.30
Rate for Payer: Optum Medicaid	$175.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$174.10
Rate for Payer: SOMOS Essential	$391.72
Rate for Payer: United Healthcare Essential Plan 1&2	$391.72
Rate for Payer: United Healthcare Essential Plan 3&4	$191.51
Rate for Payer: United Healthcare Medicaid	$174.10
Rate for Payer: Wellcare CHP/FHP/Medicaid	$174.10

OUTPATIENT EAPG 00315: COUNSELLING OR INDIVIDUAL BRIEF PSYCHOTHERAPY

Facility

$296.48

Service Code	EAPG 00315
Hospital Charge Code	EAPG 00315
Min. Negotiated Rate	$130.58
Max. Negotiated Rate	$296.48
Rate for Payer: Affinity Essential Plan 1&2	$293.80
Rate for Payer: Affinity Essential Plan 3&4	$293.80
Rate for Payer: Affinity Medicaid/CHP/HARP	$130.58
Rate for Payer: Amida Care Medicaid	$130.58
Rate for Payer: Carelon Behavioral Health HARP/QHP	$131.77
Rate for Payer: Fidelis CHP/HARP/Medicaid	$130.58
Rate for Payer: Fidelis Essential Plan Aliesa	$293.80
Rate for Payer: Fidelis Essential Plan QHP	$293.80
Rate for Payer: Fidelis Qualified Health Plan	$137.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$130.58
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$130.58
Rate for Payer: Healthfirst Commercial	$197.87
Rate for Payer: Healthfirst Essential Plan	$293.80
Rate for Payer: Healthfirst QHP	$130.58
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$131.77
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$296.48
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$296.48
Rate for Payer: Optum Medicaid	$131.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$130.58
Rate for Payer: SOMOS Essential	$293.80
Rate for Payer: United Healthcare Essential Plan 1&2	$293.80
Rate for Payer: United Healthcare Essential Plan 3&4	$143.64
Rate for Payer: United Healthcare Medicaid	$130.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$130.58

OUTPATIENT EAPG 00316: INDIVIDUAL COMPREHENSIVE PSYCHOTHERAPY

Facility

$395.30

Service Code	EAPG 00316
Hospital Charge Code	EAPG 00316
Min. Negotiated Rate	$174.10
Max. Negotiated Rate	$395.30
Rate for Payer: Affinity Essential Plan 1&2	$391.72
Rate for Payer: Affinity Essential Plan 3&4	$391.72
Rate for Payer: Affinity Medicaid/CHP/HARP	$174.10
Rate for Payer: Amida Care Medicaid	$174.10
Rate for Payer: Carelon Behavioral Health HARP/QHP	$175.69
Rate for Payer: Fidelis CHP/HARP/Medicaid	$174.10
Rate for Payer: Fidelis Essential Plan Aliesa	$391.72
Rate for Payer: Fidelis Essential Plan QHP	$391.72
Rate for Payer: Fidelis Qualified Health Plan	$182.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$174.10
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$174.10
Rate for Payer: Healthfirst Commercial	$263.83
Rate for Payer: Healthfirst Essential Plan	$391.72
Rate for Payer: Healthfirst QHP	$174.10
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$175.69
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$395.30
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$395.30
Rate for Payer: Optum Medicaid	$175.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$174.10
Rate for Payer: SOMOS Essential	$391.72
Rate for Payer: United Healthcare Essential Plan 1&2	$391.72
Rate for Payer: United Healthcare Essential Plan 3&4	$191.51
Rate for Payer: United Healthcare Medicaid	$174.10
Rate for Payer: Wellcare CHP/FHP/Medicaid	$174.10

OUTPATIENT EAPG 00317: FAMILY PSYCHOTHERAPY

Facility

$296.48

Service Code	EAPG 00317
Hospital Charge Code	EAPG 00317
Min. Negotiated Rate	$130.58
Max. Negotiated Rate	$296.48
Rate for Payer: Affinity Essential Plan 1&2	$293.80
Rate for Payer: Affinity Essential Plan 3&4	$293.80
Rate for Payer: Affinity Medicaid/CHP/HARP	$130.58
Rate for Payer: Amida Care Medicaid	$130.58
Rate for Payer: Carelon Behavioral Health HARP/QHP	$131.77
Rate for Payer: Fidelis CHP/HARP/Medicaid	$130.58
Rate for Payer: Fidelis Essential Plan Aliesa	$293.80
Rate for Payer: Fidelis Essential Plan QHP	$293.80
Rate for Payer: Fidelis Qualified Health Plan	$137.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$130.58
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$130.58
Rate for Payer: Healthfirst Commercial	$197.87
Rate for Payer: Healthfirst Essential Plan	$293.80
Rate for Payer: Healthfirst QHP	$130.58
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$131.77
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$296.48
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$296.48
Rate for Payer: Optum Medicaid	$131.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$130.58
Rate for Payer: SOMOS Essential	$293.80
Rate for Payer: United Healthcare Essential Plan 1&2	$293.80
Rate for Payer: United Healthcare Essential Plan 3&4	$143.64
Rate for Payer: United Healthcare Medicaid	$130.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$130.58

OUTPATIENT EAPG 00318: GROUP PSYCHOTHERAPY

Facility

$153.18

Service Code	EAPG 00318
Hospital Charge Code	EAPG 00318
Min. Negotiated Rate	$67.47
Max. Negotiated Rate	$153.18
Rate for Payer: Affinity Essential Plan 1&2	$151.81
Rate for Payer: Affinity Essential Plan 3&4	$151.81
Rate for Payer: Affinity Medicaid/CHP/HARP	$67.47
Rate for Payer: Amida Care Medicaid	$67.47
Rate for Payer: Carelon Behavioral Health HARP/QHP	$68.08
Rate for Payer: Fidelis CHP/HARP/Medicaid	$67.47
Rate for Payer: Fidelis Essential Plan Aliesa	$151.81
Rate for Payer: Fidelis Essential Plan QHP	$151.81
Rate for Payer: Fidelis Qualified Health Plan	$70.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$67.47
Rate for Payer: Healthfirst Commercial	$102.23
Rate for Payer: Healthfirst Essential Plan	$151.81
Rate for Payer: Healthfirst QHP	$67.47
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$68.08
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$153.18
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$153.18
Rate for Payer: Optum Medicaid	$68.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$67.47
Rate for Payer: SOMOS Essential	$151.81
Rate for Payer: United Healthcare Essential Plan 1&2	$151.81
Rate for Payer: United Healthcare Essential Plan 3&4	$74.22
Rate for Payer: United Healthcare Medicaid	$67.47
Rate for Payer: Wellcare CHP/FHP/Medicaid	$67.47

OUTPATIENT EAPG 00321: CRISIS INTERVENTION

Facility

$395.30

Service Code	EAPG 00321
Hospital Charge Code	EAPG 00321
Min. Negotiated Rate	$174.10
Max. Negotiated Rate	$395.30
Rate for Payer: Affinity Essential Plan 1&2	$391.72
Rate for Payer: Affinity Essential Plan 3&4	$391.72
Rate for Payer: Affinity Medicaid/CHP/HARP	$174.10
Rate for Payer: Amida Care Medicaid	$174.10
Rate for Payer: Carelon Behavioral Health HARP/QHP	$175.69
Rate for Payer: Fidelis CHP/HARP/Medicaid	$174.10
Rate for Payer: Fidelis Essential Plan Aliesa	$391.72
Rate for Payer: Fidelis Essential Plan QHP	$391.72
Rate for Payer: Fidelis Qualified Health Plan	$182.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$174.10
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$174.10
Rate for Payer: Healthfirst Commercial	$263.83
Rate for Payer: Healthfirst Essential Plan	$391.72
Rate for Payer: Healthfirst QHP	$174.10
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$175.69
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$395.30
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$395.30
Rate for Payer: Optum Medicaid	$175.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$174.10
Rate for Payer: SOMOS Essential	$391.72
Rate for Payer: United Healthcare Essential Plan 1&2	$391.72
Rate for Payer: United Healthcare Essential Plan 3&4	$191.51
Rate for Payer: United Healthcare Medicaid	$174.10
Rate for Payer: Wellcare CHP/FHP/Medicaid	$174.10

OUTPATIENT EAPG 00322: MEDICATION ADMINISTRATION & OBSERVATION

Facility

$55.80

Service Code	EAPG 00322
Hospital Charge Code	EAPG 00322
Min. Negotiated Rate	$24.80
Max. Negotiated Rate	$55.80
Rate for Payer: Affinity Essential Plan 1&2	$55.80
Rate for Payer: Affinity Essential Plan 3&4	$55.80
Rate for Payer: Affinity Medicaid/CHP/HARP	$24.80
Rate for Payer: Amida Care Medicaid	$24.80
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24.80
Rate for Payer: Fidelis Essential Plan Aliesa	$55.80
Rate for Payer: Fidelis Essential Plan QHP	$55.80
Rate for Payer: Fidelis Qualified Health Plan	$26.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.80
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24.80
Rate for Payer: Healthfirst Commercial	$42.56
Rate for Payer: Healthfirst Essential Plan	$55.80
Rate for Payer: Healthfirst QHP	$24.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24.80
Rate for Payer: SOMOS Essential	$55.80
Rate for Payer: United Healthcare Essential Plan 1&2	$55.80
Rate for Payer: United Healthcare Essential Plan 3&4	$27.28
Rate for Payer: United Healthcare Medicaid	$24.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24.80

OUTPATIENT EAPG 00323: BEHAVIORAL HEATLH ASSESSMENT

Facility

$494.14

Service Code	EAPG 00323
Hospital Charge Code	EAPG 00323
Min. Negotiated Rate	$217.63
Max. Negotiated Rate	$494.14
Rate for Payer: Affinity Essential Plan 1&2	$489.67
Rate for Payer: Affinity Essential Plan 3&4	$489.67
Rate for Payer: Affinity Medicaid/CHP/HARP	$217.63
Rate for Payer: Amida Care Medicaid	$217.63
Rate for Payer: Carelon Behavioral Health HARP/QHP	$219.62
Rate for Payer: Fidelis CHP/HARP/Medicaid	$217.63
Rate for Payer: Fidelis Essential Plan Aliesa	$489.67
Rate for Payer: Fidelis Essential Plan QHP	$489.67
Rate for Payer: Fidelis Qualified Health Plan	$228.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$217.63
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$217.63
Rate for Payer: Healthfirst Commercial	$329.78
Rate for Payer: Healthfirst Essential Plan	$489.67
Rate for Payer: Healthfirst QHP	$217.63
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$219.62
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$494.14
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$494.14
Rate for Payer: Optum Medicaid	$219.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$217.63
Rate for Payer: SOMOS Essential	$489.67
Rate for Payer: United Healthcare Essential Plan 1&2	$489.67
Rate for Payer: United Healthcare Essential Plan 3&4	$239.39
Rate for Payer: United Healthcare Medicaid	$217.63
Rate for Payer: Wellcare CHP/FHP/Medicaid	$217.63

OUTPATIENT EAPG 00324: BEHAVIORAL HEALTH SCREENING AND BRIEF ASSESSMENT

Facility

$132.68

Service Code	EAPG 00324
Hospital Charge Code	EAPG 00324
Min. Negotiated Rate	$58.97
Max. Negotiated Rate	$132.68
Rate for Payer: Affinity Essential Plan 1&2	$132.68
Rate for Payer: Affinity Essential Plan 3&4	$132.68
Rate for Payer: Affinity Medicaid/CHP/HARP	$58.97
Rate for Payer: Amida Care Medicaid	$58.97
Rate for Payer: Fidelis CHP/HARP/Medicaid	$58.97
Rate for Payer: Fidelis Essential Plan Aliesa	$132.68
Rate for Payer: Fidelis Essential Plan QHP	$132.68
Rate for Payer: Fidelis Qualified Health Plan	$61.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$58.97
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$58.97
Rate for Payer: Healthfirst Commercial	$89.36
Rate for Payer: Healthfirst Essential Plan	$132.68
Rate for Payer: Healthfirst QHP	$58.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$58.97
Rate for Payer: SOMOS Essential	$132.68
Rate for Payer: United Healthcare Essential Plan 1&2	$132.68
Rate for Payer: United Healthcare Essential Plan 3&4	$64.87
Rate for Payer: United Healthcare Medicaid	$58.97
Rate for Payer: Wellcare CHP/FHP/Medicaid	$58.97

Know your out-of-pocket cost for care.

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