St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

OUTPATIENT EAPG 00423: VASCULAR ACCESS BY NEEDLE OR CATHETER

Facility

$491.51

Service Code	EAPG 00423
Hospital Charge Code	EAPG 00423
Min. Negotiated Rate	$218.45
Max. Negotiated Rate	$491.51
Rate for Payer: Affinity Essential Plan 1&2	$491.51
Rate for Payer: Affinity Essential Plan 3&4	$491.51
Rate for Payer: Affinity Medicaid/CHP/HARP	$218.45
Rate for Payer: Amida Care Medicaid	$218.45
Rate for Payer: Fidelis CHP/HARP/Medicaid	$218.45
Rate for Payer: Fidelis Essential Plan Aliesa	$491.51
Rate for Payer: Fidelis Essential Plan QHP	$491.51
Rate for Payer: Fidelis Qualified Health Plan	$229.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$218.45
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$218.45
Rate for Payer: Healthfirst Commercial	$331.04
Rate for Payer: Healthfirst Essential Plan	$491.51
Rate for Payer: Healthfirst QHP	$218.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$218.45
Rate for Payer: SOMOS Essential	$491.51
Rate for Payer: United Healthcare Essential Plan 1&2	$491.51
Rate for Payer: United Healthcare Essential Plan 3&4	$240.30
Rate for Payer: United Healthcare Medicaid	$218.45
Rate for Payer: Wellcare CHP/FHP/Medicaid	$218.45

OUTPATIENT EAPG 00424: DRESSINGS AND OTHER MINOR PROCEDURES

Facility

$123.36

Service Code	EAPG 00424
Hospital Charge Code	EAPG 00424
Min. Negotiated Rate	$123.36
Max. Negotiated Rate	$123.36
Rate for Payer: Healthfirst Commercial	$123.36

OUTPATIENT EAPG 00425: LEVEL I OTHER MISCELLANEOUS ANCILLARY SERVICES

Facility

$170.76

Service Code	EAPG 00425
Hospital Charge Code	EAPG 00425
Min. Negotiated Rate	$170.76
Max. Negotiated Rate	$170.76
Rate for Payer: Healthfirst Commercial	$170.76

OUTPATIENT EAPG 00435: CLASS I PHARMACOTHERAPY

Facility

$88.94

Service Code	EAPG 00435
Hospital Charge Code	EAPG 00435
Min. Negotiated Rate	$39.53
Max. Negotiated Rate	$88.94
Rate for Payer: Affinity Essential Plan 1&2	$88.94
Rate for Payer: Affinity Essential Plan 3&4	$88.94
Rate for Payer: Affinity Medicaid/CHP/HARP	$39.53
Rate for Payer: Amida Care Medicaid	$39.53
Rate for Payer: Fidelis CHP/HARP/Medicaid	$39.53
Rate for Payer: Fidelis Essential Plan Aliesa	$88.94
Rate for Payer: Fidelis Essential Plan QHP	$88.94
Rate for Payer: Fidelis Qualified Health Plan	$41.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$39.53
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$39.53
Rate for Payer: Healthfirst Commercial	$59.90
Rate for Payer: Healthfirst Essential Plan	$88.94
Rate for Payer: Healthfirst QHP	$39.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$39.53
Rate for Payer: SOMOS Essential	$88.94
Rate for Payer: United Healthcare Essential Plan 1&2	$88.94
Rate for Payer: United Healthcare Essential Plan 3&4	$43.48
Rate for Payer: United Healthcare Medicaid	$39.53
Rate for Payer: Wellcare CHP/FHP/Medicaid	$39.53

OUTPATIENT EAPG 00436: CLASS II PHARMACOTHERAPY

Facility

$266.80

Service Code	EAPG 00436
Hospital Charge Code	EAPG 00436
Min. Negotiated Rate	$118.58
Max. Negotiated Rate	$266.80
Rate for Payer: Affinity Essential Plan 1&2	$266.80
Rate for Payer: Affinity Essential Plan 3&4	$266.80
Rate for Payer: Affinity Medicaid/CHP/HARP	$118.58
Rate for Payer: Amida Care Medicaid	$118.58
Rate for Payer: Fidelis CHP/HARP/Medicaid	$118.58
Rate for Payer: Fidelis Essential Plan Aliesa	$266.80
Rate for Payer: Fidelis Essential Plan QHP	$266.80
Rate for Payer: Fidelis Qualified Health Plan	$124.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$118.58
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$118.58
Rate for Payer: Healthfirst Commercial	$179.69
Rate for Payer: Healthfirst Essential Plan	$266.80
Rate for Payer: Healthfirst QHP	$118.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$118.58
Rate for Payer: SOMOS Essential	$266.80
Rate for Payer: United Healthcare Essential Plan 1&2	$266.80
Rate for Payer: United Healthcare Essential Plan 3&4	$130.44
Rate for Payer: United Healthcare Medicaid	$118.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$118.58

OUTPATIENT EAPG 00437: CLASS III PHARMACOTHERAPY

Facility

$479.12

Service Code	EAPG 00437
Hospital Charge Code	EAPG 00437
Min. Negotiated Rate	$212.94
Max. Negotiated Rate	$479.12
Rate for Payer: Affinity Essential Plan 1&2	$479.12
Rate for Payer: Affinity Essential Plan 3&4	$479.12
Rate for Payer: Affinity Medicaid/CHP/HARP	$212.94
Rate for Payer: Amida Care Medicaid	$212.94
Rate for Payer: Fidelis CHP/HARP/Medicaid	$212.94
Rate for Payer: Fidelis Essential Plan Aliesa	$479.12
Rate for Payer: Fidelis Essential Plan QHP	$479.12
Rate for Payer: Fidelis Qualified Health Plan	$223.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$212.94
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$212.94
Rate for Payer: Healthfirst Commercial	$322.67
Rate for Payer: Healthfirst Essential Plan	$479.12
Rate for Payer: Healthfirst QHP	$212.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$212.94
Rate for Payer: SOMOS Essential	$479.12
Rate for Payer: United Healthcare Essential Plan 1&2	$479.12
Rate for Payer: United Healthcare Essential Plan 3&4	$234.23
Rate for Payer: United Healthcare Medicaid	$212.94
Rate for Payer: Wellcare CHP/FHP/Medicaid	$212.94

OUTPATIENT EAPG 00438: CLASS IV PHARMACOTHERAPY

Facility

$803.32

Service Code	EAPG 00438
Hospital Charge Code	EAPG 00438
Min. Negotiated Rate	$357.03
Max. Negotiated Rate	$803.32
Rate for Payer: Affinity Essential Plan 1&2	$803.32
Rate for Payer: Affinity Essential Plan 3&4	$803.32
Rate for Payer: Affinity Medicaid/CHP/HARP	$357.03
Rate for Payer: Amida Care Medicaid	$357.03
Rate for Payer: Fidelis CHP/HARP/Medicaid	$357.03
Rate for Payer: Fidelis Essential Plan Aliesa	$803.32
Rate for Payer: Fidelis Essential Plan QHP	$803.32
Rate for Payer: Fidelis Qualified Health Plan	$374.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$357.03
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$357.03
Rate for Payer: Healthfirst Commercial	$541.01
Rate for Payer: Healthfirst Essential Plan	$803.32
Rate for Payer: Healthfirst QHP	$357.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$357.03
Rate for Payer: SOMOS Essential	$803.32
Rate for Payer: United Healthcare Essential Plan 1&2	$803.32
Rate for Payer: United Healthcare Essential Plan 3&4	$392.73
Rate for Payer: United Healthcare Medicaid	$357.03
Rate for Payer: Wellcare CHP/FHP/Medicaid	$357.03

OUTPATIENT EAPG 00439: CLASS V PHARMACOTHERAPY

Facility

$1,299.64

Service Code	EAPG 00439
Hospital Charge Code	EAPG 00439
Min. Negotiated Rate	$577.62
Max. Negotiated Rate	$1,299.64
Rate for Payer: Affinity Essential Plan 1&2	$1,299.64
Rate for Payer: Affinity Essential Plan 3&4	$1,299.64
Rate for Payer: Affinity Medicaid/CHP/HARP	$577.62
Rate for Payer: Amida Care Medicaid	$577.62
Rate for Payer: Fidelis CHP/HARP/Medicaid	$577.62
Rate for Payer: Fidelis Essential Plan Aliesa	$1,299.64
Rate for Payer: Fidelis Essential Plan QHP	$1,299.64
Rate for Payer: Fidelis Qualified Health Plan	$606.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$577.62
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$577.62
Rate for Payer: Healthfirst Commercial	$875.28
Rate for Payer: Healthfirst Essential Plan	$1,299.64
Rate for Payer: Healthfirst QHP	$577.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$577.62
Rate for Payer: SOMOS Essential	$1,299.64
Rate for Payer: United Healthcare Essential Plan 1&2	$1,299.64
Rate for Payer: United Healthcare Essential Plan 3&4	$635.38
Rate for Payer: United Healthcare Medicaid	$577.62
Rate for Payer: Wellcare CHP/FHP/Medicaid	$577.62

OUTPATIENT EAPG 00440: CLASS VI PHARMACOTHERAPY

Facility

$2,025.47

Service Code	EAPG 00440
Hospital Charge Code	EAPG 00440
Min. Negotiated Rate	$900.21
Max. Negotiated Rate	$2,025.47
Rate for Payer: Affinity Essential Plan 1&2	$2,025.47
Rate for Payer: Affinity Essential Plan 3&4	$2,025.47
Rate for Payer: Affinity Medicaid/CHP/HARP	$900.21
Rate for Payer: Amida Care Medicaid	$900.21
Rate for Payer: Fidelis CHP/HARP/Medicaid	$900.21
Rate for Payer: Fidelis Essential Plan Aliesa	$2,025.47
Rate for Payer: Fidelis Essential Plan QHP	$2,025.47
Rate for Payer: Fidelis Qualified Health Plan	$945.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$900.21
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$900.21
Rate for Payer: Healthfirst Commercial	$1,364.13
Rate for Payer: Healthfirst Essential Plan	$2,025.47
Rate for Payer: Healthfirst QHP	$900.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$900.21
Rate for Payer: SOMOS Essential	$2,025.47
Rate for Payer: United Healthcare Essential Plan 1&2	$2,025.47
Rate for Payer: United Healthcare Essential Plan 3&4	$990.23
Rate for Payer: United Healthcare Medicaid	$900.21
Rate for Payer: Wellcare CHP/FHP/Medicaid	$900.21

OUTPATIENT EAPG 00444: CLASS VII PHARMACOTHERAPY

Facility

$3,032.48

Service Code	EAPG 00444
Hospital Charge Code	EAPG 00444
Min. Negotiated Rate	$1,347.77
Max. Negotiated Rate	$3,032.48
Rate for Payer: Affinity Essential Plan 1&2	$3,032.48
Rate for Payer: Affinity Essential Plan 3&4	$3,032.48
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,347.77
Rate for Payer: Amida Care Medicaid	$1,347.77
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,347.77
Rate for Payer: Fidelis Essential Plan Aliesa	$3,032.48
Rate for Payer: Fidelis Essential Plan QHP	$3,032.48
Rate for Payer: Fidelis Qualified Health Plan	$1,415.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,347.77
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,347.77
Rate for Payer: Healthfirst Commercial	$2,042.32
Rate for Payer: Healthfirst Essential Plan	$3,032.48
Rate for Payer: Healthfirst QHP	$1,347.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,347.77
Rate for Payer: SOMOS Essential	$3,032.48
Rate for Payer: United Healthcare Essential Plan 1&2	$3,032.48
Rate for Payer: United Healthcare Essential Plan 3&4	$1,482.55
Rate for Payer: United Healthcare Medicaid	$1,347.77
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,347.77

OUTPATIENT EAPG 00448: EXPANDED HOURS ACCESS

Facility

$35.91

Service Code	EAPG 00448
Hospital Charge Code	EAPG 00448
Min. Negotiated Rate	$15.96
Max. Negotiated Rate	$35.91
Rate for Payer: Affinity Essential Plan 1&2	$35.91
Rate for Payer: Affinity Essential Plan 3&4	$35.91
Rate for Payer: Affinity Medicaid/CHP/HARP	$15.96
Rate for Payer: Amida Care Medicaid	$15.96
Rate for Payer: Fidelis CHP/HARP/Medicaid	$15.96
Rate for Payer: Fidelis Essential Plan Aliesa	$35.91
Rate for Payer: Fidelis Essential Plan QHP	$35.91
Rate for Payer: Fidelis Qualified Health Plan	$16.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.96
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$15.96
Rate for Payer: Healthfirst Commercial	$24.19
Rate for Payer: Healthfirst Essential Plan	$35.91
Rate for Payer: Healthfirst QHP	$15.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$15.96
Rate for Payer: SOMOS Essential	$35.91
Rate for Payer: United Healthcare Essential Plan 1&2	$35.91
Rate for Payer: United Healthcare Essential Plan 3&4	$17.56
Rate for Payer: United Healthcare Medicaid	$15.96
Rate for Payer: Wellcare CHP/FHP/Medicaid	$15.96

OUTPATIENT EAPG 00450: OBSERVATION

Facility

$73.98

Service Code	EAPG 00450
Hospital Charge Code	EAPG 00450
Min. Negotiated Rate	$32.88
Max. Negotiated Rate	$73.98
Rate for Payer: Affinity Essential Plan 1&2	$73.98
Rate for Payer: Affinity Essential Plan 3&4	$73.98
Rate for Payer: Affinity Medicaid/CHP/HARP	$32.88
Rate for Payer: Amida Care Medicaid	$32.88
Rate for Payer: Fidelis CHP/HARP/Medicaid	$32.88
Rate for Payer: Fidelis Essential Plan Aliesa	$73.98
Rate for Payer: Fidelis Essential Plan QHP	$73.98
Rate for Payer: Fidelis Qualified Health Plan	$34.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$32.88
Rate for Payer: Healthfirst Commercial	$49.83
Rate for Payer: Healthfirst Essential Plan	$73.98
Rate for Payer: Healthfirst QHP	$32.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$32.88
Rate for Payer: SOMOS Essential	$73.98
Rate for Payer: United Healthcare Essential Plan 1&2	$73.98
Rate for Payer: United Healthcare Essential Plan 3&4	$36.17
Rate for Payer: United Healthcare Medicaid	$32.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$32.88

OUTPATIENT EAPG 00451: SMOKING CESSATION TREATMENT

Facility

$40.39

Service Code	EAPG 00451
Hospital Charge Code	EAPG 00451
Min. Negotiated Rate	$40.39
Max. Negotiated Rate	$40.39
Rate for Payer: Healthfirst Commercial	$40.39

OUTPATIENT EAPG 00455: IMPLANTED TISSUE OF ANY TYPE

Facility

$3,056.67

Service Code	EAPG 00455
Hospital Charge Code	EAPG 00455
Min. Negotiated Rate	$1,358.52
Max. Negotiated Rate	$3,056.67
Rate for Payer: Affinity Essential Plan 1&2	$3,056.67
Rate for Payer: Affinity Essential Plan 3&4	$3,056.67
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,358.52
Rate for Payer: Amida Care Medicaid	$1,358.52
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,358.52
Rate for Payer: Fidelis Essential Plan Aliesa	$3,056.67
Rate for Payer: Fidelis Essential Plan QHP	$3,056.67
Rate for Payer: Fidelis Qualified Health Plan	$1,426.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,358.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,358.52
Rate for Payer: Healthfirst Commercial	$2,058.62
Rate for Payer: Healthfirst Essential Plan	$3,056.67
Rate for Payer: Healthfirst QHP	$1,358.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,358.52
Rate for Payer: SOMOS Essential	$3,056.67
Rate for Payer: United Healthcare Essential Plan 1&2	$3,056.67
Rate for Payer: United Healthcare Essential Plan 3&4	$1,494.37
Rate for Payer: United Healthcare Medicaid	$1,358.52
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,358.52

OUTPATIENT EAPG 00458: ALLERGY THERAPY

Facility

$84.89

Service Code	EAPG 00458
Hospital Charge Code	EAPG 00458
Min. Negotiated Rate	$37.73
Max. Negotiated Rate	$84.89
Rate for Payer: Affinity Essential Plan 1&2	$84.89
Rate for Payer: Affinity Essential Plan 3&4	$84.89
Rate for Payer: Affinity Medicaid/CHP/HARP	$37.73
Rate for Payer: Amida Care Medicaid	$37.73
Rate for Payer: Fidelis CHP/HARP/Medicaid	$37.73
Rate for Payer: Fidelis Essential Plan Aliesa	$84.89
Rate for Payer: Fidelis Essential Plan QHP	$84.89
Rate for Payer: Fidelis Qualified Health Plan	$39.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.73
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$37.73
Rate for Payer: Healthfirst Commercial	$57.16
Rate for Payer: Healthfirst Essential Plan	$84.89
Rate for Payer: Healthfirst QHP	$37.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$37.73
Rate for Payer: SOMOS Essential	$84.89
Rate for Payer: United Healthcare Essential Plan 1&2	$84.89
Rate for Payer: United Healthcare Essential Plan 3&4	$41.50
Rate for Payer: United Healthcare Medicaid	$37.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$37.73

OUTPATIENT EAPG 00459: VACCINE ADMINISTRATION

Facility

$39.15

Service Code	EAPG 00459
Hospital Charge Code	EAPG 00459
Min. Negotiated Rate	$17.40
Max. Negotiated Rate	$39.15
Rate for Payer: Affinity Essential Plan 1&2	$39.15
Rate for Payer: Affinity Essential Plan 3&4	$39.15
Rate for Payer: Affinity Medicaid/CHP/HARP	$17.40
Rate for Payer: Amida Care Medicaid	$17.40
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17.40
Rate for Payer: Fidelis Essential Plan Aliesa	$39.15
Rate for Payer: Fidelis Essential Plan QHP	$39.15
Rate for Payer: Fidelis Qualified Health Plan	$18.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17.40
Rate for Payer: Healthfirst Commercial	$26.36
Rate for Payer: Healthfirst Essential Plan	$39.15
Rate for Payer: Healthfirst QHP	$17.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17.40
Rate for Payer: SOMOS Essential	$39.15
Rate for Payer: United Healthcare Essential Plan 1&2	$39.15
Rate for Payer: United Healthcare Essential Plan 3&4	$19.14
Rate for Payer: United Healthcare Medicaid	$17.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17.40

OUTPATIENT EAPG 00460: CLASS VIII COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY

Facility

$4,363.67

Service Code	EAPG 00460
Hospital Charge Code	EAPG 00460
Min. Negotiated Rate	$1,939.41
Max. Negotiated Rate	$4,363.67
Rate for Payer: Affinity Essential Plan 1&2	$4,363.67
Rate for Payer: Affinity Essential Plan 3&4	$4,363.67
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,939.41
Rate for Payer: Amida Care Medicaid	$1,939.41
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,939.41
Rate for Payer: Fidelis Essential Plan Aliesa	$4,363.67
Rate for Payer: Fidelis Essential Plan QHP	$4,363.67
Rate for Payer: Fidelis Qualified Health Plan	$2,036.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,939.41
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,939.41
Rate for Payer: Healthfirst Commercial	$2,938.86
Rate for Payer: Healthfirst Essential Plan	$4,363.67
Rate for Payer: Healthfirst QHP	$1,939.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,939.41
Rate for Payer: SOMOS Essential	$4,363.67
Rate for Payer: United Healthcare Essential Plan 1&2	$4,363.67
Rate for Payer: United Healthcare Essential Plan 3&4	$2,133.35
Rate for Payer: United Healthcare Medicaid	$1,939.41
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,939.41

OUTPATIENT EAPG 00461: CLASS IX COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY

Facility

$6,019.06

Service Code	EAPG 00461
Hospital Charge Code	EAPG 00461
Min. Negotiated Rate	$2,675.14
Max. Negotiated Rate	$6,019.06
Rate for Payer: Affinity Essential Plan 1&2	$6,019.06
Rate for Payer: Affinity Essential Plan 3&4	$6,019.06
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,675.14
Rate for Payer: Amida Care Medicaid	$2,675.14
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2,675.14
Rate for Payer: Fidelis Essential Plan Aliesa	$6,019.06
Rate for Payer: Fidelis Essential Plan QHP	$6,019.06
Rate for Payer: Fidelis Qualified Health Plan	$2,808.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,675.14
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,675.14
Rate for Payer: Healthfirst Commercial	$4,053.74
Rate for Payer: Healthfirst Essential Plan	$6,019.06
Rate for Payer: Healthfirst QHP	$2,675.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,675.14
Rate for Payer: SOMOS Essential	$6,019.06
Rate for Payer: United Healthcare Essential Plan 1&2	$6,019.06
Rate for Payer: United Healthcare Essential Plan 3&4	$2,942.65
Rate for Payer: United Healthcare Medicaid	$2,675.14
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,675.14

OUTPATIENT EAPG 00462: CLASS X COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY

Facility

$9,562.23

Service Code	EAPG 00462
Hospital Charge Code	EAPG 00462
Min. Negotiated Rate	$4,249.88
Max. Negotiated Rate	$9,562.23
Rate for Payer: Affinity Essential Plan 1&2	$9,562.23
Rate for Payer: Affinity Essential Plan 3&4	$9,562.23
Rate for Payer: Affinity Medicaid/CHP/HARP	$4,249.88
Rate for Payer: Amida Care Medicaid	$4,249.88
Rate for Payer: Fidelis CHP/HARP/Medicaid	$4,249.88
Rate for Payer: Fidelis Essential Plan Aliesa	$9,562.23
Rate for Payer: Fidelis Essential Plan QHP	$9,562.23
Rate for Payer: Fidelis Qualified Health Plan	$4,462.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,249.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$4,249.88
Rate for Payer: Healthfirst Commercial	$6,440.00
Rate for Payer: Healthfirst Essential Plan	$9,562.23
Rate for Payer: Healthfirst QHP	$4,249.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,249.88
Rate for Payer: SOMOS Essential	$9,562.23
Rate for Payer: United Healthcare Essential Plan 1&2	$9,562.23
Rate for Payer: United Healthcare Essential Plan 3&4	$4,674.87
Rate for Payer: United Healthcare Medicaid	$4,249.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4,249.88

OUTPATIENT EAPG 00463: CLASS XI COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY

Facility

$15,423.50

Service Code	EAPG 00463
Hospital Charge Code	EAPG 00463
Min. Negotiated Rate	$6,854.89
Max. Negotiated Rate	$15,423.50
Rate for Payer: Affinity Essential Plan 1&2	$15,423.50
Rate for Payer: Affinity Essential Plan 3&4	$15,423.50
Rate for Payer: Affinity Medicaid/CHP/HARP	$6,854.89
Rate for Payer: Amida Care Medicaid	$6,854.89
Rate for Payer: Fidelis CHP/HARP/Medicaid	$6,854.89
Rate for Payer: Fidelis Essential Plan Aliesa	$15,423.50
Rate for Payer: Fidelis Essential Plan QHP	$15,423.50
Rate for Payer: Fidelis Qualified Health Plan	$7,197.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,854.89
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$6,854.89
Rate for Payer: Healthfirst Commercial	$10,387.47
Rate for Payer: Healthfirst Essential Plan	$15,423.50
Rate for Payer: Healthfirst QHP	$6,854.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,854.89
Rate for Payer: SOMOS Essential	$15,423.50
Rate for Payer: United Healthcare Essential Plan 1&2	$15,423.50
Rate for Payer: United Healthcare Essential Plan 3&4	$7,540.38
Rate for Payer: United Healthcare Medicaid	$6,854.89
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6,854.89

OUTPATIENT EAPG 00464: CLASS XII COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY

Facility

$23,671.76

Service Code	EAPG 00464
Hospital Charge Code	EAPG 00464
Min. Negotiated Rate	$10,520.78
Max. Negotiated Rate	$23,671.76
Rate for Payer: Affinity Essential Plan 1&2	$23,671.76
Rate for Payer: Affinity Essential Plan 3&4	$23,671.76
Rate for Payer: Affinity Medicaid/CHP/HARP	$10,520.78
Rate for Payer: Amida Care Medicaid	$10,520.78
Rate for Payer: Fidelis CHP/HARP/Medicaid	$10,520.78
Rate for Payer: Fidelis Essential Plan Aliesa	$23,671.76
Rate for Payer: Fidelis Essential Plan QHP	$23,671.76
Rate for Payer: Fidelis Qualified Health Plan	$11,046.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$10,520.78
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$10,520.78
Rate for Payer: Healthfirst Commercial	$15,942.52
Rate for Payer: Healthfirst Essential Plan	$23,671.76
Rate for Payer: Healthfirst QHP	$10,520.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$10,520.78
Rate for Payer: SOMOS Essential	$23,671.76
Rate for Payer: United Healthcare Essential Plan 1&2	$23,671.76
Rate for Payer: United Healthcare Essential Plan 3&4	$11,572.86
Rate for Payer: United Healthcare Medicaid	$10,520.78
Rate for Payer: Wellcare CHP/FHP/Medicaid	$10,520.78

OUTPATIENT EAPG 00470: OBSTETRICAL ULTRASOUND

Facility

$329.31

Service Code	EAPG 00470
Hospital Charge Code	EAPG 00470
Min. Negotiated Rate	$146.36
Max. Negotiated Rate	$329.31
Rate for Payer: Affinity Essential Plan 1&2	$329.31
Rate for Payer: Affinity Essential Plan 3&4	$329.31
Rate for Payer: Affinity Medicaid/CHP/HARP	$146.36
Rate for Payer: Amida Care Medicaid	$146.36
Rate for Payer: Fidelis CHP/HARP/Medicaid	$146.36
Rate for Payer: Fidelis Essential Plan Aliesa	$329.31
Rate for Payer: Fidelis Essential Plan QHP	$329.31
Rate for Payer: Fidelis Qualified Health Plan	$153.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$146.36
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$146.36
Rate for Payer: Healthfirst Commercial	$221.78
Rate for Payer: Healthfirst Essential Plan	$329.31
Rate for Payer: Healthfirst QHP	$146.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$146.36
Rate for Payer: SOMOS Essential	$329.31
Rate for Payer: United Healthcare Essential Plan 1&2	$329.31
Rate for Payer: United Healthcare Essential Plan 3&4	$161.00
Rate for Payer: United Healthcare Medicaid	$146.36
Rate for Payer: Wellcare CHP/FHP/Medicaid	$146.36

OUTPATIENT EAPG 00471: LEVEL I CONVENTIONAL RADIOLOGY

Facility

$89.78

Service Code	EAPG 00471
Hospital Charge Code	EAPG 00471
Min. Negotiated Rate	$39.90
Max. Negotiated Rate	$89.78
Rate for Payer: Affinity Essential Plan 1&2	$89.78
Rate for Payer: Affinity Essential Plan 3&4	$89.78
Rate for Payer: Affinity Medicaid/CHP/HARP	$39.90
Rate for Payer: Amida Care Medicaid	$39.90
Rate for Payer: Fidelis CHP/HARP/Medicaid	$39.90
Rate for Payer: Fidelis Essential Plan Aliesa	$89.78
Rate for Payer: Fidelis Essential Plan QHP	$89.78
Rate for Payer: Fidelis Qualified Health Plan	$41.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$39.90
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$39.90
Rate for Payer: Healthfirst Commercial	$60.46
Rate for Payer: Healthfirst Essential Plan	$89.78
Rate for Payer: Healthfirst QHP	$39.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$39.90
Rate for Payer: SOMOS Essential	$89.78
Rate for Payer: United Healthcare Essential Plan 1&2	$89.78
Rate for Payer: United Healthcare Essential Plan 3&4	$43.89
Rate for Payer: United Healthcare Medicaid	$39.90
Rate for Payer: Wellcare CHP/FHP/Medicaid	$39.90

OUTPATIENT EAPG 00472: ULTRASOUND GUIDANCE

Facility

$546.98

Service Code	EAPG 00472
Hospital Charge Code	EAPG 00472
Min. Negotiated Rate	$243.10
Max. Negotiated Rate	$546.98
Rate for Payer: Affinity Essential Plan 1&2	$546.98
Rate for Payer: Affinity Essential Plan 3&4	$546.98
Rate for Payer: Affinity Medicaid/CHP/HARP	$243.10
Rate for Payer: Amida Care Medicaid	$243.10
Rate for Payer: Fidelis CHP/HARP/Medicaid	$243.10
Rate for Payer: Fidelis Essential Plan Aliesa	$546.98
Rate for Payer: Fidelis Essential Plan QHP	$546.98
Rate for Payer: Fidelis Qualified Health Plan	$255.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$243.10
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$243.10
Rate for Payer: Healthfirst Commercial	$368.38
Rate for Payer: Healthfirst Essential Plan	$546.98
Rate for Payer: Healthfirst QHP	$243.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$243.10
Rate for Payer: SOMOS Essential	$546.98
Rate for Payer: United Healthcare Essential Plan 1&2	$546.98
Rate for Payer: United Healthcare Essential Plan 3&4	$267.41
Rate for Payer: United Healthcare Medicaid	$243.10
Rate for Payer: Wellcare CHP/FHP/Medicaid	$243.10

OUTPATIENT EAPG 00473: CT GUIDANCE

Facility

$503.73

Service Code	EAPG 00473
Hospital Charge Code	EAPG 00473
Min. Negotiated Rate	$223.88
Max. Negotiated Rate	$503.73
Rate for Payer: Affinity Essential Plan 1&2	$503.73
Rate for Payer: Affinity Essential Plan 3&4	$503.73
Rate for Payer: Affinity Medicaid/CHP/HARP	$223.88
Rate for Payer: Amida Care Medicaid	$223.88
Rate for Payer: Fidelis CHP/HARP/Medicaid	$223.88
Rate for Payer: Fidelis Essential Plan Aliesa	$503.73
Rate for Payer: Fidelis Essential Plan QHP	$503.73
Rate for Payer: Fidelis Qualified Health Plan	$235.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$223.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$223.88
Rate for Payer: Healthfirst Commercial	$339.25
Rate for Payer: Healthfirst Essential Plan	$503.73
Rate for Payer: Healthfirst QHP	$223.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$223.88
Rate for Payer: SOMOS Essential	$503.73
Rate for Payer: United Healthcare Essential Plan 1&2	$503.73
Rate for Payer: United Healthcare Essential Plan 3&4	$246.27
Rate for Payer: United Healthcare Medicaid	$223.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$223.88

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