St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

OUTPATIENT EAPG 00474: RADIOLOGICAL GUIDANCE FOR THERAPEUTIC OR DIAGNOSTIC PROCEDURES

Facility

$915.80

Service Code	EAPG 00474
Hospital Charge Code	EAPG 00474
Min. Negotiated Rate	$407.02
Max. Negotiated Rate	$915.80
Rate for Payer: Affinity Essential Plan 1&2	$915.80
Rate for Payer: Affinity Essential Plan 3&4	$915.80
Rate for Payer: Affinity Medicaid/CHP/HARP	$407.02
Rate for Payer: Amida Care Medicaid	$407.02
Rate for Payer: Fidelis CHP/HARP/Medicaid	$407.02
Rate for Payer: Fidelis Essential Plan Aliesa	$915.80
Rate for Payer: Fidelis Essential Plan QHP	$915.80
Rate for Payer: Fidelis Qualified Health Plan	$427.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$407.02
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$407.02
Rate for Payer: Healthfirst Commercial	$616.76
Rate for Payer: Healthfirst Essential Plan	$915.80
Rate for Payer: Healthfirst QHP	$407.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$407.02
Rate for Payer: SOMOS Essential	$915.80
Rate for Payer: United Healthcare Essential Plan 1&2	$915.80
Rate for Payer: United Healthcare Essential Plan 3&4	$447.72
Rate for Payer: United Healthcare Medicaid	$407.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$407.02

OUTPATIENT EAPG 00475: MRI GUIDANCE

Facility

$677.00

Service Code	EAPG 00475
Hospital Charge Code	EAPG 00475
Min. Negotiated Rate	$300.89
Max. Negotiated Rate	$677.00
Rate for Payer: Affinity Essential Plan 1&2	$677.00
Rate for Payer: Affinity Essential Plan 3&4	$677.00
Rate for Payer: Affinity Medicaid/CHP/HARP	$300.89
Rate for Payer: Amida Care Medicaid	$300.89
Rate for Payer: Fidelis CHP/HARP/Medicaid	$300.89
Rate for Payer: Fidelis Essential Plan Aliesa	$677.00
Rate for Payer: Fidelis Essential Plan QHP	$677.00
Rate for Payer: Fidelis Qualified Health Plan	$315.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$300.89
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$300.89
Rate for Payer: Healthfirst Commercial	$455.96
Rate for Payer: Healthfirst Essential Plan	$677.00
Rate for Payer: Healthfirst QHP	$300.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$300.89
Rate for Payer: SOMOS Essential	$677.00
Rate for Payer: United Healthcare Essential Plan 1&2	$677.00
Rate for Payer: United Healthcare Essential Plan 3&4	$330.98
Rate for Payer: United Healthcare Medicaid	$300.89
Rate for Payer: Wellcare CHP/FHP/Medicaid	$300.89

OUTPATIENT EAPG 00476: LEVEL I RADIATION TREATMENT PREPARATION & PLANNING

Facility

$1,207.17

Service Code	EAPG 00476
Hospital Charge Code	EAPG 00476
Min. Negotiated Rate	$536.52
Max. Negotiated Rate	$1,207.17
Rate for Payer: Affinity Essential Plan 1&2	$1,207.17
Rate for Payer: Affinity Essential Plan 3&4	$1,207.17
Rate for Payer: Affinity Medicaid/CHP/HARP	$536.52
Rate for Payer: Amida Care Medicaid	$536.52
Rate for Payer: Fidelis CHP/HARP/Medicaid	$536.52
Rate for Payer: Fidelis Essential Plan Aliesa	$1,207.17
Rate for Payer: Fidelis Essential Plan QHP	$1,207.17
Rate for Payer: Fidelis Qualified Health Plan	$563.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$536.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$536.52
Rate for Payer: Healthfirst Commercial	$813.01
Rate for Payer: Healthfirst Essential Plan	$1,207.17
Rate for Payer: Healthfirst QHP	$536.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$536.52
Rate for Payer: SOMOS Essential	$1,207.17
Rate for Payer: United Healthcare Essential Plan 1&2	$1,207.17
Rate for Payer: United Healthcare Essential Plan 3&4	$590.17
Rate for Payer: United Healthcare Medicaid	$536.52
Rate for Payer: Wellcare CHP/FHP/Medicaid	$536.52

OUTPATIENT EAPG 00477: LEVEL II RADIATION TREATMENT PREPARATION & PLANNING

Facility

$1,140.05

Service Code	EAPG 00477
Hospital Charge Code	EAPG 00477
Min. Negotiated Rate	$506.69
Max. Negotiated Rate	$1,140.05
Rate for Payer: Affinity Essential Plan 1&2	$1,140.05
Rate for Payer: Affinity Essential Plan 3&4	$1,140.05
Rate for Payer: Affinity Medicaid/CHP/HARP	$506.69
Rate for Payer: Amida Care Medicaid	$506.69
Rate for Payer: Fidelis CHP/HARP/Medicaid	$506.69
Rate for Payer: Fidelis Essential Plan Aliesa	$1,140.05
Rate for Payer: Fidelis Essential Plan QHP	$1,140.05
Rate for Payer: Fidelis Qualified Health Plan	$532.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$506.69
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$506.69
Rate for Payer: Healthfirst Commercial	$767.81
Rate for Payer: Healthfirst Essential Plan	$1,140.05
Rate for Payer: Healthfirst QHP	$506.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$506.69
Rate for Payer: SOMOS Essential	$1,140.05
Rate for Payer: United Healthcare Essential Plan 1&2	$1,140.05
Rate for Payer: United Healthcare Essential Plan 3&4	$557.36
Rate for Payer: United Healthcare Medicaid	$506.69
Rate for Payer: Wellcare CHP/FHP/Medicaid	$506.69

OUTPATIENT EAPG 00478: LEVEL III RADIATION TREATMENT PREPARATION & PLANNING

Facility

$434.59

Service Code	EAPG 00478
Hospital Charge Code	EAPG 00478
Min. Negotiated Rate	$193.15
Max. Negotiated Rate	$434.59
Rate for Payer: Affinity Essential Plan 1&2	$434.59
Rate for Payer: Affinity Essential Plan 3&4	$434.59
Rate for Payer: Affinity Medicaid/CHP/HARP	$193.15
Rate for Payer: Amida Care Medicaid	$193.15
Rate for Payer: Fidelis CHP/HARP/Medicaid	$193.15
Rate for Payer: Fidelis Essential Plan Aliesa	$434.59
Rate for Payer: Fidelis Essential Plan QHP	$434.59
Rate for Payer: Fidelis Qualified Health Plan	$202.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$193.15
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$193.15
Rate for Payer: Healthfirst Commercial	$292.68
Rate for Payer: Healthfirst Essential Plan	$434.59
Rate for Payer: Healthfirst QHP	$193.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$193.15
Rate for Payer: SOMOS Essential	$434.59
Rate for Payer: United Healthcare Essential Plan 1&2	$434.59
Rate for Payer: United Healthcare Essential Plan 3&4	$212.46
Rate for Payer: United Healthcare Medicaid	$193.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$193.15

OUTPATIENT EAPG 00483: RADIATION THERAPY MANAGEMENT

Facility

$812.72

Service Code	EAPG 00483
Hospital Charge Code	EAPG 00483
Min. Negotiated Rate	$361.21
Max. Negotiated Rate	$812.72
Rate for Payer: Affinity Essential Plan 1&2	$812.72
Rate for Payer: Affinity Essential Plan 3&4	$812.72
Rate for Payer: Affinity Medicaid/CHP/HARP	$361.21
Rate for Payer: Amida Care Medicaid	$361.21
Rate for Payer: Fidelis CHP/HARP/Medicaid	$361.21
Rate for Payer: Fidelis Essential Plan Aliesa	$812.72
Rate for Payer: Fidelis Essential Plan QHP	$812.72
Rate for Payer: Fidelis Qualified Health Plan	$379.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$361.21
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$361.21
Rate for Payer: Healthfirst Commercial	$547.35
Rate for Payer: Healthfirst Essential Plan	$812.72
Rate for Payer: Healthfirst QHP	$361.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$361.21
Rate for Payer: SOMOS Essential	$812.72
Rate for Payer: United Healthcare Essential Plan 1&2	$812.72
Rate for Payer: United Healthcare Essential Plan 3&4	$397.33
Rate for Payer: United Healthcare Medicaid	$361.21
Rate for Payer: Wellcare CHP/FHP/Medicaid	$361.21

OUTPATIENT EAPG 00485: CORNEAL TISSUE PROCESSING

Facility

$1,998.81

Service Code	EAPG 00485
Hospital Charge Code	EAPG 00485
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 00486: LEVEL I BLOOD AND TISSUE TYPING TESTS

Facility

$121.52

Service Code	EAPG 00486
Hospital Charge Code	EAPG 00486
Min. Negotiated Rate	$54.01
Max. Negotiated Rate	$121.52
Rate for Payer: Affinity Essential Plan 1&2	$121.52
Rate for Payer: Affinity Essential Plan 3&4	$121.52
Rate for Payer: Affinity Medicaid/CHP/HARP	$54.01
Rate for Payer: Amida Care Medicaid	$54.01
Rate for Payer: Fidelis CHP/HARP/Medicaid	$54.01
Rate for Payer: Fidelis Essential Plan Aliesa	$121.52
Rate for Payer: Fidelis Essential Plan QHP	$121.52
Rate for Payer: Fidelis Qualified Health Plan	$56.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.01
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$54.01
Rate for Payer: Healthfirst Commercial	$81.84
Rate for Payer: Healthfirst Essential Plan	$121.52
Rate for Payer: Healthfirst QHP	$54.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$54.01
Rate for Payer: SOMOS Essential	$121.52
Rate for Payer: United Healthcare Essential Plan 1&2	$121.52
Rate for Payer: United Healthcare Essential Plan 3&4	$59.41
Rate for Payer: United Healthcare Medicaid	$54.01
Rate for Payer: Wellcare CHP/FHP/Medicaid	$54.01

OUTPATIENT EAPG 00488: MINOR DEVICE EVALUATION AND INTERROGATION

Facility

$215.12

Service Code	EAPG 00488
Hospital Charge Code	EAPG 00488
Min. Negotiated Rate	$95.61
Max. Negotiated Rate	$215.12
Rate for Payer: Affinity Essential Plan 1&2	$215.12
Rate for Payer: Affinity Essential Plan 3&4	$215.12
Rate for Payer: Affinity Medicaid/CHP/HARP	$95.61
Rate for Payer: Amida Care Medicaid	$95.61
Rate for Payer: Fidelis CHP/HARP/Medicaid	$95.61
Rate for Payer: Fidelis Essential Plan Aliesa	$215.12
Rate for Payer: Fidelis Essential Plan QHP	$215.12
Rate for Payer: Fidelis Qualified Health Plan	$100.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$95.61
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$95.61
Rate for Payer: Healthfirst Commercial	$144.87
Rate for Payer: Healthfirst Essential Plan	$215.12
Rate for Payer: Healthfirst QHP	$95.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$95.61
Rate for Payer: SOMOS Essential	$215.12
Rate for Payer: United Healthcare Essential Plan 1&2	$215.12
Rate for Payer: United Healthcare Essential Plan 3&4	$105.17
Rate for Payer: United Healthcare Medicaid	$95.61
Rate for Payer: Wellcare CHP/FHP/Medicaid	$95.61

OUTPATIENT EAPG 00489: LEVEL II OTHER MISCELLANEOUS ANCILLARY SERVICES

Facility

$189.54

Service Code	EAPG 00489
Hospital Charge Code	EAPG 00489
Min. Negotiated Rate	$189.54
Max. Negotiated Rate	$189.54
Rate for Payer: Healthfirst Commercial	$189.54

OUTPATIENT EAPG 00493: ANCILLARY THERAPEUTIC SERVICES

Facility

$65.27

Service Code	EAPG 00493
Hospital Charge Code	EAPG 00493
Min. Negotiated Rate	$29.01
Max. Negotiated Rate	$65.27
Rate for Payer: Affinity Essential Plan 1&2	$65.27
Rate for Payer: Affinity Essential Plan 3&4	$65.27
Rate for Payer: Affinity Medicaid/CHP/HARP	$29.01
Rate for Payer: Amida Care Medicaid	$29.01
Rate for Payer: Fidelis CHP/HARP/Medicaid	$29.01
Rate for Payer: Fidelis Essential Plan Aliesa	$65.27
Rate for Payer: Fidelis Essential Plan QHP	$65.27
Rate for Payer: Fidelis Qualified Health Plan	$30.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.01
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29.01
Rate for Payer: Healthfirst Essential Plan	$65.27
Rate for Payer: Healthfirst QHP	$29.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$29.01
Rate for Payer: SOMOS Essential	$65.27
Rate for Payer: United Healthcare Essential Plan 1&2	$65.27
Rate for Payer: United Healthcare Essential Plan 3&4	$31.91
Rate for Payer: United Healthcare Medicaid	$29.01
Rate for Payer: Wellcare CHP/FHP/Medicaid	$29.01

OUTPATIENT EAPG 00494: COMPLEX BLOOD COLLECTION SERVICES

Facility

$82.55

Service Code	EAPG 00494
Hospital Charge Code	EAPG 00494
Min. Negotiated Rate	$36.69
Max. Negotiated Rate	$82.55
Rate for Payer: Affinity Essential Plan 1&2	$82.55
Rate for Payer: Affinity Essential Plan 3&4	$82.55
Rate for Payer: Affinity Medicaid/CHP/HARP	$36.69
Rate for Payer: Amida Care Medicaid	$36.69
Rate for Payer: Fidelis CHP/HARP/Medicaid	$36.69
Rate for Payer: Fidelis Essential Plan Aliesa	$82.55
Rate for Payer: Fidelis Essential Plan QHP	$82.55
Rate for Payer: Fidelis Qualified Health Plan	$38.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$36.69
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$36.69
Rate for Payer: Healthfirst Essential Plan	$82.55
Rate for Payer: Healthfirst QHP	$36.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$36.69
Rate for Payer: SOMOS Essential	$82.55
Rate for Payer: United Healthcare Essential Plan 1&2	$82.55
Rate for Payer: United Healthcare Essential Plan 3&4	$40.36
Rate for Payer: United Healthcare Medicaid	$36.69
Rate for Payer: Wellcare CHP/FHP/Medicaid	$36.69

OUTPATIENT EAPG 00499: BLOOD PROCESSING, STORAGE AND RELATED SERVICES

Facility

$119.90

Service Code	EAPG 00499
Hospital Charge Code	EAPG 00499
Min. Negotiated Rate	$53.29
Max. Negotiated Rate	$119.90
Rate for Payer: Affinity Essential Plan 1&2	$119.90
Rate for Payer: Affinity Essential Plan 3&4	$119.90
Rate for Payer: Affinity Medicaid/CHP/HARP	$53.29
Rate for Payer: Amida Care Medicaid	$53.29
Rate for Payer: Fidelis CHP/HARP/Medicaid	$53.29
Rate for Payer: Fidelis Essential Plan Aliesa	$119.90
Rate for Payer: Fidelis Essential Plan QHP	$119.90
Rate for Payer: Fidelis Qualified Health Plan	$55.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$53.29
Rate for Payer: Healthfirst Essential Plan	$119.90
Rate for Payer: Healthfirst QHP	$53.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$53.29
Rate for Payer: SOMOS Essential	$119.90
Rate for Payer: United Healthcare Essential Plan 1&2	$119.90
Rate for Payer: United Healthcare Essential Plan 3&4	$58.62
Rate for Payer: United Healthcare Medicaid	$53.29
Rate for Payer: Wellcare CHP/FHP/Medicaid	$53.29

OUTPATIENT EAPG 00510: MAJOR SIGNS, SYMPTOMS AND FINDINGS

Facility

$383.56

Service Code	EAPG 00510
Hospital Charge Code	EAPG 00510
Min. Negotiated Rate	$170.47
Max. Negotiated Rate	$383.56
Rate for Payer: Affinity Essential Plan 1&2	$383.56
Rate for Payer: Affinity Essential Plan 3&4	$383.56
Rate for Payer: Affinity Medicaid/CHP/HARP	$170.47
Rate for Payer: Amida Care Medicaid	$170.47
Rate for Payer: Fidelis CHP/HARP/Medicaid	$170.47
Rate for Payer: Fidelis Essential Plan Aliesa	$383.56
Rate for Payer: Fidelis Essential Plan QHP	$383.56
Rate for Payer: Fidelis Qualified Health Plan	$178.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$170.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$170.47
Rate for Payer: Healthfirst Commercial	$258.32
Rate for Payer: Healthfirst Essential Plan	$383.56
Rate for Payer: Healthfirst QHP	$170.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$170.47
Rate for Payer: SOMOS Essential	$383.56
Rate for Payer: United Healthcare Essential Plan 1&2	$383.56
Rate for Payer: United Healthcare Essential Plan 3&4	$187.52
Rate for Payer: United Healthcare Medicaid	$170.47
Rate for Payer: Wellcare CHP/FHP/Medicaid	$170.47

OUTPATIENT EAPG 00520: SPINAL DIAGNOSES & INJURIES

Facility

$368.19

Service Code	EAPG 00520
Hospital Charge Code	EAPG 00520
Min. Negotiated Rate	$163.64
Max. Negotiated Rate	$368.19
Rate for Payer: Affinity Essential Plan 1&2	$368.19
Rate for Payer: Affinity Essential Plan 3&4	$368.19
Rate for Payer: Affinity Medicaid/CHP/HARP	$163.64
Rate for Payer: Amida Care Medicaid	$163.64
Rate for Payer: Fidelis CHP/HARP/Medicaid	$163.64
Rate for Payer: Fidelis Essential Plan Aliesa	$368.19
Rate for Payer: Fidelis Essential Plan QHP	$368.19
Rate for Payer: Fidelis Qualified Health Plan	$171.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$163.64
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$163.64
Rate for Payer: Healthfirst Commercial	$247.97
Rate for Payer: Healthfirst Essential Plan	$368.19
Rate for Payer: Healthfirst QHP	$163.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$163.64
Rate for Payer: SOMOS Essential	$368.19
Rate for Payer: United Healthcare Essential Plan 1&2	$368.19
Rate for Payer: United Healthcare Essential Plan 3&4	$180.00
Rate for Payer: United Healthcare Medicaid	$163.64
Rate for Payer: Wellcare CHP/FHP/Medicaid	$163.64

OUTPATIENT EAPG 00521: NERVOUS SYSTEM MALIGNANCY

Facility

$342.14

Service Code	EAPG 00521
Hospital Charge Code	EAPG 00521
Min. Negotiated Rate	$152.06
Max. Negotiated Rate	$342.14
Rate for Payer: Affinity Essential Plan 1&2	$342.14
Rate for Payer: Affinity Essential Plan 3&4	$342.14
Rate for Payer: Affinity Medicaid/CHP/HARP	$152.06
Rate for Payer: Amida Care Medicaid	$152.06
Rate for Payer: Fidelis CHP/HARP/Medicaid	$152.06
Rate for Payer: Fidelis Essential Plan Aliesa	$342.14
Rate for Payer: Fidelis Essential Plan QHP	$342.14
Rate for Payer: Fidelis Qualified Health Plan	$159.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$152.06
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$152.06
Rate for Payer: Healthfirst Commercial	$230.42
Rate for Payer: Healthfirst Essential Plan	$342.14
Rate for Payer: Healthfirst QHP	$152.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$152.06
Rate for Payer: SOMOS Essential	$342.14
Rate for Payer: United Healthcare Essential Plan 1&2	$342.14
Rate for Payer: United Healthcare Essential Plan 3&4	$167.27
Rate for Payer: United Healthcare Medicaid	$152.06
Rate for Payer: Wellcare CHP/FHP/Medicaid	$152.06

OUTPATIENT EAPG 00522: DEGENERATIVE NERVOUS SYSTEM DIAGNOSES EXC MULT SCLEROSIS

Facility

$342.11

Service Code	EAPG 00522
Hospital Charge Code	EAPG 00522
Min. Negotiated Rate	$152.05
Max. Negotiated Rate	$342.11
Rate for Payer: Affinity Essential Plan 1&2	$342.11
Rate for Payer: Affinity Essential Plan 3&4	$342.11
Rate for Payer: Affinity Medicaid/CHP/HARP	$152.05
Rate for Payer: Amida Care Medicaid	$152.05
Rate for Payer: Fidelis CHP/HARP/Medicaid	$152.05
Rate for Payer: Fidelis Essential Plan Aliesa	$342.11
Rate for Payer: Fidelis Essential Plan QHP	$342.11
Rate for Payer: Fidelis Qualified Health Plan	$159.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$152.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$152.05
Rate for Payer: Healthfirst Commercial	$230.40
Rate for Payer: Healthfirst Essential Plan	$342.11
Rate for Payer: Healthfirst QHP	$152.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$152.05
Rate for Payer: SOMOS Essential	$342.11
Rate for Payer: United Healthcare Essential Plan 1&2	$342.11
Rate for Payer: United Healthcare Essential Plan 3&4	$167.26
Rate for Payer: United Healthcare Medicaid	$152.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$152.05

OUTPATIENT EAPG 00523: MULTIPLE SCLEROSIS & OTHER DEMYELINATING DISEASES

Facility

$315.63

Service Code	EAPG 00523
Hospital Charge Code	EAPG 00523
Min. Negotiated Rate	$140.28
Max. Negotiated Rate	$315.63
Rate for Payer: Affinity Essential Plan 1&2	$315.63
Rate for Payer: Affinity Essential Plan 3&4	$315.63
Rate for Payer: Affinity Medicaid/CHP/HARP	$140.28
Rate for Payer: Amida Care Medicaid	$140.28
Rate for Payer: Fidelis CHP/HARP/Medicaid	$140.28
Rate for Payer: Fidelis Essential Plan Aliesa	$315.63
Rate for Payer: Fidelis Essential Plan QHP	$315.63
Rate for Payer: Fidelis Qualified Health Plan	$147.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$140.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$140.28
Rate for Payer: Healthfirst Commercial	$212.57
Rate for Payer: Healthfirst Essential Plan	$315.63
Rate for Payer: Healthfirst QHP	$140.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$140.28
Rate for Payer: SOMOS Essential	$315.63
Rate for Payer: United Healthcare Essential Plan 1&2	$315.63
Rate for Payer: United Healthcare Essential Plan 3&4	$154.31
Rate for Payer: United Healthcare Medicaid	$140.28
Rate for Payer: Wellcare CHP/FHP/Medicaid	$140.28

OUTPATIENT EAPG 00524: LEVEL I CNS DIAGNOSES

Facility

$322.06

Service Code	EAPG 00524
Hospital Charge Code	EAPG 00524
Min. Negotiated Rate	$143.14
Max. Negotiated Rate	$322.06
Rate for Payer: Affinity Essential Plan 1&2	$322.06
Rate for Payer: Affinity Essential Plan 3&4	$322.06
Rate for Payer: Affinity Medicaid/CHP/HARP	$143.14
Rate for Payer: Amida Care Medicaid	$143.14
Rate for Payer: Fidelis CHP/HARP/Medicaid	$143.14
Rate for Payer: Fidelis Essential Plan Aliesa	$322.06
Rate for Payer: Fidelis Essential Plan QHP	$322.06
Rate for Payer: Fidelis Qualified Health Plan	$150.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.14
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$143.14
Rate for Payer: Healthfirst Commercial	$216.90
Rate for Payer: Healthfirst Essential Plan	$322.06
Rate for Payer: Healthfirst QHP	$143.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$143.14
Rate for Payer: SOMOS Essential	$322.06
Rate for Payer: United Healthcare Essential Plan 1&2	$322.06
Rate for Payer: United Healthcare Essential Plan 3&4	$157.45
Rate for Payer: United Healthcare Medicaid	$143.14
Rate for Payer: Wellcare CHP/FHP/Medicaid	$143.14

OUTPATIENT EAPG 00525: LEVEL II CNS DIAGNOSES

Facility

$247.09

Service Code	EAPG 00525
Hospital Charge Code	EAPG 00525
Min. Negotiated Rate	$247.09
Max. Negotiated Rate	$247.09
Rate for Payer: Healthfirst Commercial	$247.09

OUTPATIENT EAPG 00526: TRANSIENT ISCHEMIA

Facility

$315.07

Service Code	EAPG 00526
Hospital Charge Code	EAPG 00526
Min. Negotiated Rate	$140.03
Max. Negotiated Rate	$315.07
Rate for Payer: Affinity Essential Plan 1&2	$315.07
Rate for Payer: Affinity Essential Plan 3&4	$315.07
Rate for Payer: Affinity Medicaid/CHP/HARP	$140.03
Rate for Payer: Amida Care Medicaid	$140.03
Rate for Payer: Fidelis CHP/HARP/Medicaid	$140.03
Rate for Payer: Fidelis Essential Plan Aliesa	$315.07
Rate for Payer: Fidelis Essential Plan QHP	$315.07
Rate for Payer: Fidelis Qualified Health Plan	$147.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$140.03
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$140.03
Rate for Payer: Healthfirst Commercial	$212.19
Rate for Payer: Healthfirst Essential Plan	$315.07
Rate for Payer: Healthfirst QHP	$140.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$140.03
Rate for Payer: SOMOS Essential	$315.07
Rate for Payer: United Healthcare Essential Plan 1&2	$315.07
Rate for Payer: United Healthcare Essential Plan 3&4	$154.03
Rate for Payer: United Healthcare Medicaid	$140.03
Rate for Payer: Wellcare CHP/FHP/Medicaid	$140.03

OUTPATIENT EAPG 00527: PERIPHERAL AND CRANIAL NERVE DIAGNOSES

Facility

$327.31

Service Code	EAPG 00527
Hospital Charge Code	EAPG 00527
Min. Negotiated Rate	$145.47
Max. Negotiated Rate	$327.31
Rate for Payer: Affinity Essential Plan 1&2	$327.31
Rate for Payer: Affinity Essential Plan 3&4	$327.31
Rate for Payer: Affinity Medicaid/CHP/HARP	$145.47
Rate for Payer: Amida Care Medicaid	$145.47
Rate for Payer: Fidelis CHP/HARP/Medicaid	$145.47
Rate for Payer: Fidelis Essential Plan Aliesa	$327.31
Rate for Payer: Fidelis Essential Plan QHP	$327.31
Rate for Payer: Fidelis Qualified Health Plan	$152.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$145.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$145.47
Rate for Payer: Healthfirst Commercial	$220.42
Rate for Payer: Healthfirst Essential Plan	$327.31
Rate for Payer: Healthfirst QHP	$145.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$145.47
Rate for Payer: SOMOS Essential	$327.31
Rate for Payer: United Healthcare Essential Plan 1&2	$327.31
Rate for Payer: United Healthcare Essential Plan 3&4	$160.02
Rate for Payer: United Healthcare Medicaid	$145.47
Rate for Payer: Wellcare CHP/FHP/Medicaid	$145.47

OUTPATIENT EAPG 00528: NONTRAUMATIC STUPOR & COMA

Facility

$396.52

Service Code	EAPG 00528
Hospital Charge Code	EAPG 00528
Min. Negotiated Rate	$176.23
Max. Negotiated Rate	$396.52
Rate for Payer: Affinity Essential Plan 1&2	$396.52
Rate for Payer: Affinity Essential Plan 3&4	$396.52
Rate for Payer: Affinity Medicaid/CHP/HARP	$176.23
Rate for Payer: Amida Care Medicaid	$176.23
Rate for Payer: Fidelis CHP/HARP/Medicaid	$176.23
Rate for Payer: Fidelis Essential Plan Aliesa	$396.52
Rate for Payer: Fidelis Essential Plan QHP	$396.52
Rate for Payer: Fidelis Qualified Health Plan	$185.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$176.23
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$176.23
Rate for Payer: Healthfirst Commercial	$267.04
Rate for Payer: Healthfirst Essential Plan	$396.52
Rate for Payer: Healthfirst QHP	$176.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$176.23
Rate for Payer: SOMOS Essential	$396.52
Rate for Payer: United Healthcare Essential Plan 1&2	$396.52
Rate for Payer: United Healthcare Essential Plan 3&4	$193.85
Rate for Payer: United Healthcare Medicaid	$176.23
Rate for Payer: Wellcare CHP/FHP/Medicaid	$176.23

OUTPATIENT EAPG 00529: SEIZURE

Facility

$369.29

Service Code	EAPG 00529
Hospital Charge Code	EAPG 00529
Min. Negotiated Rate	$164.13
Max. Negotiated Rate	$369.29
Rate for Payer: Affinity Essential Plan 1&2	$369.29
Rate for Payer: Affinity Essential Plan 3&4	$369.29
Rate for Payer: Affinity Medicaid/CHP/HARP	$164.13
Rate for Payer: Amida Care Medicaid	$164.13
Rate for Payer: Fidelis CHP/HARP/Medicaid	$164.13
Rate for Payer: Fidelis Essential Plan Aliesa	$369.29
Rate for Payer: Fidelis Essential Plan QHP	$369.29
Rate for Payer: Fidelis Qualified Health Plan	$172.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$164.13
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$164.13
Rate for Payer: Healthfirst Commercial	$248.72
Rate for Payer: Healthfirst Essential Plan	$369.29
Rate for Payer: Healthfirst QHP	$164.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$164.13
Rate for Payer: SOMOS Essential	$369.29
Rate for Payer: United Healthcare Essential Plan 1&2	$369.29
Rate for Payer: United Healthcare Essential Plan 3&4	$180.54
Rate for Payer: United Healthcare Medicaid	$164.13
Rate for Payer: Wellcare CHP/FHP/Medicaid	$164.13

OUTPATIENT EAPG 00530: HEADACHES OTHER THAN MIGRAINE

Facility

$367.52

Service Code	EAPG 00530
Hospital Charge Code	EAPG 00530
Min. Negotiated Rate	$163.34
Max. Negotiated Rate	$367.52
Rate for Payer: Affinity Essential Plan 1&2	$367.52
Rate for Payer: Affinity Essential Plan 3&4	$367.52
Rate for Payer: Affinity Medicaid/CHP/HARP	$163.34
Rate for Payer: Amida Care Medicaid	$163.34
Rate for Payer: Fidelis CHP/HARP/Medicaid	$163.34
Rate for Payer: Fidelis Essential Plan Aliesa	$367.52
Rate for Payer: Fidelis Essential Plan QHP	$367.52
Rate for Payer: Fidelis Qualified Health Plan	$171.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$163.34
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$163.34
Rate for Payer: Healthfirst Commercial	$247.52
Rate for Payer: Healthfirst Essential Plan	$367.52
Rate for Payer: Healthfirst QHP	$163.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$163.34
Rate for Payer: SOMOS Essential	$367.52
Rate for Payer: United Healthcare Essential Plan 1&2	$367.52
Rate for Payer: United Healthcare Essential Plan 3&4	$179.67
Rate for Payer: United Healthcare Medicaid	$163.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$163.34

Know your out-of-pocket cost for care.

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