St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

OUTPATIENT EAPG 00577: LEVEL II OTHER RESPIRATORY DIAGNOSES

Facility

$300.05

Service Code	EAPG 00577
Hospital Charge Code	EAPG 00577
Min. Negotiated Rate	$300.05
Max. Negotiated Rate	$300.05
Rate for Payer: Healthfirst Commercial	$300.05

OUTPATIENT EAPG 00578: PNEUMONIA EXCEPT FOR COMMUNITY ACQUIRED PNEUMONIA

Facility

$243.82

Service Code	EAPG 00578
Hospital Charge Code	EAPG 00578
Min. Negotiated Rate	$243.82
Max. Negotiated Rate	$243.82
Rate for Payer: Healthfirst Commercial	$243.82

OUTPATIENT EAPG 00579: STATUS ASTHMATICUS

Facility

$344.90

Service Code	EAPG 00579
Hospital Charge Code	EAPG 00579
Min. Negotiated Rate	$153.29
Max. Negotiated Rate	$344.90
Rate for Payer: Affinity Essential Plan 1&2	$344.90
Rate for Payer: Affinity Essential Plan 3&4	$344.90
Rate for Payer: Affinity Medicaid/CHP/HARP	$153.29
Rate for Payer: Amida Care Medicaid	$153.29
Rate for Payer: Fidelis CHP/HARP/Medicaid	$153.29
Rate for Payer: Fidelis Essential Plan Aliesa	$344.90
Rate for Payer: Fidelis Essential Plan QHP	$344.90
Rate for Payer: Fidelis Qualified Health Plan	$160.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$153.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$153.29
Rate for Payer: Healthfirst Commercial	$232.28
Rate for Payer: Healthfirst Essential Plan	$344.90
Rate for Payer: Healthfirst QHP	$153.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$153.29
Rate for Payer: SOMOS Essential	$344.90
Rate for Payer: United Healthcare Essential Plan 1&2	$344.90
Rate for Payer: United Healthcare Essential Plan 3&4	$168.62
Rate for Payer: United Healthcare Medicaid	$153.29
Rate for Payer: Wellcare CHP/FHP/Medicaid	$153.29

OUTPATIENT EAPG 00591: ACUTE MYOCARDIAL INFARCTION

Facility

$697.66

Service Code	EAPG 00591
Hospital Charge Code	EAPG 00591
Min. Negotiated Rate	$310.07
Max. Negotiated Rate	$697.66
Rate for Payer: Affinity Essential Plan 1&2	$697.66
Rate for Payer: Affinity Essential Plan 3&4	$697.66
Rate for Payer: Affinity Medicaid/CHP/HARP	$310.07
Rate for Payer: Amida Care Medicaid	$310.07
Rate for Payer: Fidelis CHP/HARP/Medicaid	$310.07
Rate for Payer: Fidelis Essential Plan Aliesa	$697.66
Rate for Payer: Fidelis Essential Plan QHP	$697.66
Rate for Payer: Fidelis Qualified Health Plan	$325.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$310.07
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$310.07
Rate for Payer: Healthfirst Commercial	$469.86
Rate for Payer: Healthfirst Essential Plan	$697.66
Rate for Payer: Healthfirst QHP	$310.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$310.07
Rate for Payer: SOMOS Essential	$697.66
Rate for Payer: United Healthcare Essential Plan 1&2	$697.66
Rate for Payer: United Healthcare Essential Plan 3&4	$341.08
Rate for Payer: United Healthcare Medicaid	$310.07
Rate for Payer: Wellcare CHP/FHP/Medicaid	$310.07

OUTPATIENT EAPG 00592: LEVEL I CARDIOVASCULAR DIAGNOSES

Facility

$336.60

Service Code	EAPG 00592
Hospital Charge Code	EAPG 00592
Min. Negotiated Rate	$149.60
Max. Negotiated Rate	$336.60
Rate for Payer: Affinity Essential Plan 1&2	$336.60
Rate for Payer: Affinity Essential Plan 3&4	$336.60
Rate for Payer: Affinity Medicaid/CHP/HARP	$149.60
Rate for Payer: Amida Care Medicaid	$149.60
Rate for Payer: Fidelis CHP/HARP/Medicaid	$149.60
Rate for Payer: Fidelis Essential Plan Aliesa	$336.60
Rate for Payer: Fidelis Essential Plan QHP	$336.60
Rate for Payer: Fidelis Qualified Health Plan	$157.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$149.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$149.60
Rate for Payer: Healthfirst Commercial	$226.70
Rate for Payer: Healthfirst Essential Plan	$336.60
Rate for Payer: Healthfirst QHP	$149.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$149.60
Rate for Payer: SOMOS Essential	$336.60
Rate for Payer: United Healthcare Essential Plan 1&2	$336.60
Rate for Payer: United Healthcare Essential Plan 3&4	$164.56
Rate for Payer: United Healthcare Medicaid	$149.60
Rate for Payer: Wellcare CHP/FHP/Medicaid	$149.60

OUTPATIENT EAPG 00593: LEVEL II CARDIOVASCULAR DIAGNOSES

Facility

$235.80

Service Code	EAPG 00593
Hospital Charge Code	EAPG 00593
Min. Negotiated Rate	$235.80
Max. Negotiated Rate	$235.80
Rate for Payer: Healthfirst Commercial	$235.80

OUTPATIENT EAPG 00594: HEART FAILURE

Facility

$357.05

Service Code	EAPG 00594
Hospital Charge Code	EAPG 00594
Min. Negotiated Rate	$158.69
Max. Negotiated Rate	$357.05
Rate for Payer: Affinity Essential Plan 1&2	$357.05
Rate for Payer: Affinity Essential Plan 3&4	$357.05
Rate for Payer: Affinity Medicaid/CHP/HARP	$158.69
Rate for Payer: Amida Care Medicaid	$158.69
Rate for Payer: Fidelis CHP/HARP/Medicaid	$158.69
Rate for Payer: Fidelis Essential Plan Aliesa	$357.05
Rate for Payer: Fidelis Essential Plan QHP	$357.05
Rate for Payer: Fidelis Qualified Health Plan	$166.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$158.69
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$158.69
Rate for Payer: Healthfirst Commercial	$240.47
Rate for Payer: Healthfirst Essential Plan	$357.05
Rate for Payer: Healthfirst QHP	$158.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$158.69
Rate for Payer: SOMOS Essential	$357.05
Rate for Payer: United Healthcare Essential Plan 1&2	$357.05
Rate for Payer: United Healthcare Essential Plan 3&4	$174.56
Rate for Payer: United Healthcare Medicaid	$158.69
Rate for Payer: Wellcare CHP/FHP/Medicaid	$158.69

OUTPATIENT EAPG 00595: CARDIAC ARREST OR OTHER CAUSES OF MORTALITY

Facility

$771.57

Service Code	EAPG 00595
Hospital Charge Code	EAPG 00595
Min. Negotiated Rate	$342.92
Max. Negotiated Rate	$771.57
Rate for Payer: Affinity Essential Plan 1&2	$771.57
Rate for Payer: Affinity Essential Plan 3&4	$771.57
Rate for Payer: Affinity Medicaid/CHP/HARP	$342.92
Rate for Payer: Amida Care Medicaid	$342.92
Rate for Payer: Fidelis CHP/HARP/Medicaid	$342.92
Rate for Payer: Fidelis Essential Plan Aliesa	$771.57
Rate for Payer: Fidelis Essential Plan QHP	$771.57
Rate for Payer: Fidelis Qualified Health Plan	$360.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$342.92
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$342.92
Rate for Payer: Healthfirst Commercial	$519.63
Rate for Payer: Healthfirst Essential Plan	$771.57
Rate for Payer: Healthfirst QHP	$342.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$342.92
Rate for Payer: SOMOS Essential	$771.57
Rate for Payer: United Healthcare Essential Plan 1&2	$771.57
Rate for Payer: United Healthcare Essential Plan 3&4	$377.21
Rate for Payer: United Healthcare Medicaid	$342.92
Rate for Payer: Wellcare CHP/FHP/Medicaid	$342.92

OUTPATIENT EAPG 00596: PERIPHERAL & OTHER VASCULAR DIAGNOSES

Facility

$357.98

Service Code	EAPG 00596
Hospital Charge Code	EAPG 00596
Min. Negotiated Rate	$159.10
Max. Negotiated Rate	$357.98
Rate for Payer: Affinity Essential Plan 1&2	$357.98
Rate for Payer: Affinity Essential Plan 3&4	$357.98
Rate for Payer: Affinity Medicaid/CHP/HARP	$159.10
Rate for Payer: Amida Care Medicaid	$159.10
Rate for Payer: Fidelis CHP/HARP/Medicaid	$159.10
Rate for Payer: Fidelis Essential Plan Aliesa	$357.98
Rate for Payer: Fidelis Essential Plan QHP	$357.98
Rate for Payer: Fidelis Qualified Health Plan	$167.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$159.10
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$159.10
Rate for Payer: Healthfirst Commercial	$241.09
Rate for Payer: Healthfirst Essential Plan	$357.98
Rate for Payer: Healthfirst QHP	$159.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$159.10
Rate for Payer: SOMOS Essential	$357.98
Rate for Payer: United Healthcare Essential Plan 1&2	$357.98
Rate for Payer: United Healthcare Essential Plan 3&4	$175.01
Rate for Payer: United Healthcare Medicaid	$159.10
Rate for Payer: Wellcare CHP/FHP/Medicaid	$159.10

OUTPATIENT EAPG 00597: PHLEBITIS

Facility

$310.75

Service Code	EAPG 00597
Hospital Charge Code	EAPG 00597
Min. Negotiated Rate	$138.11
Max. Negotiated Rate	$310.75
Rate for Payer: Affinity Essential Plan 1&2	$310.75
Rate for Payer: Affinity Essential Plan 3&4	$310.75
Rate for Payer: Affinity Medicaid/CHP/HARP	$138.11
Rate for Payer: Amida Care Medicaid	$138.11
Rate for Payer: Fidelis CHP/HARP/Medicaid	$138.11
Rate for Payer: Fidelis Essential Plan Aliesa	$310.75
Rate for Payer: Fidelis Essential Plan QHP	$310.75
Rate for Payer: Fidelis Qualified Health Plan	$145.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$138.11
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$138.11
Rate for Payer: Healthfirst Commercial	$209.28
Rate for Payer: Healthfirst Essential Plan	$310.75
Rate for Payer: Healthfirst QHP	$138.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$138.11
Rate for Payer: SOMOS Essential	$310.75
Rate for Payer: United Healthcare Essential Plan 1&2	$310.75
Rate for Payer: United Healthcare Essential Plan 3&4	$151.92
Rate for Payer: United Healthcare Medicaid	$138.11
Rate for Payer: Wellcare CHP/FHP/Medicaid	$138.11

OUTPATIENT EAPG 00598: ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS

Facility

$327.28

Service Code	EAPG 00598
Hospital Charge Code	EAPG 00598
Min. Negotiated Rate	$145.46
Max. Negotiated Rate	$327.28
Rate for Payer: Affinity Essential Plan 1&2	$327.28
Rate for Payer: Affinity Essential Plan 3&4	$327.28
Rate for Payer: Affinity Medicaid/CHP/HARP	$145.46
Rate for Payer: Amida Care Medicaid	$145.46
Rate for Payer: Fidelis CHP/HARP/Medicaid	$145.46
Rate for Payer: Fidelis Essential Plan Aliesa	$327.28
Rate for Payer: Fidelis Essential Plan QHP	$327.28
Rate for Payer: Fidelis Qualified Health Plan	$152.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$145.46
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$145.46
Rate for Payer: Healthfirst Commercial	$220.42
Rate for Payer: Healthfirst Essential Plan	$327.28
Rate for Payer: Healthfirst QHP	$145.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$145.46
Rate for Payer: SOMOS Essential	$327.28
Rate for Payer: United Healthcare Essential Plan 1&2	$327.28
Rate for Payer: United Healthcare Essential Plan 3&4	$160.01
Rate for Payer: United Healthcare Medicaid	$145.46
Rate for Payer: Wellcare CHP/FHP/Medicaid	$145.46

OUTPATIENT EAPG 00599: HYPERTENSION

Facility

$307.12

Service Code	EAPG 00599
Hospital Charge Code	EAPG 00599
Min. Negotiated Rate	$136.50
Max. Negotiated Rate	$307.12
Rate for Payer: Affinity Essential Plan 1&2	$307.12
Rate for Payer: Affinity Essential Plan 3&4	$307.12
Rate for Payer: Affinity Medicaid/CHP/HARP	$136.50
Rate for Payer: Amida Care Medicaid	$136.50
Rate for Payer: Fidelis CHP/HARP/Medicaid	$136.50
Rate for Payer: Fidelis Essential Plan Aliesa	$307.12
Rate for Payer: Fidelis Essential Plan QHP	$307.12
Rate for Payer: Fidelis Qualified Health Plan	$143.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$136.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$136.50
Rate for Payer: Healthfirst Commercial	$206.85
Rate for Payer: Healthfirst Essential Plan	$307.12
Rate for Payer: Healthfirst QHP	$136.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$136.50
Rate for Payer: SOMOS Essential	$307.12
Rate for Payer: United Healthcare Essential Plan 1&2	$307.12
Rate for Payer: United Healthcare Essential Plan 3&4	$150.15
Rate for Payer: United Healthcare Medicaid	$136.50
Rate for Payer: Wellcare CHP/FHP/Medicaid	$136.50

OUTPATIENT EAPG 00600: CARDIAC STRUCTURAL & VALVULAR DIAGNOSES

Facility

$409.16

Service Code	EAPG 00600
Hospital Charge Code	EAPG 00600
Min. Negotiated Rate	$181.85
Max. Negotiated Rate	$409.16
Rate for Payer: Affinity Essential Plan 1&2	$409.16
Rate for Payer: Affinity Essential Plan 3&4	$409.16
Rate for Payer: Affinity Medicaid/CHP/HARP	$181.85
Rate for Payer: Amida Care Medicaid	$181.85
Rate for Payer: Fidelis CHP/HARP/Medicaid	$181.85
Rate for Payer: Fidelis Essential Plan Aliesa	$409.16
Rate for Payer: Fidelis Essential Plan QHP	$409.16
Rate for Payer: Fidelis Qualified Health Plan	$190.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$181.85
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$181.85
Rate for Payer: Healthfirst Commercial	$275.57
Rate for Payer: Healthfirst Essential Plan	$409.16
Rate for Payer: Healthfirst QHP	$181.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$181.85
Rate for Payer: SOMOS Essential	$409.16
Rate for Payer: United Healthcare Essential Plan 1&2	$409.16
Rate for Payer: United Healthcare Essential Plan 3&4	$200.04
Rate for Payer: United Healthcare Medicaid	$181.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$181.85

OUTPATIENT EAPG 00601: LEVEL I CARDIAC ARRHYTHMIA & CONDUCTION DIAGNOSES

Facility

$367.29

Service Code	EAPG 00601
Hospital Charge Code	EAPG 00601
Min. Negotiated Rate	$163.24
Max. Negotiated Rate	$367.29
Rate for Payer: Affinity Essential Plan 1&2	$367.29
Rate for Payer: Affinity Essential Plan 3&4	$367.29
Rate for Payer: Affinity Medicaid/CHP/HARP	$163.24
Rate for Payer: Amida Care Medicaid	$163.24
Rate for Payer: Fidelis CHP/HARP/Medicaid	$163.24
Rate for Payer: Fidelis Essential Plan Aliesa	$367.29
Rate for Payer: Fidelis Essential Plan QHP	$367.29
Rate for Payer: Fidelis Qualified Health Plan	$171.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$163.24
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$163.24
Rate for Payer: Healthfirst Commercial	$247.37
Rate for Payer: Healthfirst Essential Plan	$367.29
Rate for Payer: Healthfirst QHP	$163.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$163.24
Rate for Payer: SOMOS Essential	$367.29
Rate for Payer: United Healthcare Essential Plan 1&2	$367.29
Rate for Payer: United Healthcare Essential Plan 3&4	$179.56
Rate for Payer: United Healthcare Medicaid	$163.24
Rate for Payer: Wellcare CHP/FHP/Medicaid	$163.24

OUTPATIENT EAPG 00602: ATRIAL FIBRILLATION

Facility

$330.19

Service Code	EAPG 00602
Hospital Charge Code	EAPG 00602
Min. Negotiated Rate	$146.75
Max. Negotiated Rate	$330.19
Rate for Payer: Affinity Essential Plan 1&2	$330.19
Rate for Payer: Affinity Essential Plan 3&4	$330.19
Rate for Payer: Affinity Medicaid/CHP/HARP	$146.75
Rate for Payer: Amida Care Medicaid	$146.75
Rate for Payer: Fidelis CHP/HARP/Medicaid	$146.75
Rate for Payer: Fidelis Essential Plan Aliesa	$330.19
Rate for Payer: Fidelis Essential Plan QHP	$330.19
Rate for Payer: Fidelis Qualified Health Plan	$154.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$146.75
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$146.75
Rate for Payer: Healthfirst Commercial	$222.36
Rate for Payer: Healthfirst Essential Plan	$330.19
Rate for Payer: Healthfirst QHP	$146.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$146.75
Rate for Payer: SOMOS Essential	$330.19
Rate for Payer: United Healthcare Essential Plan 1&2	$330.19
Rate for Payer: United Healthcare Essential Plan 3&4	$161.42
Rate for Payer: United Healthcare Medicaid	$146.75
Rate for Payer: Wellcare CHP/FHP/Medicaid	$146.75

OUTPATIENT EAPG 00603: LEVEL II CARDIAC ARRHYTHMIA & CONDUCTION DIAGNOSES

Facility

$271.04

Service Code	EAPG 00603
Hospital Charge Code	EAPG 00603
Min. Negotiated Rate	$271.04
Max. Negotiated Rate	$271.04
Rate for Payer: Healthfirst Commercial	$271.04

OUTPATIENT EAPG 00604: CHEST PAIN

Facility

$432.61

Service Code	EAPG 00604
Hospital Charge Code	EAPG 00604
Min. Negotiated Rate	$192.27
Max. Negotiated Rate	$432.61
Rate for Payer: Affinity Essential Plan 1&2	$432.61
Rate for Payer: Affinity Essential Plan 3&4	$432.61
Rate for Payer: Affinity Medicaid/CHP/HARP	$192.27
Rate for Payer: Amida Care Medicaid	$192.27
Rate for Payer: Fidelis CHP/HARP/Medicaid	$192.27
Rate for Payer: Fidelis Essential Plan Aliesa	$432.61
Rate for Payer: Fidelis Essential Plan QHP	$432.61
Rate for Payer: Fidelis Qualified Health Plan	$201.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$192.27
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$192.27
Rate for Payer: Healthfirst Commercial	$291.36
Rate for Payer: Healthfirst Essential Plan	$432.61
Rate for Payer: Healthfirst QHP	$192.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$192.27
Rate for Payer: SOMOS Essential	$432.61
Rate for Payer: United Healthcare Essential Plan 1&2	$432.61
Rate for Payer: United Healthcare Essential Plan 3&4	$211.50
Rate for Payer: United Healthcare Medicaid	$192.27
Rate for Payer: Wellcare CHP/FHP/Medicaid	$192.27

OUTPATIENT EAPG 00605: SYNCOPE & COLLAPSE

Facility

$389.18

Service Code	EAPG 00605
Hospital Charge Code	EAPG 00605
Min. Negotiated Rate	$172.97
Max. Negotiated Rate	$389.18
Rate for Payer: Affinity Essential Plan 1&2	$389.18
Rate for Payer: Affinity Essential Plan 3&4	$389.18
Rate for Payer: Affinity Medicaid/CHP/HARP	$172.97
Rate for Payer: Amida Care Medicaid	$172.97
Rate for Payer: Fidelis CHP/HARP/Medicaid	$172.97
Rate for Payer: Fidelis Essential Plan Aliesa	$389.18
Rate for Payer: Fidelis Essential Plan QHP	$389.18
Rate for Payer: Fidelis Qualified Health Plan	$181.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$172.97
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$172.97
Rate for Payer: Healthfirst Commercial	$262.10
Rate for Payer: Healthfirst Essential Plan	$389.18
Rate for Payer: Healthfirst QHP	$172.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$172.97
Rate for Payer: SOMOS Essential	$389.18
Rate for Payer: United Healthcare Essential Plan 1&2	$389.18
Rate for Payer: United Healthcare Essential Plan 3&4	$190.27
Rate for Payer: United Healthcare Medicaid	$172.97
Rate for Payer: Wellcare CHP/FHP/Medicaid	$172.97

OUTPATIENT EAPG 00620: DIGESTIVE MALIGNANCY

Facility

$297.18

Service Code	EAPG 00620
Hospital Charge Code	EAPG 00620
Min. Negotiated Rate	$132.08
Max. Negotiated Rate	$297.18
Rate for Payer: Affinity Essential Plan 1&2	$297.18
Rate for Payer: Affinity Essential Plan 3&4	$297.18
Rate for Payer: Affinity Medicaid/CHP/HARP	$132.08
Rate for Payer: Amida Care Medicaid	$132.08
Rate for Payer: Fidelis CHP/HARP/Medicaid	$132.08
Rate for Payer: Fidelis Essential Plan Aliesa	$297.18
Rate for Payer: Fidelis Essential Plan QHP	$297.18
Rate for Payer: Fidelis Qualified Health Plan	$138.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$132.08
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$132.08
Rate for Payer: Healthfirst Commercial	$200.15
Rate for Payer: Healthfirst Essential Plan	$297.18
Rate for Payer: Healthfirst QHP	$132.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$132.08
Rate for Payer: SOMOS Essential	$297.18
Rate for Payer: United Healthcare Essential Plan 1&2	$297.18
Rate for Payer: United Healthcare Essential Plan 3&4	$145.29
Rate for Payer: United Healthcare Medicaid	$132.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$132.08

OUTPATIENT EAPG 00621: PEPTIC ULCER & GASTRITIS

Facility

$402.91

Service Code	EAPG 00621
Hospital Charge Code	EAPG 00621
Min. Negotiated Rate	$179.07
Max. Negotiated Rate	$402.91
Rate for Payer: Affinity Essential Plan 1&2	$402.91
Rate for Payer: Affinity Essential Plan 3&4	$402.91
Rate for Payer: Affinity Medicaid/CHP/HARP	$179.07
Rate for Payer: Amida Care Medicaid	$179.07
Rate for Payer: Fidelis CHP/HARP/Medicaid	$179.07
Rate for Payer: Fidelis Essential Plan Aliesa	$402.91
Rate for Payer: Fidelis Essential Plan QHP	$402.91
Rate for Payer: Fidelis Qualified Health Plan	$188.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.07
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$179.07
Rate for Payer: Healthfirst Commercial	$271.35
Rate for Payer: Healthfirst Essential Plan	$402.91
Rate for Payer: Healthfirst QHP	$179.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$179.07
Rate for Payer: SOMOS Essential	$402.91
Rate for Payer: United Healthcare Essential Plan 1&2	$402.91
Rate for Payer: United Healthcare Essential Plan 3&4	$196.98
Rate for Payer: United Healthcare Medicaid	$179.07
Rate for Payer: Wellcare CHP/FHP/Medicaid	$179.07

OUTPATIENT EAPG 00623: ESOPHAGITIS

Facility

$319.86

Service Code	EAPG 00623
Hospital Charge Code	EAPG 00623
Min. Negotiated Rate	$142.16
Max. Negotiated Rate	$319.86
Rate for Payer: Affinity Essential Plan 1&2	$319.86
Rate for Payer: Affinity Essential Plan 3&4	$319.86
Rate for Payer: Affinity Medicaid/CHP/HARP	$142.16
Rate for Payer: Amida Care Medicaid	$142.16
Rate for Payer: Fidelis CHP/HARP/Medicaid	$142.16
Rate for Payer: Fidelis Essential Plan Aliesa	$319.86
Rate for Payer: Fidelis Essential Plan QHP	$319.86
Rate for Payer: Fidelis Qualified Health Plan	$149.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$142.16
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$142.16
Rate for Payer: Healthfirst Commercial	$215.42
Rate for Payer: Healthfirst Essential Plan	$319.86
Rate for Payer: Healthfirst QHP	$142.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$142.16
Rate for Payer: SOMOS Essential	$319.86
Rate for Payer: United Healthcare Essential Plan 1&2	$319.86
Rate for Payer: United Healthcare Essential Plan 3&4	$156.38
Rate for Payer: United Healthcare Medicaid	$142.16
Rate for Payer: Wellcare CHP/FHP/Medicaid	$142.16

OUTPATIENT EAPG 00624: LEVEL I GASTROINTESTINAL DIAGNOSES

Facility

$347.62

Service Code	EAPG 00624
Hospital Charge Code	EAPG 00624
Min. Negotiated Rate	$154.50
Max. Negotiated Rate	$347.62
Rate for Payer: Affinity Essential Plan 1&2	$347.62
Rate for Payer: Affinity Essential Plan 3&4	$347.62
Rate for Payer: Affinity Medicaid/CHP/HARP	$154.50
Rate for Payer: Amida Care Medicaid	$154.50
Rate for Payer: Fidelis CHP/HARP/Medicaid	$154.50
Rate for Payer: Fidelis Essential Plan Aliesa	$347.62
Rate for Payer: Fidelis Essential Plan QHP	$347.62
Rate for Payer: Fidelis Qualified Health Plan	$162.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$154.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$154.50
Rate for Payer: Healthfirst Commercial	$234.12
Rate for Payer: Healthfirst Essential Plan	$347.62
Rate for Payer: Healthfirst QHP	$154.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$154.50
Rate for Payer: SOMOS Essential	$347.62
Rate for Payer: United Healthcare Essential Plan 1&2	$347.62
Rate for Payer: United Healthcare Essential Plan 3&4	$169.95
Rate for Payer: United Healthcare Medicaid	$154.50
Rate for Payer: Wellcare CHP/FHP/Medicaid	$154.50

OUTPATIENT EAPG 00625: LEVEL II GASTROINTESTINAL DIAGNOSES

Facility

$238.13

Service Code	EAPG 00625
Hospital Charge Code	EAPG 00625
Min. Negotiated Rate	$238.13
Max. Negotiated Rate	$238.13
Rate for Payer: Healthfirst Commercial	$238.13

OUTPATIENT EAPG 00626: INFLAMMATORY BOWEL DISEASE

Facility

$291.78

Service Code	EAPG 00626
Hospital Charge Code	EAPG 00626
Min. Negotiated Rate	$129.68
Max. Negotiated Rate	$291.78
Rate for Payer: Affinity Essential Plan 1&2	$291.78
Rate for Payer: Affinity Essential Plan 3&4	$291.78
Rate for Payer: Affinity Medicaid/CHP/HARP	$129.68
Rate for Payer: Amida Care Medicaid	$129.68
Rate for Payer: Fidelis CHP/HARP/Medicaid	$129.68
Rate for Payer: Fidelis Essential Plan Aliesa	$291.78
Rate for Payer: Fidelis Essential Plan QHP	$291.78
Rate for Payer: Fidelis Qualified Health Plan	$136.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.68
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$129.68
Rate for Payer: Healthfirst Commercial	$196.51
Rate for Payer: Healthfirst Essential Plan	$291.78
Rate for Payer: Healthfirst QHP	$129.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$129.68
Rate for Payer: SOMOS Essential	$291.78
Rate for Payer: United Healthcare Essential Plan 1&2	$291.78
Rate for Payer: United Healthcare Essential Plan 3&4	$142.65
Rate for Payer: United Healthcare Medicaid	$129.68
Rate for Payer: Wellcare CHP/FHP/Medicaid	$129.68

OUTPATIENT EAPG 00627: NON-BACTERIAL GASTROENTERITIS, NAUSEA & VOMITING

Facility

$354.96

Service Code	EAPG 00627
Hospital Charge Code	EAPG 00627
Min. Negotiated Rate	$157.76
Max. Negotiated Rate	$354.96
Rate for Payer: Affinity Essential Plan 1&2	$354.96
Rate for Payer: Affinity Essential Plan 3&4	$354.96
Rate for Payer: Affinity Medicaid/CHP/HARP	$157.76
Rate for Payer: Amida Care Medicaid	$157.76
Rate for Payer: Fidelis CHP/HARP/Medicaid	$157.76
Rate for Payer: Fidelis Essential Plan Aliesa	$354.96
Rate for Payer: Fidelis Essential Plan QHP	$354.96
Rate for Payer: Fidelis Qualified Health Plan	$165.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.76
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$157.76
Rate for Payer: Healthfirst Commercial	$239.06
Rate for Payer: Healthfirst Essential Plan	$354.96
Rate for Payer: Healthfirst QHP	$157.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$157.76
Rate for Payer: SOMOS Essential	$354.96
Rate for Payer: United Healthcare Essential Plan 1&2	$354.96
Rate for Payer: United Healthcare Essential Plan 3&4	$173.54
Rate for Payer: United Healthcare Medicaid	$157.76
Rate for Payer: Wellcare CHP/FHP/Medicaid	$157.76

Know your out-of-pocket cost for care.

All Charges