St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

OUTPATIENT EAPG 00659: MALFUNCTION, REACTION, COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDURE

Facility

$410.31

Service Code	EAPG 00659
Hospital Charge Code	EAPG 00659
Min. Negotiated Rate	$182.36
Max. Negotiated Rate	$410.31
Rate for Payer: Affinity Essential Plan 1&2	$410.31
Rate for Payer: Affinity Essential Plan 3&4	$410.31
Rate for Payer: Affinity Medicaid/CHP/HARP	$182.36
Rate for Payer: Amida Care Medicaid	$182.36
Rate for Payer: Fidelis CHP/HARP/Medicaid	$182.36
Rate for Payer: Fidelis Essential Plan Aliesa	$410.31
Rate for Payer: Fidelis Essential Plan QHP	$410.31
Rate for Payer: Fidelis Qualified Health Plan	$191.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$182.36
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$182.36
Rate for Payer: Healthfirst Commercial	$276.33
Rate for Payer: Healthfirst Essential Plan	$410.31
Rate for Payer: Healthfirst QHP	$182.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$182.36
Rate for Payer: SOMOS Essential	$410.31
Rate for Payer: United Healthcare Essential Plan 1&2	$410.31
Rate for Payer: United Healthcare Essential Plan 3&4	$200.60
Rate for Payer: United Healthcare Medicaid	$182.36
Rate for Payer: Wellcare CHP/FHP/Medicaid	$182.36

OUTPATIENT EAPG 00660: LEVEL I OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES

Facility

$360.58

Service Code	EAPG 00660
Hospital Charge Code	EAPG 00660
Min. Negotiated Rate	$160.26
Max. Negotiated Rate	$360.58
Rate for Payer: Affinity Essential Plan 1&2	$360.58
Rate for Payer: Affinity Essential Plan 3&4	$360.58
Rate for Payer: Affinity Medicaid/CHP/HARP	$160.26
Rate for Payer: Amida Care Medicaid	$160.26
Rate for Payer: Fidelis CHP/HARP/Medicaid	$160.26
Rate for Payer: Fidelis Essential Plan Aliesa	$360.58
Rate for Payer: Fidelis Essential Plan QHP	$360.58
Rate for Payer: Fidelis Qualified Health Plan	$168.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$160.26
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$160.26
Rate for Payer: Healthfirst Commercial	$242.85
Rate for Payer: Healthfirst Essential Plan	$360.58
Rate for Payer: Healthfirst QHP	$160.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$160.26
Rate for Payer: SOMOS Essential	$360.58
Rate for Payer: United Healthcare Essential Plan 1&2	$360.58
Rate for Payer: United Healthcare Essential Plan 3&4	$176.29
Rate for Payer: United Healthcare Medicaid	$160.26
Rate for Payer: Wellcare CHP/FHP/Medicaid	$160.26

OUTPATIENT EAPG 00661: LEVEL II OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES

Facility

$268.28

Service Code	EAPG 00661
Hospital Charge Code	EAPG 00661
Min. Negotiated Rate	$268.28
Max. Negotiated Rate	$268.28
Rate for Payer: Healthfirst Commercial	$268.28

OUTPATIENT EAPG 00662: OSTEOPOROSIS

Facility

$271.87

Service Code	EAPG 00662
Hospital Charge Code	EAPG 00662
Min. Negotiated Rate	$120.83
Max. Negotiated Rate	$271.87
Rate for Payer: Affinity Essential Plan 1&2	$271.87
Rate for Payer: Affinity Essential Plan 3&4	$271.87
Rate for Payer: Affinity Medicaid/CHP/HARP	$120.83
Rate for Payer: Amida Care Medicaid	$120.83
Rate for Payer: Fidelis CHP/HARP/Medicaid	$120.83
Rate for Payer: Fidelis Essential Plan Aliesa	$271.87
Rate for Payer: Fidelis Essential Plan QHP	$271.87
Rate for Payer: Fidelis Qualified Health Plan	$126.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.83
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$120.83
Rate for Payer: Healthfirst Commercial	$183.10
Rate for Payer: Healthfirst Essential Plan	$271.87
Rate for Payer: Healthfirst QHP	$120.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$120.83
Rate for Payer: SOMOS Essential	$271.87
Rate for Payer: United Healthcare Essential Plan 1&2	$271.87
Rate for Payer: United Healthcare Essential Plan 3&4	$132.91
Rate for Payer: United Healthcare Medicaid	$120.83
Rate for Payer: Wellcare CHP/FHP/Medicaid	$120.83

OUTPATIENT EAPG 00663: PAIN

Facility

$359.42

Service Code	EAPG 00663
Hospital Charge Code	EAPG 00663
Min. Negotiated Rate	$159.74
Max. Negotiated Rate	$359.42
Rate for Payer: Affinity Essential Plan 1&2	$359.42
Rate for Payer: Affinity Essential Plan 3&4	$359.42
Rate for Payer: Affinity Medicaid/CHP/HARP	$159.74
Rate for Payer: Amida Care Medicaid	$159.74
Rate for Payer: Fidelis CHP/HARP/Medicaid	$159.74
Rate for Payer: Fidelis Essential Plan Aliesa	$359.42
Rate for Payer: Fidelis Essential Plan QHP	$359.42
Rate for Payer: Fidelis Qualified Health Plan	$167.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$159.74
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$159.74
Rate for Payer: Healthfirst Commercial	$242.07
Rate for Payer: Healthfirst Essential Plan	$359.42
Rate for Payer: Healthfirst QHP	$159.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$159.74
Rate for Payer: SOMOS Essential	$359.42
Rate for Payer: United Healthcare Essential Plan 1&2	$359.42
Rate for Payer: United Healthcare Essential Plan 3&4	$175.71
Rate for Payer: United Healthcare Medicaid	$159.74
Rate for Payer: Wellcare CHP/FHP/Medicaid	$159.74

OUTPATIENT EAPG 00670: SKIN ULCERS

Facility

$406.78

Service Code	EAPG 00670
Hospital Charge Code	EAPG 00670
Min. Negotiated Rate	$180.79
Max. Negotiated Rate	$406.78
Rate for Payer: Affinity Essential Plan 1&2	$406.78
Rate for Payer: Affinity Essential Plan 3&4	$406.78
Rate for Payer: Affinity Medicaid/CHP/HARP	$180.79
Rate for Payer: Amida Care Medicaid	$180.79
Rate for Payer: Fidelis CHP/HARP/Medicaid	$180.79
Rate for Payer: Fidelis Essential Plan Aliesa	$406.78
Rate for Payer: Fidelis Essential Plan QHP	$406.78
Rate for Payer: Fidelis Qualified Health Plan	$189.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$180.79
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$180.79
Rate for Payer: Healthfirst Commercial	$273.95
Rate for Payer: Healthfirst Essential Plan	$406.78
Rate for Payer: Healthfirst QHP	$180.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$180.79
Rate for Payer: SOMOS Essential	$406.78
Rate for Payer: United Healthcare Essential Plan 1&2	$406.78
Rate for Payer: United Healthcare Essential Plan 3&4	$198.87
Rate for Payer: United Healthcare Medicaid	$180.79
Rate for Payer: Wellcare CHP/FHP/Medicaid	$180.79

OUTPATIENT EAPG 00671: MAJOR SKIN DIAGNOSES

Facility

$310.95

Service Code	EAPG 00671
Hospital Charge Code	EAPG 00671
Min. Negotiated Rate	$138.20
Max. Negotiated Rate	$310.95
Rate for Payer: Affinity Essential Plan 1&2	$310.95
Rate for Payer: Affinity Essential Plan 3&4	$310.95
Rate for Payer: Affinity Medicaid/CHP/HARP	$138.20
Rate for Payer: Amida Care Medicaid	$138.20
Rate for Payer: Fidelis CHP/HARP/Medicaid	$138.20
Rate for Payer: Fidelis Essential Plan Aliesa	$310.95
Rate for Payer: Fidelis Essential Plan QHP	$310.95
Rate for Payer: Fidelis Qualified Health Plan	$145.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$138.20
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$138.20
Rate for Payer: Healthfirst Commercial	$209.41
Rate for Payer: Healthfirst Essential Plan	$310.95
Rate for Payer: Healthfirst QHP	$138.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$138.20
Rate for Payer: SOMOS Essential	$310.95
Rate for Payer: United Healthcare Essential Plan 1&2	$310.95
Rate for Payer: United Healthcare Essential Plan 3&4	$152.02
Rate for Payer: United Healthcare Medicaid	$138.20
Rate for Payer: Wellcare CHP/FHP/Medicaid	$138.20

OUTPATIENT EAPG 00672: MALIGNANT BREAST DIAGNOSES

Facility

$306.68

Service Code	EAPG 00672
Hospital Charge Code	EAPG 00672
Min. Negotiated Rate	$136.30
Max. Negotiated Rate	$306.68
Rate for Payer: Affinity Essential Plan 1&2	$306.68
Rate for Payer: Affinity Essential Plan 3&4	$306.68
Rate for Payer: Affinity Medicaid/CHP/HARP	$136.30
Rate for Payer: Amida Care Medicaid	$136.30
Rate for Payer: Fidelis CHP/HARP/Medicaid	$136.30
Rate for Payer: Fidelis Essential Plan Aliesa	$306.68
Rate for Payer: Fidelis Essential Plan QHP	$306.68
Rate for Payer: Fidelis Qualified Health Plan	$143.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$136.30
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$136.30
Rate for Payer: Healthfirst Commercial	$206.54
Rate for Payer: Healthfirst Essential Plan	$306.68
Rate for Payer: Healthfirst QHP	$136.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$136.30
Rate for Payer: SOMOS Essential	$306.68
Rate for Payer: United Healthcare Essential Plan 1&2	$306.68
Rate for Payer: United Healthcare Essential Plan 3&4	$149.93
Rate for Payer: United Healthcare Medicaid	$136.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$136.30

OUTPATIENT EAPG 00673: CELLULITIS & OTHER BACTERIAL SKIN INFECTIONS

Facility

$315.40

Service Code	EAPG 00673
Hospital Charge Code	EAPG 00673
Min. Negotiated Rate	$140.18
Max. Negotiated Rate	$315.40
Rate for Payer: Affinity Essential Plan 1&2	$315.40
Rate for Payer: Affinity Essential Plan 3&4	$315.40
Rate for Payer: Affinity Medicaid/CHP/HARP	$140.18
Rate for Payer: Amida Care Medicaid	$140.18
Rate for Payer: Fidelis CHP/HARP/Medicaid	$140.18
Rate for Payer: Fidelis Essential Plan Aliesa	$315.40
Rate for Payer: Fidelis Essential Plan QHP	$315.40
Rate for Payer: Fidelis Qualified Health Plan	$147.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$140.18
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$140.18
Rate for Payer: Healthfirst Commercial	$212.42
Rate for Payer: Healthfirst Essential Plan	$315.40
Rate for Payer: Healthfirst QHP	$140.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$140.18
Rate for Payer: SOMOS Essential	$315.40
Rate for Payer: United Healthcare Essential Plan 1&2	$315.40
Rate for Payer: United Healthcare Essential Plan 3&4	$154.20
Rate for Payer: United Healthcare Medicaid	$140.18
Rate for Payer: Wellcare CHP/FHP/Medicaid	$140.18

OUTPATIENT EAPG 00674: CONTUSION, OPEN WOUND & OTHER TRAUMA TO SKIN & SUBCUTANEOUS TISSUE

Facility

$457.27

Service Code	EAPG 00674
Hospital Charge Code	EAPG 00674
Min. Negotiated Rate	$203.23
Max. Negotiated Rate	$457.27
Rate for Payer: Affinity Essential Plan 1&2	$457.27
Rate for Payer: Affinity Essential Plan 3&4	$457.27
Rate for Payer: Affinity Medicaid/CHP/HARP	$203.23
Rate for Payer: Amida Care Medicaid	$203.23
Rate for Payer: Fidelis CHP/HARP/Medicaid	$203.23
Rate for Payer: Fidelis Essential Plan Aliesa	$457.27
Rate for Payer: Fidelis Essential Plan QHP	$457.27
Rate for Payer: Fidelis Qualified Health Plan	$213.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$203.23
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$203.23
Rate for Payer: Healthfirst Commercial	$307.96
Rate for Payer: Healthfirst Essential Plan	$457.27
Rate for Payer: Healthfirst QHP	$203.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$203.23
Rate for Payer: SOMOS Essential	$457.27
Rate for Payer: United Healthcare Essential Plan 1&2	$457.27
Rate for Payer: United Healthcare Essential Plan 3&4	$223.55
Rate for Payer: United Healthcare Medicaid	$203.23
Rate for Payer: Wellcare CHP/FHP/Medicaid	$203.23

OUTPATIENT EAPG 00675: OTHER SKIN, SUBCUTANEOUS TISSUE & BREAST DIAGNOSES

Facility

$309.87

Service Code	EAPG 00675
Hospital Charge Code	EAPG 00675
Min. Negotiated Rate	$137.72
Max. Negotiated Rate	$309.87
Rate for Payer: Affinity Essential Plan 1&2	$309.87
Rate for Payer: Affinity Essential Plan 3&4	$309.87
Rate for Payer: Affinity Medicaid/CHP/HARP	$137.72
Rate for Payer: Amida Care Medicaid	$137.72
Rate for Payer: Fidelis CHP/HARP/Medicaid	$137.72
Rate for Payer: Fidelis Essential Plan Aliesa	$309.87
Rate for Payer: Fidelis Essential Plan QHP	$309.87
Rate for Payer: Fidelis Qualified Health Plan	$144.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$137.72
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$137.72
Rate for Payer: Healthfirst Commercial	$208.69
Rate for Payer: Healthfirst Essential Plan	$309.87
Rate for Payer: Healthfirst QHP	$137.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$137.72
Rate for Payer: SOMOS Essential	$309.87
Rate for Payer: United Healthcare Essential Plan 1&2	$309.87
Rate for Payer: United Healthcare Essential Plan 3&4	$151.49
Rate for Payer: United Healthcare Medicaid	$137.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$137.72

OUTPATIENT EAPG 00676: DECUBITUS ULCER

Facility

$377.01

Service Code	EAPG 00676
Hospital Charge Code	EAPG 00676
Min. Negotiated Rate	$167.56
Max. Negotiated Rate	$377.01
Rate for Payer: Affinity Essential Plan 1&2	$377.01
Rate for Payer: Affinity Essential Plan 3&4	$377.01
Rate for Payer: Affinity Medicaid/CHP/HARP	$167.56
Rate for Payer: Amida Care Medicaid	$167.56
Rate for Payer: Fidelis CHP/HARP/Medicaid	$167.56
Rate for Payer: Fidelis Essential Plan Aliesa	$377.01
Rate for Payer: Fidelis Essential Plan QHP	$377.01
Rate for Payer: Fidelis Qualified Health Plan	$175.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$167.56
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$167.56
Rate for Payer: Healthfirst Commercial	$253.91
Rate for Payer: Healthfirst Essential Plan	$377.01
Rate for Payer: Healthfirst QHP	$167.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$167.56
Rate for Payer: SOMOS Essential	$377.01
Rate for Payer: United Healthcare Essential Plan 1&2	$377.01
Rate for Payer: United Healthcare Essential Plan 3&4	$184.32
Rate for Payer: United Healthcare Medicaid	$167.56
Rate for Payer: Wellcare CHP/FHP/Medicaid	$167.56

OUTPATIENT EAPG 00690: MALNUTRITION, FAILURE TO THRIVE & OTHER NUTRITIONAL DIAGNOSES

Facility

$339.50

Service Code	EAPG 00690
Hospital Charge Code	EAPG 00690
Min. Negotiated Rate	$150.89
Max. Negotiated Rate	$339.50
Rate for Payer: Affinity Essential Plan 1&2	$339.50
Rate for Payer: Affinity Essential Plan 3&4	$339.50
Rate for Payer: Affinity Medicaid/CHP/HARP	$150.89
Rate for Payer: Amida Care Medicaid	$150.89
Rate for Payer: Fidelis CHP/HARP/Medicaid	$150.89
Rate for Payer: Fidelis Essential Plan Aliesa	$339.50
Rate for Payer: Fidelis Essential Plan QHP	$339.50
Rate for Payer: Fidelis Qualified Health Plan	$158.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$150.89
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$150.89
Rate for Payer: Healthfirst Commercial	$228.66
Rate for Payer: Healthfirst Essential Plan	$339.50
Rate for Payer: Healthfirst QHP	$150.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$150.89
Rate for Payer: SOMOS Essential	$339.50
Rate for Payer: United Healthcare Essential Plan 1&2	$339.50
Rate for Payer: United Healthcare Essential Plan 3&4	$165.98
Rate for Payer: United Healthcare Medicaid	$150.89
Rate for Payer: Wellcare CHP/FHP/Medicaid	$150.89

OUTPATIENT EAPG 00691: INBORN ERRORS OF METABOLISM

Facility

$288.88

Service Code	EAPG 00691
Hospital Charge Code	EAPG 00691
Min. Negotiated Rate	$128.39
Max. Negotiated Rate	$288.88
Rate for Payer: Affinity Essential Plan 1&2	$288.88
Rate for Payer: Affinity Essential Plan 3&4	$288.88
Rate for Payer: Affinity Medicaid/CHP/HARP	$128.39
Rate for Payer: Amida Care Medicaid	$128.39
Rate for Payer: Fidelis CHP/HARP/Medicaid	$128.39
Rate for Payer: Fidelis Essential Plan Aliesa	$288.88
Rate for Payer: Fidelis Essential Plan QHP	$288.88
Rate for Payer: Fidelis Qualified Health Plan	$134.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$128.39
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$128.39
Rate for Payer: Healthfirst Commercial	$194.56
Rate for Payer: Healthfirst Essential Plan	$288.88
Rate for Payer: Healthfirst QHP	$128.39
Rate for Payer: SOMOS CHP/HARP/Medicaid	$128.39
Rate for Payer: SOMOS Essential	$288.88
Rate for Payer: United Healthcare Essential Plan 1&2	$288.88
Rate for Payer: United Healthcare Essential Plan 3&4	$141.23
Rate for Payer: United Healthcare Medicaid	$128.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$128.39

OUTPATIENT EAPG 00692: LEVEL I ENDOCRINE DIAGNOSES

Facility

$325.84

Service Code	EAPG 00692
Hospital Charge Code	EAPG 00692
Min. Negotiated Rate	$144.82
Max. Negotiated Rate	$325.84
Rate for Payer: Affinity Essential Plan 1&2	$325.84
Rate for Payer: Affinity Essential Plan 3&4	$325.84
Rate for Payer: Affinity Medicaid/CHP/HARP	$144.82
Rate for Payer: Amida Care Medicaid	$144.82
Rate for Payer: Fidelis CHP/HARP/Medicaid	$144.82
Rate for Payer: Fidelis Essential Plan Aliesa	$325.84
Rate for Payer: Fidelis Essential Plan QHP	$325.84
Rate for Payer: Fidelis Qualified Health Plan	$152.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$144.82
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$144.82
Rate for Payer: Healthfirst Commercial	$219.45
Rate for Payer: Healthfirst Essential Plan	$325.84
Rate for Payer: Healthfirst QHP	$144.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$144.82
Rate for Payer: SOMOS Essential	$325.84
Rate for Payer: United Healthcare Essential Plan 1&2	$325.84
Rate for Payer: United Healthcare Essential Plan 3&4	$159.30
Rate for Payer: United Healthcare Medicaid	$144.82
Rate for Payer: Wellcare CHP/FHP/Medicaid	$144.82

OUTPATIENT EAPG 00693: LEVEL II ENDOCRINE DIAGNOSES

Facility

$215.32

Service Code	EAPG 00693
Hospital Charge Code	EAPG 00693
Min. Negotiated Rate	$215.32
Max. Negotiated Rate	$215.32
Rate for Payer: Healthfirst Commercial	$215.32

OUTPATIENT EAPG 00694: ELECTROLYTE DISORDERS

Facility

$347.54

Service Code	EAPG 00694
Hospital Charge Code	EAPG 00694
Min. Negotiated Rate	$154.46
Max. Negotiated Rate	$347.54
Rate for Payer: Affinity Essential Plan 1&2	$347.54
Rate for Payer: Affinity Essential Plan 3&4	$347.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$154.46
Rate for Payer: Amida Care Medicaid	$154.46
Rate for Payer: Fidelis CHP/HARP/Medicaid	$154.46
Rate for Payer: Fidelis Essential Plan Aliesa	$347.54
Rate for Payer: Fidelis Essential Plan QHP	$347.54
Rate for Payer: Fidelis Qualified Health Plan	$162.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$154.46
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$154.46
Rate for Payer: Healthfirst Commercial	$234.07
Rate for Payer: Healthfirst Essential Plan	$347.54
Rate for Payer: Healthfirst QHP	$154.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$154.46
Rate for Payer: SOMOS Essential	$347.54
Rate for Payer: United Healthcare Essential Plan 1&2	$347.54
Rate for Payer: United Healthcare Essential Plan 3&4	$169.91
Rate for Payer: United Healthcare Medicaid	$154.46
Rate for Payer: Wellcare CHP/FHP/Medicaid	$154.46

OUTPATIENT EAPG 00695: OBESITY

Facility

$317.86

Service Code	EAPG 00695
Hospital Charge Code	EAPG 00695
Min. Negotiated Rate	$141.27
Max. Negotiated Rate	$317.86
Rate for Payer: Affinity Essential Plan 1&2	$317.86
Rate for Payer: Affinity Essential Plan 3&4	$317.86
Rate for Payer: Affinity Medicaid/CHP/HARP	$141.27
Rate for Payer: Amida Care Medicaid	$141.27
Rate for Payer: Fidelis CHP/HARP/Medicaid	$141.27
Rate for Payer: Fidelis Essential Plan Aliesa	$317.86
Rate for Payer: Fidelis Essential Plan QHP	$317.86
Rate for Payer: Fidelis Qualified Health Plan	$148.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$141.27
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$141.27
Rate for Payer: Healthfirst Commercial	$214.07
Rate for Payer: Healthfirst Essential Plan	$317.86
Rate for Payer: Healthfirst QHP	$141.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$141.27
Rate for Payer: SOMOS Essential	$317.86
Rate for Payer: United Healthcare Essential Plan 1&2	$317.86
Rate for Payer: United Healthcare Essential Plan 3&4	$155.40
Rate for Payer: United Healthcare Medicaid	$141.27
Rate for Payer: Wellcare CHP/FHP/Medicaid	$141.27

OUTPATIENT EAPG 00710: DIABETES WITH OPHTHALMIC MANIFESTATIONS

Facility

$355.36

Service Code	EAPG 00710
Hospital Charge Code	EAPG 00710
Min. Negotiated Rate	$157.94
Max. Negotiated Rate	$355.36
Rate for Payer: Affinity Essential Plan 1&2	$355.36
Rate for Payer: Affinity Essential Plan 3&4	$355.36
Rate for Payer: Affinity Medicaid/CHP/HARP	$157.94
Rate for Payer: Amida Care Medicaid	$157.94
Rate for Payer: Fidelis CHP/HARP/Medicaid	$157.94
Rate for Payer: Fidelis Essential Plan Aliesa	$355.36
Rate for Payer: Fidelis Essential Plan QHP	$355.36
Rate for Payer: Fidelis Qualified Health Plan	$165.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.94
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$157.94
Rate for Payer: Healthfirst Commercial	$239.33
Rate for Payer: Healthfirst Essential Plan	$355.36
Rate for Payer: Healthfirst QHP	$157.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$157.94
Rate for Payer: SOMOS Essential	$355.36
Rate for Payer: United Healthcare Essential Plan 1&2	$355.36
Rate for Payer: United Healthcare Essential Plan 3&4	$173.73
Rate for Payer: United Healthcare Medicaid	$157.94
Rate for Payer: Wellcare CHP/FHP/Medicaid	$157.94

OUTPATIENT EAPG 00711: DIABETES WITH OTHER MANIFESTATIONS & COMPLICATIONS

Facility

$321.57

Service Code	EAPG 00711
Hospital Charge Code	EAPG 00711
Min. Negotiated Rate	$142.92
Max. Negotiated Rate	$321.57
Rate for Payer: Affinity Essential Plan 1&2	$321.57
Rate for Payer: Affinity Essential Plan 3&4	$321.57
Rate for Payer: Affinity Medicaid/CHP/HARP	$142.92
Rate for Payer: Amida Care Medicaid	$142.92
Rate for Payer: Fidelis CHP/HARP/Medicaid	$142.92
Rate for Payer: Fidelis Essential Plan Aliesa	$321.57
Rate for Payer: Fidelis Essential Plan QHP	$321.57
Rate for Payer: Fidelis Qualified Health Plan	$150.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$142.92
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$142.92
Rate for Payer: Healthfirst Commercial	$216.56
Rate for Payer: Healthfirst Essential Plan	$321.57
Rate for Payer: Healthfirst QHP	$142.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$142.92
Rate for Payer: SOMOS Essential	$321.57
Rate for Payer: United Healthcare Essential Plan 1&2	$321.57
Rate for Payer: United Healthcare Essential Plan 3&4	$157.21
Rate for Payer: United Healthcare Medicaid	$142.92
Rate for Payer: Wellcare CHP/FHP/Medicaid	$142.92

OUTPATIENT EAPG 00712: DIABETES WITH NEUROLOGIC MANIFESTATIONS

Facility

$350.86

Service Code	EAPG 00712
Hospital Charge Code	EAPG 00712
Min. Negotiated Rate	$155.94
Max. Negotiated Rate	$350.86
Rate for Payer: Affinity Essential Plan 1&2	$350.86
Rate for Payer: Affinity Essential Plan 3&4	$350.86
Rate for Payer: Affinity Medicaid/CHP/HARP	$155.94
Rate for Payer: Amida Care Medicaid	$155.94
Rate for Payer: Fidelis CHP/HARP/Medicaid	$155.94
Rate for Payer: Fidelis Essential Plan Aliesa	$350.86
Rate for Payer: Fidelis Essential Plan QHP	$350.86
Rate for Payer: Fidelis Qualified Health Plan	$163.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$155.94
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$155.94
Rate for Payer: Healthfirst Commercial	$236.30
Rate for Payer: Healthfirst Essential Plan	$350.86
Rate for Payer: Healthfirst QHP	$155.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$155.94
Rate for Payer: SOMOS Essential	$350.86
Rate for Payer: United Healthcare Essential Plan 1&2	$350.86
Rate for Payer: United Healthcare Essential Plan 3&4	$171.53
Rate for Payer: United Healthcare Medicaid	$155.94
Rate for Payer: Wellcare CHP/FHP/Medicaid	$155.94

OUTPATIENT EAPG 00713: DIABETES WITHOUT COMPLICATIONS

Facility

$305.26

Service Code	EAPG 00713
Hospital Charge Code	EAPG 00713
Min. Negotiated Rate	$135.67
Max. Negotiated Rate	$305.26
Rate for Payer: Affinity Essential Plan 1&2	$305.26
Rate for Payer: Affinity Essential Plan 3&4	$305.26
Rate for Payer: Affinity Medicaid/CHP/HARP	$135.67
Rate for Payer: Amida Care Medicaid	$135.67
Rate for Payer: Fidelis CHP/HARP/Medicaid	$135.67
Rate for Payer: Fidelis Essential Plan Aliesa	$305.26
Rate for Payer: Fidelis Essential Plan QHP	$305.26
Rate for Payer: Fidelis Qualified Health Plan	$142.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$135.67
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$135.67
Rate for Payer: Healthfirst Commercial	$205.58
Rate for Payer: Healthfirst Essential Plan	$305.26
Rate for Payer: Healthfirst QHP	$135.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$135.67
Rate for Payer: SOMOS Essential	$305.26
Rate for Payer: United Healthcare Essential Plan 1&2	$305.26
Rate for Payer: United Healthcare Essential Plan 3&4	$149.24
Rate for Payer: United Healthcare Medicaid	$135.67
Rate for Payer: Wellcare CHP/FHP/Medicaid	$135.67

OUTPATIENT EAPG 00714: DIABETES WITH RENAL MANIFESTATIONS

Facility

$284.80

Service Code	EAPG 00714
Hospital Charge Code	EAPG 00714
Min. Negotiated Rate	$126.58
Max. Negotiated Rate	$284.80
Rate for Payer: Affinity Essential Plan 1&2	$284.80
Rate for Payer: Affinity Essential Plan 3&4	$284.80
Rate for Payer: Affinity Medicaid/CHP/HARP	$126.58
Rate for Payer: Amida Care Medicaid	$126.58
Rate for Payer: Fidelis CHP/HARP/Medicaid	$126.58
Rate for Payer: Fidelis Essential Plan Aliesa	$284.80
Rate for Payer: Fidelis Essential Plan QHP	$284.80
Rate for Payer: Fidelis Qualified Health Plan	$132.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$126.58
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$126.58
Rate for Payer: Healthfirst Commercial	$191.82
Rate for Payer: Healthfirst Essential Plan	$284.80
Rate for Payer: Healthfirst QHP	$126.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$126.58
Rate for Payer: SOMOS Essential	$284.80
Rate for Payer: United Healthcare Essential Plan 1&2	$284.80
Rate for Payer: United Healthcare Essential Plan 3&4	$139.24
Rate for Payer: United Healthcare Medicaid	$126.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$126.58

OUTPATIENT EAPG 00720: RENAL FAILURE

Facility

$316.19

Service Code	EAPG 00720
Hospital Charge Code	EAPG 00720
Min. Negotiated Rate	$140.53
Max. Negotiated Rate	$316.19
Rate for Payer: Affinity Essential Plan 1&2	$316.19
Rate for Payer: Affinity Essential Plan 3&4	$316.19
Rate for Payer: Affinity Medicaid/CHP/HARP	$140.53
Rate for Payer: Amida Care Medicaid	$140.53
Rate for Payer: Fidelis CHP/HARP/Medicaid	$140.53
Rate for Payer: Fidelis Essential Plan Aliesa	$316.19
Rate for Payer: Fidelis Essential Plan QHP	$316.19
Rate for Payer: Fidelis Qualified Health Plan	$147.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$140.53
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$140.53
Rate for Payer: Healthfirst Commercial	$212.94
Rate for Payer: Healthfirst Essential Plan	$316.19
Rate for Payer: Healthfirst QHP	$140.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$140.53
Rate for Payer: SOMOS Essential	$316.19
Rate for Payer: United Healthcare Essential Plan 1&2	$316.19
Rate for Payer: United Healthcare Essential Plan 3&4	$154.58
Rate for Payer: United Healthcare Medicaid	$140.53
Rate for Payer: Wellcare CHP/FHP/Medicaid	$140.53

OUTPATIENT EAPG 00721: KIDNEY & URINARY TRACT MALIGNANCY

Facility

$354.87

Service Code	EAPG 00721
Hospital Charge Code	EAPG 00721
Min. Negotiated Rate	$157.72
Max. Negotiated Rate	$354.87
Rate for Payer: Affinity Essential Plan 1&2	$354.87
Rate for Payer: Affinity Essential Plan 3&4	$354.87
Rate for Payer: Affinity Medicaid/CHP/HARP	$157.72
Rate for Payer: Amida Care Medicaid	$157.72
Rate for Payer: Fidelis CHP/HARP/Medicaid	$157.72
Rate for Payer: Fidelis Essential Plan Aliesa	$354.87
Rate for Payer: Fidelis Essential Plan QHP	$354.87
Rate for Payer: Fidelis Qualified Health Plan	$165.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.72
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$157.72
Rate for Payer: Healthfirst Commercial	$238.99
Rate for Payer: Healthfirst Essential Plan	$354.87
Rate for Payer: Healthfirst QHP	$157.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$157.72
Rate for Payer: SOMOS Essential	$354.87
Rate for Payer: United Healthcare Essential Plan 1&2	$354.87
Rate for Payer: United Healthcare Essential Plan 3&4	$173.49
Rate for Payer: United Healthcare Medicaid	$157.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$157.72

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