St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

OUTPATIENT EAPG 00722: NEPHRITIS & NEPHROSIS

Facility

$350.84

Service Code	EAPG 00722
Hospital Charge Code	EAPG 00722
Min. Negotiated Rate	$155.93
Max. Negotiated Rate	$350.84
Rate for Payer: Affinity Essential Plan 1&2	$350.84
Rate for Payer: Affinity Essential Plan 3&4	$350.84
Rate for Payer: Affinity Medicaid/CHP/HARP	$155.93
Rate for Payer: Amida Care Medicaid	$155.93
Rate for Payer: Fidelis CHP/HARP/Medicaid	$155.93
Rate for Payer: Fidelis Essential Plan Aliesa	$350.84
Rate for Payer: Fidelis Essential Plan QHP	$350.84
Rate for Payer: Fidelis Qualified Health Plan	$163.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$155.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$155.93
Rate for Payer: Healthfirst Commercial	$236.28
Rate for Payer: Healthfirst Essential Plan	$350.84
Rate for Payer: Healthfirst QHP	$155.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$155.93
Rate for Payer: SOMOS Essential	$350.84
Rate for Payer: United Healthcare Essential Plan 1&2	$350.84
Rate for Payer: United Healthcare Essential Plan 3&4	$171.52
Rate for Payer: United Healthcare Medicaid	$155.93
Rate for Payer: Wellcare CHP/FHP/Medicaid	$155.93

OUTPATIENT EAPG 00723: KIDNEY AND CHRONIC URINARY TRACT INFECTIONS

Facility

$378.22

Service Code	EAPG 00723
Hospital Charge Code	EAPG 00723
Min. Negotiated Rate	$168.10
Max. Negotiated Rate	$378.22
Rate for Payer: Affinity Essential Plan 1&2	$378.22
Rate for Payer: Affinity Essential Plan 3&4	$378.22
Rate for Payer: Affinity Medicaid/CHP/HARP	$168.10
Rate for Payer: Amida Care Medicaid	$168.10
Rate for Payer: Fidelis CHP/HARP/Medicaid	$168.10
Rate for Payer: Fidelis Essential Plan Aliesa	$378.22
Rate for Payer: Fidelis Essential Plan QHP	$378.22
Rate for Payer: Fidelis Qualified Health Plan	$176.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$168.10
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$168.10
Rate for Payer: Healthfirst Commercial	$254.72
Rate for Payer: Healthfirst Essential Plan	$378.22
Rate for Payer: Healthfirst QHP	$168.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$168.10
Rate for Payer: SOMOS Essential	$378.22
Rate for Payer: United Healthcare Essential Plan 1&2	$378.22
Rate for Payer: United Healthcare Essential Plan 3&4	$184.91
Rate for Payer: United Healthcare Medicaid	$168.10
Rate for Payer: Wellcare CHP/FHP/Medicaid	$168.10

OUTPATIENT EAPG 00724: URINARY STONES & ACQUIRED UPPER URINARY TRACT OBSTRUCTION

Facility

$361.64

Service Code	EAPG 00724
Hospital Charge Code	EAPG 00724
Min. Negotiated Rate	$160.73
Max. Negotiated Rate	$361.64
Rate for Payer: Affinity Essential Plan 1&2	$361.64
Rate for Payer: Affinity Essential Plan 3&4	$361.64
Rate for Payer: Affinity Medicaid/CHP/HARP	$160.73
Rate for Payer: Amida Care Medicaid	$160.73
Rate for Payer: Fidelis CHP/HARP/Medicaid	$160.73
Rate for Payer: Fidelis Essential Plan Aliesa	$361.64
Rate for Payer: Fidelis Essential Plan QHP	$361.64
Rate for Payer: Fidelis Qualified Health Plan	$168.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$160.73
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$160.73
Rate for Payer: Healthfirst Commercial	$243.55
Rate for Payer: Healthfirst Essential Plan	$361.64
Rate for Payer: Healthfirst QHP	$160.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$160.73
Rate for Payer: SOMOS Essential	$361.64
Rate for Payer: United Healthcare Essential Plan 1&2	$361.64
Rate for Payer: United Healthcare Essential Plan 3&4	$176.80
Rate for Payer: United Healthcare Medicaid	$160.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$160.73

OUTPATIENT EAPG 00725: MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PROC

Facility

$543.76

Service Code	EAPG 00725
Hospital Charge Code	EAPG 00725
Min. Negotiated Rate	$241.67
Max. Negotiated Rate	$543.76
Rate for Payer: Affinity Essential Plan 1&2	$543.76
Rate for Payer: Affinity Essential Plan 3&4	$543.76
Rate for Payer: Affinity Medicaid/CHP/HARP	$241.67
Rate for Payer: Amida Care Medicaid	$241.67
Rate for Payer: Fidelis CHP/HARP/Medicaid	$241.67
Rate for Payer: Fidelis Essential Plan Aliesa	$543.76
Rate for Payer: Fidelis Essential Plan QHP	$543.76
Rate for Payer: Fidelis Qualified Health Plan	$253.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$241.67
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$241.67
Rate for Payer: Healthfirst Commercial	$366.21
Rate for Payer: Healthfirst Essential Plan	$543.76
Rate for Payer: Healthfirst QHP	$241.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$241.67
Rate for Payer: SOMOS Essential	$543.76
Rate for Payer: United Healthcare Essential Plan 1&2	$543.76
Rate for Payer: United Healthcare Essential Plan 3&4	$265.84
Rate for Payer: United Healthcare Medicaid	$241.67
Rate for Payer: Wellcare CHP/FHP/Medicaid	$241.67

OUTPATIENT EAPG 00726: OTHER KIDNEY & URINARY TRACT DIAGNOSES, SIGNS & SYMPTOMS

Facility

$345.98

Service Code	EAPG 00726
Hospital Charge Code	EAPG 00726
Min. Negotiated Rate	$153.77
Max. Negotiated Rate	$345.98
Rate for Payer: Affinity Essential Plan 1&2	$345.98
Rate for Payer: Affinity Essential Plan 3&4	$345.98
Rate for Payer: Affinity Medicaid/CHP/HARP	$153.77
Rate for Payer: Amida Care Medicaid	$153.77
Rate for Payer: Fidelis CHP/HARP/Medicaid	$153.77
Rate for Payer: Fidelis Essential Plan Aliesa	$345.98
Rate for Payer: Fidelis Essential Plan QHP	$345.98
Rate for Payer: Fidelis Qualified Health Plan	$161.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$153.77
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$153.77
Rate for Payer: Healthfirst Commercial	$233.02
Rate for Payer: Healthfirst Essential Plan	$345.98
Rate for Payer: Healthfirst QHP	$153.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$153.77
Rate for Payer: SOMOS Essential	$345.98
Rate for Payer: United Healthcare Essential Plan 1&2	$345.98
Rate for Payer: United Healthcare Essential Plan 3&4	$169.15
Rate for Payer: United Healthcare Medicaid	$153.77
Rate for Payer: Wellcare CHP/FHP/Medicaid	$153.77

OUTPATIENT EAPG 00727: ACUTE LOWER URINARY TRACT INFECTIONS

Facility

$367.40

Service Code	EAPG 00727
Hospital Charge Code	EAPG 00727
Min. Negotiated Rate	$163.29
Max. Negotiated Rate	$367.40
Rate for Payer: Affinity Essential Plan 1&2	$367.40
Rate for Payer: Affinity Essential Plan 3&4	$367.40
Rate for Payer: Affinity Medicaid/CHP/HARP	$163.29
Rate for Payer: Amida Care Medicaid	$163.29
Rate for Payer: Fidelis CHP/HARP/Medicaid	$163.29
Rate for Payer: Fidelis Essential Plan Aliesa	$367.40
Rate for Payer: Fidelis Essential Plan QHP	$367.40
Rate for Payer: Fidelis Qualified Health Plan	$171.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$163.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$163.29
Rate for Payer: Healthfirst Commercial	$247.43
Rate for Payer: Healthfirst Essential Plan	$367.40
Rate for Payer: Healthfirst QHP	$163.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$163.29
Rate for Payer: SOMOS Essential	$367.40
Rate for Payer: United Healthcare Essential Plan 1&2	$367.40
Rate for Payer: United Healthcare Essential Plan 3&4	$179.62
Rate for Payer: United Healthcare Medicaid	$163.29
Rate for Payer: Wellcare CHP/FHP/Medicaid	$163.29

OUTPATIENT EAPG 00740: MALIGNANCY, MALE REPRODUCTIVE SYSTEM

Facility

$327.87

Service Code	EAPG 00740
Hospital Charge Code	EAPG 00740
Min. Negotiated Rate	$145.72
Max. Negotiated Rate	$327.87
Rate for Payer: Affinity Essential Plan 1&2	$327.87
Rate for Payer: Affinity Essential Plan 3&4	$327.87
Rate for Payer: Affinity Medicaid/CHP/HARP	$145.72
Rate for Payer: Amida Care Medicaid	$145.72
Rate for Payer: Fidelis CHP/HARP/Medicaid	$145.72
Rate for Payer: Fidelis Essential Plan Aliesa	$327.87
Rate for Payer: Fidelis Essential Plan QHP	$327.87
Rate for Payer: Fidelis Qualified Health Plan	$153.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$145.72
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$145.72
Rate for Payer: Healthfirst Commercial	$220.82
Rate for Payer: Healthfirst Essential Plan	$327.87
Rate for Payer: Healthfirst QHP	$145.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$145.72
Rate for Payer: SOMOS Essential	$327.87
Rate for Payer: United Healthcare Essential Plan 1&2	$327.87
Rate for Payer: United Healthcare Essential Plan 3&4	$160.29
Rate for Payer: United Healthcare Medicaid	$145.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$145.72

OUTPATIENT EAPG 00741: MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY

Facility

$339.03

Service Code	EAPG 00741
Hospital Charge Code	EAPG 00741
Min. Negotiated Rate	$150.68
Max. Negotiated Rate	$339.03
Rate for Payer: Affinity Essential Plan 1&2	$339.03
Rate for Payer: Affinity Essential Plan 3&4	$339.03
Rate for Payer: Affinity Medicaid/CHP/HARP	$150.68
Rate for Payer: Amida Care Medicaid	$150.68
Rate for Payer: Fidelis CHP/HARP/Medicaid	$150.68
Rate for Payer: Fidelis Essential Plan Aliesa	$339.03
Rate for Payer: Fidelis Essential Plan QHP	$339.03
Rate for Payer: Fidelis Qualified Health Plan	$158.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$150.68
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$150.68
Rate for Payer: Healthfirst Commercial	$228.33
Rate for Payer: Healthfirst Essential Plan	$339.03
Rate for Payer: Healthfirst QHP	$150.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$150.68
Rate for Payer: SOMOS Essential	$339.03
Rate for Payer: United Healthcare Essential Plan 1&2	$339.03
Rate for Payer: United Healthcare Essential Plan 3&4	$165.75
Rate for Payer: United Healthcare Medicaid	$150.68
Rate for Payer: Wellcare CHP/FHP/Medicaid	$150.68

OUTPATIENT EAPG 00742: NEOPLASMS OF THE MALE REPRODUCTIVE SYSTEM

Facility

$244.21

Service Code	EAPG 00742
Hospital Charge Code	EAPG 00742
Min. Negotiated Rate	$244.21
Max. Negotiated Rate	$244.21
Rate for Payer: Healthfirst Commercial	$244.21

OUTPATIENT EAPG 00743: PROSTATITIS

Facility

$308.59

Service Code	EAPG 00743
Hospital Charge Code	EAPG 00743
Min. Negotiated Rate	$137.15
Max. Negotiated Rate	$308.59
Rate for Payer: Affinity Essential Plan 1&2	$308.59
Rate for Payer: Affinity Essential Plan 3&4	$308.59
Rate for Payer: Affinity Medicaid/CHP/HARP	$137.15
Rate for Payer: Amida Care Medicaid	$137.15
Rate for Payer: Fidelis CHP/HARP/Medicaid	$137.15
Rate for Payer: Fidelis Essential Plan Aliesa	$308.59
Rate for Payer: Fidelis Essential Plan QHP	$308.59
Rate for Payer: Fidelis Qualified Health Plan	$144.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$137.15
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$137.15
Rate for Payer: Healthfirst Commercial	$207.82
Rate for Payer: Healthfirst Essential Plan	$308.59
Rate for Payer: Healthfirst QHP	$137.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$137.15
Rate for Payer: SOMOS Essential	$308.59
Rate for Payer: United Healthcare Essential Plan 1&2	$308.59
Rate for Payer: United Healthcare Essential Plan 3&4	$150.86
Rate for Payer: United Healthcare Medicaid	$137.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$137.15

OUTPATIENT EAPG 00744: MALE REPRODUCTIVE INFECTIONS

Facility

$359.10

Service Code	EAPG 00744
Hospital Charge Code	EAPG 00744
Min. Negotiated Rate	$159.60
Max. Negotiated Rate	$359.10
Rate for Payer: Affinity Essential Plan 1&2	$359.10
Rate for Payer: Affinity Essential Plan 3&4	$359.10
Rate for Payer: Affinity Medicaid/CHP/HARP	$159.60
Rate for Payer: Amida Care Medicaid	$159.60
Rate for Payer: Fidelis CHP/HARP/Medicaid	$159.60
Rate for Payer: Fidelis Essential Plan Aliesa	$359.10
Rate for Payer: Fidelis Essential Plan QHP	$359.10
Rate for Payer: Fidelis Qualified Health Plan	$167.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$159.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$159.60
Rate for Payer: Healthfirst Commercial	$241.84
Rate for Payer: Healthfirst Essential Plan	$359.10
Rate for Payer: Healthfirst QHP	$159.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$159.60
Rate for Payer: SOMOS Essential	$359.10
Rate for Payer: United Healthcare Essential Plan 1&2	$359.10
Rate for Payer: United Healthcare Essential Plan 3&4	$175.56
Rate for Payer: United Healthcare Medicaid	$159.60
Rate for Payer: Wellcare CHP/FHP/Medicaid	$159.60

OUTPATIENT EAPG 00750: FEMALE REPRODUCTIVE SYSTEM MALIGNANCY

Facility

$311.40

Service Code	EAPG 00750
Hospital Charge Code	EAPG 00750
Min. Negotiated Rate	$138.40
Max. Negotiated Rate	$311.40
Rate for Payer: Affinity Essential Plan 1&2	$311.40
Rate for Payer: Affinity Essential Plan 3&4	$311.40
Rate for Payer: Affinity Medicaid/CHP/HARP	$138.40
Rate for Payer: Amida Care Medicaid	$138.40
Rate for Payer: Fidelis CHP/HARP/Medicaid	$138.40
Rate for Payer: Fidelis Essential Plan Aliesa	$311.40
Rate for Payer: Fidelis Essential Plan QHP	$311.40
Rate for Payer: Fidelis Qualified Health Plan	$145.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$138.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$138.40
Rate for Payer: Healthfirst Commercial	$209.72
Rate for Payer: Healthfirst Essential Plan	$311.40
Rate for Payer: Healthfirst QHP	$138.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$138.40
Rate for Payer: SOMOS Essential	$311.40
Rate for Payer: United Healthcare Essential Plan 1&2	$311.40
Rate for Payer: United Healthcare Essential Plan 3&4	$152.24
Rate for Payer: United Healthcare Medicaid	$138.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$138.40

OUTPATIENT EAPG 00751: FEMALE REPRODUCTIVE SYSTEM INFECTIONS

Facility

$342.11

Service Code	EAPG 00751
Hospital Charge Code	EAPG 00751
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 00752: LEVEL I MENSTRUAL AND OTHER FEMALE DIAGNOSES

Facility

$306.72

Service Code	EAPG 00752
Hospital Charge Code	EAPG 00752
Min. Negotiated Rate	$136.32
Max. Negotiated Rate	$306.72
Rate for Payer: Affinity Essential Plan 1&2	$306.72
Rate for Payer: Affinity Essential Plan 3&4	$306.72
Rate for Payer: Affinity Medicaid/CHP/HARP	$136.32
Rate for Payer: Amida Care Medicaid	$136.32
Rate for Payer: Fidelis CHP/HARP/Medicaid	$136.32
Rate for Payer: Fidelis Essential Plan Aliesa	$306.72
Rate for Payer: Fidelis Essential Plan QHP	$306.72
Rate for Payer: Fidelis Qualified Health Plan	$143.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$136.32
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$136.32
Rate for Payer: Healthfirst Commercial	$206.57
Rate for Payer: Healthfirst Essential Plan	$306.72
Rate for Payer: Healthfirst QHP	$136.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$136.32
Rate for Payer: SOMOS Essential	$306.72
Rate for Payer: United Healthcare Essential Plan 1&2	$306.72
Rate for Payer: United Healthcare Essential Plan 3&4	$149.95
Rate for Payer: United Healthcare Medicaid	$136.32
Rate for Payer: Wellcare CHP/FHP/Medicaid	$136.32

OUTPATIENT EAPG 00753: LEVEL II MENSTRUAL AND OTHER FEMALE DIAGNOSES

Facility

$249.57

Service Code	EAPG 00753
Hospital Charge Code	EAPG 00753
Min. Negotiated Rate	$249.57
Max. Negotiated Rate	$249.57
Rate for Payer: Healthfirst Commercial	$249.57

OUTPATIENT EAPG 00760: VAGINAL DELIVERY

Facility

$299.56

Service Code	EAPG 00760
Hospital Charge Code	EAPG 00760
Min. Negotiated Rate	$133.14
Max. Negotiated Rate	$299.56
Rate for Payer: Affinity Essential Plan 1&2	$299.56
Rate for Payer: Affinity Essential Plan 3&4	$299.56
Rate for Payer: Affinity Medicaid/CHP/HARP	$133.14
Rate for Payer: Amida Care Medicaid	$133.14
Rate for Payer: Fidelis CHP/HARP/Medicaid	$133.14
Rate for Payer: Fidelis Essential Plan Aliesa	$299.56
Rate for Payer: Fidelis Essential Plan QHP	$299.56
Rate for Payer: Fidelis Qualified Health Plan	$139.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$133.14
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$133.14
Rate for Payer: Healthfirst Commercial	$201.75
Rate for Payer: Healthfirst Essential Plan	$299.56
Rate for Payer: Healthfirst QHP	$133.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$133.14
Rate for Payer: SOMOS Essential	$299.56
Rate for Payer: United Healthcare Essential Plan 1&2	$299.56
Rate for Payer: United Healthcare Essential Plan 3&4	$146.45
Rate for Payer: United Healthcare Medicaid	$133.14
Rate for Payer: Wellcare CHP/FHP/Medicaid	$133.14

OUTPATIENT EAPG 00761: POSTPARTUM & POST ABORTION DIAGNOSES W/O PROCEDURE

Facility

$341.21

Service Code	EAPG 00761
Hospital Charge Code	EAPG 00761
Min. Negotiated Rate	$151.65
Max. Negotiated Rate	$341.21
Rate for Payer: Affinity Essential Plan 1&2	$341.21
Rate for Payer: Affinity Essential Plan 3&4	$341.21
Rate for Payer: Affinity Medicaid/CHP/HARP	$151.65
Rate for Payer: Amida Care Medicaid	$151.65
Rate for Payer: Fidelis CHP/HARP/Medicaid	$151.65
Rate for Payer: Fidelis Essential Plan Aliesa	$341.21
Rate for Payer: Fidelis Essential Plan QHP	$341.21
Rate for Payer: Fidelis Qualified Health Plan	$159.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$151.65
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$151.65
Rate for Payer: Healthfirst Commercial	$229.81
Rate for Payer: Healthfirst Essential Plan	$341.21
Rate for Payer: Healthfirst QHP	$151.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$151.65
Rate for Payer: SOMOS Essential	$341.21
Rate for Payer: United Healthcare Essential Plan 1&2	$341.21
Rate for Payer: United Healthcare Essential Plan 3&4	$166.82
Rate for Payer: United Healthcare Medicaid	$151.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$151.65

OUTPATIENT EAPG 00762: THREATENED ABORTION

Facility

$438.44

Service Code	EAPG 00762
Hospital Charge Code	EAPG 00762
Min. Negotiated Rate	$194.86
Max. Negotiated Rate	$438.44
Rate for Payer: Affinity Essential Plan 1&2	$438.44
Rate for Payer: Affinity Essential Plan 3&4	$438.44
Rate for Payer: Affinity Medicaid/CHP/HARP	$194.86
Rate for Payer: Amida Care Medicaid	$194.86
Rate for Payer: Fidelis CHP/HARP/Medicaid	$194.86
Rate for Payer: Fidelis Essential Plan Aliesa	$438.44
Rate for Payer: Fidelis Essential Plan QHP	$438.44
Rate for Payer: Fidelis Qualified Health Plan	$204.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$194.86
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$194.86
Rate for Payer: Healthfirst Commercial	$295.27
Rate for Payer: Healthfirst Essential Plan	$438.44
Rate for Payer: Healthfirst QHP	$194.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$194.86
Rate for Payer: SOMOS Essential	$438.44
Rate for Payer: United Healthcare Essential Plan 1&2	$438.44
Rate for Payer: United Healthcare Essential Plan 3&4	$214.35
Rate for Payer: United Healthcare Medicaid	$194.86
Rate for Payer: Wellcare CHP/FHP/Medicaid	$194.86

OUTPATIENT EAPG 00763: ABORTION W/O D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$349.72

Service Code	EAPG 00763
Hospital Charge Code	EAPG 00763
Min. Negotiated Rate	$155.43
Max. Negotiated Rate	$349.72
Rate for Payer: Affinity Essential Plan 1&2	$349.72
Rate for Payer: Affinity Essential Plan 3&4	$349.72
Rate for Payer: Affinity Medicaid/CHP/HARP	$155.43
Rate for Payer: Amida Care Medicaid	$155.43
Rate for Payer: Fidelis CHP/HARP/Medicaid	$155.43
Rate for Payer: Fidelis Essential Plan Aliesa	$349.72
Rate for Payer: Fidelis Essential Plan QHP	$349.72
Rate for Payer: Fidelis Qualified Health Plan	$163.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$155.43
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$155.43
Rate for Payer: Healthfirst Commercial	$235.54
Rate for Payer: Healthfirst Essential Plan	$349.72
Rate for Payer: Healthfirst QHP	$155.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$155.43
Rate for Payer: SOMOS Essential	$349.72
Rate for Payer: United Healthcare Essential Plan 1&2	$349.72
Rate for Payer: United Healthcare Essential Plan 3&4	$170.97
Rate for Payer: United Healthcare Medicaid	$155.43
Rate for Payer: Wellcare CHP/FHP/Medicaid	$155.43

OUTPATIENT EAPG 00764: FALSE LABOR

Facility

$518.58

Service Code	EAPG 00764
Hospital Charge Code	EAPG 00764
Min. Negotiated Rate	$230.48
Max. Negotiated Rate	$518.58
Rate for Payer: Affinity Essential Plan 1&2	$518.58
Rate for Payer: Affinity Essential Plan 3&4	$518.58
Rate for Payer: Affinity Medicaid/CHP/HARP	$230.48
Rate for Payer: Amida Care Medicaid	$230.48
Rate for Payer: Fidelis CHP/HARP/Medicaid	$230.48
Rate for Payer: Fidelis Essential Plan Aliesa	$518.58
Rate for Payer: Fidelis Essential Plan QHP	$518.58
Rate for Payer: Fidelis Qualified Health Plan	$242.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$230.48
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$230.48
Rate for Payer: Healthfirst Commercial	$349.24
Rate for Payer: Healthfirst Essential Plan	$518.58
Rate for Payer: Healthfirst QHP	$230.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$230.48
Rate for Payer: SOMOS Essential	$518.58
Rate for Payer: United Healthcare Essential Plan 1&2	$518.58
Rate for Payer: United Healthcare Essential Plan 3&4	$253.53
Rate for Payer: United Healthcare Medicaid	$230.48
Rate for Payer: Wellcare CHP/FHP/Medicaid	$230.48

OUTPATIENT EAPG 00765: OTHER ANTEPARTUM DIAGNOSES

Facility

$363.02

Service Code	EAPG 00765
Hospital Charge Code	EAPG 00765
Min. Negotiated Rate	$161.34
Max. Negotiated Rate	$363.02
Rate for Payer: Affinity Essential Plan 1&2	$363.02
Rate for Payer: Affinity Essential Plan 3&4	$363.02
Rate for Payer: Affinity Medicaid/CHP/HARP	$161.34
Rate for Payer: Amida Care Medicaid	$161.34
Rate for Payer: Fidelis CHP/HARP/Medicaid	$161.34
Rate for Payer: Fidelis Essential Plan Aliesa	$363.02
Rate for Payer: Fidelis Essential Plan QHP	$363.02
Rate for Payer: Fidelis Qualified Health Plan	$169.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$161.34
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$161.34
Rate for Payer: Healthfirst Commercial	$244.48
Rate for Payer: Healthfirst Essential Plan	$363.02
Rate for Payer: Healthfirst QHP	$161.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$161.34
Rate for Payer: SOMOS Essential	$363.02
Rate for Payer: United Healthcare Essential Plan 1&2	$363.02
Rate for Payer: United Healthcare Essential Plan 3&4	$177.47
Rate for Payer: United Healthcare Medicaid	$161.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$161.34

OUTPATIENT EAPG 00766: ROUTINE PRENATAL CARE

Facility

$348.34

Service Code	EAPG 00766
Hospital Charge Code	EAPG 00766
Min. Negotiated Rate	$154.82
Max. Negotiated Rate	$348.34
Rate for Payer: Affinity Essential Plan 1&2	$348.34
Rate for Payer: Affinity Essential Plan 3&4	$348.34
Rate for Payer: Affinity Medicaid/CHP/HARP	$154.82
Rate for Payer: Amida Care Medicaid	$154.82
Rate for Payer: Fidelis CHP/HARP/Medicaid	$154.82
Rate for Payer: Fidelis Essential Plan Aliesa	$348.34
Rate for Payer: Fidelis Essential Plan QHP	$348.34
Rate for Payer: Fidelis Qualified Health Plan	$162.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$154.82
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$154.82
Rate for Payer: Healthfirst Commercial	$234.61
Rate for Payer: Healthfirst Essential Plan	$348.34
Rate for Payer: Healthfirst QHP	$154.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$154.82
Rate for Payer: SOMOS Essential	$348.34
Rate for Payer: United Healthcare Essential Plan 1&2	$348.34
Rate for Payer: United Healthcare Essential Plan 3&4	$170.30
Rate for Payer: United Healthcare Medicaid	$154.82
Rate for Payer: Wellcare CHP/FHP/Medicaid	$154.82

OUTPATIENT EAPG 00770: NORMAL NEONATE

Facility

$293.20

Service Code	EAPG 00770
Hospital Charge Code	EAPG 00770
Min. Negotiated Rate	$130.31
Max. Negotiated Rate	$293.20
Rate for Payer: Affinity Essential Plan 1&2	$293.20
Rate for Payer: Affinity Essential Plan 3&4	$293.20
Rate for Payer: Affinity Medicaid/CHP/HARP	$130.31
Rate for Payer: Amida Care Medicaid	$130.31
Rate for Payer: Fidelis CHP/HARP/Medicaid	$130.31
Rate for Payer: Fidelis Essential Plan Aliesa	$293.20
Rate for Payer: Fidelis Essential Plan QHP	$293.20
Rate for Payer: Fidelis Qualified Health Plan	$136.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$130.31
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$130.31
Rate for Payer: Healthfirst Commercial	$197.46
Rate for Payer: Healthfirst Essential Plan	$293.20
Rate for Payer: Healthfirst QHP	$130.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$130.31
Rate for Payer: SOMOS Essential	$293.20
Rate for Payer: United Healthcare Essential Plan 1&2	$293.20
Rate for Payer: United Healthcare Essential Plan 3&4	$143.34
Rate for Payer: United Healthcare Medicaid	$130.31
Rate for Payer: Wellcare CHP/FHP/Medicaid	$130.31

OUTPATIENT EAPG 00771: LEVEL I NEONATAL DIAGNOSES

Facility

$365.96

Service Code	EAPG 00771
Hospital Charge Code	EAPG 00771
Min. Negotiated Rate	$162.65
Max. Negotiated Rate	$365.96
Rate for Payer: Affinity Essential Plan 1&2	$365.96
Rate for Payer: Affinity Essential Plan 3&4	$365.96
Rate for Payer: Affinity Medicaid/CHP/HARP	$162.65
Rate for Payer: Amida Care Medicaid	$162.65
Rate for Payer: Fidelis CHP/HARP/Medicaid	$162.65
Rate for Payer: Fidelis Essential Plan Aliesa	$365.96
Rate for Payer: Fidelis Essential Plan QHP	$365.96
Rate for Payer: Fidelis Qualified Health Plan	$170.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$162.65
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$162.65
Rate for Payer: Healthfirst Commercial	$246.47
Rate for Payer: Healthfirst Essential Plan	$365.96
Rate for Payer: Healthfirst QHP	$162.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$162.65
Rate for Payer: SOMOS Essential	$365.96
Rate for Payer: United Healthcare Essential Plan 1&2	$365.96
Rate for Payer: United Healthcare Essential Plan 3&4	$178.92
Rate for Payer: United Healthcare Medicaid	$162.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$162.65

OUTPATIENT EAPG 00772: LEVEL II NEONATAL DIAGNOSES

Facility

$228.04

Service Code	EAPG 00772
Hospital Charge Code	EAPG 00772
Min. Negotiated Rate	$228.04
Max. Negotiated Rate	$228.04
Rate for Payer: Healthfirst Commercial	$228.04

Know your out-of-pocket cost for care.

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