St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

OUTPATIENT EAPG 00780: OTHER HEMATOLOGICAL DIAGNOSES

Facility

$375.84

Service Code	EAPG 00780
Hospital Charge Code	EAPG 00780
Min. Negotiated Rate	$167.04
Max. Negotiated Rate	$375.84
Rate for Payer: Affinity Essential Plan 1&2	$375.84
Rate for Payer: Affinity Essential Plan 3&4	$375.84
Rate for Payer: Affinity Medicaid/CHP/HARP	$167.04
Rate for Payer: Amida Care Medicaid	$167.04
Rate for Payer: Fidelis CHP/HARP/Medicaid	$167.04
Rate for Payer: Fidelis Essential Plan Aliesa	$375.84
Rate for Payer: Fidelis Essential Plan QHP	$375.84
Rate for Payer: Fidelis Qualified Health Plan	$175.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$167.04
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$167.04
Rate for Payer: Healthfirst Commercial	$253.12
Rate for Payer: Healthfirst Essential Plan	$375.84
Rate for Payer: Healthfirst QHP	$167.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$167.04
Rate for Payer: SOMOS Essential	$375.84
Rate for Payer: United Healthcare Essential Plan 1&2	$375.84
Rate for Payer: United Healthcare Essential Plan 3&4	$183.74
Rate for Payer: United Healthcare Medicaid	$167.04
Rate for Payer: Wellcare CHP/FHP/Medicaid	$167.04

OUTPATIENT EAPG 00781: COAGULATION & PLATELET DIAGNOSES

Facility

$320.78

Service Code	EAPG 00781
Hospital Charge Code	EAPG 00781
Min. Negotiated Rate	$142.57
Max. Negotiated Rate	$320.78
Rate for Payer: Affinity Essential Plan 1&2	$320.78
Rate for Payer: Affinity Essential Plan 3&4	$320.78
Rate for Payer: Affinity Medicaid/CHP/HARP	$142.57
Rate for Payer: Amida Care Medicaid	$142.57
Rate for Payer: Fidelis CHP/HARP/Medicaid	$142.57
Rate for Payer: Fidelis Essential Plan Aliesa	$320.78
Rate for Payer: Fidelis Essential Plan QHP	$320.78
Rate for Payer: Fidelis Qualified Health Plan	$149.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$142.57
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$142.57
Rate for Payer: Healthfirst Commercial	$216.04
Rate for Payer: Healthfirst Essential Plan	$320.78
Rate for Payer: Healthfirst QHP	$142.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$142.57
Rate for Payer: SOMOS Essential	$320.78
Rate for Payer: United Healthcare Essential Plan 1&2	$320.78
Rate for Payer: United Healthcare Essential Plan 3&4	$156.83
Rate for Payer: United Healthcare Medicaid	$142.57
Rate for Payer: Wellcare CHP/FHP/Medicaid	$142.57

OUTPATIENT EAPG 00782: CONGENITAL FACTOR DEFICIENCIES

Facility

$294.95

Service Code	EAPG 00782
Hospital Charge Code	EAPG 00782
Min. Negotiated Rate	$294.95
Max. Negotiated Rate	$294.95
Rate for Payer: Healthfirst Commercial	$294.95

OUTPATIENT EAPG 00783: SICKLE CELL ANEMIA CRISIS

Facility

$824.08

Service Code	EAPG 00783
Hospital Charge Code	EAPG 00783
Min. Negotiated Rate	$366.26
Max. Negotiated Rate	$824.08
Rate for Payer: Affinity Essential Plan 1&2	$824.08
Rate for Payer: Affinity Essential Plan 3&4	$824.08
Rate for Payer: Affinity Medicaid/CHP/HARP	$366.26
Rate for Payer: Amida Care Medicaid	$366.26
Rate for Payer: Fidelis CHP/HARP/Medicaid	$366.26
Rate for Payer: Fidelis Essential Plan Aliesa	$824.08
Rate for Payer: Fidelis Essential Plan QHP	$824.08
Rate for Payer: Fidelis Qualified Health Plan	$384.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$366.26
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$366.26
Rate for Payer: Healthfirst Commercial	$555.02
Rate for Payer: Healthfirst Essential Plan	$824.08
Rate for Payer: Healthfirst QHP	$366.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$366.26
Rate for Payer: SOMOS Essential	$824.08
Rate for Payer: United Healthcare Essential Plan 1&2	$824.08
Rate for Payer: United Healthcare Essential Plan 3&4	$402.89
Rate for Payer: United Healthcare Medicaid	$366.26
Rate for Payer: Wellcare CHP/FHP/Medicaid	$366.26

OUTPATIENT EAPG 00784: SICKLE CELL ANEMIA

Facility

$286.49

Service Code	EAPG 00784
Hospital Charge Code	EAPG 00784
Min. Negotiated Rate	$286.49
Max. Negotiated Rate	$286.49
Rate for Payer: Healthfirst Commercial	$286.49

OUTPATIENT EAPG 00785: ANEMIA EXCEPT FOR IRON DEFICIENCY ANEMIA AND SICKLE CELL ANEMIA

Facility

$311.15

Service Code	EAPG 00785
Hospital Charge Code	EAPG 00785
Min. Negotiated Rate	$138.29
Max. Negotiated Rate	$311.15
Rate for Payer: Affinity Essential Plan 1&2	$311.15
Rate for Payer: Affinity Essential Plan 3&4	$311.15
Rate for Payer: Affinity Medicaid/CHP/HARP	$138.29
Rate for Payer: Amida Care Medicaid	$138.29
Rate for Payer: Fidelis CHP/HARP/Medicaid	$138.29
Rate for Payer: Fidelis Essential Plan Aliesa	$311.15
Rate for Payer: Fidelis Essential Plan QHP	$311.15
Rate for Payer: Fidelis Qualified Health Plan	$145.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$138.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$138.29
Rate for Payer: Healthfirst Commercial	$209.55
Rate for Payer: Healthfirst Essential Plan	$311.15
Rate for Payer: Healthfirst QHP	$138.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$138.29
Rate for Payer: SOMOS Essential	$311.15
Rate for Payer: United Healthcare Essential Plan 1&2	$311.15
Rate for Payer: United Healthcare Essential Plan 3&4	$152.12
Rate for Payer: United Healthcare Medicaid	$138.29
Rate for Payer: Wellcare CHP/FHP/Medicaid	$138.29

OUTPATIENT EAPG 00786: IRON DEFICIENCY ANEMIA

Facility

$208.10

Service Code	EAPG 00786
Hospital Charge Code	EAPG 00786
Min. Negotiated Rate	$208.10
Max. Negotiated Rate	$208.10
Rate for Payer: Healthfirst Commercial	$208.10

OUTPATIENT EAPG 00800: ACUTE LEUKEMIA

Facility

$483.91

Service Code	EAPG 00800
Hospital Charge Code	EAPG 00800
Min. Negotiated Rate	$215.07
Max. Negotiated Rate	$483.91
Rate for Payer: Affinity Essential Plan 1&2	$483.91
Rate for Payer: Affinity Essential Plan 3&4	$483.91
Rate for Payer: Affinity Medicaid/CHP/HARP	$215.07
Rate for Payer: Amida Care Medicaid	$215.07
Rate for Payer: Fidelis CHP/HARP/Medicaid	$215.07
Rate for Payer: Fidelis Essential Plan Aliesa	$483.91
Rate for Payer: Fidelis Essential Plan QHP	$483.91
Rate for Payer: Fidelis Qualified Health Plan	$225.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$215.07
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$215.07
Rate for Payer: Healthfirst Commercial	$325.90
Rate for Payer: Healthfirst Essential Plan	$483.91
Rate for Payer: Healthfirst QHP	$215.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$215.07
Rate for Payer: SOMOS Essential	$483.91
Rate for Payer: United Healthcare Essential Plan 1&2	$483.91
Rate for Payer: United Healthcare Essential Plan 3&4	$236.58
Rate for Payer: United Healthcare Medicaid	$215.07
Rate for Payer: Wellcare CHP/FHP/Medicaid	$215.07

OUTPATIENT EAPG 00801: LYMPHOMA, MYELOMA & NON-ACUTE LEUKEMIA

Facility

$363.46

Service Code	EAPG 00801
Hospital Charge Code	EAPG 00801
Min. Negotiated Rate	$161.54
Max. Negotiated Rate	$363.46
Rate for Payer: Affinity Essential Plan 1&2	$363.46
Rate for Payer: Affinity Essential Plan 3&4	$363.46
Rate for Payer: Affinity Medicaid/CHP/HARP	$161.54
Rate for Payer: Amida Care Medicaid	$161.54
Rate for Payer: Fidelis CHP/HARP/Medicaid	$161.54
Rate for Payer: Fidelis Essential Plan Aliesa	$363.46
Rate for Payer: Fidelis Essential Plan QHP	$363.46
Rate for Payer: Fidelis Qualified Health Plan	$169.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$161.54
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$161.54
Rate for Payer: Healthfirst Commercial	$244.78
Rate for Payer: Healthfirst Essential Plan	$363.46
Rate for Payer: Healthfirst QHP	$161.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$161.54
Rate for Payer: SOMOS Essential	$363.46
Rate for Payer: United Healthcare Essential Plan 1&2	$363.46
Rate for Payer: United Healthcare Essential Plan 3&4	$177.69
Rate for Payer: United Healthcare Medicaid	$161.54
Rate for Payer: Wellcare CHP/FHP/Medicaid	$161.54

OUTPATIENT EAPG 00802: RADIOTHERAPY

Facility

$286.00

Service Code	EAPG 00802
Hospital Charge Code	EAPG 00802
Min. Negotiated Rate	$127.11
Max. Negotiated Rate	$286.00
Rate for Payer: Affinity Essential Plan 1&2	$286.00
Rate for Payer: Affinity Essential Plan 3&4	$286.00
Rate for Payer: Affinity Medicaid/CHP/HARP	$127.11
Rate for Payer: Amida Care Medicaid	$127.11
Rate for Payer: Fidelis CHP/HARP/Medicaid	$127.11
Rate for Payer: Fidelis Essential Plan Aliesa	$286.00
Rate for Payer: Fidelis Essential Plan QHP	$286.00
Rate for Payer: Fidelis Qualified Health Plan	$133.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$127.11
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$127.11
Rate for Payer: Healthfirst Commercial	$192.62
Rate for Payer: Healthfirst Essential Plan	$286.00
Rate for Payer: Healthfirst QHP	$127.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$127.11
Rate for Payer: SOMOS Essential	$286.00
Rate for Payer: United Healthcare Essential Plan 1&2	$286.00
Rate for Payer: United Healthcare Essential Plan 3&4	$139.82
Rate for Payer: United Healthcare Medicaid	$127.11
Rate for Payer: Wellcare CHP/FHP/Medicaid	$127.11

OUTPATIENT EAPG 00803: CHEMOTHERAPY

Facility

$413.50

Service Code	EAPG 00803
Hospital Charge Code	EAPG 00803
Min. Negotiated Rate	$183.78
Max. Negotiated Rate	$413.50
Rate for Payer: Affinity Essential Plan 1&2	$413.50
Rate for Payer: Affinity Essential Plan 3&4	$413.50
Rate for Payer: Affinity Medicaid/CHP/HARP	$183.78
Rate for Payer: Amida Care Medicaid	$183.78
Rate for Payer: Fidelis CHP/HARP/Medicaid	$183.78
Rate for Payer: Fidelis Essential Plan Aliesa	$413.50
Rate for Payer: Fidelis Essential Plan QHP	$413.50
Rate for Payer: Fidelis Qualified Health Plan	$192.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$183.78
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$183.78
Rate for Payer: Healthfirst Commercial	$278.49
Rate for Payer: Healthfirst Essential Plan	$413.50
Rate for Payer: Healthfirst QHP	$183.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$183.78
Rate for Payer: SOMOS Essential	$413.50
Rate for Payer: United Healthcare Essential Plan 1&2	$413.50
Rate for Payer: United Healthcare Essential Plan 3&4	$202.16
Rate for Payer: United Healthcare Medicaid	$183.78
Rate for Payer: Wellcare CHP/FHP/Medicaid	$183.78

OUTPATIENT EAPG 00804: LYMPHATIC & OTHER MALIGNANCIES & NEOPLASMS OF UNCERTAIN BEHAVIOR

Facility

$364.75

Service Code	EAPG 00804
Hospital Charge Code	EAPG 00804
Min. Negotiated Rate	$162.11
Max. Negotiated Rate	$364.75
Rate for Payer: Affinity Essential Plan 1&2	$364.75
Rate for Payer: Affinity Essential Plan 3&4	$364.75
Rate for Payer: Affinity Medicaid/CHP/HARP	$162.11
Rate for Payer: Amida Care Medicaid	$162.11
Rate for Payer: Fidelis CHP/HARP/Medicaid	$162.11
Rate for Payer: Fidelis Essential Plan Aliesa	$364.75
Rate for Payer: Fidelis Essential Plan QHP	$364.75
Rate for Payer: Fidelis Qualified Health Plan	$170.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$162.11
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$162.11
Rate for Payer: Healthfirst Commercial	$245.64
Rate for Payer: Healthfirst Essential Plan	$364.75
Rate for Payer: Healthfirst QHP	$162.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$162.11
Rate for Payer: SOMOS Essential	$364.75
Rate for Payer: United Healthcare Essential Plan 1&2	$364.75
Rate for Payer: United Healthcare Essential Plan 3&4	$178.32
Rate for Payer: United Healthcare Medicaid	$162.11
Rate for Payer: Wellcare CHP/FHP/Medicaid	$162.11

OUTPATIENT EAPG 00805: SEPTICEMIA & DISSEMINATED INFECTIONS

Facility

$436.79

Service Code	EAPG 00805
Hospital Charge Code	EAPG 00805
Min. Negotiated Rate	$194.13
Max. Negotiated Rate	$436.79
Rate for Payer: Affinity Essential Plan 1&2	$436.79
Rate for Payer: Affinity Essential Plan 3&4	$436.79
Rate for Payer: Affinity Medicaid/CHP/HARP	$194.13
Rate for Payer: Amida Care Medicaid	$194.13
Rate for Payer: Fidelis CHP/HARP/Medicaid	$194.13
Rate for Payer: Fidelis Essential Plan Aliesa	$436.79
Rate for Payer: Fidelis Essential Plan QHP	$436.79
Rate for Payer: Fidelis Qualified Health Plan	$203.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$194.13
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$194.13
Rate for Payer: Healthfirst Commercial	$294.17
Rate for Payer: Healthfirst Essential Plan	$436.79
Rate for Payer: Healthfirst QHP	$194.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$194.13
Rate for Payer: SOMOS Essential	$436.79
Rate for Payer: United Healthcare Essential Plan 1&2	$436.79
Rate for Payer: United Healthcare Essential Plan 3&4	$213.54
Rate for Payer: United Healthcare Medicaid	$194.13
Rate for Payer: Wellcare CHP/FHP/Medicaid	$194.13

OUTPATIENT EAPG 00806: POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS AND COMPLICATIONS

Facility

$368.78

Service Code	EAPG 00806
Hospital Charge Code	EAPG 00806
Min. Negotiated Rate	$163.90
Max. Negotiated Rate	$368.78
Rate for Payer: Affinity Essential Plan 1&2	$368.78
Rate for Payer: Affinity Essential Plan 3&4	$368.78
Rate for Payer: Affinity Medicaid/CHP/HARP	$163.90
Rate for Payer: Amida Care Medicaid	$163.90
Rate for Payer: Fidelis CHP/HARP/Medicaid	$163.90
Rate for Payer: Fidelis Essential Plan Aliesa	$368.78
Rate for Payer: Fidelis Essential Plan QHP	$368.78
Rate for Payer: Fidelis Qualified Health Plan	$172.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$163.90
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$163.90
Rate for Payer: Healthfirst Commercial	$248.36
Rate for Payer: Healthfirst Essential Plan	$368.78
Rate for Payer: Healthfirst QHP	$163.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$163.90
Rate for Payer: SOMOS Essential	$368.78
Rate for Payer: United Healthcare Essential Plan 1&2	$368.78
Rate for Payer: United Healthcare Essential Plan 3&4	$180.29
Rate for Payer: United Healthcare Medicaid	$163.90
Rate for Payer: Wellcare CHP/FHP/Medicaid	$163.90

OUTPATIENT EAPG 00807: FEVER

Facility

$338.67

Service Code	EAPG 00807
Hospital Charge Code	EAPG 00807
Min. Negotiated Rate	$150.52
Max. Negotiated Rate	$338.67
Rate for Payer: Affinity Essential Plan 1&2	$338.67
Rate for Payer: Affinity Essential Plan 3&4	$338.67
Rate for Payer: Affinity Medicaid/CHP/HARP	$150.52
Rate for Payer: Amida Care Medicaid	$150.52
Rate for Payer: Fidelis CHP/HARP/Medicaid	$150.52
Rate for Payer: Fidelis Essential Plan Aliesa	$338.67
Rate for Payer: Fidelis Essential Plan QHP	$338.67
Rate for Payer: Fidelis Qualified Health Plan	$158.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$150.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$150.52
Rate for Payer: Healthfirst Commercial	$228.09
Rate for Payer: Healthfirst Essential Plan	$338.67
Rate for Payer: Healthfirst QHP	$150.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$150.52
Rate for Payer: SOMOS Essential	$338.67
Rate for Payer: United Healthcare Essential Plan 1&2	$338.67
Rate for Payer: United Healthcare Essential Plan 3&4	$165.57
Rate for Payer: United Healthcare Medicaid	$150.52
Rate for Payer: Wellcare CHP/FHP/Medicaid	$150.52

OUTPATIENT EAPG 00808: VIRAL ILLNESS

Facility

$335.41

Service Code	EAPG 00808
Hospital Charge Code	EAPG 00808
Min. Negotiated Rate	$149.07
Max. Negotiated Rate	$335.41
Rate for Payer: Affinity Essential Plan 1&2	$335.41
Rate for Payer: Affinity Essential Plan 3&4	$335.41
Rate for Payer: Affinity Medicaid/CHP/HARP	$149.07
Rate for Payer: Amida Care Medicaid	$149.07
Rate for Payer: Fidelis CHP/HARP/Medicaid	$149.07
Rate for Payer: Fidelis Essential Plan Aliesa	$335.41
Rate for Payer: Fidelis Essential Plan QHP	$335.41
Rate for Payer: Fidelis Qualified Health Plan	$156.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$149.07
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$149.07
Rate for Payer: Healthfirst Commercial	$225.90
Rate for Payer: Healthfirst Essential Plan	$335.41
Rate for Payer: Healthfirst QHP	$149.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$149.07
Rate for Payer: SOMOS Essential	$335.41
Rate for Payer: United Healthcare Essential Plan 1&2	$335.41
Rate for Payer: United Healthcare Essential Plan 3&4	$163.98
Rate for Payer: United Healthcare Medicaid	$149.07
Rate for Payer: Wellcare CHP/FHP/Medicaid	$149.07

OUTPATIENT EAPG 00809: OTHER INFECTIOUS & PARASITIC DISEASES

Facility

$317.81

Service Code	EAPG 00809
Hospital Charge Code	EAPG 00809
Min. Negotiated Rate	$141.25
Max. Negotiated Rate	$317.81
Rate for Payer: Affinity Essential Plan 1&2	$317.81
Rate for Payer: Affinity Essential Plan 3&4	$317.81
Rate for Payer: Affinity Medicaid/CHP/HARP	$141.25
Rate for Payer: Amida Care Medicaid	$141.25
Rate for Payer: Fidelis CHP/HARP/Medicaid	$141.25
Rate for Payer: Fidelis Essential Plan Aliesa	$317.81
Rate for Payer: Fidelis Essential Plan QHP	$317.81
Rate for Payer: Fidelis Qualified Health Plan	$148.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$141.25
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$141.25
Rate for Payer: Healthfirst Commercial	$214.04
Rate for Payer: Healthfirst Essential Plan	$317.81
Rate for Payer: Healthfirst QHP	$141.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$141.25
Rate for Payer: SOMOS Essential	$317.81
Rate for Payer: United Healthcare Essential Plan 1&2	$317.81
Rate for Payer: United Healthcare Essential Plan 3&4	$155.38
Rate for Payer: United Healthcare Medicaid	$141.25
Rate for Payer: Wellcare CHP/FHP/Medicaid	$141.25

OUTPATIENT EAPG 00810: H. PYLORI INFECTION

Facility

$255.76

Service Code	EAPG 00810
Hospital Charge Code	EAPG 00810
Min. Negotiated Rate	$113.67
Max. Negotiated Rate	$255.76
Rate for Payer: Affinity Essential Plan 1&2	$255.76
Rate for Payer: Affinity Essential Plan 3&4	$255.76
Rate for Payer: Affinity Medicaid/CHP/HARP	$113.67
Rate for Payer: Amida Care Medicaid	$113.67
Rate for Payer: Fidelis CHP/HARP/Medicaid	$113.67
Rate for Payer: Fidelis Essential Plan Aliesa	$255.76
Rate for Payer: Fidelis Essential Plan QHP	$255.76
Rate for Payer: Fidelis Qualified Health Plan	$119.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$113.67
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$113.67
Rate for Payer: Healthfirst Commercial	$172.26
Rate for Payer: Healthfirst Essential Plan	$255.76
Rate for Payer: Healthfirst QHP	$113.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$113.67
Rate for Payer: SOMOS Essential	$255.76
Rate for Payer: United Healthcare Essential Plan 1&2	$255.76
Rate for Payer: United Healthcare Essential Plan 3&4	$125.04
Rate for Payer: United Healthcare Medicaid	$113.67
Rate for Payer: Wellcare CHP/FHP/Medicaid	$113.67

OUTPATIENT EAPG 00820: SCHIZOPHRENIA

Facility

$313.38

Service Code	EAPG 00820
Hospital Charge Code	EAPG 00820
Min. Negotiated Rate	$139.28
Max. Negotiated Rate	$313.38
Rate for Payer: Affinity Essential Plan 1&2	$313.38
Rate for Payer: Affinity Essential Plan 3&4	$313.38
Rate for Payer: Affinity Medicaid/CHP/HARP	$139.28
Rate for Payer: Amida Care Medicaid	$139.28
Rate for Payer: Fidelis CHP/HARP/Medicaid	$139.28
Rate for Payer: Fidelis Essential Plan Aliesa	$313.38
Rate for Payer: Fidelis Essential Plan QHP	$313.38
Rate for Payer: Fidelis Qualified Health Plan	$146.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$139.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$139.28
Rate for Payer: Healthfirst Commercial	$211.05
Rate for Payer: Healthfirst Essential Plan	$313.38
Rate for Payer: Healthfirst QHP	$139.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$139.28
Rate for Payer: SOMOS Essential	$313.38
Rate for Payer: United Healthcare Essential Plan 1&2	$313.38
Rate for Payer: United Healthcare Essential Plan 3&4	$153.21
Rate for Payer: United Healthcare Medicaid	$139.28
Rate for Payer: Wellcare CHP/FHP/Medicaid	$139.28

OUTPATIENT EAPG 00821: MAJOR DEPRESSIVE DIAGNOSES & OTHER/UNSPECIFIED PSYCHOSES

Facility

$313.38

Service Code	EAPG 00821
Hospital Charge Code	EAPG 00821
Min. Negotiated Rate	$139.28
Max. Negotiated Rate	$313.38
Rate for Payer: Affinity Essential Plan 1&2	$313.38
Rate for Payer: Affinity Essential Plan 3&4	$313.38
Rate for Payer: Affinity Medicaid/CHP/HARP	$139.28
Rate for Payer: Amida Care Medicaid	$139.28
Rate for Payer: Fidelis CHP/HARP/Medicaid	$139.28
Rate for Payer: Fidelis Essential Plan Aliesa	$313.38
Rate for Payer: Fidelis Essential Plan QHP	$313.38
Rate for Payer: Fidelis Qualified Health Plan	$146.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$139.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$139.28
Rate for Payer: Healthfirst Commercial	$211.05
Rate for Payer: Healthfirst Essential Plan	$313.38
Rate for Payer: Healthfirst QHP	$139.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$139.28
Rate for Payer: SOMOS Essential	$313.38
Rate for Payer: United Healthcare Essential Plan 1&2	$313.38
Rate for Payer: United Healthcare Essential Plan 3&4	$153.21
Rate for Payer: United Healthcare Medicaid	$139.28
Rate for Payer: Wellcare CHP/FHP/Medicaid	$139.28

OUTPATIENT EAPG 00822: PERSONALITY & IMPULSE CONTROL DIAGNOSES

Facility

$313.38

Service Code	EAPG 00822
Hospital Charge Code	EAPG 00822
Min. Negotiated Rate	$139.28
Max. Negotiated Rate	$313.38
Rate for Payer: Affinity Essential Plan 1&2	$313.38
Rate for Payer: Affinity Essential Plan 3&4	$313.38
Rate for Payer: Affinity Medicaid/CHP/HARP	$139.28
Rate for Payer: Amida Care Medicaid	$139.28
Rate for Payer: Fidelis CHP/HARP/Medicaid	$139.28
Rate for Payer: Fidelis Essential Plan Aliesa	$313.38
Rate for Payer: Fidelis Essential Plan QHP	$313.38
Rate for Payer: Fidelis Qualified Health Plan	$146.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$139.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$139.28
Rate for Payer: Healthfirst Commercial	$211.05
Rate for Payer: Healthfirst Essential Plan	$313.38
Rate for Payer: Healthfirst QHP	$139.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$139.28
Rate for Payer: SOMOS Essential	$313.38
Rate for Payer: United Healthcare Essential Plan 1&2	$313.38
Rate for Payer: United Healthcare Essential Plan 3&4	$153.21
Rate for Payer: United Healthcare Medicaid	$139.28
Rate for Payer: Wellcare CHP/FHP/Medicaid	$139.28

OUTPATIENT EAPG 00823: BIPOLAR DISORDERS

Facility

$313.38

Service Code	EAPG 00823
Hospital Charge Code	EAPG 00823
Min. Negotiated Rate	$139.28
Max. Negotiated Rate	$313.38
Rate for Payer: Affinity Essential Plan 1&2	$313.38
Rate for Payer: Affinity Essential Plan 3&4	$313.38
Rate for Payer: Affinity Medicaid/CHP/HARP	$139.28
Rate for Payer: Amida Care Medicaid	$139.28
Rate for Payer: Fidelis CHP/HARP/Medicaid	$139.28
Rate for Payer: Fidelis Essential Plan Aliesa	$313.38
Rate for Payer: Fidelis Essential Plan QHP	$313.38
Rate for Payer: Fidelis Qualified Health Plan	$146.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$139.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$139.28
Rate for Payer: Healthfirst Commercial	$211.05
Rate for Payer: Healthfirst Essential Plan	$313.38
Rate for Payer: Healthfirst QHP	$139.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$139.28
Rate for Payer: SOMOS Essential	$313.38
Rate for Payer: United Healthcare Essential Plan 1&2	$313.38
Rate for Payer: United Healthcare Essential Plan 3&4	$153.21
Rate for Payer: United Healthcare Medicaid	$139.28
Rate for Payer: Wellcare CHP/FHP/Medicaid	$139.28

OUTPATIENT EAPG 00824: DEPRESSION EXCEPT MAJOR DEPRESSIVE DIAGNOSES

Facility

$313.38

Service Code	EAPG 00824
Hospital Charge Code	EAPG 00824
Min. Negotiated Rate	$139.28
Max. Negotiated Rate	$313.38
Rate for Payer: Affinity Essential Plan 1&2	$313.38
Rate for Payer: Affinity Essential Plan 3&4	$313.38
Rate for Payer: Affinity Medicaid/CHP/HARP	$139.28
Rate for Payer: Amida Care Medicaid	$139.28
Rate for Payer: Fidelis CHP/HARP/Medicaid	$139.28
Rate for Payer: Fidelis Essential Plan Aliesa	$313.38
Rate for Payer: Fidelis Essential Plan QHP	$313.38
Rate for Payer: Fidelis Qualified Health Plan	$146.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$139.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$139.28
Rate for Payer: Healthfirst Commercial	$211.05
Rate for Payer: Healthfirst Essential Plan	$313.38
Rate for Payer: Healthfirst QHP	$139.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$139.28
Rate for Payer: SOMOS Essential	$313.38
Rate for Payer: United Healthcare Essential Plan 1&2	$313.38
Rate for Payer: United Healthcare Essential Plan 3&4	$153.21
Rate for Payer: United Healthcare Medicaid	$139.28
Rate for Payer: Wellcare CHP/FHP/Medicaid	$139.28

OUTPATIENT EAPG 00825: ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES

Facility

$313.38

Service Code	EAPG 00825
Hospital Charge Code	EAPG 00825
Min. Negotiated Rate	$139.28
Max. Negotiated Rate	$313.38
Rate for Payer: Affinity Essential Plan 1&2	$313.38
Rate for Payer: Affinity Essential Plan 3&4	$313.38
Rate for Payer: Affinity Medicaid/CHP/HARP	$139.28
Rate for Payer: Amida Care Medicaid	$139.28
Rate for Payer: Fidelis CHP/HARP/Medicaid	$139.28
Rate for Payer: Fidelis Essential Plan Aliesa	$313.38
Rate for Payer: Fidelis Essential Plan QHP	$313.38
Rate for Payer: Fidelis Qualified Health Plan	$146.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$139.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$139.28
Rate for Payer: Healthfirst Commercial	$211.05
Rate for Payer: Healthfirst Essential Plan	$313.38
Rate for Payer: Healthfirst QHP	$139.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$139.28
Rate for Payer: SOMOS Essential	$313.38
Rate for Payer: United Healthcare Essential Plan 1&2	$313.38
Rate for Payer: United Healthcare Essential Plan 3&4	$153.21
Rate for Payer: United Healthcare Medicaid	$139.28
Rate for Payer: Wellcare CHP/FHP/Medicaid	$139.28

OUTPATIENT EAPG 00826: ACUTE ANXIETY & DELIRIUM STATES

Facility

$313.38

Service Code	EAPG 00826
Hospital Charge Code	EAPG 00826
Min. Negotiated Rate	$139.28
Max. Negotiated Rate	$313.38
Rate for Payer: Affinity Essential Plan 1&2	$313.38
Rate for Payer: Affinity Essential Plan 3&4	$313.38
Rate for Payer: Affinity Medicaid/CHP/HARP	$139.28
Rate for Payer: Amida Care Medicaid	$139.28
Rate for Payer: Fidelis CHP/HARP/Medicaid	$139.28
Rate for Payer: Fidelis Essential Plan Aliesa	$313.38
Rate for Payer: Fidelis Essential Plan QHP	$313.38
Rate for Payer: Fidelis Qualified Health Plan	$146.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$139.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$139.28
Rate for Payer: Healthfirst Commercial	$211.05
Rate for Payer: Healthfirst Essential Plan	$313.38
Rate for Payer: Healthfirst QHP	$139.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$139.28
Rate for Payer: SOMOS Essential	$313.38
Rate for Payer: United Healthcare Essential Plan 1&2	$313.38
Rate for Payer: United Healthcare Essential Plan 3&4	$153.21
Rate for Payer: United Healthcare Medicaid	$139.28
Rate for Payer: Wellcare CHP/FHP/Medicaid	$139.28

Know your out-of-pocket cost for care.

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