St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

OUTPATIENT EAPG 00827: ORGANIC BEHAVIORAL HEALTH DISTURBANCES

Facility

$382.41

Service Code	EAPG 00827
Hospital Charge Code	EAPG 00827
Min. Negotiated Rate	$169.96
Max. Negotiated Rate	$382.41
Rate for Payer: Affinity Essential Plan 1&2	$382.41
Rate for Payer: Affinity Essential Plan 3&4	$382.41
Rate for Payer: Affinity Medicaid/CHP/HARP	$169.96
Rate for Payer: Amida Care Medicaid	$169.96
Rate for Payer: Fidelis CHP/HARP/Medicaid	$169.96
Rate for Payer: Fidelis Essential Plan Aliesa	$382.41
Rate for Payer: Fidelis Essential Plan QHP	$382.41
Rate for Payer: Fidelis Qualified Health Plan	$178.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.96
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$169.96
Rate for Payer: Healthfirst Commercial	$257.56
Rate for Payer: Healthfirst Essential Plan	$382.41
Rate for Payer: Healthfirst QHP	$169.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$169.96
Rate for Payer: SOMOS Essential	$382.41
Rate for Payer: United Healthcare Essential Plan 1&2	$382.41
Rate for Payer: United Healthcare Essential Plan 3&4	$186.96
Rate for Payer: United Healthcare Medicaid	$169.96
Rate for Payer: Wellcare CHP/FHP/Medicaid	$169.96

OUTPATIENT EAPG 00828: INTELLECTUAL DISABILITY

Facility

$324.22

Service Code	EAPG 00828
Hospital Charge Code	EAPG 00828
Min. Negotiated Rate	$144.10
Max. Negotiated Rate	$324.22
Rate for Payer: Affinity Essential Plan 1&2	$324.22
Rate for Payer: Affinity Essential Plan 3&4	$324.22
Rate for Payer: Affinity Medicaid/CHP/HARP	$144.10
Rate for Payer: Amida Care Medicaid	$144.10
Rate for Payer: Fidelis CHP/HARP/Medicaid	$144.10
Rate for Payer: Fidelis Essential Plan Aliesa	$324.22
Rate for Payer: Fidelis Essential Plan QHP	$324.22
Rate for Payer: Fidelis Qualified Health Plan	$151.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$144.10
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$144.10
Rate for Payer: Healthfirst Commercial	$218.35
Rate for Payer: Healthfirst Essential Plan	$324.22
Rate for Payer: Healthfirst QHP	$144.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$144.10
Rate for Payer: SOMOS Essential	$324.22
Rate for Payer: United Healthcare Essential Plan 1&2	$324.22
Rate for Payer: United Healthcare Essential Plan 3&4	$158.51
Rate for Payer: United Healthcare Medicaid	$144.10
Rate for Payer: Wellcare CHP/FHP/Medicaid	$144.10

OUTPATIENT EAPG 00829: CHILDHOOD BEHAVIORAL DIAGNOSES

Facility

$324.07

Service Code	EAPG 00829
Hospital Charge Code	EAPG 00829
Min. Negotiated Rate	$144.03
Max. Negotiated Rate	$324.07
Rate for Payer: Affinity Essential Plan 1&2	$324.07
Rate for Payer: Affinity Essential Plan 3&4	$324.07
Rate for Payer: Affinity Medicaid/CHP/HARP	$144.03
Rate for Payer: Amida Care Medicaid	$144.03
Rate for Payer: Fidelis CHP/HARP/Medicaid	$144.03
Rate for Payer: Fidelis Essential Plan Aliesa	$324.07
Rate for Payer: Fidelis Essential Plan QHP	$324.07
Rate for Payer: Fidelis Qualified Health Plan	$151.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$144.03
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$144.03
Rate for Payer: Healthfirst Commercial	$218.26
Rate for Payer: Healthfirst Essential Plan	$324.07
Rate for Payer: Healthfirst QHP	$144.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$144.03
Rate for Payer: SOMOS Essential	$324.07
Rate for Payer: United Healthcare Essential Plan 1&2	$324.07
Rate for Payer: United Healthcare Essential Plan 3&4	$158.43
Rate for Payer: United Healthcare Medicaid	$144.03
Rate for Payer: Wellcare CHP/FHP/Medicaid	$144.03

OUTPATIENT EAPG 00830: EATING DISORDERS

Facility

$313.38

Service Code	EAPG 00830
Hospital Charge Code	EAPG 00830
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 00831: OTHER BEHAVIORAL HEALTH DIAGNOSES

Facility

$313.38

Service Code	EAPG 00831
Hospital Charge Code	EAPG 00831
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 00840: OPIOID ABUSE & DEPENDENCE

Facility

$380.54

Service Code	EAPG 00840
Hospital Charge Code	EAPG 00840
Min. Negotiated Rate	$169.13
Max. Negotiated Rate	$380.54
Rate for Payer: Affinity Essential Plan 1&2	$380.54
Rate for Payer: Affinity Essential Plan 3&4	$380.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$169.13
Rate for Payer: Amida Care Medicaid	$169.13
Rate for Payer: Fidelis CHP/HARP/Medicaid	$169.13
Rate for Payer: Fidelis Essential Plan Aliesa	$380.54
Rate for Payer: Fidelis Essential Plan QHP	$380.54
Rate for Payer: Fidelis Qualified Health Plan	$177.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.13
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$169.13
Rate for Payer: Healthfirst Commercial	$221.45
Rate for Payer: Healthfirst Essential Plan	$380.54
Rate for Payer: Healthfirst QHP	$169.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$169.13
Rate for Payer: SOMOS Essential	$380.54
Rate for Payer: United Healthcare Essential Plan 1&2	$380.54
Rate for Payer: United Healthcare Essential Plan 3&4	$186.04
Rate for Payer: United Healthcare Medicaid	$169.13
Rate for Payer: Wellcare CHP/FHP/Medicaid	$169.13

OUTPATIENT EAPG 00841: COCAINE ABUSE & DEPENDENCE

Facility

$380.54

Service Code	EAPG 00841
Hospital Charge Code	EAPG 00841
Min. Negotiated Rate	$169.13
Max. Negotiated Rate	$380.54
Rate for Payer: Affinity Essential Plan 1&2	$380.54
Rate for Payer: Affinity Essential Plan 3&4	$380.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$169.13
Rate for Payer: Amida Care Medicaid	$169.13
Rate for Payer: Fidelis CHP/HARP/Medicaid	$169.13
Rate for Payer: Fidelis Essential Plan Aliesa	$380.54
Rate for Payer: Fidelis Essential Plan QHP	$380.54
Rate for Payer: Fidelis Qualified Health Plan	$177.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.13
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$169.13
Rate for Payer: Healthfirst Commercial	$254.31
Rate for Payer: Healthfirst Essential Plan	$380.54
Rate for Payer: Healthfirst QHP	$169.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$169.13
Rate for Payer: SOMOS Essential	$380.54
Rate for Payer: United Healthcare Essential Plan 1&2	$380.54
Rate for Payer: United Healthcare Essential Plan 3&4	$186.04
Rate for Payer: United Healthcare Medicaid	$169.13
Rate for Payer: Wellcare CHP/FHP/Medicaid	$169.13

OUTPATIENT EAPG 00842: ALCOHOL ABUSE & DEPENDENCE

Facility

$380.54

Service Code	EAPG 00842
Hospital Charge Code	EAPG 00842
Min. Negotiated Rate	$169.13
Max. Negotiated Rate	$380.54
Rate for Payer: Affinity Essential Plan 1&2	$380.54
Rate for Payer: Affinity Essential Plan 3&4	$380.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$169.13
Rate for Payer: Amida Care Medicaid	$169.13
Rate for Payer: Fidelis CHP/HARP/Medicaid	$169.13
Rate for Payer: Fidelis Essential Plan Aliesa	$380.54
Rate for Payer: Fidelis Essential Plan QHP	$380.54
Rate for Payer: Fidelis Qualified Health Plan	$177.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.13
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$169.13
Rate for Payer: Healthfirst Commercial	$263.93
Rate for Payer: Healthfirst Essential Plan	$380.54
Rate for Payer: Healthfirst QHP	$169.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$169.13
Rate for Payer: SOMOS Essential	$380.54
Rate for Payer: United Healthcare Essential Plan 1&2	$380.54
Rate for Payer: United Healthcare Essential Plan 3&4	$186.04
Rate for Payer: United Healthcare Medicaid	$169.13
Rate for Payer: Wellcare CHP/FHP/Medicaid	$169.13

OUTPATIENT EAPG 00843: OTHER DRUG ABUSE & DEPENDENCE

Facility

$380.54

Service Code	EAPG 00843
Hospital Charge Code	EAPG 00843
Min. Negotiated Rate	$169.13
Max. Negotiated Rate	$380.54
Rate for Payer: Affinity Essential Plan 1&2	$380.54
Rate for Payer: Affinity Essential Plan 3&4	$380.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$169.13
Rate for Payer: Amida Care Medicaid	$169.13
Rate for Payer: Fidelis CHP/HARP/Medicaid	$169.13
Rate for Payer: Fidelis Essential Plan Aliesa	$380.54
Rate for Payer: Fidelis Essential Plan QHP	$380.54
Rate for Payer: Fidelis Qualified Health Plan	$177.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.13
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$169.13
Rate for Payer: Healthfirst Commercial	$239.66
Rate for Payer: Healthfirst Essential Plan	$380.54
Rate for Payer: Healthfirst QHP	$169.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$169.13
Rate for Payer: SOMOS Essential	$380.54
Rate for Payer: United Healthcare Essential Plan 1&2	$380.54
Rate for Payer: United Healthcare Essential Plan 3&4	$186.04
Rate for Payer: United Healthcare Medicaid	$169.13
Rate for Payer: Wellcare CHP/FHP/Medicaid	$169.13

OUTPATIENT EAPG 00850: ALLERGIC REACTIONS

Facility

$412.60

Service Code	EAPG 00850
Hospital Charge Code	EAPG 00850
Min. Negotiated Rate	$183.38
Max. Negotiated Rate	$412.60
Rate for Payer: Affinity Essential Plan 1&2	$412.60
Rate for Payer: Affinity Essential Plan 3&4	$412.60
Rate for Payer: Affinity Medicaid/CHP/HARP	$183.38
Rate for Payer: Amida Care Medicaid	$183.38
Rate for Payer: Fidelis CHP/HARP/Medicaid	$183.38
Rate for Payer: Fidelis Essential Plan Aliesa	$412.60
Rate for Payer: Fidelis Essential Plan QHP	$412.60
Rate for Payer: Fidelis Qualified Health Plan	$192.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$183.38
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$183.38
Rate for Payer: Healthfirst Commercial	$277.88
Rate for Payer: Healthfirst Essential Plan	$412.60
Rate for Payer: Healthfirst QHP	$183.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$183.38
Rate for Payer: SOMOS Essential	$412.60
Rate for Payer: United Healthcare Essential Plan 1&2	$412.60
Rate for Payer: United Healthcare Essential Plan 3&4	$201.72
Rate for Payer: United Healthcare Medicaid	$183.38
Rate for Payer: Wellcare CHP/FHP/Medicaid	$183.38

OUTPATIENT EAPG 00851: POISONING OF MEDICINAL AGENTS

Facility

$475.11

Service Code	EAPG 00851
Hospital Charge Code	EAPG 00851
Min. Negotiated Rate	$211.16
Max. Negotiated Rate	$475.11
Rate for Payer: Affinity Essential Plan 1&2	$475.11
Rate for Payer: Affinity Essential Plan 3&4	$475.11
Rate for Payer: Affinity Medicaid/CHP/HARP	$211.16
Rate for Payer: Amida Care Medicaid	$211.16
Rate for Payer: Fidelis CHP/HARP/Medicaid	$211.16
Rate for Payer: Fidelis Essential Plan Aliesa	$475.11
Rate for Payer: Fidelis Essential Plan QHP	$475.11
Rate for Payer: Fidelis Qualified Health Plan	$221.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$211.16
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$211.16
Rate for Payer: Healthfirst Commercial	$319.99
Rate for Payer: Healthfirst Essential Plan	$475.11
Rate for Payer: Healthfirst QHP	$211.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$211.16
Rate for Payer: SOMOS Essential	$475.11
Rate for Payer: United Healthcare Essential Plan 1&2	$475.11
Rate for Payer: United Healthcare Essential Plan 3&4	$232.28
Rate for Payer: United Healthcare Medicaid	$211.16
Rate for Payer: Wellcare CHP/FHP/Medicaid	$211.16

OUTPATIENT EAPG 00852: OTHER COMPLICATIONS OF TREATMENT

Facility

$407.88

Service Code	EAPG 00852
Hospital Charge Code	EAPG 00852
Min. Negotiated Rate	$181.28
Max. Negotiated Rate	$407.88
Rate for Payer: Affinity Essential Plan 1&2	$407.88
Rate for Payer: Affinity Essential Plan 3&4	$407.88
Rate for Payer: Affinity Medicaid/CHP/HARP	$181.28
Rate for Payer: Amida Care Medicaid	$181.28
Rate for Payer: Fidelis CHP/HARP/Medicaid	$181.28
Rate for Payer: Fidelis Essential Plan Aliesa	$407.88
Rate for Payer: Fidelis Essential Plan QHP	$407.88
Rate for Payer: Fidelis Qualified Health Plan	$190.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$181.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$181.28
Rate for Payer: Healthfirst Commercial	$274.69
Rate for Payer: Healthfirst Essential Plan	$407.88
Rate for Payer: Healthfirst QHP	$181.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$181.28
Rate for Payer: SOMOS Essential	$407.88
Rate for Payer: United Healthcare Essential Plan 1&2	$407.88
Rate for Payer: United Healthcare Essential Plan 3&4	$199.41
Rate for Payer: United Healthcare Medicaid	$181.28
Rate for Payer: Wellcare CHP/FHP/Medicaid	$181.28

OUTPATIENT EAPG 00853: OTHER INJURY, POISONING & TOXIC EFFECT DIAGNOSES

Facility

$426.26

Service Code	EAPG 00853
Hospital Charge Code	EAPG 00853
Min. Negotiated Rate	$189.45
Max. Negotiated Rate	$426.26
Rate for Payer: Affinity Essential Plan 1&2	$426.26
Rate for Payer: Affinity Essential Plan 3&4	$426.26
Rate for Payer: Affinity Medicaid/CHP/HARP	$189.45
Rate for Payer: Amida Care Medicaid	$189.45
Rate for Payer: Fidelis CHP/HARP/Medicaid	$189.45
Rate for Payer: Fidelis Essential Plan Aliesa	$426.26
Rate for Payer: Fidelis Essential Plan QHP	$426.26
Rate for Payer: Fidelis Qualified Health Plan	$198.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$189.45
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$189.45
Rate for Payer: Healthfirst Commercial	$287.09
Rate for Payer: Healthfirst Essential Plan	$426.26
Rate for Payer: Healthfirst QHP	$189.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$189.45
Rate for Payer: SOMOS Essential	$426.26
Rate for Payer: United Healthcare Essential Plan 1&2	$426.26
Rate for Payer: United Healthcare Essential Plan 3&4	$208.40
Rate for Payer: United Healthcare Medicaid	$189.45
Rate for Payer: Wellcare CHP/FHP/Medicaid	$189.45

OUTPATIENT EAPG 00854: TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES

Facility

$370.51

Service Code	EAPG 00854
Hospital Charge Code	EAPG 00854
Min. Negotiated Rate	$164.67
Max. Negotiated Rate	$370.51
Rate for Payer: Affinity Essential Plan 1&2	$370.51
Rate for Payer: Affinity Essential Plan 3&4	$370.51
Rate for Payer: Affinity Medicaid/CHP/HARP	$164.67
Rate for Payer: Amida Care Medicaid	$164.67
Rate for Payer: Fidelis CHP/HARP/Medicaid	$164.67
Rate for Payer: Fidelis Essential Plan Aliesa	$370.51
Rate for Payer: Fidelis Essential Plan QHP	$370.51
Rate for Payer: Fidelis Qualified Health Plan	$172.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$164.67
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$164.67
Rate for Payer: Healthfirst Commercial	$249.54
Rate for Payer: Healthfirst Essential Plan	$370.51
Rate for Payer: Healthfirst QHP	$164.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$164.67
Rate for Payer: SOMOS Essential	$370.51
Rate for Payer: United Healthcare Essential Plan 1&2	$370.51
Rate for Payer: United Healthcare Essential Plan 3&4	$181.14
Rate for Payer: United Healthcare Medicaid	$164.67
Rate for Payer: Wellcare CHP/FHP/Medicaid	$164.67

OUTPATIENT EAPG 00860: EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS W/O SKIN GRAFT

Facility

$426.42

Service Code	EAPG 00860
Hospital Charge Code	EAPG 00860
Min. Negotiated Rate	$189.52
Max. Negotiated Rate	$426.42
Rate for Payer: Affinity Essential Plan 1&2	$426.42
Rate for Payer: Affinity Essential Plan 3&4	$426.42
Rate for Payer: Affinity Medicaid/CHP/HARP	$189.52
Rate for Payer: Amida Care Medicaid	$189.52
Rate for Payer: Fidelis CHP/HARP/Medicaid	$189.52
Rate for Payer: Fidelis Essential Plan Aliesa	$426.42
Rate for Payer: Fidelis Essential Plan QHP	$426.42
Rate for Payer: Fidelis Qualified Health Plan	$199.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$189.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$189.52
Rate for Payer: Healthfirst Commercial	$287.19
Rate for Payer: Healthfirst Essential Plan	$426.42
Rate for Payer: Healthfirst QHP	$189.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$189.52
Rate for Payer: SOMOS Essential	$426.42
Rate for Payer: United Healthcare Essential Plan 1&2	$426.42
Rate for Payer: United Healthcare Essential Plan 3&4	$208.47
Rate for Payer: United Healthcare Medicaid	$189.52
Rate for Payer: Wellcare CHP/FHP/Medicaid	$189.52

OUTPATIENT EAPG 00861: PARTIAL THICKNESS BURNS W OR W/O SKIN GRAFT

Facility

$408.62

Service Code	EAPG 00861
Hospital Charge Code	EAPG 00861
Min. Negotiated Rate	$181.61
Max. Negotiated Rate	$408.62
Rate for Payer: Affinity Essential Plan 1&2	$408.62
Rate for Payer: Affinity Essential Plan 3&4	$408.62
Rate for Payer: Affinity Medicaid/CHP/HARP	$181.61
Rate for Payer: Amida Care Medicaid	$181.61
Rate for Payer: Fidelis CHP/HARP/Medicaid	$181.61
Rate for Payer: Fidelis Essential Plan Aliesa	$408.62
Rate for Payer: Fidelis Essential Plan QHP	$408.62
Rate for Payer: Fidelis Qualified Health Plan	$190.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$181.61
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$181.61
Rate for Payer: Healthfirst Commercial	$275.19
Rate for Payer: Healthfirst Essential Plan	$408.62
Rate for Payer: Healthfirst QHP	$181.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$181.61
Rate for Payer: SOMOS Essential	$408.62
Rate for Payer: United Healthcare Essential Plan 1&2	$408.62
Rate for Payer: United Healthcare Essential Plan 3&4	$199.77
Rate for Payer: United Healthcare Medicaid	$181.61
Rate for Payer: Wellcare CHP/FHP/Medicaid	$181.61

OUTPATIENT EAPG 00869: AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE INJURIES

Facility

$350.44

Service Code	EAPG 00869
Hospital Charge Code	EAPG 00869
Min. Negotiated Rate	$155.75
Max. Negotiated Rate	$350.44
Rate for Payer: Affinity Essential Plan 1&2	$350.44
Rate for Payer: Affinity Essential Plan 3&4	$350.44
Rate for Payer: Affinity Medicaid/CHP/HARP	$155.75
Rate for Payer: Amida Care Medicaid	$155.75
Rate for Payer: Fidelis CHP/HARP/Medicaid	$155.75
Rate for Payer: Fidelis Essential Plan Aliesa	$350.44
Rate for Payer: Fidelis Essential Plan QHP	$350.44
Rate for Payer: Fidelis Qualified Health Plan	$163.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$155.75
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$155.75
Rate for Payer: Healthfirst Essential Plan	$350.44
Rate for Payer: Healthfirst QHP	$155.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$155.75
Rate for Payer: SOMOS Essential	$350.44
Rate for Payer: United Healthcare Essential Plan 1&2	$350.44
Rate for Payer: United Healthcare Essential Plan 3&4	$171.32
Rate for Payer: United Healthcare Medicaid	$155.75
Rate for Payer: Wellcare CHP/FHP/Medicaid	$155.75

OUTPATIENT EAPG 00870: REHABILITATION

Facility

$293.38

Service Code	EAPG 00870
Hospital Charge Code	EAPG 00870
Min. Negotiated Rate	$130.39
Max. Negotiated Rate	$293.38
Rate for Payer: Affinity Essential Plan 1&2	$293.38
Rate for Payer: Affinity Essential Plan 3&4	$293.38
Rate for Payer: Affinity Medicaid/CHP/HARP	$130.39
Rate for Payer: Amida Care Medicaid	$130.39
Rate for Payer: Fidelis CHP/HARP/Medicaid	$130.39
Rate for Payer: Fidelis Essential Plan Aliesa	$293.38
Rate for Payer: Fidelis Essential Plan QHP	$293.38
Rate for Payer: Fidelis Qualified Health Plan	$136.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$130.39
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$130.39
Rate for Payer: Healthfirst Commercial	$197.59
Rate for Payer: Healthfirst Essential Plan	$293.38
Rate for Payer: Healthfirst QHP	$130.39
Rate for Payer: SOMOS CHP/HARP/Medicaid	$130.39
Rate for Payer: SOMOS Essential	$293.38
Rate for Payer: United Healthcare Essential Plan 1&2	$293.38
Rate for Payer: United Healthcare Essential Plan 3&4	$143.43
Rate for Payer: United Healthcare Medicaid	$130.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$130.39

OUTPATIENT EAPG 00871: SIGNS, SYMPTOMS & OTHER FACTORS INFLUENCING HEALTH STATUS

Facility

$329.85

Service Code	EAPG 00871
Hospital Charge Code	EAPG 00871
Min. Negotiated Rate	$146.60
Max. Negotiated Rate	$329.85
Rate for Payer: Affinity Essential Plan 1&2	$329.85
Rate for Payer: Affinity Essential Plan 3&4	$329.85
Rate for Payer: Affinity Medicaid/CHP/HARP	$146.60
Rate for Payer: Amida Care Medicaid	$146.60
Rate for Payer: Fidelis CHP/HARP/Medicaid	$146.60
Rate for Payer: Fidelis Essential Plan Aliesa	$329.85
Rate for Payer: Fidelis Essential Plan QHP	$329.85
Rate for Payer: Fidelis Qualified Health Plan	$153.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$146.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$146.60
Rate for Payer: Healthfirst Commercial	$222.15
Rate for Payer: Healthfirst Essential Plan	$329.85
Rate for Payer: Healthfirst QHP	$146.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$146.60
Rate for Payer: SOMOS Essential	$329.85
Rate for Payer: United Healthcare Essential Plan 1&2	$329.85
Rate for Payer: United Healthcare Essential Plan 3&4	$161.26
Rate for Payer: United Healthcare Medicaid	$146.60
Rate for Payer: Wellcare CHP/FHP/Medicaid	$146.60

OUTPATIENT EAPG 00872: OTHER AFTERCARE & CONVALESCENCE

Facility

$323.08

Service Code	EAPG 00872
Hospital Charge Code	EAPG 00872
Min. Negotiated Rate	$143.59
Max. Negotiated Rate	$323.08
Rate for Payer: Affinity Essential Plan 1&2	$323.08
Rate for Payer: Affinity Essential Plan 3&4	$323.08
Rate for Payer: Affinity Medicaid/CHP/HARP	$143.59
Rate for Payer: Amida Care Medicaid	$143.59
Rate for Payer: Fidelis CHP/HARP/Medicaid	$143.59
Rate for Payer: Fidelis Essential Plan Aliesa	$323.08
Rate for Payer: Fidelis Essential Plan QHP	$323.08
Rate for Payer: Fidelis Qualified Health Plan	$150.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$143.59
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$143.59
Rate for Payer: Healthfirst Commercial	$217.59
Rate for Payer: Healthfirst Essential Plan	$323.08
Rate for Payer: Healthfirst QHP	$143.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$143.59
Rate for Payer: SOMOS Essential	$323.08
Rate for Payer: United Healthcare Essential Plan 1&2	$323.08
Rate for Payer: United Healthcare Essential Plan 3&4	$157.95
Rate for Payer: United Healthcare Medicaid	$143.59
Rate for Payer: Wellcare CHP/FHP/Medicaid	$143.59

OUTPATIENT EAPG 00873: NEONATAL AFTERCARE

Facility

$351.54

Service Code	EAPG 00873
Hospital Charge Code	EAPG 00873
Min. Negotiated Rate	$156.24
Max. Negotiated Rate	$351.54
Rate for Payer: Affinity Essential Plan 1&2	$351.54
Rate for Payer: Affinity Essential Plan 3&4	$351.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$156.24
Rate for Payer: Amida Care Medicaid	$156.24
Rate for Payer: Fidelis CHP/HARP/Medicaid	$156.24
Rate for Payer: Fidelis Essential Plan Aliesa	$351.54
Rate for Payer: Fidelis Essential Plan QHP	$351.54
Rate for Payer: Fidelis Qualified Health Plan	$164.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$156.24
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$156.24
Rate for Payer: Healthfirst Commercial	$236.76
Rate for Payer: Healthfirst Essential Plan	$351.54
Rate for Payer: Healthfirst QHP	$156.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$156.24
Rate for Payer: SOMOS Essential	$351.54
Rate for Payer: United Healthcare Essential Plan 1&2	$351.54
Rate for Payer: United Healthcare Essential Plan 3&4	$171.86
Rate for Payer: United Healthcare Medicaid	$156.24
Rate for Payer: Wellcare CHP/FHP/Medicaid	$156.24

OUTPATIENT EAPG 00874: JOINT REPLACEMENT

Facility

$310.00

Service Code	EAPG 00874
Hospital Charge Code	EAPG 00874
Min. Negotiated Rate	$137.78
Max. Negotiated Rate	$310.00
Rate for Payer: Affinity Essential Plan 1&2	$310.00
Rate for Payer: Affinity Essential Plan 3&4	$310.00
Rate for Payer: Affinity Medicaid/CHP/HARP	$137.78
Rate for Payer: Amida Care Medicaid	$137.78
Rate for Payer: Fidelis CHP/HARP/Medicaid	$137.78
Rate for Payer: Fidelis Essential Plan Aliesa	$310.00
Rate for Payer: Fidelis Essential Plan QHP	$310.00
Rate for Payer: Fidelis Qualified Health Plan	$144.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$137.78
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$137.78
Rate for Payer: Healthfirst Commercial	$208.77
Rate for Payer: Healthfirst Essential Plan	$310.00
Rate for Payer: Healthfirst QHP	$137.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$137.78
Rate for Payer: SOMOS Essential	$310.00
Rate for Payer: United Healthcare Essential Plan 1&2	$310.00
Rate for Payer: United Healthcare Essential Plan 3&4	$151.56
Rate for Payer: United Healthcare Medicaid	$137.78
Rate for Payer: Wellcare CHP/FHP/Medicaid	$137.78

OUTPATIENT EAPG 00875: CONTRACEPTIVE MANAGEMENT

Facility

$771.88

Service Code	EAPG 00875
Hospital Charge Code	EAPG 00875
Min. Negotiated Rate	$343.06
Max. Negotiated Rate	$771.88
Rate for Payer: Affinity Essential Plan 1&2	$771.88
Rate for Payer: Affinity Essential Plan 3&4	$771.88
Rate for Payer: Affinity Medicaid/CHP/HARP	$343.06
Rate for Payer: Amida Care Medicaid	$343.06
Rate for Payer: Fidelis CHP/HARP/Medicaid	$343.06
Rate for Payer: Fidelis Essential Plan Aliesa	$771.88
Rate for Payer: Fidelis Essential Plan QHP	$771.88
Rate for Payer: Fidelis Qualified Health Plan	$360.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$343.06
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$343.06
Rate for Payer: Healthfirst Commercial	$399.89
Rate for Payer: Healthfirst Essential Plan	$771.88
Rate for Payer: Healthfirst QHP	$343.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$343.06
Rate for Payer: SOMOS Essential	$771.88
Rate for Payer: United Healthcare Essential Plan 1&2	$771.88
Rate for Payer: United Healthcare Essential Plan 3&4	$377.37
Rate for Payer: United Healthcare Medicaid	$343.06
Rate for Payer: Wellcare CHP/FHP/Medicaid	$343.06

OUTPATIENT EAPG 00876: ADULT PREVENTIVE MEDICINE

Facility

$329.85

Service Code	EAPG 00876
Hospital Charge Code	EAPG 00876
Min. Negotiated Rate	$146.60
Max. Negotiated Rate	$329.85
Rate for Payer: Affinity Essential Plan 1&2	$329.85
Rate for Payer: Affinity Essential Plan 3&4	$329.85
Rate for Payer: Affinity Medicaid/CHP/HARP	$146.60
Rate for Payer: Amida Care Medicaid	$146.60
Rate for Payer: Fidelis CHP/HARP/Medicaid	$146.60
Rate for Payer: Fidelis Essential Plan Aliesa	$329.85
Rate for Payer: Fidelis Essential Plan QHP	$329.85
Rate for Payer: Fidelis Qualified Health Plan	$153.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$146.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$146.60
Rate for Payer: Healthfirst Commercial	$222.15
Rate for Payer: Healthfirst Essential Plan	$329.85
Rate for Payer: Healthfirst QHP	$146.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$146.60
Rate for Payer: SOMOS Essential	$329.85
Rate for Payer: United Healthcare Essential Plan 1&2	$329.85
Rate for Payer: United Healthcare Essential Plan 3&4	$161.26
Rate for Payer: United Healthcare Medicaid	$146.60
Rate for Payer: Wellcare CHP/FHP/Medicaid	$146.60

OUTPATIENT EAPG 00877: CHILD PREVENTIVE MEDICINE

Facility

$329.85

Service Code	EAPG 00877
Hospital Charge Code	EAPG 00877
Min. Negotiated Rate	$146.60
Max. Negotiated Rate	$329.85
Rate for Payer: Affinity Essential Plan 1&2	$329.85
Rate for Payer: Affinity Essential Plan 3&4	$329.85
Rate for Payer: Affinity Medicaid/CHP/HARP	$146.60
Rate for Payer: Amida Care Medicaid	$146.60
Rate for Payer: Fidelis CHP/HARP/Medicaid	$146.60
Rate for Payer: Fidelis Essential Plan Aliesa	$329.85
Rate for Payer: Fidelis Essential Plan QHP	$329.85
Rate for Payer: Fidelis Qualified Health Plan	$153.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$146.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$146.60
Rate for Payer: Healthfirst Commercial	$222.15
Rate for Payer: Healthfirst Essential Plan	$329.85
Rate for Payer: Healthfirst QHP	$146.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$146.60
Rate for Payer: SOMOS Essential	$329.85
Rate for Payer: United Healthcare Essential Plan 1&2	$329.85
Rate for Payer: United Healthcare Essential Plan 3&4	$161.26
Rate for Payer: United Healthcare Medicaid	$146.60
Rate for Payer: Wellcare CHP/FHP/Medicaid	$146.60

Know your out-of-pocket cost for care.

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