St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ACIDOPHILUS PROBIOTIC BLEND PO TABS

Facility

$0.09

Service Code	NDC 3504600100
Hospital Charge Code	3504600100
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Brighton Health Commercial	$0.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.06
Rate for Payer: EmblemHealth Commercial	$0.04
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.06

ACUTE AND SUBACUTE ENDOCARDITIS

Facility

$164.32

Service Code	EAPG 00608
Min. Negotiated Rate	$164.32
Max. Negotiated Rate	$164.32
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$164.32

ACUTE ANXIETY AND DELIRIUM STATES

Facility

$211.05

Service Code	EAPG 00826
Min. Negotiated Rate	$152.74
Max. Negotiated Rate	$211.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$152.74
Rate for Payer: Healthfirst Commercial	$211.05

Acute anxiety & delirium states

Facility

$11,818.00

Service Code	APR-DRG 7564
Min. Negotiated Rate	$3,508.43
Max. Negotiated Rate	$11,818.00
Rate for Payer: Affinity Essential Plan 1&2	$3,508.43
Rate for Payer: Affinity Essential Plan 3&4	$3,508.43
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,508.43
Rate for Payer: Carelon Behavioral Health HARP/QHP	$3,508.43
Rate for Payer: EmblemHealth Essential Plan 1&2	$7,893.97
Rate for Payer: EmblemHealth Essential Plan 3&4	$3,508.43
Rate for Payer: Fidelis Qualified Health Plan	$4,210.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,508.43
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,508.43
Rate for Payer: Healthfirst Commercial	$11,818.00
Rate for Payer: Healthfirst Essential Plan	$7,893.97
Rate for Payer: Healthfirst QHP	$6,385.34
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$3,508.43
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7,893.97
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7,893.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,508.43
Rate for Payer: SOMOS Essential	$7,893.97
Rate for Payer: United Healthcare Essential Plan 1&2	$7,893.97
Rate for Payer: United Healthcare Essential Plan 3&4	$7,893.97
Rate for Payer: United Healthcare Medicaid	$3,508.43

Acute anxiety & delirium states

Facility

$11,818.00

Service Code	APR-DRG 7562
Min. Negotiated Rate	$3,508.43
Max. Negotiated Rate	$11,818.00
Rate for Payer: Affinity Essential Plan 1&2	$3,508.43
Rate for Payer: Affinity Essential Plan 3&4	$3,508.43
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,508.43
Rate for Payer: Carelon Behavioral Health HARP/QHP	$3,508.43
Rate for Payer: EmblemHealth Essential Plan 1&2	$7,893.97
Rate for Payer: EmblemHealth Essential Plan 3&4	$3,508.43
Rate for Payer: Fidelis Qualified Health Plan	$4,210.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,508.43
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,508.43
Rate for Payer: Healthfirst Commercial	$11,818.00
Rate for Payer: Healthfirst Essential Plan	$7,893.97
Rate for Payer: Healthfirst QHP	$6,385.34
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$3,508.43
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7,893.97
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7,893.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,508.43
Rate for Payer: SOMOS Essential	$7,893.97
Rate for Payer: United Healthcare Essential Plan 1&2	$7,893.97
Rate for Payer: United Healthcare Essential Plan 3&4	$7,893.97
Rate for Payer: United Healthcare Medicaid	$3,508.43

Acute anxiety & delirium states

Facility

$11,818.00

Service Code	APR-DRG 7563
Min. Negotiated Rate	$3,508.43
Max. Negotiated Rate	$11,818.00
Rate for Payer: Affinity Essential Plan 1&2	$3,508.43
Rate for Payer: Affinity Essential Plan 3&4	$3,508.43
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,508.43
Rate for Payer: Carelon Behavioral Health HARP/QHP	$3,508.43
Rate for Payer: EmblemHealth Essential Plan 1&2	$7,893.97
Rate for Payer: EmblemHealth Essential Plan 3&4	$3,508.43
Rate for Payer: Fidelis Qualified Health Plan	$4,210.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,508.43
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,508.43
Rate for Payer: Healthfirst Commercial	$11,818.00
Rate for Payer: Healthfirst Essential Plan	$7,893.97
Rate for Payer: Healthfirst QHP	$6,385.34
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$3,508.43
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7,893.97
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7,893.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,508.43
Rate for Payer: SOMOS Essential	$7,893.97
Rate for Payer: United Healthcare Essential Plan 1&2	$7,893.97
Rate for Payer: United Healthcare Essential Plan 3&4	$7,893.97
Rate for Payer: United Healthcare Medicaid	$3,508.43

Acute anxiety & delirium states

Facility

$8,912.00

Service Code	APR-DRG 7561
Min. Negotiated Rate	$3,463.72
Max. Negotiated Rate	$8,912.00
Rate for Payer: Affinity Essential Plan 1&2	$3,463.72
Rate for Payer: Affinity Essential Plan 3&4	$3,463.72
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,463.72
Rate for Payer: Carelon Behavioral Health HARP/QHP	$3,463.72
Rate for Payer: EmblemHealth Essential Plan 1&2	$7,793.37
Rate for Payer: EmblemHealth Essential Plan 3&4	$3,463.72
Rate for Payer: Fidelis Qualified Health Plan	$4,156.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,463.72
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,463.72
Rate for Payer: Healthfirst Commercial	$8,912.00
Rate for Payer: Healthfirst Essential Plan	$7,793.37
Rate for Payer: Healthfirst QHP	$6,303.97
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$3,463.72
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7,793.37
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7,793.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,463.72
Rate for Payer: SOMOS Essential	$7,793.37
Rate for Payer: United Healthcare Essential Plan 1&2	$7,793.37
Rate for Payer: United Healthcare Essential Plan 3&4	$7,793.37
Rate for Payer: United Healthcare Medicaid	$3,463.72

ACUTE BRONCHITIS

Facility

$192.09

Service Code	EAPG 00584
Min. Negotiated Rate	$192.09
Max. Negotiated Rate	$192.09
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$192.09

Acute Kidney Injury #

Facility

$90,078.16

Service Code	APR-DRG 4694
Min. Negotiated Rate	$40,034.74
Max. Negotiated Rate	$90,078.16
Rate for Payer: Affinity Essential Plan 1&2	$90,078.16
Rate for Payer: Affinity Essential Plan 3&4	$90,078.16
Rate for Payer: Affinity Medicaid/CHP/HARP	$40,034.74
Rate for Payer: Amida Care Medicaid	$40,034.74
Rate for Payer: EmblemHealth Essential Plan 1&2	$90,078.16
Rate for Payer: EmblemHealth Essential Plan 3&4	$40,034.74
Rate for Payer: Fidelis CHP/HARP/Medicaid	$40,034.74
Rate for Payer: Fidelis Qualified Health Plan	$48,041.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$40,034.74
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$40,034.74
Rate for Payer: Healthfirst Essential Plan	$90,078.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$40,034.74
Rate for Payer: SOMOS Essential	$90,078.16
Rate for Payer: United Healthcare Essential Plan 1&2	$90,078.16
Rate for Payer: United Healthcare Essential Plan 3&4	$90,078.16
Rate for Payer: United Healthcare Medicaid	$40,034.74
Rate for Payer: Wellcare CHP/FHP/Medicaid	$40,034.74

Acute Kidney Injury #

Facility

$45,110.54

Service Code	APR-DRG 4692
Min. Negotiated Rate	$20,049.13
Max. Negotiated Rate	$45,110.54
Rate for Payer: Affinity Essential Plan 1&2	$45,110.54
Rate for Payer: Affinity Essential Plan 3&4	$45,110.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,049.13
Rate for Payer: Amida Care Medicaid	$20,049.13
Rate for Payer: EmblemHealth Essential Plan 1&2	$45,110.54
Rate for Payer: EmblemHealth Essential Plan 3&4	$20,049.13
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,049.13
Rate for Payer: Fidelis Qualified Health Plan	$24,058.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,049.13
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,049.13
Rate for Payer: Healthfirst Essential Plan	$45,110.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,049.13
Rate for Payer: SOMOS Essential	$45,110.54
Rate for Payer: United Healthcare Essential Plan 1&2	$45,110.54
Rate for Payer: United Healthcare Essential Plan 3&4	$45,110.54
Rate for Payer: United Healthcare Medicaid	$20,049.13
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,049.13

Acute Kidney Injury #

Facility

$55,903.95

Service Code	APR-DRG 4693
Min. Negotiated Rate	$24,846.20
Max. Negotiated Rate	$55,903.95
Rate for Payer: Affinity Essential Plan 1&2	$55,903.95
Rate for Payer: Affinity Essential Plan 3&4	$55,903.95
Rate for Payer: Affinity Medicaid/CHP/HARP	$24,846.20
Rate for Payer: Amida Care Medicaid	$24,846.20
Rate for Payer: EmblemHealth Essential Plan 1&2	$55,903.95
Rate for Payer: EmblemHealth Essential Plan 3&4	$24,846.20
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,846.20
Rate for Payer: Fidelis Qualified Health Plan	$29,815.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,846.20
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,846.20
Rate for Payer: Healthfirst Essential Plan	$55,903.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,846.20
Rate for Payer: SOMOS Essential	$55,903.95
Rate for Payer: United Healthcare Essential Plan 1&2	$55,903.95
Rate for Payer: United Healthcare Essential Plan 3&4	$55,903.95
Rate for Payer: United Healthcare Medicaid	$24,846.20
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,846.20

Acute Kidney Injury #

Facility

$41,276.47

Service Code	APR-DRG 4691
Min. Negotiated Rate	$18,345.10
Max. Negotiated Rate	$41,276.47
Rate for Payer: Affinity Essential Plan 1&2	$41,276.47
Rate for Payer: Affinity Essential Plan 3&4	$41,276.47
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,345.10
Rate for Payer: Amida Care Medicaid	$18,345.10
Rate for Payer: EmblemHealth Essential Plan 1&2	$41,276.47
Rate for Payer: EmblemHealth Essential Plan 3&4	$18,345.10
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,345.10
Rate for Payer: Fidelis Qualified Health Plan	$22,014.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,345.10
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,345.10
Rate for Payer: Healthfirst Essential Plan	$41,276.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,345.10
Rate for Payer: SOMOS Essential	$41,276.47
Rate for Payer: United Healthcare Essential Plan 1&2	$41,276.47
Rate for Payer: United Healthcare Essential Plan 3&4	$41,276.47
Rate for Payer: United Healthcare Medicaid	$18,345.10
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,345.10

ACUTE KIDNEY INJURY

Facility

$155.06

Service Code	EAPG 00729
Min. Negotiated Rate	$155.06
Max. Negotiated Rate	$155.06
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$155.06

Acute leukemia

Facility

$79,831.71

Service Code	APR-DRG 6902
Min. Negotiated Rate	$31,706.00
Max. Negotiated Rate	$79,831.71
Rate for Payer: Affinity Essential Plan 1&2	$79,831.71
Rate for Payer: Affinity Essential Plan 3&4	$79,831.71
Rate for Payer: Affinity Medicaid/CHP/HARP	$35,480.76
Rate for Payer: Amida Care Medicaid	$35,480.76
Rate for Payer: EmblemHealth Essential Plan 1&2	$79,831.71
Rate for Payer: EmblemHealth Essential Plan 3&4	$35,480.76
Rate for Payer: Fidelis CHP/HARP/Medicaid	$35,480.76
Rate for Payer: Fidelis Qualified Health Plan	$42,576.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$35,480.76
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$35,480.76
Rate for Payer: Healthfirst Commercial	$43,079.00
Rate for Payer: Healthfirst Essential Plan	$79,831.71
Rate for Payer: Healthfirst QHP	$31,706.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$35,480.76
Rate for Payer: SOMOS Essential	$79,831.71
Rate for Payer: United Healthcare Essential Plan 1&2	$79,831.71
Rate for Payer: United Healthcare Essential Plan 3&4	$79,831.71
Rate for Payer: United Healthcare Medicaid	$35,480.76
Rate for Payer: Wellcare CHP/FHP/Medicaid	$35,480.76

Acute leukemia

Facility

$138,647.70

Service Code	APR-DRG 6903
Min. Negotiated Rate	$61,621.20
Max. Negotiated Rate	$138,647.70
Rate for Payer: Affinity Essential Plan 1&2	$138,647.70
Rate for Payer: Affinity Essential Plan 3&4	$138,647.70
Rate for Payer: Affinity Medicaid/CHP/HARP	$61,621.20
Rate for Payer: Amida Care Medicaid	$61,621.20
Rate for Payer: EmblemHealth Essential Plan 1&2	$138,647.70
Rate for Payer: EmblemHealth Essential Plan 3&4	$61,621.20
Rate for Payer: Fidelis CHP/HARP/Medicaid	$61,621.20
Rate for Payer: Fidelis Qualified Health Plan	$73,945.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$61,621.20
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$61,621.20
Rate for Payer: Healthfirst Commercial	$90,583.00
Rate for Payer: Healthfirst Essential Plan	$138,647.70
Rate for Payer: Healthfirst QHP	$62,704.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$61,621.20
Rate for Payer: SOMOS Essential	$138,647.70
Rate for Payer: United Healthcare Essential Plan 1&2	$138,647.70
Rate for Payer: United Healthcare Essential Plan 3&4	$138,647.70
Rate for Payer: United Healthcare Medicaid	$61,621.20
Rate for Payer: Wellcare CHP/FHP/Medicaid	$61,621.20

Acute leukemia

Facility

$55,525.84

Service Code	APR-DRG 6901
Min. Negotiated Rate	$15,442.00
Max. Negotiated Rate	$55,525.84
Rate for Payer: Affinity Essential Plan 1&2	$55,525.84
Rate for Payer: Affinity Essential Plan 3&4	$55,525.84
Rate for Payer: Affinity Medicaid/CHP/HARP	$24,678.15
Rate for Payer: Amida Care Medicaid	$24,678.15
Rate for Payer: EmblemHealth Essential Plan 1&2	$55,525.84
Rate for Payer: EmblemHealth Essential Plan 3&4	$24,678.15
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,678.15
Rate for Payer: Fidelis Qualified Health Plan	$29,613.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,678.15
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,678.15
Rate for Payer: Healthfirst Commercial	$22,399.00
Rate for Payer: Healthfirst Essential Plan	$55,525.84
Rate for Payer: Healthfirst QHP	$15,442.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,678.15
Rate for Payer: SOMOS Essential	$55,525.84
Rate for Payer: United Healthcare Essential Plan 1&2	$55,525.84
Rate for Payer: United Healthcare Essential Plan 3&4	$55,525.84
Rate for Payer: United Healthcare Medicaid	$24,678.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,678.15

Acute leukemia

Facility

$185,961.49

Service Code	APR-DRG 6904
Min. Negotiated Rate	$82,649.55
Max. Negotiated Rate	$185,961.49
Rate for Payer: Affinity Essential Plan 1&2	$185,961.49
Rate for Payer: Affinity Essential Plan 3&4	$185,961.49
Rate for Payer: Affinity Medicaid/CHP/HARP	$82,649.55
Rate for Payer: Amida Care Medicaid	$82,649.55
Rate for Payer: EmblemHealth Essential Plan 1&2	$185,961.49
Rate for Payer: EmblemHealth Essential Plan 3&4	$82,649.55
Rate for Payer: Fidelis CHP/HARP/Medicaid	$82,649.55
Rate for Payer: Fidelis Qualified Health Plan	$99,179.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$82,649.55
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$82,649.55
Rate for Payer: Healthfirst Commercial	$161,483.00
Rate for Payer: Healthfirst Essential Plan	$185,961.49
Rate for Payer: Healthfirst QHP	$103,813.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$82,649.55
Rate for Payer: SOMOS Essential	$185,961.49
Rate for Payer: United Healthcare Essential Plan 1&2	$185,961.49
Rate for Payer: United Healthcare Essential Plan 3&4	$185,961.49
Rate for Payer: United Healthcare Medicaid	$82,649.55
Rate for Payer: Wellcare CHP/FHP/Medicaid	$82,649.55

ACUTE LEUKEMIA

Facility

$325.90

Service Code	EAPG 00800
Min. Negotiated Rate	$236.06
Max. Negotiated Rate	$325.90
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$236.06
Rate for Payer: Healthfirst Commercial	$325.90

ACUTE LOWER URINARY TRACT INFECTIONS

Facility

$247.43

Service Code	EAPG 00727
Min. Negotiated Rate	$180.52
Max. Negotiated Rate	$247.43
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$180.52
Rate for Payer: Healthfirst Commercial	$247.43

Acute major eye infections

Facility

$41,684.49

Service Code	APR-DRG 0801
Min. Negotiated Rate	$5,950.00
Max. Negotiated Rate	$41,684.49
Rate for Payer: Affinity Essential Plan 1&2	$41,684.49
Rate for Payer: Affinity Essential Plan 3&4	$41,684.49
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,526.44
Rate for Payer: Amida Care Medicaid	$18,526.44
Rate for Payer: EmblemHealth Essential Plan 1&2	$41,684.49
Rate for Payer: EmblemHealth Essential Plan 3&4	$18,526.44
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,526.44
Rate for Payer: Fidelis Qualified Health Plan	$22,231.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,526.44
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,526.44
Rate for Payer: Healthfirst Commercial	$10,564.00
Rate for Payer: Healthfirst Essential Plan	$41,684.49
Rate for Payer: Healthfirst QHP	$5,950.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,526.44
Rate for Payer: SOMOS Essential	$41,684.49
Rate for Payer: United Healthcare Essential Plan 1&2	$41,684.49
Rate for Payer: United Healthcare Essential Plan 3&4	$41,684.49
Rate for Payer: United Healthcare Medicaid	$18,526.44
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,526.44

Acute major eye infections

Facility

$55,794.92

Service Code	APR-DRG 0804
Min. Negotiated Rate	$11,716.00
Max. Negotiated Rate	$55,794.92
Rate for Payer: Affinity Essential Plan 1&2	$55,794.92
Rate for Payer: Affinity Essential Plan 3&4	$55,794.92
Rate for Payer: Affinity Medicaid/CHP/HARP	$24,797.74
Rate for Payer: Amida Care Medicaid	$24,797.74
Rate for Payer: EmblemHealth Essential Plan 1&2	$55,794.92
Rate for Payer: EmblemHealth Essential Plan 3&4	$24,797.74
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,797.74
Rate for Payer: Fidelis Qualified Health Plan	$29,757.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,797.74
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,797.74
Rate for Payer: Healthfirst Commercial	$21,496.00
Rate for Payer: Healthfirst Essential Plan	$55,794.92
Rate for Payer: Healthfirst QHP	$11,716.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,797.74
Rate for Payer: SOMOS Essential	$55,794.92
Rate for Payer: United Healthcare Essential Plan 1&2	$55,794.92
Rate for Payer: United Healthcare Essential Plan 3&4	$55,794.92
Rate for Payer: United Healthcare Medicaid	$24,797.74
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,797.74

Acute major eye infections

Facility

$44,368.33

Service Code	APR-DRG 0802
Min. Negotiated Rate	$7,292.00
Max. Negotiated Rate	$44,368.33
Rate for Payer: Affinity Essential Plan 1&2	$44,368.33
Rate for Payer: Affinity Essential Plan 3&4	$44,368.33
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,719.26
Rate for Payer: Amida Care Medicaid	$19,719.26
Rate for Payer: EmblemHealth Essential Plan 1&2	$44,368.33
Rate for Payer: EmblemHealth Essential Plan 3&4	$19,719.26
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,719.26
Rate for Payer: Fidelis Qualified Health Plan	$23,663.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,719.26
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,719.26
Rate for Payer: Healthfirst Commercial	$13,055.00
Rate for Payer: Healthfirst Essential Plan	$44,368.33
Rate for Payer: Healthfirst QHP	$7,292.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,719.26
Rate for Payer: SOMOS Essential	$44,368.33
Rate for Payer: United Healthcare Essential Plan 1&2	$44,368.33
Rate for Payer: United Healthcare Essential Plan 3&4	$44,368.33
Rate for Payer: United Healthcare Medicaid	$19,719.26
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,719.26

Acute major eye infections

Facility

$53,318.61

Service Code	APR-DRG 0803
Min. Negotiated Rate	$10,912.00
Max. Negotiated Rate	$53,318.61
Rate for Payer: Affinity Essential Plan 1&2	$53,318.61
Rate for Payer: Affinity Essential Plan 3&4	$53,318.61
Rate for Payer: Affinity Medicaid/CHP/HARP	$23,697.16
Rate for Payer: Amida Care Medicaid	$23,697.16
Rate for Payer: EmblemHealth Essential Plan 1&2	$53,318.61
Rate for Payer: EmblemHealth Essential Plan 3&4	$23,697.16
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,697.16
Rate for Payer: Fidelis Qualified Health Plan	$28,436.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,697.16
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,697.16
Rate for Payer: Healthfirst Commercial	$18,667.00
Rate for Payer: Healthfirst Essential Plan	$53,318.61
Rate for Payer: Healthfirst QHP	$10,912.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,697.16
Rate for Payer: SOMOS Essential	$53,318.61
Rate for Payer: United Healthcare Essential Plan 1&2	$53,318.61
Rate for Payer: United Healthcare Essential Plan 3&4	$53,318.61
Rate for Payer: United Healthcare Medicaid	$23,697.16
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,697.16

ACUTE MAJOR EYE INFECTIONS

Facility

$207.92

Service Code	EAPG 00550
Min. Negotiated Rate	$150.43
Max. Negotiated Rate	$207.92
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$150.43
Rate for Payer: Healthfirst Commercial	$207.92

Acute myocardial infarction

Facility

$44,955.76

Service Code	APR-DRG 1901
Min. Negotiated Rate	$8,833.00
Max. Negotiated Rate	$44,955.76
Rate for Payer: Affinity Essential Plan 1&2	$44,955.76
Rate for Payer: Affinity Essential Plan 3&4	$44,955.76
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,980.34
Rate for Payer: Amida Care Medicaid	$19,980.34
Rate for Payer: EmblemHealth Essential Plan 1&2	$44,955.76
Rate for Payer: EmblemHealth Essential Plan 3&4	$19,980.34
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,980.34
Rate for Payer: Fidelis Qualified Health Plan	$23,976.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,980.34
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,980.34
Rate for Payer: Healthfirst Commercial	$14,788.00
Rate for Payer: Healthfirst Essential Plan	$44,955.76
Rate for Payer: Healthfirst QHP	$8,833.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,980.34
Rate for Payer: SOMOS Essential	$44,955.76
Rate for Payer: United Healthcare Essential Plan 1&2	$44,955.76
Rate for Payer: United Healthcare Essential Plan 3&4	$44,955.76
Rate for Payer: United Healthcare Medicaid	$19,980.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,980.34

Know your out-of-pocket cost for care.

All Charges