St. Barnabas Hospital

All Charges

Charge

Type

Price

APR-DRG 3422: Fractures & dislocations except femur, pelvis & back

Facility IP

$41,238.54

Service Code	APR-DRG 3422
Min. Negotiated Rate	$7,684.00
Max. Negotiated Rate	$41,238.54
Rate for Payer: Amida Care Medicaid	$18,328.24
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,328.24
Rate for Payer: Fidelis Qualified Health Plan	$21,993.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,328.24
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,328.24
Rate for Payer: Healthfirst Commercial	$13,044.00
Rate for Payer: Healthfirst Essential Plan	$41,238.54
Rate for Payer: Healthfirst QHP	$7,684.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,328.24
Rate for Payer: SOMOS Essential	$41,238.54
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,328.24

APR-DRG 3423: Fractures & dislocations except femur, pelvis & back

Facility IP

$48,697.38

Service Code	APR-DRG 3423
Min. Negotiated Rate	$12,075.00
Max. Negotiated Rate	$48,697.38
Rate for Payer: Amida Care Medicaid	$21,643.28
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,643.28
Rate for Payer: Fidelis Qualified Health Plan	$25,971.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,643.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,643.28
Rate for Payer: Healthfirst Commercial	$20,928.00
Rate for Payer: Healthfirst Essential Plan	$48,697.38
Rate for Payer: Healthfirst QHP	$12,075.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,643.28
Rate for Payer: SOMOS Essential	$48,697.38
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,643.28

APR-DRG 3424: Fractures & dislocations except femur, pelvis & back

Facility IP

$76,190.11

Service Code	APR-DRG 3424
Min. Negotiated Rate	$23,592.00
Max. Negotiated Rate	$76,190.11
Rate for Payer: Amida Care Medicaid	$33,862.27
Rate for Payer: Fidelis CHP/HARP/Medicaid	$33,862.27
Rate for Payer: Fidelis Qualified Health Plan	$40,634.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$33,862.27
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$33,862.27
Rate for Payer: Healthfirst Commercial	$49,791.00
Rate for Payer: Healthfirst Essential Plan	$76,190.11
Rate for Payer: Healthfirst QHP	$23,592.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$33,862.27
Rate for Payer: SOMOS Essential	$76,190.11
Rate for Payer: Wellcare CHP/FHP/Medicaid	$33,862.27

APR-DRG 3431: Musculoskeletal malignancy & pathol fracture d/t muscskel malig

Facility IP

$44,235.43

Service Code	APR-DRG 3431
Min. Negotiated Rate	$8,184.00
Max. Negotiated Rate	$44,235.43
Rate for Payer: Amida Care Medicaid	$19,660.19
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,660.19
Rate for Payer: Fidelis Qualified Health Plan	$23,592.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,660.19
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,660.19
Rate for Payer: Healthfirst Commercial	$14,928.00
Rate for Payer: Healthfirst Essential Plan	$44,235.43
Rate for Payer: Healthfirst QHP	$8,184.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,660.19
Rate for Payer: SOMOS Essential	$44,235.43
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,660.19

APR-DRG 3432: Musculoskeletal malignancy & pathol fracture d/t muscskel malig

Facility IP

$47,188.37

Service Code	APR-DRG 3432
Min. Negotiated Rate	$10,513.00
Max. Negotiated Rate	$47,188.37
Rate for Payer: Amida Care Medicaid	$20,972.61
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,972.61
Rate for Payer: Fidelis Qualified Health Plan	$25,167.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,972.61
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,972.61
Rate for Payer: Healthfirst Commercial	$17,595.00
Rate for Payer: Healthfirst Essential Plan	$47,188.37
Rate for Payer: Healthfirst QHP	$10,513.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,972.61
Rate for Payer: SOMOS Essential	$47,188.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,972.61

APR-DRG 3433: Musculoskeletal malignancy & pathol fracture d/t muscskel malig

Facility IP

$67,396.36

Service Code	APR-DRG 3433
Min. Negotiated Rate	$18,591.00
Max. Negotiated Rate	$67,396.36
Rate for Payer: Amida Care Medicaid	$29,953.94
Rate for Payer: Fidelis CHP/HARP/Medicaid	$29,953.94
Rate for Payer: Fidelis Qualified Health Plan	$35,944.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$29,953.94
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29,953.94
Rate for Payer: Healthfirst Commercial	$31,629.00
Rate for Payer: Healthfirst Essential Plan	$67,396.36
Rate for Payer: Healthfirst QHP	$18,591.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$29,953.94
Rate for Payer: SOMOS Essential	$67,396.36
Rate for Payer: Wellcare CHP/FHP/Medicaid	$29,953.94

APR-DRG 3434: Musculoskeletal malignancy & pathol fracture d/t muscskel malig

Facility IP

$97,386.50

Service Code	APR-DRG 3434
Min. Negotiated Rate	$34,814.00
Max. Negotiated Rate	$97,386.50
Rate for Payer: Amida Care Medicaid	$43,282.89
Rate for Payer: Fidelis CHP/HARP/Medicaid	$43,282.89
Rate for Payer: Fidelis Qualified Health Plan	$51,939.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$43,282.89
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$43,282.89
Rate for Payer: Healthfirst Commercial	$51,819.00
Rate for Payer: Healthfirst Essential Plan	$97,386.50
Rate for Payer: Healthfirst QHP	$34,814.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$43,282.89
Rate for Payer: SOMOS Essential	$97,386.50
Rate for Payer: Wellcare CHP/FHP/Medicaid	$43,282.89

APR-DRG 3441: Osteomyelitis, septic arthritis & other musculoskeletal infections

Facility IP

$43,785.20

Service Code	APR-DRG 3441
Min. Negotiated Rate	$8,873.00
Max. Negotiated Rate	$43,785.20
Rate for Payer: Amida Care Medicaid	$19,460.09
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,460.09
Rate for Payer: Fidelis Qualified Health Plan	$23,352.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,460.09
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,460.09
Rate for Payer: Healthfirst Commercial	$15,630.00
Rate for Payer: Healthfirst Essential Plan	$43,785.20
Rate for Payer: Healthfirst QHP	$8,873.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,460.09
Rate for Payer: SOMOS Essential	$43,785.20
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,460.09

APR-DRG 3442: Osteomyelitis, septic arthritis & other musculoskeletal infections

Facility IP

$49,865.18

Service Code	APR-DRG 3442
Min. Negotiated Rate	$12,070.00
Max. Negotiated Rate	$49,865.18
Rate for Payer: Amida Care Medicaid	$22,162.30
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,162.30
Rate for Payer: Fidelis Qualified Health Plan	$26,594.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,162.30
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,162.30
Rate for Payer: Healthfirst Commercial	$20,527.00
Rate for Payer: Healthfirst Essential Plan	$49,865.18
Rate for Payer: Healthfirst QHP	$12,070.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,162.30
Rate for Payer: SOMOS Essential	$49,865.18
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,162.30

APR-DRG 3443: Osteomyelitis, septic arthritis & other musculoskeletal infections

Facility IP

$61,008.59

Service Code	APR-DRG 3443
Min. Negotiated Rate	$17,838.00
Max. Negotiated Rate	$61,008.59
Rate for Payer: Amida Care Medicaid	$27,114.93
Rate for Payer: Fidelis CHP/HARP/Medicaid	$27,114.93
Rate for Payer: Fidelis Qualified Health Plan	$32,537.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$27,114.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$27,114.93
Rate for Payer: Healthfirst Commercial	$29,889.00
Rate for Payer: Healthfirst Essential Plan	$61,008.59
Rate for Payer: Healthfirst QHP	$17,838.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$27,114.93
Rate for Payer: SOMOS Essential	$61,008.59
Rate for Payer: Wellcare CHP/FHP/Medicaid	$27,114.93

APR-DRG 3444: Osteomyelitis, septic arthritis & other musculoskeletal infections

Facility IP

$90,017.37

Service Code	APR-DRG 3444
Min. Negotiated Rate	$35,869.00
Max. Negotiated Rate	$90,017.37
Rate for Payer: Amida Care Medicaid	$40,007.72
Rate for Payer: Fidelis CHP/HARP/Medicaid	$40,007.72
Rate for Payer: Fidelis Qualified Health Plan	$48,009.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$40,007.72
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$40,007.72
Rate for Payer: Healthfirst Commercial	$58,078.00
Rate for Payer: Healthfirst Essential Plan	$90,017.37
Rate for Payer: Healthfirst QHP	$35,869.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$40,007.72
Rate for Payer: SOMOS Essential	$90,017.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$40,007.72

APR-DRG 3461: Connective tissue disorders

Facility IP

$42,508.35

Service Code	APR-DRG 3461
Min. Negotiated Rate	$7,515.00
Max. Negotiated Rate	$42,508.35
Rate for Payer: Amida Care Medicaid	$18,892.60
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,892.60
Rate for Payer: Fidelis Qualified Health Plan	$22,671.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,892.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,892.60
Rate for Payer: Healthfirst Commercial	$12,396.00
Rate for Payer: Healthfirst Essential Plan	$42,508.35
Rate for Payer: Healthfirst QHP	$7,515.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,892.60
Rate for Payer: SOMOS Essential	$42,508.35
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,892.60

APR-DRG 3462: Connective tissue disorders

Facility IP

$46,565.78

Service Code	APR-DRG 3462
Min. Negotiated Rate	$9,727.00
Max. Negotiated Rate	$46,565.78
Rate for Payer: Amida Care Medicaid	$20,695.90
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,695.90
Rate for Payer: Fidelis Qualified Health Plan	$24,835.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,695.90
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,695.90
Rate for Payer: Healthfirst Commercial	$16,275.00
Rate for Payer: Healthfirst Essential Plan	$46,565.78
Rate for Payer: Healthfirst QHP	$9,727.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,695.90
Rate for Payer: SOMOS Essential	$46,565.78
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,695.90

APR-DRG 3463: Connective tissue disorders

Facility IP

$58,889.32

Service Code	APR-DRG 3463
Min. Negotiated Rate	$15,403.00
Max. Negotiated Rate	$58,889.32
Rate for Payer: Amida Care Medicaid	$26,173.03
Rate for Payer: Fidelis CHP/HARP/Medicaid	$26,173.03
Rate for Payer: Fidelis Qualified Health Plan	$31,407.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$26,173.03
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$26,173.03
Rate for Payer: Healthfirst Commercial	$27,520.00
Rate for Payer: Healthfirst Essential Plan	$58,889.32
Rate for Payer: Healthfirst QHP	$15,403.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26,173.03
Rate for Payer: SOMOS Essential	$58,889.32
Rate for Payer: Wellcare CHP/FHP/Medicaid	$26,173.03

APR-DRG 3464: Connective tissue disorders

Facility IP

$115,373.20

Service Code	APR-DRG 3464
Min. Negotiated Rate	$37,345.00
Max. Negotiated Rate	$115,373.20
Rate for Payer: Amida Care Medicaid	$51,276.98
Rate for Payer: Fidelis CHP/HARP/Medicaid	$51,276.98
Rate for Payer: Fidelis Qualified Health Plan	$61,532.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$51,276.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$51,276.98
Rate for Payer: Healthfirst Commercial	$74,422.00
Rate for Payer: Healthfirst Essential Plan	$115,373.20
Rate for Payer: Healthfirst QHP	$37,345.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$51,276.98
Rate for Payer: SOMOS Essential	$115,373.20
Rate for Payer: Wellcare CHP/FHP/Medicaid	$51,276.98

APR-DRG 3471: Other back & neck disorders, fractures & injuries

Facility IP

$39,300.39

Service Code	APR-DRG 3471
Min. Negotiated Rate	$6,279.00
Max. Negotiated Rate	$39,300.39
Rate for Payer: Amida Care Medicaid	$17,466.84
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,466.84
Rate for Payer: Fidelis Qualified Health Plan	$20,960.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,466.84
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,466.84
Rate for Payer: Healthfirst Commercial	$10,639.00
Rate for Payer: Healthfirst Essential Plan	$39,300.39
Rate for Payer: Healthfirst QHP	$6,279.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,466.84
Rate for Payer: SOMOS Essential	$39,300.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,466.84

APR-DRG 3472: Other back & neck disorders, fractures & injuries

Facility IP

$42,740.50

Service Code	APR-DRG 3472
Min. Negotiated Rate	$8,196.00
Max. Negotiated Rate	$42,740.50
Rate for Payer: Amida Care Medicaid	$18,995.78
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,995.78
Rate for Payer: Fidelis Qualified Health Plan	$22,794.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,995.78
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,995.78
Rate for Payer: Healthfirst Commercial	$13,775.00
Rate for Payer: Healthfirst Essential Plan	$42,740.50
Rate for Payer: Healthfirst QHP	$8,196.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,995.78
Rate for Payer: SOMOS Essential	$42,740.50
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,995.78

APR-DRG 3473: Other back & neck disorders, fractures & injuries

Facility IP

$49,406.15

Service Code	APR-DRG 3473
Min. Negotiated Rate	$11,852.00
Max. Negotiated Rate	$49,406.15
Rate for Payer: Amida Care Medicaid	$21,958.29
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,958.29
Rate for Payer: Fidelis Qualified Health Plan	$26,349.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,958.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,958.29
Rate for Payer: Healthfirst Commercial	$20,252.00
Rate for Payer: Healthfirst Essential Plan	$49,406.15
Rate for Payer: Healthfirst QHP	$11,852.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,958.29
Rate for Payer: SOMOS Essential	$49,406.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,958.29

APR-DRG 3474: Other back & neck disorders, fractures & injuries

Facility IP

$85,136.85

Service Code	APR-DRG 3474
Min. Negotiated Rate	$30,805.00
Max. Negotiated Rate	$85,136.85
Rate for Payer: Amida Care Medicaid	$37,838.60
Rate for Payer: Fidelis CHP/HARP/Medicaid	$37,838.60
Rate for Payer: Fidelis Qualified Health Plan	$45,406.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$37,838.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$37,838.60
Rate for Payer: Healthfirst Commercial	$51,812.00
Rate for Payer: Healthfirst Essential Plan	$85,136.85
Rate for Payer: Healthfirst QHP	$30,805.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$37,838.60
Rate for Payer: SOMOS Essential	$85,136.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$37,838.60

APR-DRG 3491: Malfunction, reaction, complic of orthopedic device or procedure

Facility IP

$39,208.95

Service Code	APR-DRG 3491
Min. Negotiated Rate	$6,160.00
Max. Negotiated Rate	$39,208.95
Rate for Payer: Amida Care Medicaid	$17,426.20
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,426.20
Rate for Payer: Fidelis Qualified Health Plan	$20,911.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,426.20
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,426.20
Rate for Payer: Healthfirst Commercial	$10,453.00
Rate for Payer: Healthfirst Essential Plan	$39,208.95
Rate for Payer: Healthfirst QHP	$6,160.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,426.20
Rate for Payer: SOMOS Essential	$39,208.95
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,426.20

APR-DRG 3492: Malfunction, reaction, complic of orthopedic device or procedure

Facility IP

$45,106.02

Service Code	APR-DRG 3492
Min. Negotiated Rate	$9,009.00
Max. Negotiated Rate	$45,106.02
Rate for Payer: Amida Care Medicaid	$20,047.12
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,047.12
Rate for Payer: Fidelis Qualified Health Plan	$24,056.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,047.12
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,047.12
Rate for Payer: Healthfirst Commercial	$16,441.00
Rate for Payer: Healthfirst Essential Plan	$45,106.02
Rate for Payer: Healthfirst QHP	$9,009.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,047.12
Rate for Payer: SOMOS Essential	$45,106.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,047.12

APR-DRG 3493: Malfunction, reaction, complic of orthopedic device or procedure

Facility IP

$57,044.38

Service Code	APR-DRG 3493
Min. Negotiated Rate	$14,937.00
Max. Negotiated Rate	$57,044.38
Rate for Payer: Amida Care Medicaid	$25,353.06
Rate for Payer: Fidelis CHP/HARP/Medicaid	$25,353.06
Rate for Payer: Fidelis Qualified Health Plan	$30,423.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$25,353.06
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25,353.06
Rate for Payer: Healthfirst Commercial	$25,840.00
Rate for Payer: Healthfirst Essential Plan	$57,044.38
Rate for Payer: Healthfirst QHP	$14,937.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$25,353.06
Rate for Payer: SOMOS Essential	$57,044.38
Rate for Payer: Wellcare CHP/FHP/Medicaid	$25,353.06

APR-DRG 3494: Malfunction, reaction, complic of orthopedic device or procedure

Facility IP

$92,454.98

Service Code	APR-DRG 3494
Min. Negotiated Rate	$25,634.00
Max. Negotiated Rate	$92,454.98
Rate for Payer: Amida Care Medicaid	$41,091.10
Rate for Payer: Fidelis CHP/HARP/Medicaid	$41,091.10
Rate for Payer: Fidelis Qualified Health Plan	$49,309.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$41,091.10
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$41,091.10
Rate for Payer: Healthfirst Commercial	$52,004.00
Rate for Payer: Healthfirst Essential Plan	$92,454.98
Rate for Payer: Healthfirst QHP	$25,634.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$41,091.10
Rate for Payer: SOMOS Essential	$92,454.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$41,091.10

APR-DRG 3511: Other musculoskeletal system & connective tissue diagnoses

Facility IP

$38,276.80

Service Code	APR-DRG 3511
Min. Negotiated Rate	$5,540.00
Max. Negotiated Rate	$38,276.80
Rate for Payer: Amida Care Medicaid	$17,011.91
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,011.91
Rate for Payer: Fidelis Qualified Health Plan	$20,414.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,011.91
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,011.91
Rate for Payer: Healthfirst Commercial	$9,581.00
Rate for Payer: Healthfirst Essential Plan	$38,276.80
Rate for Payer: Healthfirst QHP	$5,540.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,011.91
Rate for Payer: SOMOS Essential	$38,276.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,011.91

APR-DRG 3512: Other musculoskeletal system & connective tissue diagnoses

Facility IP

$40,878.00

Service Code	APR-DRG 3512
Min. Negotiated Rate	$7,041.00
Max. Negotiated Rate	$40,878.00
Rate for Payer: Amida Care Medicaid	$18,168.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,168.00
Rate for Payer: Fidelis Qualified Health Plan	$21,801.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,168.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,168.00
Rate for Payer: Healthfirst Commercial	$12,035.00
Rate for Payer: Healthfirst Essential Plan	$40,878.00
Rate for Payer: Healthfirst QHP	$7,041.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,168.00
Rate for Payer: SOMOS Essential	$40,878.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,168.00

Price Transparency.

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