St. Barnabas Hospital

All Charges

Charge

Type

Price

APR-DRG 3513: Other musculoskeletal system & connective tissue diagnoses

Facility IP

$49,951.37

Service Code	APR-DRG 3513
Min. Negotiated Rate	$10,650.00
Max. Negotiated Rate	$49,951.37
Rate for Payer: Amida Care Medicaid	$22,200.61
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,200.61
Rate for Payer: Fidelis Qualified Health Plan	$26,640.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,200.61
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,200.61
Rate for Payer: Healthfirst Commercial	$19,859.00
Rate for Payer: Healthfirst Essential Plan	$49,951.37
Rate for Payer: Healthfirst QHP	$10,650.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,200.61
Rate for Payer: SOMOS Essential	$49,951.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,200.61

APR-DRG 3514: Other musculoskeletal system & connective tissue diagnoses

Facility IP

$83,821.30

Service Code	APR-DRG 3514
Min. Negotiated Rate	$25,022.00
Max. Negotiated Rate	$83,821.30
Rate for Payer: Amida Care Medicaid	$37,253.91
Rate for Payer: Fidelis CHP/HARP/Medicaid	$37,253.91
Rate for Payer: Fidelis Qualified Health Plan	$44,704.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$37,253.91
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$37,253.91
Rate for Payer: Healthfirst Commercial	$48,157.00
Rate for Payer: Healthfirst Essential Plan	$83,821.30
Rate for Payer: Healthfirst QHP	$25,022.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$37,253.91
Rate for Payer: SOMOS Essential	$83,821.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$37,253.91

APR-DRG 3611: Skin graft for skin & subcutaneous tissue diagnoses

Facility IP

$52,969.36

Service Code	APR-DRG 3611
Min. Negotiated Rate	$21,942.00
Max. Negotiated Rate	$52,969.36
Rate for Payer: Amida Care Medicaid	$23,541.94
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,541.94
Rate for Payer: Fidelis Qualified Health Plan	$28,250.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,541.94
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,541.94
Rate for Payer: Healthfirst Commercial	$34,410.00
Rate for Payer: Healthfirst Essential Plan	$52,969.36
Rate for Payer: Healthfirst QHP	$21,942.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,541.94
Rate for Payer: SOMOS Essential	$52,969.36
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,541.94

APR-DRG 3612: Skin graft for skin & subcutaneous tissue diagnoses

Facility IP

$62,670.62

Service Code	APR-DRG 3612
Min. Negotiated Rate	$27,853.61
Max. Negotiated Rate	$62,670.62
Rate for Payer: Amida Care Medicaid	$27,853.61
Rate for Payer: Fidelis CHP/HARP/Medicaid	$27,853.61
Rate for Payer: Fidelis Qualified Health Plan	$33,424.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$27,853.61
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$27,853.61
Rate for Payer: Healthfirst Commercial	$51,155.00
Rate for Payer: Healthfirst Essential Plan	$62,670.62
Rate for Payer: Healthfirst QHP	$30,605.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$27,853.61
Rate for Payer: SOMOS Essential	$62,670.62
Rate for Payer: Wellcare CHP/FHP/Medicaid	$27,853.61

APR-DRG 3613: Skin graft for skin & subcutaneous tissue diagnoses

Facility IP

$90,920.00

Service Code	APR-DRG 3613
Min. Negotiated Rate	$39,280.77
Max. Negotiated Rate	$90,920.00
Rate for Payer: Amida Care Medicaid	$39,280.77
Rate for Payer: Fidelis CHP/HARP/Medicaid	$39,280.77
Rate for Payer: Fidelis Qualified Health Plan	$47,136.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$39,280.77
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$39,280.77
Rate for Payer: Healthfirst Commercial	$90,920.00
Rate for Payer: Healthfirst Essential Plan	$88,381.73
Rate for Payer: Healthfirst QHP	$55,041.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$39,280.77
Rate for Payer: SOMOS Essential	$88,381.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$39,280.77

APR-DRG 3614: Skin graft for skin & subcutaneous tissue diagnoses

Facility IP

$217,030.00

Service Code	APR-DRG 3614
Min. Negotiated Rate	$88,218.47
Max. Negotiated Rate	$217,030.00
Rate for Payer: Amida Care Medicaid	$88,218.47
Rate for Payer: Fidelis CHP/HARP/Medicaid	$88,218.47
Rate for Payer: Fidelis Qualified Health Plan	$105,862.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$88,218.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$88,218.47
Rate for Payer: Healthfirst Commercial	$217,030.00
Rate for Payer: Healthfirst Essential Plan	$198,491.56
Rate for Payer: Healthfirst QHP	$152,380.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$88,218.47
Rate for Payer: SOMOS Essential	$198,491.56
Rate for Payer: Wellcare CHP/FHP/Medicaid	$88,218.47

APR-DRG 3621: Mastectomy procedures

Facility IP

$53,627.15

Service Code	APR-DRG 3621
Min. Negotiated Rate	$11,823.00
Max. Negotiated Rate	$53,627.15
Rate for Payer: Amida Care Medicaid	$23,834.29
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,834.29
Rate for Payer: Fidelis Qualified Health Plan	$28,601.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,834.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,834.29
Rate for Payer: Healthfirst Commercial	$20,350.00
Rate for Payer: Healthfirst Essential Plan	$53,627.15
Rate for Payer: Healthfirst QHP	$11,823.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,834.29
Rate for Payer: SOMOS Essential	$53,627.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,834.29

APR-DRG 3622: Mastectomy procedures

Facility IP

$61,393.77

Service Code	APR-DRG 3622
Min. Negotiated Rate	$16,753.00
Max. Negotiated Rate	$61,393.77
Rate for Payer: Amida Care Medicaid	$27,286.12
Rate for Payer: Fidelis CHP/HARP/Medicaid	$27,286.12
Rate for Payer: Fidelis Qualified Health Plan	$32,743.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$27,286.12
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$27,286.12
Rate for Payer: Healthfirst Commercial	$28,536.00
Rate for Payer: Healthfirst Essential Plan	$61,393.77
Rate for Payer: Healthfirst QHP	$16,753.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$27,286.12
Rate for Payer: SOMOS Essential	$61,393.77
Rate for Payer: Wellcare CHP/FHP/Medicaid	$27,286.12

APR-DRG 3623: Mastectomy procedures

Facility IP

$78,506.37

Service Code	APR-DRG 3623
Min. Negotiated Rate	$25,303.00
Max. Negotiated Rate	$78,506.37
Rate for Payer: Amida Care Medicaid	$34,891.72
Rate for Payer: Fidelis CHP/HARP/Medicaid	$34,891.72
Rate for Payer: Fidelis Qualified Health Plan	$41,870.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$34,891.72
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$34,891.72
Rate for Payer: Healthfirst Commercial	$39,404.00
Rate for Payer: Healthfirst Essential Plan	$78,506.37
Rate for Payer: Healthfirst QHP	$25,303.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$34,891.72
Rate for Payer: SOMOS Essential	$78,506.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$34,891.72

APR-DRG 3624: Mastectomy procedures

Facility IP

$80,711.84

Service Code	APR-DRG 3624
Min. Negotiated Rate	$26,089.00
Max. Negotiated Rate	$80,711.84
Rate for Payer: Amida Care Medicaid	$35,871.93
Rate for Payer: Fidelis CHP/HARP/Medicaid	$35,871.93
Rate for Payer: Fidelis Qualified Health Plan	$43,046.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$35,871.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$35,871.93
Rate for Payer: Healthfirst Commercial	$39,995.00
Rate for Payer: Healthfirst Essential Plan	$80,711.84
Rate for Payer: Healthfirst QHP	$26,089.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$35,871.93
Rate for Payer: SOMOS Essential	$80,711.84
Rate for Payer: Wellcare CHP/FHP/Medicaid	$35,871.93

APR-DRG 3631: Breast procedures except mastectomy

Facility IP

$45,565.04

Service Code	APR-DRG 3631
Min. Negotiated Rate	$9,129.00
Max. Negotiated Rate	$45,565.04
Rate for Payer: Amida Care Medicaid	$20,251.13
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,251.13
Rate for Payer: Fidelis Qualified Health Plan	$24,301.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,251.13
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,251.13
Rate for Payer: Healthfirst Commercial	$16,146.00
Rate for Payer: Healthfirst Essential Plan	$45,565.04
Rate for Payer: Healthfirst QHP	$9,129.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,251.13
Rate for Payer: SOMOS Essential	$45,565.04
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,251.13

APR-DRG 3632: Breast procedures except mastectomy

Facility IP

$56,347.92

Service Code	APR-DRG 3632
Min. Negotiated Rate	$13,651.00
Max. Negotiated Rate	$56,347.92
Rate for Payer: Amida Care Medicaid	$25,043.52
Rate for Payer: Fidelis CHP/HARP/Medicaid	$25,043.52
Rate for Payer: Fidelis Qualified Health Plan	$30,052.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$25,043.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25,043.52
Rate for Payer: Healthfirst Commercial	$24,912.00
Rate for Payer: Healthfirst Essential Plan	$56,347.92
Rate for Payer: Healthfirst QHP	$13,651.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$25,043.52
Rate for Payer: SOMOS Essential	$56,347.92
Rate for Payer: Wellcare CHP/FHP/Medicaid	$25,043.52

APR-DRG 3633: Breast procedures except mastectomy

Facility IP

$70,011.63

Service Code	APR-DRG 3633
Min. Negotiated Rate	$20,455.00
Max. Negotiated Rate	$70,011.63
Rate for Payer: Amida Care Medicaid	$31,116.28
Rate for Payer: Fidelis CHP/HARP/Medicaid	$31,116.28
Rate for Payer: Fidelis Qualified Health Plan	$37,339.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$31,116.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31,116.28
Rate for Payer: Healthfirst Commercial	$34,640.00
Rate for Payer: Healthfirst Essential Plan	$70,011.63
Rate for Payer: Healthfirst QHP	$20,455.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$31,116.28
Rate for Payer: SOMOS Essential	$70,011.63
Rate for Payer: Wellcare CHP/FHP/Medicaid	$31,116.28

APR-DRG 3634: Breast procedures except mastectomy

Facility IP

$71,154.81

Service Code	APR-DRG 3634
Min. Negotiated Rate	$21,670.00
Max. Negotiated Rate	$71,154.81
Rate for Payer: Amida Care Medicaid	$31,624.36
Rate for Payer: Fidelis CHP/HARP/Medicaid	$31,624.36
Rate for Payer: Fidelis Qualified Health Plan	$37,949.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$31,624.36
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31,624.36
Rate for Payer: Healthfirst Commercial	$36,316.00
Rate for Payer: Healthfirst Essential Plan	$71,154.81
Rate for Payer: Healthfirst QHP	$21,670.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$31,624.36
Rate for Payer: SOMOS Essential	$71,154.81
Rate for Payer: Wellcare CHP/FHP/Medicaid	$31,624.36

APR-DRG 3641: Other skin, subcutaneous tissue & related procedures

Facility IP

$43,176.67

Service Code	APR-DRG 3641
Min. Negotiated Rate	$8,321.00
Max. Negotiated Rate	$43,176.67
Rate for Payer: Amida Care Medicaid	$19,189.63
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,189.63
Rate for Payer: Fidelis Qualified Health Plan	$23,027.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,189.63
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,189.63
Rate for Payer: Healthfirst Commercial	$14,466.00
Rate for Payer: Healthfirst Essential Plan	$43,176.67
Rate for Payer: Healthfirst QHP	$8,321.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,189.63
Rate for Payer: SOMOS Essential	$43,176.67
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,189.63

APR-DRG 3642: Other skin, subcutaneous tissue & related procedures

Facility IP

$49,161.69

Service Code	APR-DRG 3642
Min. Negotiated Rate	$12,325.00
Max. Negotiated Rate	$49,161.69
Rate for Payer: Amida Care Medicaid	$21,849.64
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,849.64
Rate for Payer: Fidelis Qualified Health Plan	$26,219.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,849.64
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,849.64
Rate for Payer: Healthfirst Commercial	$20,435.00
Rate for Payer: Healthfirst Essential Plan	$49,161.69
Rate for Payer: Healthfirst QHP	$12,325.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,849.64
Rate for Payer: SOMOS Essential	$49,161.69
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,849.64

APR-DRG 3643: Other skin, subcutaneous tissue & related procedures

Facility IP

$65,224.30

Service Code	APR-DRG 3643
Min. Negotiated Rate	$21,928.00
Max. Negotiated Rate	$65,224.30
Rate for Payer: Amida Care Medicaid	$28,988.58
Rate for Payer: Fidelis CHP/HARP/Medicaid	$28,988.58
Rate for Payer: Fidelis Qualified Health Plan	$34,786.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$28,988.58
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$28,988.58
Rate for Payer: Healthfirst Commercial	$37,104.00
Rate for Payer: Healthfirst Essential Plan	$65,224.30
Rate for Payer: Healthfirst QHP	$21,928.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$28,988.58
Rate for Payer: SOMOS Essential	$65,224.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$28,988.58

APR-DRG 3644: Other skin, subcutaneous tissue & related procedures

Facility IP

$123,020.24

Service Code	APR-DRG 3644
Min. Negotiated Rate	$46,475.00
Max. Negotiated Rate	$123,020.24
Rate for Payer: Amida Care Medicaid	$54,675.66
Rate for Payer: Fidelis CHP/HARP/Medicaid	$54,675.66
Rate for Payer: Fidelis Qualified Health Plan	$65,610.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$54,675.66
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$54,675.66
Rate for Payer: Healthfirst Commercial	$74,670.00
Rate for Payer: Healthfirst Essential Plan	$123,020.24
Rate for Payer: Healthfirst QHP	$46,475.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$54,675.66
Rate for Payer: SOMOS Essential	$123,020.24
Rate for Payer: Wellcare CHP/FHP/Medicaid	$54,675.66

APR-DRG 3801: Skin ulcers

Facility IP

$41,716.91

Service Code	APR-DRG 3801
Min. Negotiated Rate	$7,494.00
Max. Negotiated Rate	$41,716.91
Rate for Payer: Amida Care Medicaid	$18,540.85
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,540.85
Rate for Payer: Fidelis Qualified Health Plan	$22,249.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,540.85
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,540.85
Rate for Payer: Healthfirst Commercial	$12,348.00
Rate for Payer: Healthfirst Essential Plan	$41,716.91
Rate for Payer: Healthfirst QHP	$7,494.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,540.85
Rate for Payer: SOMOS Essential	$41,716.91
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,540.85

APR-DRG 3802: Skin ulcers

Facility IP

$44,316.34

Service Code	APR-DRG 3802
Min. Negotiated Rate	$9,165.00
Max. Negotiated Rate	$44,316.34
Rate for Payer: Amida Care Medicaid	$19,696.15
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,696.15
Rate for Payer: Fidelis Qualified Health Plan	$23,635.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,696.15
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,696.15
Rate for Payer: Healthfirst Commercial	$14,913.00
Rate for Payer: Healthfirst Essential Plan	$44,316.34
Rate for Payer: Healthfirst QHP	$9,165.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,696.15
Rate for Payer: SOMOS Essential	$44,316.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,696.15

APR-DRG 3803: Skin ulcers

Facility IP

$52,468.13

Service Code	APR-DRG 3803
Min. Negotiated Rate	$13,216.00
Max. Negotiated Rate	$52,468.13
Rate for Payer: Amida Care Medicaid	$23,319.17
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,319.17
Rate for Payer: Fidelis Qualified Health Plan	$27,983.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,319.17
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,319.17
Rate for Payer: Healthfirst Commercial	$22,953.00
Rate for Payer: Healthfirst Essential Plan	$52,468.13
Rate for Payer: Healthfirst QHP	$13,216.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,319.17
Rate for Payer: SOMOS Essential	$52,468.13
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,319.17

APR-DRG 3804: Skin ulcers

Facility IP

$73,476.36

Service Code	APR-DRG 3804
Min. Negotiated Rate	$27,505.00
Max. Negotiated Rate	$73,476.36
Rate for Payer: Amida Care Medicaid	$32,656.16
Rate for Payer: Fidelis CHP/HARP/Medicaid	$32,656.16
Rate for Payer: Fidelis Qualified Health Plan	$39,187.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$32,656.16
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$32,656.16
Rate for Payer: Healthfirst Commercial	$55,942.00
Rate for Payer: Healthfirst Essential Plan	$73,476.36
Rate for Payer: Healthfirst QHP	$27,505.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$32,656.16
Rate for Payer: SOMOS Essential	$73,476.36
Rate for Payer: Wellcare CHP/FHP/Medicaid	$32,656.16

APR-DRG 3811: Major skin disorders

Facility IP

$40,098.87

Service Code	APR-DRG 3811
Min. Negotiated Rate	$6,248.00
Max. Negotiated Rate	$40,098.87
Rate for Payer: Amida Care Medicaid	$17,821.72
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,821.72
Rate for Payer: Fidelis Qualified Health Plan	$21,386.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,821.72
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,821.72
Rate for Payer: Healthfirst Commercial	$11,158.00
Rate for Payer: Healthfirst Essential Plan	$40,098.87
Rate for Payer: Healthfirst QHP	$6,248.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,821.72
Rate for Payer: SOMOS Essential	$40,098.87
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,821.72

APR-DRG 3812: Major skin disorders

Facility IP

$45,130.64

Service Code	APR-DRG 3812
Min. Negotiated Rate	$8,811.00
Max. Negotiated Rate	$45,130.64
Rate for Payer: Amida Care Medicaid	$20,058.06
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,058.06
Rate for Payer: Fidelis Qualified Health Plan	$24,069.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,058.06
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,058.06
Rate for Payer: Healthfirst Commercial	$14,857.00
Rate for Payer: Healthfirst Essential Plan	$45,130.64
Rate for Payer: Healthfirst QHP	$8,811.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,058.06
Rate for Payer: SOMOS Essential	$45,130.64
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,058.06

APR-DRG 3813: Major skin disorders

Facility IP

$63,535.93

Service Code	APR-DRG 3813
Min. Negotiated Rate	$13,513.00
Max. Negotiated Rate	$63,535.93
Rate for Payer: Amida Care Medicaid	$28,238.19
Rate for Payer: Fidelis CHP/HARP/Medicaid	$28,238.19
Rate for Payer: Fidelis Qualified Health Plan	$33,885.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$28,238.19
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$28,238.19
Rate for Payer: Healthfirst Commercial	$24,218.00
Rate for Payer: Healthfirst Essential Plan	$63,535.93
Rate for Payer: Healthfirst QHP	$13,513.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$28,238.19
Rate for Payer: SOMOS Essential	$63,535.93
Rate for Payer: Wellcare CHP/FHP/Medicaid	$28,238.19

Price Transparency.

All Charges