St. Barnabas Hospital

All Charges

Charge

Type

Price

APR-DRG 5631: Preterm labor

Facility IP

$35,763.55

Service Code	APR-DRG 5631
Min. Negotiated Rate	$4,395.00
Max. Negotiated Rate	$35,763.55
Rate for Payer: Amida Care Medicaid	$15,894.91
Rate for Payer: Fidelis CHP/HARP/Medicaid	$15,894.91
Rate for Payer: Fidelis Qualified Health Plan	$19,073.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$15,894.91
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$15,894.91
Rate for Payer: Healthfirst Commercial	$7,801.00
Rate for Payer: Healthfirst Essential Plan	$35,763.55
Rate for Payer: Healthfirst QHP	$4,395.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$15,894.91
Rate for Payer: SOMOS Essential	$35,763.55
Rate for Payer: Wellcare CHP/FHP/Medicaid	$15,894.91

APR-DRG 5632: Preterm labor

Facility IP

$37,008.74

Service Code	APR-DRG 5632
Min. Negotiated Rate	$5,176.00
Max. Negotiated Rate	$37,008.74
Rate for Payer: Amida Care Medicaid	$16,448.33
Rate for Payer: Fidelis CHP/HARP/Medicaid	$16,448.33
Rate for Payer: Fidelis Qualified Health Plan	$19,738.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$16,448.33
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16,448.33
Rate for Payer: Healthfirst Commercial	$8,978.00
Rate for Payer: Healthfirst Essential Plan	$37,008.74
Rate for Payer: Healthfirst QHP	$5,176.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$16,448.33
Rate for Payer: SOMOS Essential	$37,008.74
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,448.33

APR-DRG 5633: Preterm labor

Facility IP

$40,100.62

Service Code	APR-DRG 5633
Min. Negotiated Rate	$6,947.00
Max. Negotiated Rate	$40,100.62
Rate for Payer: Amida Care Medicaid	$17,822.50
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,822.50
Rate for Payer: Fidelis Qualified Health Plan	$21,387.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,822.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,822.50
Rate for Payer: Healthfirst Commercial	$11,588.00
Rate for Payer: Healthfirst Essential Plan	$40,100.62
Rate for Payer: Healthfirst QHP	$6,947.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,822.50
Rate for Payer: SOMOS Essential	$40,100.62
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,822.50

APR-DRG 5634: Preterm labor

Facility IP

$40,100.62

Service Code	APR-DRG 5634
Min. Negotiated Rate	$6,998.00
Max. Negotiated Rate	$40,100.62
Rate for Payer: Amida Care Medicaid	$17,822.50
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,822.50
Rate for Payer: Fidelis Qualified Health Plan	$21,387.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,822.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,822.50
Rate for Payer: Healthfirst Commercial	$11,832.00
Rate for Payer: Healthfirst Essential Plan	$40,100.62
Rate for Payer: Healthfirst QHP	$6,998.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,822.50
Rate for Payer: SOMOS Essential	$40,100.62
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,822.50

APR-DRG 5641: Abortion w/o D&C, aspiration curettage or hysterotomy

Facility IP

$36,060.80

Service Code	APR-DRG 5641
Min. Negotiated Rate	$4,613.00
Max. Negotiated Rate	$36,060.80
Rate for Payer: Amida Care Medicaid	$16,027.02
Rate for Payer: Fidelis CHP/HARP/Medicaid	$16,027.02
Rate for Payer: Fidelis Qualified Health Plan	$19,232.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$16,027.02
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16,027.02
Rate for Payer: Healthfirst Commercial	$7,906.00
Rate for Payer: Healthfirst Essential Plan	$36,060.80
Rate for Payer: Healthfirst QHP	$4,613.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$16,027.02
Rate for Payer: SOMOS Essential	$36,060.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,027.02

APR-DRG 5642: Abortion w/o D&C, aspiration curettage or hysterotomy

Facility IP

$37,070.30

Service Code	APR-DRG 5642
Min. Negotiated Rate	$5,175.00
Max. Negotiated Rate	$37,070.30
Rate for Payer: Amida Care Medicaid	$16,475.69
Rate for Payer: Fidelis CHP/HARP/Medicaid	$16,475.69
Rate for Payer: Fidelis Qualified Health Plan	$19,770.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$16,475.69
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16,475.69
Rate for Payer: Healthfirst Commercial	$8,899.00
Rate for Payer: Healthfirst Essential Plan	$37,070.30
Rate for Payer: Healthfirst QHP	$5,175.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$16,475.69
Rate for Payer: SOMOS Essential	$37,070.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,475.69

APR-DRG 5643: Abortion w/o D&C, aspiration curettage or hysterotomy

Facility IP

$40,255.40

Service Code	APR-DRG 5643
Min. Negotiated Rate	$6,657.00
Max. Negotiated Rate	$40,255.40
Rate for Payer: Amida Care Medicaid	$17,891.29
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,891.29
Rate for Payer: Fidelis Qualified Health Plan	$21,469.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,891.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,891.29
Rate for Payer: Healthfirst Commercial	$11,832.00
Rate for Payer: Healthfirst Essential Plan	$40,255.40
Rate for Payer: Healthfirst QHP	$6,657.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,891.29
Rate for Payer: SOMOS Essential	$40,255.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,891.29

APR-DRG 5644: Abortion w/o D&C, aspiration curettage or hysterotomy

Facility IP

$42,399.32

Service Code	APR-DRG 5644
Min. Negotiated Rate	$7,191.00
Max. Negotiated Rate	$42,399.32
Rate for Payer: Amida Care Medicaid	$18,844.14
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,844.14
Rate for Payer: Fidelis Qualified Health Plan	$22,612.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,844.14
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,844.14
Rate for Payer: Healthfirst Commercial	$13,637.00
Rate for Payer: Healthfirst Essential Plan	$42,399.32
Rate for Payer: Healthfirst QHP	$7,191.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,844.14
Rate for Payer: SOMOS Essential	$42,399.32
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,844.14

APR-DRG 5651: False labor

Facility IP

$33,646.03

Service Code	APR-DRG 5651
Min. Negotiated Rate	$3,396.00
Max. Negotiated Rate	$33,646.03
Rate for Payer: Amida Care Medicaid	$14,953.79
Rate for Payer: Fidelis CHP/HARP/Medicaid	$14,953.79
Rate for Payer: Fidelis Qualified Health Plan	$17,944.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$14,953.79
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$14,953.79
Rate for Payer: Healthfirst Commercial	$6,158.00
Rate for Payer: Healthfirst Essential Plan	$33,646.03
Rate for Payer: Healthfirst QHP	$3,396.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$14,953.79
Rate for Payer: SOMOS Essential	$33,646.03
Rate for Payer: Wellcare CHP/FHP/Medicaid	$14,953.79

APR-DRG 5652: False labor

Facility IP

$34,609.82

Service Code	APR-DRG 5652
Min. Negotiated Rate	$4,055.00
Max. Negotiated Rate	$34,609.82
Rate for Payer: Amida Care Medicaid	$15,382.14
Rate for Payer: Fidelis CHP/HARP/Medicaid	$15,382.14
Rate for Payer: Fidelis Qualified Health Plan	$18,458.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$15,382.14
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$15,382.14
Rate for Payer: Healthfirst Commercial	$7,334.00
Rate for Payer: Healthfirst Essential Plan	$34,609.82
Rate for Payer: Healthfirst QHP	$4,055.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$15,382.14
Rate for Payer: SOMOS Essential	$34,609.82
Rate for Payer: Wellcare CHP/FHP/Medicaid	$15,382.14

APR-DRG 5653: False labor

Facility IP

$34,697.77

Service Code	APR-DRG 5653
Min. Negotiated Rate	$4,065.00
Max. Negotiated Rate	$34,697.77
Rate for Payer: Amida Care Medicaid	$15,421.23
Rate for Payer: Fidelis CHP/HARP/Medicaid	$15,421.23
Rate for Payer: Fidelis Qualified Health Plan	$18,505.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$15,421.23
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$15,421.23
Rate for Payer: Healthfirst Commercial	$7,514.00
Rate for Payer: Healthfirst Essential Plan	$34,697.77
Rate for Payer: Healthfirst QHP	$4,065.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$15,421.23
Rate for Payer: SOMOS Essential	$34,697.77
Rate for Payer: Wellcare CHP/FHP/Medicaid	$15,421.23

APR-DRG 5654: False labor

Facility IP

$34,697.77

Service Code	APR-DRG 5654
Min. Negotiated Rate	$4,065.00
Max. Negotiated Rate	$34,697.77
Rate for Payer: Amida Care Medicaid	$15,421.23
Rate for Payer: Fidelis CHP/HARP/Medicaid	$15,421.23
Rate for Payer: Fidelis Qualified Health Plan	$18,505.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$15,421.23
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$15,421.23
Rate for Payer: Healthfirst Commercial	$7,514.00
Rate for Payer: Healthfirst Essential Plan	$34,697.77
Rate for Payer: Healthfirst QHP	$4,065.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$15,421.23
Rate for Payer: SOMOS Essential	$34,697.77
Rate for Payer: Wellcare CHP/FHP/Medicaid	$15,421.23

APR-DRG 5661: Other antepartum diagnoses

Facility IP

$8,429.00

Service Code	APR-DRG 5661
Min. Negotiated Rate	$2,141.67
Max. Negotiated Rate	$8,429.00
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,141.67
Rate for Payer: Fidelis Qualified Health Plan	$2,570.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,141.67
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,141.67
Rate for Payer: Healthfirst Commercial	$8,429.00
Rate for Payer: Healthfirst Essential Plan	$4,818.76
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,141.67
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$4,818.76
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$4,818.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,141.67
Rate for Payer: SOMOS Essential	$4,818.76

APR-DRG 5662: Other antepartum diagnoses

Facility IP

$9,733.00

Service Code	APR-DRG 5662
Min. Negotiated Rate	$2,141.67
Max. Negotiated Rate	$9,733.00
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,141.67
Rate for Payer: Fidelis Qualified Health Plan	$2,570.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,141.67
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,141.67
Rate for Payer: Healthfirst Commercial	$9,733.00
Rate for Payer: Healthfirst Essential Plan	$4,818.76
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,141.67
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$4,818.76
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$4,818.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,141.67
Rate for Payer: SOMOS Essential	$4,818.76

APR-DRG 5663: Other antepartum diagnoses

Facility IP

$13,472.00

Service Code	APR-DRG 5663
Min. Negotiated Rate	$2,283.78
Max. Negotiated Rate	$13,472.00
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,283.78
Rate for Payer: Fidelis Qualified Health Plan	$2,740.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,283.78
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,283.78
Rate for Payer: Healthfirst Commercial	$13,472.00
Rate for Payer: Healthfirst Essential Plan	$5,138.50
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,283.78
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$5,138.50
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$5,138.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,283.78
Rate for Payer: SOMOS Essential	$5,138.50

APR-DRG 5664: Other antepartum diagnoses

Facility IP

$24,533.00

Service Code	APR-DRG 5664
Min. Negotiated Rate	$2,283.78
Max. Negotiated Rate	$24,533.00
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,283.78
Rate for Payer: Fidelis Qualified Health Plan	$2,740.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,283.78
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,283.78
Rate for Payer: Healthfirst Commercial	$24,533.00
Rate for Payer: Healthfirst Essential Plan	$5,138.50
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,283.78
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$5,138.50
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$5,138.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,283.78
Rate for Payer: SOMOS Essential	$5,138.50

APR-DRG 5801: Neonate, transferred <5 days old, not born here

Facility IP

$35,005.54

Service Code	APR-DRG 5801
Min. Negotiated Rate	$4,513.00
Max. Negotiated Rate	$35,005.54
Rate for Payer: Amida Care Medicaid	$15,558.02
Rate for Payer: Fidelis CHP/HARP/Medicaid	$15,558.02
Rate for Payer: Fidelis Qualified Health Plan	$18,669.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$15,558.02
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$15,558.02
Rate for Payer: Healthfirst Commercial	$8,469.00
Rate for Payer: Healthfirst Essential Plan	$35,005.54
Rate for Payer: Healthfirst QHP	$4,513.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$15,558.02
Rate for Payer: SOMOS Essential	$35,005.54
Rate for Payer: Wellcare CHP/FHP/Medicaid	$15,558.02

APR-DRG 5802: Neonate, transferred <5 days old, not born here

Facility IP

$36,431.89

Service Code	APR-DRG 5802
Min. Negotiated Rate	$5,684.00
Max. Negotiated Rate	$36,431.89
Rate for Payer: Amida Care Medicaid	$16,191.95
Rate for Payer: Fidelis CHP/HARP/Medicaid	$16,191.95
Rate for Payer: Fidelis Qualified Health Plan	$19,430.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$16,191.95
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16,191.95
Rate for Payer: Healthfirst Commercial	$9,260.00
Rate for Payer: Healthfirst Essential Plan	$36,431.89
Rate for Payer: Healthfirst QHP	$5,684.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$16,191.95
Rate for Payer: SOMOS Essential	$36,431.89
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,191.95

APR-DRG 5803: Neonate, transferred <5 days old, not born here

Facility IP

$39,172.00

Service Code	APR-DRG 5803
Min. Negotiated Rate	$7,343.00
Max. Negotiated Rate	$39,172.00
Rate for Payer: Amida Care Medicaid	$17,409.78
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,409.78
Rate for Payer: Fidelis Qualified Health Plan	$20,891.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,409.78
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,409.78
Rate for Payer: Healthfirst Commercial	$11,809.00
Rate for Payer: Healthfirst Essential Plan	$39,172.00
Rate for Payer: Healthfirst QHP	$7,343.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,409.78
Rate for Payer: SOMOS Essential	$39,172.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,409.78

APR-DRG 5804: Neonate, transferred <5 days old, not born here

Facility IP

$49,221.47

Service Code	APR-DRG 5804
Min. Negotiated Rate	$9,115.00
Max. Negotiated Rate	$49,221.47
Rate for Payer: Amida Care Medicaid	$21,876.21
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,876.21
Rate for Payer: Fidelis Qualified Health Plan	$26,251.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,876.21
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,876.21
Rate for Payer: Healthfirst Commercial	$19,435.00
Rate for Payer: Healthfirst Essential Plan	$49,221.47
Rate for Payer: Healthfirst QHP	$9,115.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,876.21
Rate for Payer: SOMOS Essential	$49,221.47
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,876.21

APR-DRG 5811: Neonate, transferred < 5 days old, born here

Facility IP

$32,043.80

Service Code	APR-DRG 5811
Min. Negotiated Rate	$2,866.00
Max. Negotiated Rate	$32,043.80
Rate for Payer: Amida Care Medicaid	$14,241.69
Rate for Payer: Fidelis CHP/HARP/Medicaid	$14,241.69
Rate for Payer: Fidelis Qualified Health Plan	$17,090.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$14,241.69
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$14,241.69
Rate for Payer: Healthfirst Commercial	$4,987.00
Rate for Payer: Healthfirst Essential Plan	$32,043.80
Rate for Payer: Healthfirst QHP	$2,866.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$14,241.69
Rate for Payer: SOMOS Essential	$32,043.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$14,241.69

APR-DRG 5812: Neonate, transferred < 5 days old, born here

Facility IP

$32,910.86

Service Code	APR-DRG 5812
Min. Negotiated Rate	$3,160.00
Max. Negotiated Rate	$32,910.86
Rate for Payer: Amida Care Medicaid	$14,627.05
Rate for Payer: Fidelis CHP/HARP/Medicaid	$14,627.05
Rate for Payer: Fidelis Qualified Health Plan	$17,552.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$14,627.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$14,627.05
Rate for Payer: Healthfirst Commercial	$5,524.00
Rate for Payer: Healthfirst Essential Plan	$32,910.86
Rate for Payer: Healthfirst QHP	$3,160.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$14,627.05
Rate for Payer: SOMOS Essential	$32,910.86
Rate for Payer: Wellcare CHP/FHP/Medicaid	$14,627.05

APR-DRG 5813: Neonate, transferred < 5 days old, born here

Facility IP

$34,462.08

Service Code	APR-DRG 5813
Min. Negotiated Rate	$3,631.00
Max. Negotiated Rate	$34,462.08
Rate for Payer: Amida Care Medicaid	$15,316.48
Rate for Payer: Fidelis CHP/HARP/Medicaid	$15,316.48
Rate for Payer: Fidelis Qualified Health Plan	$18,379.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$15,316.48
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$15,316.48
Rate for Payer: Healthfirst Commercial	$6,453.00
Rate for Payer: Healthfirst Essential Plan	$34,462.08
Rate for Payer: Healthfirst QHP	$3,631.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$15,316.48
Rate for Payer: SOMOS Essential	$34,462.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$15,316.48

APR-DRG 5814: Neonate, transferred < 5 days old, born here

Facility IP

$38,341.89

Service Code	APR-DRG 5814
Min. Negotiated Rate	$5,093.00
Max. Negotiated Rate	$38,341.89
Rate for Payer: Amida Care Medicaid	$17,040.84
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,040.84
Rate for Payer: Fidelis Qualified Health Plan	$20,449.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,040.84
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,040.84
Rate for Payer: Healthfirst Commercial	$9,907.00
Rate for Payer: Healthfirst Essential Plan	$38,341.89
Rate for Payer: Healthfirst QHP	$5,093.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,040.84
Rate for Payer: SOMOS Essential	$38,341.89
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,040.84

APR-DRG 5831: Neonate w ECMO

Facility IP

$281,486.79

Service Code	APR-DRG 5831
Min. Negotiated Rate	$125,105.24
Max. Negotiated Rate	$281,486.79
Rate for Payer: Amida Care Medicaid	$125,105.24
Rate for Payer: Fidelis CHP/HARP/Medicaid	$125,105.24
Rate for Payer: Fidelis Qualified Health Plan	$150,126.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$125,105.24
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$125,105.24
Rate for Payer: Healthfirst Commercial	$239,949.00
Rate for Payer: Healthfirst Essential Plan	$281,486.79
Rate for Payer: Healthfirst QHP	$178,464.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$125,105.24
Rate for Payer: SOMOS Essential	$281,486.79
Rate for Payer: Wellcare CHP/FHP/Medicaid	$125,105.24

Price Transparency.

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