St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR XTRNL PT ACTIV ECG TRANSMIS W/R&I </30 DAYS

Professional

Both

$761.78

Service Code	HCPCS 93268
Min. Negotiated Rate	$136.27
Max. Negotiated Rate	$438.01
Rate for Payer: Amida Care Medicaid	$151.20
Rate for Payer: Cash Price	$204.92
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$194.67
Rate for Payer: Fidelis CHP/HARP/Medicaid	$175.20
Rate for Payer: Fidelis Essential Plan Aliesa	$175.20
Rate for Payer: Fidelis Essential Plan QHP	$184.94
Rate for Payer: Fidelis Medicare Advantage	$194.67
Rate for Payer: Fidelis Qualified Health Plan	$184.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$194.67
Rate for Payer: Hamaspik Choice Inc Medicare	$194.67
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$146.00
Rate for Payer: Healthfirst Commercial	$194.67
Rate for Payer: Healthfirst Essential Plan	$438.01
Rate for Payer: Healthfirst Medicare Advantage	$184.94
Rate for Payer: Healthfirst QHP	$194.67
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$136.27
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$194.67
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$165.47
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$136.27
Rate for Payer: Senior Whole Health Medicare Advantage	$194.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$146.00
Rate for Payer: SOMOS Essential	$146.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$194.67

PR XTRNL PT ACTIVTD ECG DWNLD W/R&I </30 DAYS

Professional

Both

$95.03

Service Code	HCPCS 93272
Min. Negotiated Rate	$18.02
Max. Negotiated Rate	$57.94
Rate for Payer: Amida Care Medicaid	$42.42
Rate for Payer: Cash Price	$26.07
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$25.75
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23.18
Rate for Payer: Fidelis Essential Plan Aliesa	$23.18
Rate for Payer: Fidelis Essential Plan QHP	$24.46
Rate for Payer: Fidelis Medicare Advantage	$25.75
Rate for Payer: Fidelis Qualified Health Plan	$24.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.75
Rate for Payer: Hamaspik Choice Inc Medicare	$25.75
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19.31
Rate for Payer: Healthfirst Commercial	$25.75
Rate for Payer: Healthfirst Essential Plan	$57.94
Rate for Payer: Healthfirst Medicare Advantage	$24.46
Rate for Payer: Healthfirst QHP	$25.75
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$18.02
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$25.75
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$21.89
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$18.02
Rate for Payer: Senior Whole Health Medicare Advantage	$25.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19.31
Rate for Payer: SOMOS Essential	$19.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$25.75

PR XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBLNGL

Professional

Both

$1,251.95

Service Code	HCPCS 41015
Min. Negotiated Rate	$242.42
Max. Negotiated Rate	$779.22
Rate for Payer: Cash Price	$344.13
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$346.32
Rate for Payer: Fidelis CHP/HARP/Medicaid	$311.69
Rate for Payer: Fidelis Essential Plan Aliesa	$311.69
Rate for Payer: Fidelis Essential Plan QHP	$329.00
Rate for Payer: Fidelis Medicare Advantage	$346.32
Rate for Payer: Fidelis Qualified Health Plan	$329.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$346.32
Rate for Payer: Hamaspik Choice Inc Medicare	$346.32
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$259.74
Rate for Payer: Healthfirst Commercial	$346.32
Rate for Payer: Healthfirst Essential Plan	$779.22
Rate for Payer: Healthfirst Medicare Advantage	$329.00
Rate for Payer: Healthfirst QHP	$346.32
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$242.42
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$346.32
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$294.37
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$242.42
Rate for Payer: Senior Whole Health Medicare Advantage	$346.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$259.74
Rate for Payer: SOMOS Essential	$259.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$346.32

PR XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMENT

Professional

Both

$1,463.11

Service Code	HCPCS 41016
Min. Negotiated Rate	$279.56
Max. Negotiated Rate	$898.58
Rate for Payer: Cash Price	$399.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$399.37
Rate for Payer: Fidelis CHP/HARP/Medicaid	$359.43
Rate for Payer: Fidelis Essential Plan Aliesa	$359.43
Rate for Payer: Fidelis Essential Plan QHP	$379.40
Rate for Payer: Fidelis Medicare Advantage	$399.37
Rate for Payer: Fidelis Qualified Health Plan	$379.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$399.37
Rate for Payer: Hamaspik Choice Inc Medicare	$399.37
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$299.53
Rate for Payer: Healthfirst Commercial	$399.37
Rate for Payer: Healthfirst Essential Plan	$898.58
Rate for Payer: Healthfirst Medicare Advantage	$379.40
Rate for Payer: Healthfirst QHP	$399.37
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$279.56
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$399.37
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$339.46
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$279.56
Rate for Payer: Senior Whole Health Medicare Advantage	$399.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$299.53
Rate for Payer: SOMOS Essential	$299.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$399.37

PR XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMNDB

Professional

Both

$1,457.37

Service Code	HCPCS 41017
Min. Negotiated Rate	$277.23
Max. Negotiated Rate	$891.09
Rate for Payer: Cash Price	$396.67
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$396.04
Rate for Payer: Fidelis CHP/HARP/Medicaid	$356.44
Rate for Payer: Fidelis Essential Plan Aliesa	$356.44
Rate for Payer: Fidelis Essential Plan QHP	$376.24
Rate for Payer: Fidelis Medicare Advantage	$396.04
Rate for Payer: Fidelis Qualified Health Plan	$376.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$396.04
Rate for Payer: Hamaspik Choice Inc Medicare	$396.04
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$297.03
Rate for Payer: Healthfirst Commercial	$396.04
Rate for Payer: Healthfirst Essential Plan	$891.09
Rate for Payer: Healthfirst Medicare Advantage	$376.24
Rate for Payer: Healthfirst QHP	$396.04
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$277.23
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$396.04
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$336.63
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$277.23
Rate for Payer: Senior Whole Health Medicare Advantage	$396.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$297.03
Rate for Payer: SOMOS Essential	$297.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$396.04

PR XTRORAL I&D FLOOR MASTICATOR SPACE

Professional

Both

$1,695.40

Service Code	HCPCS 41018
Min. Negotiated Rate	$324.10
Max. Negotiated Rate	$1,041.75
Rate for Payer: Cash Price	$462.57
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$463.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$416.70
Rate for Payer: Fidelis Essential Plan Aliesa	$416.70
Rate for Payer: Fidelis Essential Plan QHP	$439.85
Rate for Payer: Fidelis Medicare Advantage	$463.00
Rate for Payer: Fidelis Qualified Health Plan	$439.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$463.00
Rate for Payer: Hamaspik Choice Inc Medicare	$463.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$347.25
Rate for Payer: Healthfirst Commercial	$463.00
Rate for Payer: Healthfirst Essential Plan	$1,041.75
Rate for Payer: Healthfirst Medicare Advantage	$439.85
Rate for Payer: Healthfirst QHP	$463.00
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$324.10
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$463.00
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$393.55
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$324.10
Rate for Payer: Senior Whole Health Medicare Advantage	$463.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$347.25
Rate for Payer: SOMOS Essential	$347.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$463.00

PSEUDOEPHEDRINE HCL 15 MG/5ML PO LIQD

Facility

$0.06

Service Code	NDC 5058053604
Hospital Charge Code	5058053604
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.04
Rate for Payer: EmblemHealth Commercial	$0.03
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.04

PSEUDOEPHEDRINE HCL 15 MG/5ML PO LIQD

Facility

$0.06

Service Code	NDC 5058053604
Hospital Charge Code	5058053604
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03

PSEUDOEPHEDRINE HCL 30 MG PO TABS

Facility

$0.10

Service Code	NDC 4580243262
Hospital Charge Code	4580243262
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
Rate for Payer: EmblemHealth Commercial	$0.05
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.07

PSEUDOEPHEDRINE HCL 30 MG PO TABS

Facility

$0.05

Service Code	NDC 0904633724
Hospital Charge Code	0904633724
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03

PSEUDOEPHEDRINE HCL 30 MG PO TABS

Facility

$0.03

Service Code	NDC 0904505359
Hospital Charge Code	0904505359
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
Rate for Payer: EmblemHealth Commercial	$0.02
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.02

PSEUDOEPHEDRINE HCL 30 MG PO TABS

Facility

$0.05

Service Code	NDC 0904633724
Hospital Charge Code	0904633724
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.04
Rate for Payer: EmblemHealth Commercial	$0.03
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

PSEUDOEPHEDRINE HCL 30 MG PO TABS

Facility

$0.03

Service Code	NDC 0904505359
Hospital Charge Code	0904505359
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02

PSEUDOEPHEDRINE HCL 30 MG PO TABS

Facility

$0.04

Service Code	NDC 0904699061
Hospital Charge Code	0904699061
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$0.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: EmblemHealth Commercial	$0.02
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

PSEUDOEPHEDRINE HCL 30 MG PO TABS

Facility

$0.04

Service Code	NDC 0904699061
Hospital Charge Code	0904699061
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02

PSEUDOEPHEDRINE HCL 30 MG PO TABS

Facility

$0.10

Service Code	NDC 4580243262
Hospital Charge Code	4580243262
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05

PSEUDOEPHEDRINE HCL 60 MG PO TABS

Facility

$0.09

Service Code	NDC 0904672846
Hospital Charge Code	0904672846
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04

PSEUDOEPHEDRINE HCL 60 MG PO TABS

Facility

$0.07

Service Code	NDC 0904690706
Hospital Charge Code	0904690706
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03

PSEUDOEPHEDRINE HCL 60 MG PO TABS

Facility

$0.07

Service Code	NDC 0904690706
Hospital Charge Code	0904690706
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$0.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
Rate for Payer: EmblemHealth Commercial	$0.03
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.04

PSEUDOEPHEDRINE HCL 60 MG PO TABS

Facility

$0.09

Service Code	NDC 0904672846
Hospital Charge Code	0904672846
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	$0.06
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

Pulmonary embolism

Facility

$58,563.18

Service Code	APR-DRG 1343
Min. Negotiated Rate	$15,684.00
Max. Negotiated Rate	$58,563.18
Rate for Payer: Affinity Essential Plan 1&2	$58,563.18
Rate for Payer: Affinity Essential Plan 3&4	$58,563.18
Rate for Payer: Affinity Medicaid/CHP/HARP	$26,028.08
Rate for Payer: Amida Care Medicaid	$26,028.08
Rate for Payer: EmblemHealth Essential Plan 1&2	$58,563.18
Rate for Payer: EmblemHealth Essential Plan 3&4	$26,028.08
Rate for Payer: Fidelis CHP/HARP/Medicaid	$26,028.08
Rate for Payer: Fidelis Qualified Health Plan	$31,233.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$26,028.08
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$26,028.08
Rate for Payer: Healthfirst Commercial	$26,700.00
Rate for Payer: Healthfirst Essential Plan	$58,563.18
Rate for Payer: Healthfirst QHP	$15,684.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26,028.08
Rate for Payer: SOMOS Essential	$58,563.18
Rate for Payer: United Healthcare Essential Plan 1&2	$58,563.18
Rate for Payer: United Healthcare Essential Plan 3&4	$58,563.18
Rate for Payer: United Healthcare Medicaid	$26,028.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$26,028.08

Pulmonary embolism

Facility

$76,977.25

Service Code	APR-DRG 1344
Min. Negotiated Rate	$26,951.00
Max. Negotiated Rate	$76,977.25
Rate for Payer: Affinity Essential Plan 1&2	$76,977.25
Rate for Payer: Affinity Essential Plan 3&4	$76,977.25
Rate for Payer: Affinity Medicaid/CHP/HARP	$34,212.11
Rate for Payer: Amida Care Medicaid	$34,212.11
Rate for Payer: EmblemHealth Essential Plan 1&2	$76,977.25
Rate for Payer: EmblemHealth Essential Plan 3&4	$34,212.11
Rate for Payer: Fidelis CHP/HARP/Medicaid	$34,212.11
Rate for Payer: Fidelis Qualified Health Plan	$41,054.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$34,212.11
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$34,212.11
Rate for Payer: Healthfirst Commercial	$45,408.00
Rate for Payer: Healthfirst Essential Plan	$76,977.25
Rate for Payer: Healthfirst QHP	$26,951.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$34,212.11
Rate for Payer: SOMOS Essential	$76,977.25
Rate for Payer: United Healthcare Essential Plan 1&2	$76,977.25
Rate for Payer: United Healthcare Essential Plan 3&4	$76,977.25
Rate for Payer: United Healthcare Medicaid	$34,212.11
Rate for Payer: Wellcare CHP/FHP/Medicaid	$34,212.11

Pulmonary embolism

Facility

$48,462.71

Service Code	APR-DRG 1342
Min. Negotiated Rate	$11,099.00
Max. Negotiated Rate	$48,462.71
Rate for Payer: Affinity Essential Plan 1&2	$48,462.71
Rate for Payer: Affinity Essential Plan 3&4	$48,462.71
Rate for Payer: Affinity Medicaid/CHP/HARP	$21,538.98
Rate for Payer: Amida Care Medicaid	$21,538.98
Rate for Payer: EmblemHealth Essential Plan 1&2	$48,462.71
Rate for Payer: EmblemHealth Essential Plan 3&4	$21,538.98
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,538.98
Rate for Payer: Fidelis Qualified Health Plan	$25,846.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,538.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,538.98
Rate for Payer: Healthfirst Commercial	$18,483.00
Rate for Payer: Healthfirst Essential Plan	$48,462.71
Rate for Payer: Healthfirst QHP	$11,099.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,538.98
Rate for Payer: SOMOS Essential	$48,462.71
Rate for Payer: United Healthcare Essential Plan 1&2	$48,462.71
Rate for Payer: United Healthcare Essential Plan 3&4	$48,462.71
Rate for Payer: United Healthcare Medicaid	$21,538.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,538.98

Pulmonary embolism

Facility

$44,410.54

Service Code	APR-DRG 1341
Min. Negotiated Rate	$9,168.00
Max. Negotiated Rate	$44,410.54
Rate for Payer: Affinity Essential Plan 1&2	$44,410.54
Rate for Payer: Affinity Essential Plan 3&4	$44,410.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,738.02
Rate for Payer: Amida Care Medicaid	$19,738.02
Rate for Payer: EmblemHealth Essential Plan 1&2	$44,410.54
Rate for Payer: EmblemHealth Essential Plan 3&4	$19,738.02
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,738.02
Rate for Payer: Fidelis Qualified Health Plan	$23,685.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,738.02
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,738.02
Rate for Payer: Healthfirst Commercial	$14,727.00
Rate for Payer: Healthfirst Essential Plan	$44,410.54
Rate for Payer: Healthfirst QHP	$9,168.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,738.02
Rate for Payer: SOMOS Essential	$44,410.54
Rate for Payer: United Healthcare Essential Plan 1&2	$44,410.54
Rate for Payer: United Healthcare Essential Plan 3&4	$44,410.54
Rate for Payer: United Healthcare Medicaid	$19,738.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,738.02

PULMONARY EMBOLISM

Facility

$187.46

Service Code	EAPG 00586
Min. Negotiated Rate	$187.46
Max. Negotiated Rate	$187.46
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$187.46

Know your out-of-pocket cost for care.

All Charges