St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

RENAL FAILURE

Facility

$212.94

Service Code	EAPG 00720
Min. Negotiated Rate	$155.06
Max. Negotiated Rate	$212.94
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$155.06
Rate for Payer: Healthfirst Commercial	$212.94

Respiratory Failure

Facility

$48,223.51

Service Code	APR-DRG 1331
Min. Negotiated Rate	$6,522.00
Max. Negotiated Rate	$48,223.51
Rate for Payer: Affinity Essential Plan 1&2	$48,223.51
Rate for Payer: Affinity Essential Plan 3&4	$48,223.51
Rate for Payer: Affinity Medicaid/CHP/HARP	$21,432.67
Rate for Payer: Amida Care Medicaid	$21,432.67
Rate for Payer: EmblemHealth Essential Plan 1&2	$48,223.51
Rate for Payer: EmblemHealth Essential Plan 3&4	$21,432.67
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,432.67
Rate for Payer: Fidelis Qualified Health Plan	$25,719.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,432.67
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,432.67
Rate for Payer: Healthfirst Commercial	$12,692.00
Rate for Payer: Healthfirst Essential Plan	$48,223.51
Rate for Payer: Healthfirst QHP	$6,522.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,432.67
Rate for Payer: SOMOS Essential	$48,223.51
Rate for Payer: United Healthcare Essential Plan 1&2	$48,223.51
Rate for Payer: United Healthcare Essential Plan 3&4	$48,223.51
Rate for Payer: United Healthcare Medicaid	$21,432.67
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,432.67

Respiratory Failure

Facility

$48,256.92

Service Code	APR-DRG 1332
Min. Negotiated Rate	$9,943.00
Max. Negotiated Rate	$48,256.92
Rate for Payer: Affinity Essential Plan 1&2	$48,256.92
Rate for Payer: Affinity Essential Plan 3&4	$48,256.92
Rate for Payer: Affinity Medicaid/CHP/HARP	$21,447.52
Rate for Payer: Amida Care Medicaid	$21,447.52
Rate for Payer: EmblemHealth Essential Plan 1&2	$48,256.92
Rate for Payer: EmblemHealth Essential Plan 3&4	$21,447.52
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,447.52
Rate for Payer: Fidelis Qualified Health Plan	$25,737.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,447.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,447.52
Rate for Payer: Healthfirst Commercial	$17,049.00
Rate for Payer: Healthfirst Essential Plan	$48,256.92
Rate for Payer: Healthfirst QHP	$9,943.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,447.52
Rate for Payer: SOMOS Essential	$48,256.92
Rate for Payer: United Healthcare Essential Plan 1&2	$48,256.92
Rate for Payer: United Healthcare Essential Plan 3&4	$48,256.92
Rate for Payer: United Healthcare Medicaid	$21,447.52
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,447.52

Respiratory Failure

Facility

$56,055.22

Service Code	APR-DRG 1333
Min. Negotiated Rate	$13,820.00
Max. Negotiated Rate	$56,055.22
Rate for Payer: Affinity Essential Plan 1&2	$56,055.22
Rate for Payer: Affinity Essential Plan 3&4	$56,055.22
Rate for Payer: Affinity Medicaid/CHP/HARP	$24,913.43
Rate for Payer: Amida Care Medicaid	$24,913.43
Rate for Payer: EmblemHealth Essential Plan 1&2	$56,055.22
Rate for Payer: EmblemHealth Essential Plan 3&4	$24,913.43
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,913.43
Rate for Payer: Fidelis Qualified Health Plan	$29,896.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,913.43
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,913.43
Rate for Payer: Healthfirst Commercial	$24,519.00
Rate for Payer: Healthfirst Essential Plan	$56,055.22
Rate for Payer: Healthfirst QHP	$13,820.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,913.43
Rate for Payer: SOMOS Essential	$56,055.22
Rate for Payer: United Healthcare Essential Plan 1&2	$56,055.22
Rate for Payer: United Healthcare Essential Plan 3&4	$56,055.22
Rate for Payer: United Healthcare Medicaid	$24,913.43
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,913.43

Respiratory Failure

Facility

$67,492.33

Service Code	APR-DRG 1334
Min. Negotiated Rate	$19,947.00
Max. Negotiated Rate	$67,492.33
Rate for Payer: Affinity Essential Plan 1&2	$67,492.33
Rate for Payer: Affinity Essential Plan 3&4	$67,492.33
Rate for Payer: Affinity Medicaid/CHP/HARP	$29,996.59
Rate for Payer: Amida Care Medicaid	$29,996.59
Rate for Payer: EmblemHealth Essential Plan 1&2	$67,492.33
Rate for Payer: EmblemHealth Essential Plan 3&4	$29,996.59
Rate for Payer: Fidelis CHP/HARP/Medicaid	$29,996.59
Rate for Payer: Fidelis Qualified Health Plan	$35,995.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$29,996.59
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29,996.59
Rate for Payer: Healthfirst Commercial	$33,523.00
Rate for Payer: Healthfirst Essential Plan	$67,492.33
Rate for Payer: Healthfirst QHP	$19,947.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$29,996.59
Rate for Payer: SOMOS Essential	$67,492.33
Rate for Payer: United Healthcare Essential Plan 1&2	$67,492.33
Rate for Payer: United Healthcare Essential Plan 3&4	$67,492.33
Rate for Payer: United Healthcare Medicaid	$29,996.59
Rate for Payer: Wellcare CHP/FHP/Medicaid	$29,996.59

RESPIRATORY FAILURE

Facility

$178.20

Service Code	EAPG 00587
Min. Negotiated Rate	$178.20
Max. Negotiated Rate	$178.20
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$178.20

Respiratory malignancy

Facility

$42,023.93

Service Code	APR-DRG 1361
Min. Negotiated Rate	$7,402.00
Max. Negotiated Rate	$42,023.93
Rate for Payer: Affinity Essential Plan 1&2	$42,023.93
Rate for Payer: Affinity Essential Plan 3&4	$42,023.93
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,677.30
Rate for Payer: Amida Care Medicaid	$18,677.30
Rate for Payer: EmblemHealth Essential Plan 1&2	$42,023.93
Rate for Payer: EmblemHealth Essential Plan 3&4	$18,677.30
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,677.30
Rate for Payer: Fidelis Qualified Health Plan	$22,412.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,677.30
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,677.30
Rate for Payer: Healthfirst Commercial	$13,161.00
Rate for Payer: Healthfirst Essential Plan	$42,023.93
Rate for Payer: Healthfirst QHP	$7,402.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,677.30
Rate for Payer: SOMOS Essential	$42,023.93
Rate for Payer: United Healthcare Essential Plan 1&2	$42,023.93
Rate for Payer: United Healthcare Essential Plan 3&4	$42,023.93
Rate for Payer: United Healthcare Medicaid	$18,677.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,677.30

Respiratory malignancy

Facility

$47,913.97

Service Code	APR-DRG 1362
Min. Negotiated Rate	$10,060.00
Max. Negotiated Rate	$47,913.97
Rate for Payer: Affinity Essential Plan 1&2	$47,913.97
Rate for Payer: Affinity Essential Plan 3&4	$47,913.97
Rate for Payer: Affinity Medicaid/CHP/HARP	$21,295.10
Rate for Payer: Amida Care Medicaid	$21,295.10
Rate for Payer: EmblemHealth Essential Plan 1&2	$47,913.97
Rate for Payer: EmblemHealth Essential Plan 3&4	$21,295.10
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,295.10
Rate for Payer: Fidelis Qualified Health Plan	$25,554.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,295.10
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,295.10
Rate for Payer: Healthfirst Commercial	$16,014.00
Rate for Payer: Healthfirst Essential Plan	$47,913.97
Rate for Payer: Healthfirst QHP	$10,060.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,295.10
Rate for Payer: SOMOS Essential	$47,913.97
Rate for Payer: United Healthcare Essential Plan 1&2	$47,913.97
Rate for Payer: United Healthcare Essential Plan 3&4	$47,913.97
Rate for Payer: United Healthcare Medicaid	$21,295.10
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,295.10

Respiratory malignancy

Facility

$59,447.83

Service Code	APR-DRG 1363
Min. Negotiated Rate	$16,998.00
Max. Negotiated Rate	$59,447.83
Rate for Payer: Affinity Essential Plan 1&2	$59,447.83
Rate for Payer: Affinity Essential Plan 3&4	$59,447.83
Rate for Payer: Affinity Medicaid/CHP/HARP	$26,421.26
Rate for Payer: Amida Care Medicaid	$26,421.26
Rate for Payer: EmblemHealth Essential Plan 1&2	$59,447.83
Rate for Payer: EmblemHealth Essential Plan 3&4	$26,421.26
Rate for Payer: Fidelis CHP/HARP/Medicaid	$26,421.26
Rate for Payer: Fidelis Qualified Health Plan	$31,705.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$26,421.26
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$26,421.26
Rate for Payer: Healthfirst Commercial	$26,979.00
Rate for Payer: Healthfirst Essential Plan	$59,447.83
Rate for Payer: Healthfirst QHP	$16,998.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26,421.26
Rate for Payer: SOMOS Essential	$59,447.83
Rate for Payer: United Healthcare Essential Plan 1&2	$59,447.83
Rate for Payer: United Healthcare Essential Plan 3&4	$59,447.83
Rate for Payer: United Healthcare Medicaid	$26,421.26
Rate for Payer: Wellcare CHP/FHP/Medicaid	$26,421.26

Respiratory malignancy

Facility

$72,355.27

Service Code	APR-DRG 1364
Min. Negotiated Rate	$27,840.00
Max. Negotiated Rate	$72,355.27
Rate for Payer: Affinity Essential Plan 1&2	$72,355.27
Rate for Payer: Affinity Essential Plan 3&4	$72,355.27
Rate for Payer: Affinity Medicaid/CHP/HARP	$32,157.90
Rate for Payer: Amida Care Medicaid	$32,157.90
Rate for Payer: EmblemHealth Essential Plan 1&2	$72,355.27
Rate for Payer: EmblemHealth Essential Plan 3&4	$32,157.90
Rate for Payer: Fidelis CHP/HARP/Medicaid	$32,157.90
Rate for Payer: Fidelis Qualified Health Plan	$38,589.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$32,157.90
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$32,157.90
Rate for Payer: Healthfirst Commercial	$42,127.00
Rate for Payer: Healthfirst Essential Plan	$72,355.27
Rate for Payer: Healthfirst QHP	$27,840.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$32,157.90
Rate for Payer: SOMOS Essential	$72,355.27
Rate for Payer: United Healthcare Essential Plan 1&2	$72,355.27
Rate for Payer: United Healthcare Essential Plan 3&4	$72,355.27
Rate for Payer: United Healthcare Medicaid	$32,157.90
Rate for Payer: Wellcare CHP/FHP/Medicaid	$32,157.90

RESPIRATORY MALIGNANCY

Facility

$218.66

Service Code	EAPG 00571
Min. Negotiated Rate	$159.69
Max. Negotiated Rate	$218.66
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$159.69
Rate for Payer: Healthfirst Commercial	$218.66

Respiratory signs, symptoms & minor diagnoses

Facility

$39,978.52

Service Code	APR-DRG 1441
Min. Negotiated Rate	$5,381.00
Max. Negotiated Rate	$39,978.52
Rate for Payer: Affinity Essential Plan 1&2	$39,978.52
Rate for Payer: Affinity Essential Plan 3&4	$39,978.52
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,768.23
Rate for Payer: Amida Care Medicaid	$17,768.23
Rate for Payer: EmblemHealth Essential Plan 1&2	$39,978.52
Rate for Payer: EmblemHealth Essential Plan 3&4	$17,768.23
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,768.23
Rate for Payer: Fidelis Qualified Health Plan	$21,321.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,768.23
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,768.23
Rate for Payer: Healthfirst Commercial	$9,136.00
Rate for Payer: Healthfirst Essential Plan	$39,978.52
Rate for Payer: Healthfirst QHP	$5,381.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,768.23
Rate for Payer: SOMOS Essential	$39,978.52
Rate for Payer: United Healthcare Essential Plan 1&2	$39,978.52
Rate for Payer: United Healthcare Essential Plan 3&4	$39,978.52
Rate for Payer: United Healthcare Medicaid	$17,768.23
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,768.23

Respiratory signs, symptoms & minor diagnoses

Facility

$42,022.17

Service Code	APR-DRG 1442
Min. Negotiated Rate	$6,415.00
Max. Negotiated Rate	$42,022.17
Rate for Payer: Affinity Essential Plan 1&2	$42,022.17
Rate for Payer: Affinity Essential Plan 3&4	$42,022.17
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,676.52
Rate for Payer: Amida Care Medicaid	$18,676.52
Rate for Payer: EmblemHealth Essential Plan 1&2	$42,022.17
Rate for Payer: EmblemHealth Essential Plan 3&4	$18,676.52
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,676.52
Rate for Payer: Fidelis Qualified Health Plan	$22,411.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,676.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,676.52
Rate for Payer: Healthfirst Commercial	$11,103.00
Rate for Payer: Healthfirst Essential Plan	$42,022.17
Rate for Payer: Healthfirst QHP	$6,415.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,676.52
Rate for Payer: SOMOS Essential	$42,022.17
Rate for Payer: United Healthcare Essential Plan 1&2	$42,022.17
Rate for Payer: United Healthcare Essential Plan 3&4	$42,022.17
Rate for Payer: United Healthcare Medicaid	$18,676.52
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,676.52

Respiratory signs, symptoms & minor diagnoses

Facility

$61,896.01

Service Code	APR-DRG 1444
Min. Negotiated Rate	$13,279.00
Max. Negotiated Rate	$61,896.01
Rate for Payer: Affinity Essential Plan 1&2	$61,896.01
Rate for Payer: Affinity Essential Plan 3&4	$61,896.01
Rate for Payer: Affinity Medicaid/CHP/HARP	$27,509.34
Rate for Payer: Amida Care Medicaid	$27,509.34
Rate for Payer: EmblemHealth Essential Plan 1&2	$61,896.01
Rate for Payer: EmblemHealth Essential Plan 3&4	$27,509.34
Rate for Payer: Fidelis CHP/HARP/Medicaid	$27,509.34
Rate for Payer: Fidelis Qualified Health Plan	$33,011.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$27,509.34
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$27,509.34
Rate for Payer: Healthfirst Commercial	$25,418.00
Rate for Payer: Healthfirst Essential Plan	$61,896.01
Rate for Payer: Healthfirst QHP	$13,279.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$27,509.34
Rate for Payer: SOMOS Essential	$61,896.01
Rate for Payer: United Healthcare Essential Plan 1&2	$61,896.01
Rate for Payer: United Healthcare Essential Plan 3&4	$61,896.01
Rate for Payer: United Healthcare Medicaid	$27,509.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$27,509.34

Respiratory signs, symptoms & minor diagnoses

Facility

$47,215.75

Service Code	APR-DRG 1443
Min. Negotiated Rate	$8,788.00
Max. Negotiated Rate	$47,215.75
Rate for Payer: Affinity Essential Plan 1&2	$47,215.75
Rate for Payer: Affinity Essential Plan 3&4	$47,215.75
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,984.78
Rate for Payer: Amida Care Medicaid	$20,984.78
Rate for Payer: EmblemHealth Essential Plan 1&2	$47,215.75
Rate for Payer: EmblemHealth Essential Plan 3&4	$20,984.78
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,984.78
Rate for Payer: Fidelis Qualified Health Plan	$25,181.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,984.78
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,984.78
Rate for Payer: Healthfirst Commercial	$15,473.00
Rate for Payer: Healthfirst Essential Plan	$47,215.75
Rate for Payer: Healthfirst QHP	$8,788.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,984.78
Rate for Payer: SOMOS Essential	$47,215.75
Rate for Payer: United Healthcare Essential Plan 1&2	$47,215.75
Rate for Payer: United Healthcare Essential Plan 3&4	$47,215.75
Rate for Payer: United Healthcare Medicaid	$20,984.78
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,984.78

Respiratory system diagnosis w ventilator support 96+ hours

Facility

$92,345.18

Service Code	APR-DRG 1301
Min. Negotiated Rate	$31,811.00
Max. Negotiated Rate	$92,345.18
Rate for Payer: Affinity Essential Plan 1&2	$92,345.18
Rate for Payer: Affinity Essential Plan 3&4	$92,345.18
Rate for Payer: Affinity Medicaid/CHP/HARP	$41,042.30
Rate for Payer: Amida Care Medicaid	$41,042.30
Rate for Payer: EmblemHealth Essential Plan 1&2	$92,345.18
Rate for Payer: EmblemHealth Essential Plan 3&4	$41,042.30
Rate for Payer: Fidelis CHP/HARP/Medicaid	$41,042.30
Rate for Payer: Fidelis Qualified Health Plan	$49,250.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$41,042.30
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$41,042.30
Rate for Payer: Healthfirst Commercial	$54,309.00
Rate for Payer: Healthfirst Essential Plan	$92,345.18
Rate for Payer: Healthfirst QHP	$31,811.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$41,042.30
Rate for Payer: SOMOS Essential	$92,345.18
Rate for Payer: United Healthcare Essential Plan 1&2	$92,345.18
Rate for Payer: United Healthcare Essential Plan 3&4	$92,345.18
Rate for Payer: United Healthcare Medicaid	$41,042.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$41,042.30

Respiratory system diagnosis w ventilator support 96+ hours

Facility

$92,345.18

Service Code	APR-DRG 1302
Min. Negotiated Rate	$34,665.00
Max. Negotiated Rate	$92,345.18
Rate for Payer: Affinity Essential Plan 1&2	$92,345.18
Rate for Payer: Affinity Essential Plan 3&4	$92,345.18
Rate for Payer: Affinity Medicaid/CHP/HARP	$41,042.30
Rate for Payer: Amida Care Medicaid	$41,042.30
Rate for Payer: EmblemHealth Essential Plan 1&2	$92,345.18
Rate for Payer: EmblemHealth Essential Plan 3&4	$41,042.30
Rate for Payer: Fidelis CHP/HARP/Medicaid	$41,042.30
Rate for Payer: Fidelis Qualified Health Plan	$49,250.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$41,042.30
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$41,042.30
Rate for Payer: Healthfirst Commercial	$58,513.00
Rate for Payer: Healthfirst Essential Plan	$92,345.18
Rate for Payer: Healthfirst QHP	$34,665.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$41,042.30
Rate for Payer: SOMOS Essential	$92,345.18
Rate for Payer: United Healthcare Essential Plan 1&2	$92,345.18
Rate for Payer: United Healthcare Essential Plan 3&4	$92,345.18
Rate for Payer: United Healthcare Medicaid	$41,042.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$41,042.30

Respiratory system diagnosis w ventilator support 96+ hours

Facility

$107,280.45

Service Code	APR-DRG 1303
Min. Negotiated Rate	$44,048.00
Max. Negotiated Rate	$107,280.45
Rate for Payer: Affinity Essential Plan 1&2	$107,280.45
Rate for Payer: Affinity Essential Plan 3&4	$107,280.45
Rate for Payer: Affinity Medicaid/CHP/HARP	$47,680.20
Rate for Payer: Amida Care Medicaid	$47,680.20
Rate for Payer: EmblemHealth Essential Plan 1&2	$107,280.45
Rate for Payer: EmblemHealth Essential Plan 3&4	$47,680.20
Rate for Payer: Fidelis CHP/HARP/Medicaid	$47,680.20
Rate for Payer: Fidelis Qualified Health Plan	$57,216.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$47,680.20
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$47,680.20
Rate for Payer: Healthfirst Commercial	$71,006.00
Rate for Payer: Healthfirst Essential Plan	$107,280.45
Rate for Payer: Healthfirst QHP	$44,048.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$47,680.20
Rate for Payer: SOMOS Essential	$107,280.45
Rate for Payer: United Healthcare Essential Plan 1&2	$107,280.45
Rate for Payer: United Healthcare Essential Plan 3&4	$107,280.45
Rate for Payer: United Healthcare Medicaid	$47,680.20
Rate for Payer: Wellcare CHP/FHP/Medicaid	$47,680.20

Respiratory system diagnosis w ventilator support 96+ hours

Facility

$138,821.80

Service Code	APR-DRG 1304
Min. Negotiated Rate	$61,698.58
Max. Negotiated Rate	$138,821.80
Rate for Payer: Affinity Essential Plan 1&2	$138,821.80
Rate for Payer: Affinity Essential Plan 3&4	$138,821.80
Rate for Payer: Affinity Medicaid/CHP/HARP	$61,698.58
Rate for Payer: Amida Care Medicaid	$61,698.58
Rate for Payer: EmblemHealth Essential Plan 1&2	$138,821.80
Rate for Payer: EmblemHealth Essential Plan 3&4	$61,698.58
Rate for Payer: Fidelis CHP/HARP/Medicaid	$61,698.58
Rate for Payer: Fidelis Qualified Health Plan	$74,038.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$61,698.58
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$61,698.58
Rate for Payer: Healthfirst Commercial	$105,969.00
Rate for Payer: Healthfirst Essential Plan	$138,821.80
Rate for Payer: Healthfirst QHP	$63,222.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$61,698.58
Rate for Payer: SOMOS Essential	$138,821.80
Rate for Payer: United Healthcare Essential Plan 1&2	$138,821.80
Rate for Payer: United Healthcare Essential Plan 3&4	$138,821.80
Rate for Payer: United Healthcare Medicaid	$61,698.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$61,698.58

RESUSCITATION

Facility

$997.41

Service Code	EAPG 00092
Min. Negotiated Rate	$724.38
Max. Negotiated Rate	$997.41
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$724.38
Rate for Payer: Healthfirst Commercial	$997.41

REVISION, REPAIR OR REMOVAL OF CENTRAL VENOUS ACCESS DEVICE

Facility

$1,036.81

Service Code	EAPG 00076
Min. Negotiated Rate	$1,036.81
Max. Negotiated Rate	$1,036.81
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,036.81

REVISION, REPLACEMENT OR REMOVAL OF CARDIAC DEVICE COMPONENT

Facility

$3,318.71

Service Code	EAPG 00074
Min. Negotiated Rate	$3,318.71
Max. Negotiated Rate	$3,318.71
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,318.71

RHO D IMMUNE GLOBULIN 1500 UNITS IM SOSY

Facility

$90.62

Service Code	HCPCS J2790
Hospital Charge Code	1353363110
Hospital Revenue Code	250
Min. Negotiated Rate	$45.31
Max. Negotiated Rate	$45.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$45.31

RHO D IMMUNE GLOBULIN 1500 UNITS IM SOSY

Facility

$126.14

Service Code	HCPCS J2790
Hospital Charge Code	0562780501
Hospital Revenue Code	250
Min. Negotiated Rate	$63.07
Max. Negotiated Rate	$63.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.07

RHO D IMMUNE GLOBULIN 1500 UNITS IM SOSY

Facility

$126.14

Service Code	HCPCS J2790
Hospital Charge Code	0562780501
Hospital Revenue Code	250
Min. Negotiated Rate	$44.15
Max. Negotiated Rate	$100.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$69.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$75.54
Rate for Payer: Aetna Government	$75.54
Rate for Payer: Brighton Health Commercial	$94.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$100.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$85.78
Rate for Payer: EmblemHealth Commercial	$63.07
Rate for Payer: Group Health Inc Commercial	$63.07
Rate for Payer: Group Health Inc Medicare	$44.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.07
Rate for Payer: Hamaspik Choice Inc Medicare	$63.07
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$82.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$81.99

Know your out-of-pocket cost for care.

All Charges