St. Barnabas Hospital

All Charges

Charge

Type

Price

APR-DRG 8151: Other injury, poisoning & toxic effect diagnoses

Facility IP

$35,997.48

Service Code	APR-DRG 8151
Min. Negotiated Rate	$4,459.00
Max. Negotiated Rate	$35,997.48
Rate for Payer: Amida Care Medicaid	$15,998.88
Rate for Payer: Fidelis CHP/HARP/Medicaid	$15,998.88
Rate for Payer: Fidelis Qualified Health Plan	$19,198.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$15,998.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$15,998.88
Rate for Payer: Healthfirst Commercial	$7,629.00
Rate for Payer: Healthfirst Essential Plan	$35,997.48
Rate for Payer: Healthfirst QHP	$4,459.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$15,998.88
Rate for Payer: SOMOS Essential	$35,997.48
Rate for Payer: Wellcare CHP/FHP/Medicaid	$15,998.88

APR-DRG 8152: Other injury, poisoning & toxic effect diagnoses

Facility IP

$40,512.17

Service Code	APR-DRG 8152
Min. Negotiated Rate	$6,595.00
Max. Negotiated Rate	$40,512.17
Rate for Payer: Amida Care Medicaid	$18,005.41
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,005.41
Rate for Payer: Fidelis Qualified Health Plan	$21,606.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,005.41
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,005.41
Rate for Payer: Healthfirst Commercial	$10,791.00
Rate for Payer: Healthfirst Essential Plan	$40,512.17
Rate for Payer: Healthfirst QHP	$6,595.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,005.41
Rate for Payer: SOMOS Essential	$40,512.17
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,005.41

APR-DRG 8153: Other injury, poisoning & toxic effect diagnoses

Facility IP

$48,190.86

Service Code	APR-DRG 8153
Min. Negotiated Rate	$11,550.00
Max. Negotiated Rate	$48,190.86
Rate for Payer: Amida Care Medicaid	$21,418.16
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,418.16
Rate for Payer: Fidelis Qualified Health Plan	$25,701.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,418.16
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,418.16
Rate for Payer: Healthfirst Commercial	$19,420.00
Rate for Payer: Healthfirst Essential Plan	$48,190.86
Rate for Payer: Healthfirst QHP	$11,550.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,418.16
Rate for Payer: SOMOS Essential	$48,190.86
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,418.16

APR-DRG 8154: Other injury, poisoning & toxic effect diagnoses

Facility IP

$77,208.41

Service Code	APR-DRG 8154
Min. Negotiated Rate	$25,346.00
Max. Negotiated Rate	$77,208.41
Rate for Payer: Amida Care Medicaid	$34,314.85
Rate for Payer: Fidelis CHP/HARP/Medicaid	$34,314.85
Rate for Payer: Fidelis Qualified Health Plan	$41,177.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$34,314.85
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$34,314.85
Rate for Payer: Healthfirst Commercial	$42,388.00
Rate for Payer: Healthfirst Essential Plan	$77,208.41
Rate for Payer: Healthfirst QHP	$25,346.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$34,314.85
Rate for Payer: SOMOS Essential	$77,208.41
Rate for Payer: Wellcare CHP/FHP/Medicaid	$34,314.85

APR-DRG 8161: Toxic effects of non-medicinal substances

Facility IP

$37,522.30

Service Code	APR-DRG 8161
Min. Negotiated Rate	$4,795.00
Max. Negotiated Rate	$37,522.30
Rate for Payer: Amida Care Medicaid	$16,676.58
Rate for Payer: Fidelis CHP/HARP/Medicaid	$16,676.58
Rate for Payer: Fidelis Qualified Health Plan	$20,011.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$16,676.58
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16,676.58
Rate for Payer: Healthfirst Commercial	$8,661.00
Rate for Payer: Healthfirst Essential Plan	$37,522.30
Rate for Payer: Healthfirst QHP	$4,795.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$16,676.58
Rate for Payer: SOMOS Essential	$37,522.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,676.58

APR-DRG 8162: Toxic effects of non-medicinal substances

Facility IP

$39,604.66

Service Code	APR-DRG 8162
Min. Negotiated Rate	$5,969.00
Max. Negotiated Rate	$39,604.66
Rate for Payer: Amida Care Medicaid	$17,602.07
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,602.07
Rate for Payer: Fidelis Qualified Health Plan	$21,122.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,602.07
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,602.07
Rate for Payer: Healthfirst Commercial	$10,676.00
Rate for Payer: Healthfirst Essential Plan	$39,604.66
Rate for Payer: Healthfirst QHP	$5,969.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,602.07
Rate for Payer: SOMOS Essential	$39,604.66
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,602.07

APR-DRG 8163: Toxic effects of non-medicinal substances

Facility IP

$45,139.43

Service Code	APR-DRG 8163
Min. Negotiated Rate	$8,947.00
Max. Negotiated Rate	$45,139.43
Rate for Payer: Amida Care Medicaid	$20,061.97
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,061.97
Rate for Payer: Fidelis Qualified Health Plan	$24,074.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,061.97
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,061.97
Rate for Payer: Healthfirst Commercial	$16,026.00
Rate for Payer: Healthfirst Essential Plan	$45,139.43
Rate for Payer: Healthfirst QHP	$8,947.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,061.97
Rate for Payer: SOMOS Essential	$45,139.43
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,061.97

APR-DRG 8164: Toxic effects of non-medicinal substances

Facility IP

$66,471.28

Service Code	APR-DRG 8164
Min. Negotiated Rate	$22,054.00
Max. Negotiated Rate	$66,471.28
Rate for Payer: Amida Care Medicaid	$29,542.79
Rate for Payer: Fidelis CHP/HARP/Medicaid	$29,542.79
Rate for Payer: Fidelis Qualified Health Plan	$35,451.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$29,542.79
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29,542.79
Rate for Payer: Healthfirst Commercial	$38,329.00
Rate for Payer: Healthfirst Essential Plan	$66,471.28
Rate for Payer: Healthfirst QHP	$22,054.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$29,542.79
Rate for Payer: SOMOS Essential	$66,471.28
Rate for Payer: Wellcare CHP/FHP/Medicaid	$29,542.79

APR-DRG 8411: Extensive 3rd degree burns w skin graft

Facility IP

$301,254.00

Service Code	APR-DRG 8411
Min. Negotiated Rate	$55,125.12
Max. Negotiated Rate	$301,254.00
Rate for Payer: Amida Care Medicaid	$55,125.12
Rate for Payer: Fidelis CHP/HARP/Medicaid	$55,125.12
Rate for Payer: Fidelis Qualified Health Plan	$66,150.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$55,125.12
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$55,125.12
Rate for Payer: Healthfirst Commercial	$165,466.00
Rate for Payer: Healthfirst Essential Plan	$124,031.52
Rate for Payer: Healthfirst QHP	$301,254.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$55,125.12
Rate for Payer: SOMOS Essential	$124,031.52
Rate for Payer: Wellcare CHP/FHP/Medicaid	$55,125.12

APR-DRG 8412: Extensive 3rd degree burns w skin graft

Facility IP

$301,254.00

Service Code	APR-DRG 8412
Min. Negotiated Rate	$68,531.45
Max. Negotiated Rate	$301,254.00
Rate for Payer: Amida Care Medicaid	$68,531.45
Rate for Payer: Fidelis CHP/HARP/Medicaid	$68,531.45
Rate for Payer: Fidelis Qualified Health Plan	$82,237.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$68,531.45
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$68,531.45
Rate for Payer: Healthfirst Commercial	$165,466.00
Rate for Payer: Healthfirst Essential Plan	$154,195.76
Rate for Payer: Healthfirst QHP	$301,254.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$68,531.45
Rate for Payer: SOMOS Essential	$154,195.76
Rate for Payer: Wellcare CHP/FHP/Medicaid	$68,531.45

APR-DRG 8413: Extensive 3rd degree burns w skin graft

Facility IP

$301,805.00

Service Code	APR-DRG 8413
Min. Negotiated Rate	$127,633.14
Max. Negotiated Rate	$301,805.00
Rate for Payer: Amida Care Medicaid	$127,633.14
Rate for Payer: Fidelis CHP/HARP/Medicaid	$127,633.14
Rate for Payer: Fidelis Qualified Health Plan	$153,159.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$127,633.14
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$127,633.14
Rate for Payer: Healthfirst Commercial	$166,826.00
Rate for Payer: Healthfirst Essential Plan	$287,174.56
Rate for Payer: Healthfirst QHP	$301,805.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$127,633.14
Rate for Payer: SOMOS Essential	$287,174.56
Rate for Payer: Wellcare CHP/FHP/Medicaid	$127,633.14

APR-DRG 8414: Extensive 3rd degree burns w skin graft

Facility IP

$474,024.00

Service Code	APR-DRG 8414
Min. Negotiated Rate	$159,646.23
Max. Negotiated Rate	$474,024.00
Rate for Payer: Amida Care Medicaid	$159,646.23
Rate for Payer: Fidelis CHP/HARP/Medicaid	$159,646.23
Rate for Payer: Fidelis Qualified Health Plan	$191,575.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$159,646.23
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$159,646.23
Rate for Payer: Healthfirst Commercial	$474,024.00
Rate for Payer: Healthfirst Essential Plan	$359,204.02
Rate for Payer: Healthfirst QHP	$301,805.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$159,646.23
Rate for Payer: SOMOS Essential	$359,204.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$159,646.23

APR-DRG 8421: Burns with skin graft except extensive 3rd degree burns

Facility IP

$67,547.61

Service Code	APR-DRG 8421
Min. Negotiated Rate	$30,021.16
Max. Negotiated Rate	$67,547.61
Rate for Payer: Amida Care Medicaid	$30,021.16
Rate for Payer: Fidelis CHP/HARP/Medicaid	$30,021.16
Rate for Payer: Fidelis Qualified Health Plan	$36,025.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$30,021.16
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$30,021.16
Rate for Payer: Healthfirst Commercial	$42,567.00
Rate for Payer: Healthfirst Essential Plan	$67,547.61
Rate for Payer: Healthfirst QHP	$31,652.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$30,021.16
Rate for Payer: SOMOS Essential	$67,547.61
Rate for Payer: Wellcare CHP/FHP/Medicaid	$30,021.16

APR-DRG 8422: Burns with skin graft except extensive 3rd degree burns

Facility IP

$79,493.02

Service Code	APR-DRG 8422
Min. Negotiated Rate	$35,330.23
Max. Negotiated Rate	$79,493.02
Rate for Payer: Amida Care Medicaid	$35,330.23
Rate for Payer: Fidelis CHP/HARP/Medicaid	$35,330.23
Rate for Payer: Fidelis Qualified Health Plan	$42,396.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$35,330.23
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$35,330.23
Rate for Payer: Healthfirst Commercial	$65,412.00
Rate for Payer: Healthfirst Essential Plan	$79,493.02
Rate for Payer: Healthfirst QHP	$70,380.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$35,330.23
Rate for Payer: SOMOS Essential	$79,493.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$35,330.23

APR-DRG 8423: Burns with skin graft except extensive 3rd degree burns

Facility IP

$113,704.00

Service Code	APR-DRG 8423
Min. Negotiated Rate	$47,282.67
Max. Negotiated Rate	$113,704.00
Rate for Payer: Amida Care Medicaid	$47,282.67
Rate for Payer: Fidelis CHP/HARP/Medicaid	$47,282.67
Rate for Payer: Fidelis Qualified Health Plan	$56,739.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$47,282.67
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$47,282.67
Rate for Payer: Healthfirst Commercial	$113,704.00
Rate for Payer: Healthfirst Essential Plan	$106,386.01
Rate for Payer: Healthfirst QHP	$99,660.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$47,282.67
Rate for Payer: SOMOS Essential	$106,386.01
Rate for Payer: Wellcare CHP/FHP/Medicaid	$47,282.67

APR-DRG 8424: Burns with skin graft except extensive 3rd degree burns

Facility IP

$233,529.00

Service Code	APR-DRG 8424
Min. Negotiated Rate	$80,692.60
Max. Negotiated Rate	$233,529.00
Rate for Payer: Amida Care Medicaid	$80,692.60
Rate for Payer: Fidelis CHP/HARP/Medicaid	$80,692.60
Rate for Payer: Fidelis Qualified Health Plan	$96,831.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$80,692.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$80,692.60
Rate for Payer: Healthfirst Commercial	$213,461.00
Rate for Payer: Healthfirst Essential Plan	$181,558.35
Rate for Payer: Healthfirst QHP	$233,529.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$80,692.60
Rate for Payer: SOMOS Essential	$181,558.35
Rate for Payer: Wellcare CHP/FHP/Medicaid	$80,692.60

APR-DRG 8431: Extensive 3rd degree or full thickness burns w/o skin graft

Facility IP

$64,315.04

Service Code	APR-DRG 8431
Min. Negotiated Rate	$9,103.00
Max. Negotiated Rate	$64,315.04
Rate for Payer: Amida Care Medicaid	$28,584.46
Rate for Payer: Fidelis CHP/HARP/Medicaid	$28,584.46
Rate for Payer: Fidelis Qualified Health Plan	$34,301.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$28,584.46
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$28,584.46
Rate for Payer: Healthfirst Commercial	$15,424.00
Rate for Payer: Healthfirst Essential Plan	$64,315.04
Rate for Payer: Healthfirst QHP	$9,103.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$28,584.46
Rate for Payer: SOMOS Essential	$64,315.04
Rate for Payer: Wellcare CHP/FHP/Medicaid	$28,584.46

APR-DRG 8432: Extensive 3rd degree or full thickness burns w/o skin graft

Facility IP

$64,315.04

Service Code	APR-DRG 8432
Min. Negotiated Rate	$15,308.00
Max. Negotiated Rate	$64,315.04
Rate for Payer: Amida Care Medicaid	$28,584.46
Rate for Payer: Fidelis CHP/HARP/Medicaid	$28,584.46
Rate for Payer: Fidelis Qualified Health Plan	$34,301.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$28,584.46
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$28,584.46
Rate for Payer: Healthfirst Commercial	$21,275.00
Rate for Payer: Healthfirst Essential Plan	$64,315.04
Rate for Payer: Healthfirst QHP	$15,308.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$28,584.46
Rate for Payer: SOMOS Essential	$64,315.04
Rate for Payer: Wellcare CHP/FHP/Medicaid	$28,584.46

APR-DRG 8433: Extensive 3rd degree or full thickness burns w/o skin graft

Facility IP

$64,315.04

Service Code	APR-DRG 8433
Min. Negotiated Rate	$19,507.00
Max. Negotiated Rate	$64,315.04
Rate for Payer: Amida Care Medicaid	$28,584.46
Rate for Payer: Fidelis CHP/HARP/Medicaid	$28,584.46
Rate for Payer: Fidelis Qualified Health Plan	$34,301.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$28,584.46
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$28,584.46
Rate for Payer: Healthfirst Commercial	$30,817.00
Rate for Payer: Healthfirst Essential Plan	$64,315.04
Rate for Payer: Healthfirst QHP	$19,507.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$28,584.46
Rate for Payer: SOMOS Essential	$64,315.04
Rate for Payer: Wellcare CHP/FHP/Medicaid	$28,584.46

APR-DRG 8434: Extensive 3rd degree or full thickness burns w/o skin graft

Facility IP

$64,315.04

Service Code	APR-DRG 8434
Min. Negotiated Rate	$28,584.46
Max. Negotiated Rate	$64,315.04
Rate for Payer: Amida Care Medicaid	$28,584.46
Rate for Payer: Fidelis CHP/HARP/Medicaid	$28,584.46
Rate for Payer: Fidelis Qualified Health Plan	$34,301.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$28,584.46
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$28,584.46
Rate for Payer: Healthfirst Commercial	$47,891.00
Rate for Payer: Healthfirst Essential Plan	$64,315.04
Rate for Payer: Healthfirst QHP	$32,630.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$28,584.46
Rate for Payer: SOMOS Essential	$64,315.04
Rate for Payer: Wellcare CHP/FHP/Medicaid	$28,584.46

APR-DRG 8441: Partial thickness burns without skin graft

Facility IP

$41,062.66

Service Code	APR-DRG 8441
Min. Negotiated Rate	$7,278.00
Max. Negotiated Rate	$41,062.66
Rate for Payer: Amida Care Medicaid	$18,250.07
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,250.07
Rate for Payer: Fidelis Qualified Health Plan	$21,900.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,250.07
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,250.07
Rate for Payer: Healthfirst Commercial	$13,184.00
Rate for Payer: Healthfirst Essential Plan	$41,062.66
Rate for Payer: Healthfirst QHP	$7,278.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,250.07
Rate for Payer: SOMOS Essential	$41,062.66
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,250.07

APR-DRG 8442: Partial thickness burns without skin graft

Facility IP

$48,349.15

Service Code	APR-DRG 8442
Min. Negotiated Rate	$21,488.51
Max. Negotiated Rate	$48,349.15
Rate for Payer: Amida Care Medicaid	$21,488.51
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,488.51
Rate for Payer: Fidelis Qualified Health Plan	$25,786.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,488.51
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,488.51
Rate for Payer: Healthfirst Commercial	$21,751.00
Rate for Payer: Healthfirst Essential Plan	$48,349.15
Rate for Payer: Healthfirst QHP	$27,333.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,488.51
Rate for Payer: SOMOS Essential	$48,349.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,488.51

APR-DRG 8443: Partial thickness burns without skin graft

Facility IP

$62,744.49

Service Code	APR-DRG 8443
Min. Negotiated Rate	$27,886.44
Max. Negotiated Rate	$62,744.49
Rate for Payer: Amida Care Medicaid	$27,886.44
Rate for Payer: Fidelis CHP/HARP/Medicaid	$27,886.44
Rate for Payer: Fidelis Qualified Health Plan	$33,463.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$27,886.44
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$27,886.44
Rate for Payer: Healthfirst Commercial	$35,767.00
Rate for Payer: Healthfirst Essential Plan	$62,744.49
Rate for Payer: Healthfirst QHP	$43,299.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$27,886.44
Rate for Payer: SOMOS Essential	$62,744.49
Rate for Payer: Wellcare CHP/FHP/Medicaid	$27,886.44

APR-DRG 8444: Partial thickness burns without skin graft

Facility IP

$118,982.16

Service Code	APR-DRG 8444
Min. Negotiated Rate	$42,257.00
Max. Negotiated Rate	$118,982.16
Rate for Payer: Amida Care Medicaid	$52,880.96
Rate for Payer: Fidelis CHP/HARP/Medicaid	$52,880.96
Rate for Payer: Fidelis Qualified Health Plan	$63,457.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$52,880.96
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$52,880.96
Rate for Payer: Healthfirst Commercial	$42,257.00
Rate for Payer: Healthfirst Essential Plan	$118,982.16
Rate for Payer: Healthfirst QHP	$90,505.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$52,880.96
Rate for Payer: SOMOS Essential	$118,982.16
Rate for Payer: Wellcare CHP/FHP/Medicaid	$52,880.96

APR-DRG 8501: Procedure w diag of rehab, aftercare or oth contact w health service

Facility IP

$50,063.92

Service Code	APR-DRG 8501
Min. Negotiated Rate	$13,223.00
Max. Negotiated Rate	$50,063.92
Rate for Payer: Amida Care Medicaid	$22,250.63
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,250.63
Rate for Payer: Fidelis Qualified Health Plan	$26,700.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,250.63
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,250.63
Rate for Payer: Healthfirst Commercial	$22,015.00
Rate for Payer: Healthfirst Essential Plan	$50,063.92
Rate for Payer: Healthfirst QHP	$13,223.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,250.63
Rate for Payer: SOMOS Essential	$50,063.92
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,250.63

Price Transparency.

All Charges