St. Barnabas Hospital

All Charges

Charge

Type

Price

APR-DRG 8923: HIV w major HIV related condition

Facility IP

$52,673.90

Service Code	APR-DRG 8923
Min. Negotiated Rate	$13,971.00
Max. Negotiated Rate	$52,673.90
Rate for Payer: Amida Care Medicaid	$23,410.62
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,410.62
Rate for Payer: Fidelis Qualified Health Plan	$28,092.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,410.62
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,410.62
Rate for Payer: Healthfirst Commercial	$22,082.00
Rate for Payer: Healthfirst Essential Plan	$52,673.90
Rate for Payer: Healthfirst QHP	$13,971.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,410.62
Rate for Payer: SOMOS Essential	$52,673.90
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,410.62

APR-DRG 8924: HIV w major HIV related condition

Facility IP

$70,701.05

Service Code	APR-DRG 8924
Min. Negotiated Rate	$26,169.00
Max. Negotiated Rate	$70,701.05
Rate for Payer: Amida Care Medicaid	$31,422.69
Rate for Payer: Fidelis CHP/HARP/Medicaid	$31,422.69
Rate for Payer: Fidelis Qualified Health Plan	$37,707.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$31,422.69
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31,422.69
Rate for Payer: Healthfirst Commercial	$42,925.00
Rate for Payer: Healthfirst Essential Plan	$70,701.05
Rate for Payer: Healthfirst QHP	$26,169.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$31,422.69
Rate for Payer: SOMOS Essential	$70,701.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$31,422.69

APR-DRG 8931: HIV w multiple significant HIV related conditions

Facility IP

$43,401.80

Service Code	APR-DRG 8931
Min. Negotiated Rate	$9,539.00
Max. Negotiated Rate	$43,401.80
Rate for Payer: Amida Care Medicaid	$19,289.69
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,289.69
Rate for Payer: Fidelis Qualified Health Plan	$23,147.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,289.69
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,289.69
Rate for Payer: Healthfirst Commercial	$12,913.00
Rate for Payer: Healthfirst Essential Plan	$43,401.80
Rate for Payer: Healthfirst QHP	$9,539.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,289.69
Rate for Payer: SOMOS Essential	$43,401.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,289.69

APR-DRG 8932: HIV w multiple significant HIV related conditions

Facility IP

$45,902.72

Service Code	APR-DRG 8932
Min. Negotiated Rate	$10,728.00
Max. Negotiated Rate	$45,902.72
Rate for Payer: Amida Care Medicaid	$20,401.21
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,401.21
Rate for Payer: Fidelis Qualified Health Plan	$24,481.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,401.21
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,401.21
Rate for Payer: Healthfirst Commercial	$16,543.00
Rate for Payer: Healthfirst Essential Plan	$45,902.72
Rate for Payer: Healthfirst QHP	$10,728.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,401.21
Rate for Payer: SOMOS Essential	$45,902.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,401.21

APR-DRG 8933: HIV w multiple significant HIV related conditions

Facility IP

$55,187.14

Service Code	APR-DRG 8933
Min. Negotiated Rate	$14,487.00
Max. Negotiated Rate	$55,187.14
Rate for Payer: Amida Care Medicaid	$24,527.62
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,527.62
Rate for Payer: Fidelis Qualified Health Plan	$29,433.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,527.62
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,527.62
Rate for Payer: Healthfirst Commercial	$22,988.00
Rate for Payer: Healthfirst Essential Plan	$55,187.14
Rate for Payer: Healthfirst QHP	$14,487.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,527.62
Rate for Payer: SOMOS Essential	$55,187.14
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,527.62

APR-DRG 8934: HIV w multiple significant HIV related conditions

Facility IP

$55,697.20

Service Code	APR-DRG 8934
Min. Negotiated Rate	$14,808.00
Max. Negotiated Rate	$55,697.20
Rate for Payer: Amida Care Medicaid	$24,754.31
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,754.31
Rate for Payer: Fidelis Qualified Health Plan	$29,705.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,754.31
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,754.31
Rate for Payer: Healthfirst Commercial	$23,761.00
Rate for Payer: Healthfirst Essential Plan	$55,697.20
Rate for Payer: Healthfirst QHP	$14,808.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,754.31
Rate for Payer: SOMOS Essential	$55,697.20
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,754.31

APR-DRG 8941: HIV w one signif HIV cond or w/o signif related cond

Facility IP

$40,438.30

Service Code	APR-DRG 8941
Min. Negotiated Rate	$6,645.00
Max. Negotiated Rate	$40,438.30
Rate for Payer: Amida Care Medicaid	$17,972.58
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,972.58
Rate for Payer: Fidelis Qualified Health Plan	$21,567.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,972.58
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,972.58
Rate for Payer: Healthfirst Commercial	$11,213.00
Rate for Payer: Healthfirst Essential Plan	$40,438.30
Rate for Payer: Healthfirst QHP	$6,645.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,972.58
Rate for Payer: SOMOS Essential	$40,438.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,972.58

APR-DRG 8942: HIV w one signif HIV cond or w/o signif related cond

Facility IP

$43,044.77

Service Code	APR-DRG 8942
Min. Negotiated Rate	$8,022.00
Max. Negotiated Rate	$43,044.77
Rate for Payer: Amida Care Medicaid	$19,131.01
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,131.01
Rate for Payer: Fidelis Qualified Health Plan	$22,957.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,131.01
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,131.01
Rate for Payer: Healthfirst Commercial	$13,170.00
Rate for Payer: Healthfirst Essential Plan	$43,044.77
Rate for Payer: Healthfirst QHP	$8,022.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,131.01
Rate for Payer: SOMOS Essential	$43,044.77
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,131.01

APR-DRG 8943: HIV w one signif HIV cond or w/o signif related cond

Facility IP

$50,030.50

Service Code	APR-DRG 8943
Min. Negotiated Rate	$11,297.00
Max. Negotiated Rate	$50,030.50
Rate for Payer: Amida Care Medicaid	$22,235.78
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,235.78
Rate for Payer: Fidelis Qualified Health Plan	$26,682.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,235.78
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,235.78
Rate for Payer: Healthfirst Commercial	$18,899.00
Rate for Payer: Healthfirst Essential Plan	$50,030.50
Rate for Payer: Healthfirst QHP	$11,297.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,235.78
Rate for Payer: SOMOS Essential	$50,030.50
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,235.78

APR-DRG 8944: HIV w one signif HIV cond or w/o signif related cond

Facility IP

$50,030.50

Service Code	APR-DRG 8944
Min. Negotiated Rate	$11,405.00
Max. Negotiated Rate	$50,030.50
Rate for Payer: Amida Care Medicaid	$22,235.78
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,235.78
Rate for Payer: Fidelis Qualified Health Plan	$26,682.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,235.78
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,235.78
Rate for Payer: Healthfirst Commercial	$19,000.00
Rate for Payer: Healthfirst Essential Plan	$50,030.50
Rate for Payer: Healthfirst QHP	$11,405.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,235.78
Rate for Payer: SOMOS Essential	$50,030.50
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,235.78

APR-DRG 9101: Craniotomy for multiple significant trauma

Facility IP

$95,761.42

Service Code	APR-DRG 9101
Min. Negotiated Rate	$36,049.00
Max. Negotiated Rate	$95,761.42
Rate for Payer: Amida Care Medicaid	$42,560.63
Rate for Payer: Fidelis CHP/HARP/Medicaid	$42,560.63
Rate for Payer: Fidelis Qualified Health Plan	$51,072.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$42,560.63
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$42,560.63
Rate for Payer: Healthfirst Commercial	$47,941.00
Rate for Payer: Healthfirst Essential Plan	$95,761.42
Rate for Payer: Healthfirst QHP	$36,049.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$42,560.63
Rate for Payer: SOMOS Essential	$95,761.42
Rate for Payer: Wellcare CHP/FHP/Medicaid	$42,560.63

APR-DRG 9102: Craniotomy for multiple significant trauma

Facility IP

$95,761.42

Service Code	APR-DRG 9102
Min. Negotiated Rate	$36,049.00
Max. Negotiated Rate	$95,761.42
Rate for Payer: Amida Care Medicaid	$42,560.63
Rate for Payer: Fidelis CHP/HARP/Medicaid	$42,560.63
Rate for Payer: Fidelis Qualified Health Plan	$51,072.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$42,560.63
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$42,560.63
Rate for Payer: Healthfirst Commercial	$47,941.00
Rate for Payer: Healthfirst Essential Plan	$95,761.42
Rate for Payer: Healthfirst QHP	$36,049.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$42,560.63
Rate for Payer: SOMOS Essential	$95,761.42
Rate for Payer: Wellcare CHP/FHP/Medicaid	$42,560.63

APR-DRG 9103: Craniotomy for multiple significant trauma

Facility IP

$97,831.46

Service Code	APR-DRG 9103
Min. Negotiated Rate	$43,480.65
Max. Negotiated Rate	$97,831.46
Rate for Payer: Amida Care Medicaid	$43,480.65
Rate for Payer: Fidelis CHP/HARP/Medicaid	$43,480.65
Rate for Payer: Fidelis Qualified Health Plan	$52,176.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$43,480.65
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$43,480.65
Rate for Payer: Healthfirst Commercial	$68,166.00
Rate for Payer: Healthfirst Essential Plan	$97,831.46
Rate for Payer: Healthfirst QHP	$45,621.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$43,480.65
Rate for Payer: SOMOS Essential	$97,831.46
Rate for Payer: Wellcare CHP/FHP/Medicaid	$43,480.65

APR-DRG 9104: Craniotomy for multiple significant trauma

Facility IP

$155,965.07

Service Code	APR-DRG 9104
Min. Negotiated Rate	$69,317.81
Max. Negotiated Rate	$155,965.07
Rate for Payer: Amida Care Medicaid	$69,317.81
Rate for Payer: Fidelis CHP/HARP/Medicaid	$69,317.81
Rate for Payer: Fidelis Qualified Health Plan	$83,181.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$69,317.81
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$69,317.81
Rate for Payer: Healthfirst Commercial	$122,264.00
Rate for Payer: Healthfirst Essential Plan	$155,965.07
Rate for Payer: Healthfirst QHP	$84,332.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$69,317.81
Rate for Payer: SOMOS Essential	$155,965.07
Rate for Payer: Wellcare CHP/FHP/Medicaid	$69,317.81

APR-DRG 9111: Extensive abdominal/thoracic procedures for mult significant trauma

Facility IP

$62,556.30

Service Code	APR-DRG 9111
Min. Negotiated Rate	$24,668.00
Max. Negotiated Rate	$62,556.30
Rate for Payer: Amida Care Medicaid	$27,802.80
Rate for Payer: Fidelis CHP/HARP/Medicaid	$27,802.80
Rate for Payer: Fidelis Qualified Health Plan	$33,363.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$27,802.80
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$27,802.80
Rate for Payer: Healthfirst Commercial	$38,449.00
Rate for Payer: Healthfirst Essential Plan	$62,556.30
Rate for Payer: Healthfirst QHP	$24,668.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$27,802.80
Rate for Payer: SOMOS Essential	$62,556.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$27,802.80

APR-DRG 9112: Extensive abdominal/thoracic procedures for mult significant trauma

Facility IP

$62,556.30

Service Code	APR-DRG 9112
Min. Negotiated Rate	$24,722.00
Max. Negotiated Rate	$62,556.30
Rate for Payer: Amida Care Medicaid	$27,802.80
Rate for Payer: Fidelis CHP/HARP/Medicaid	$27,802.80
Rate for Payer: Fidelis Qualified Health Plan	$33,363.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$27,802.80
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$27,802.80
Rate for Payer: Healthfirst Commercial	$38,896.00
Rate for Payer: Healthfirst Essential Plan	$62,556.30
Rate for Payer: Healthfirst QHP	$24,722.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$27,802.80
Rate for Payer: SOMOS Essential	$62,556.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$27,802.80

APR-DRG 9113: Extensive abdominal/thoracic procedures for mult significant trauma

Facility IP

$74,721.56

Service Code	APR-DRG 9113
Min. Negotiated Rate	$29,206.00
Max. Negotiated Rate	$74,721.56
Rate for Payer: Amida Care Medicaid	$33,209.58
Rate for Payer: Fidelis CHP/HARP/Medicaid	$33,209.58
Rate for Payer: Fidelis Qualified Health Plan	$39,851.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$33,209.58
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$33,209.58
Rate for Payer: Healthfirst Commercial	$47,801.00
Rate for Payer: Healthfirst Essential Plan	$74,721.56
Rate for Payer: Healthfirst QHP	$29,206.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$33,209.58
Rate for Payer: SOMOS Essential	$74,721.56
Rate for Payer: Wellcare CHP/FHP/Medicaid	$33,209.58

APR-DRG 9114: Extensive abdominal/thoracic procedures for mult significant trauma

Facility IP

$143,791.02

Service Code	APR-DRG 9114
Min. Negotiated Rate	$63,907.12
Max. Negotiated Rate	$143,791.02
Rate for Payer: Amida Care Medicaid	$63,907.12
Rate for Payer: Fidelis CHP/HARP/Medicaid	$63,907.12
Rate for Payer: Fidelis Qualified Health Plan	$76,688.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$63,907.12
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$63,907.12
Rate for Payer: Healthfirst Commercial	$116,804.00
Rate for Payer: Healthfirst Essential Plan	$143,791.02
Rate for Payer: Healthfirst QHP	$73,824.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$63,907.12
Rate for Payer: SOMOS Essential	$143,791.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$63,907.12

APR-DRG 9121: Musculoskeletal & other procedures for multiple significant trauma

Facility IP

$71,219.88

Service Code	APR-DRG 9121
Min. Negotiated Rate	$28,028.00
Max. Negotiated Rate	$71,219.88
Rate for Payer: Amida Care Medicaid	$31,653.28
Rate for Payer: Fidelis CHP/HARP/Medicaid	$31,653.28
Rate for Payer: Fidelis Qualified Health Plan	$37,983.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$31,653.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31,653.28
Rate for Payer: Healthfirst Commercial	$45,055.00
Rate for Payer: Healthfirst Essential Plan	$71,219.88
Rate for Payer: Healthfirst QHP	$28,028.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$31,653.28
Rate for Payer: SOMOS Essential	$71,219.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$31,653.28

APR-DRG 9122: Musculoskeletal & other procedures for multiple significant trauma

Facility IP

$71,251.54

Service Code	APR-DRG 9122
Min. Negotiated Rate	$28,073.00
Max. Negotiated Rate	$71,251.54
Rate for Payer: Amida Care Medicaid	$31,667.35
Rate for Payer: Fidelis CHP/HARP/Medicaid	$31,667.35
Rate for Payer: Fidelis Qualified Health Plan	$38,000.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$31,667.35
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31,667.35
Rate for Payer: Healthfirst Commercial	$45,055.00
Rate for Payer: Healthfirst Essential Plan	$71,251.54
Rate for Payer: Healthfirst QHP	$28,073.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$31,667.35
Rate for Payer: SOMOS Essential	$71,251.54
Rate for Payer: Wellcare CHP/FHP/Medicaid	$31,667.35

APR-DRG 9123: Musculoskeletal & other procedures for multiple significant trauma

Facility IP

$98,858.59

Service Code	APR-DRG 9123
Min. Negotiated Rate	$43,937.15
Max. Negotiated Rate	$98,858.59
Rate for Payer: Amida Care Medicaid	$43,937.15
Rate for Payer: Fidelis CHP/HARP/Medicaid	$43,937.15
Rate for Payer: Fidelis Qualified Health Plan	$52,724.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$43,937.15
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$43,937.15
Rate for Payer: Healthfirst Commercial	$71,751.00
Rate for Payer: Healthfirst Essential Plan	$98,858.59
Rate for Payer: Healthfirst QHP	$46,869.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$43,937.15
Rate for Payer: SOMOS Essential	$98,858.59
Rate for Payer: Wellcare CHP/FHP/Medicaid	$43,937.15

APR-DRG 9124: Musculoskeletal & other procedures for multiple significant trauma

Facility IP

$162,896.29

Service Code	APR-DRG 9124
Min. Negotiated Rate	$72,398.35
Max. Negotiated Rate	$162,896.29
Rate for Payer: Amida Care Medicaid	$72,398.35
Rate for Payer: Fidelis CHP/HARP/Medicaid	$72,398.35
Rate for Payer: Fidelis Qualified Health Plan	$86,878.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$72,398.35
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$72,398.35
Rate for Payer: Healthfirst Commercial	$127,779.00
Rate for Payer: Healthfirst Essential Plan	$162,896.29
Rate for Payer: Healthfirst QHP	$84,831.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$72,398.35
Rate for Payer: SOMOS Essential	$162,896.29
Rate for Payer: Wellcare CHP/FHP/Medicaid	$72,398.35

APR-DRG 9301: Multiple significant trauma w/o O.R. procedure

Facility IP

$45,153.50

Service Code	APR-DRG 9301
Min. Negotiated Rate	$9,062.00
Max. Negotiated Rate	$45,153.50
Rate for Payer: Amida Care Medicaid	$20,068.22
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,068.22
Rate for Payer: Fidelis Qualified Health Plan	$24,081.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,068.22
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,068.22
Rate for Payer: Healthfirst Commercial	$11,950.00
Rate for Payer: Healthfirst Essential Plan	$45,153.50
Rate for Payer: Healthfirst QHP	$9,062.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,068.22
Rate for Payer: SOMOS Essential	$45,153.50
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,068.22

APR-DRG 9302: Multiple significant trauma w/o O.R. procedure

Facility IP

$45,234.40

Service Code	APR-DRG 9302
Min. Negotiated Rate	$10,690.00
Max. Negotiated Rate	$45,234.40
Rate for Payer: Amida Care Medicaid	$20,104.18
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,104.18
Rate for Payer: Fidelis Qualified Health Plan	$24,125.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,104.18
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,104.18
Rate for Payer: Healthfirst Commercial	$17,376.00
Rate for Payer: Healthfirst Essential Plan	$45,234.40
Rate for Payer: Healthfirst QHP	$10,690.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,104.18
Rate for Payer: SOMOS Essential	$45,234.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,104.18

APR-DRG 9303: Multiple significant trauma w/o O.R. procedure

Facility IP

$57,478.79

Service Code	APR-DRG 9303
Min. Negotiated Rate	$16,996.00
Max. Negotiated Rate	$57,478.79
Rate for Payer: Amida Care Medicaid	$25,546.13
Rate for Payer: Fidelis CHP/HARP/Medicaid	$25,546.13
Rate for Payer: Fidelis Qualified Health Plan	$30,655.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$25,546.13
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25,546.13
Rate for Payer: Healthfirst Commercial	$28,553.00
Rate for Payer: Healthfirst Essential Plan	$57,478.79
Rate for Payer: Healthfirst QHP	$16,996.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$25,546.13
Rate for Payer: SOMOS Essential	$57,478.79
Rate for Payer: Wellcare CHP/FHP/Medicaid	$25,546.13

Price Transparency.

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