St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

APR-DRG 7513: Major depressive disorders & other/unspecified psychoses

Facility

$24,962.00

Service Code	APR-DRG 7513
Min. Negotiated Rate	$2,261.21
Max. Negotiated Rate	$24,962.00
Rate for Payer: Affinity Essential Plan 1&2	$2,261.21
Rate for Payer: Affinity Essential Plan 3&4	$2,261.21
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,261.21
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,261.21
Rate for Payer: Fidelis Qualified Health Plan	$2,713.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,261.21
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,261.21
Rate for Payer: Healthfirst Commercial	$24,962.00
Rate for Payer: Healthfirst Essential Plan	$5,087.72
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,261.21
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$5,087.72
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$5,087.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,261.21
Rate for Payer: SOMOS Essential	$5,087.72
Rate for Payer: United Healthcare Essential Plan 1&2	$5,087.72
Rate for Payer: United Healthcare Essential Plan 3&4	$5,087.72
Rate for Payer: United Healthcare Medicaid	$2,261.21

APR-DRG 7514: Major depressive disorders & other/unspecified psychoses

Facility

$25,517.00

Service Code	APR-DRG 7514
Min. Negotiated Rate	$2,319.75
Max. Negotiated Rate	$25,517.00
Rate for Payer: Affinity Essential Plan 1&2	$2,319.75
Rate for Payer: Affinity Essential Plan 3&4	$2,319.75
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,319.75
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,319.75
Rate for Payer: Fidelis Qualified Health Plan	$2,783.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,319.75
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,319.75
Rate for Payer: Healthfirst Commercial	$25,517.00
Rate for Payer: Healthfirst Essential Plan	$5,219.44
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,319.75
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$5,219.44
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$5,219.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,319.75
Rate for Payer: SOMOS Essential	$5,219.44
Rate for Payer: United Healthcare Essential Plan 1&2	$5,219.44
Rate for Payer: United Healthcare Essential Plan 3&4	$5,219.44
Rate for Payer: United Healthcare Medicaid	$2,319.75

APR-DRG 7521: Disorders of personality & impulse control

Facility

$26,252.00

Service Code	APR-DRG 7521
Min. Negotiated Rate	$2,172.77
Max. Negotiated Rate	$26,252.00
Rate for Payer: Affinity Essential Plan 1&2	$2,172.77
Rate for Payer: Affinity Essential Plan 3&4	$2,172.77
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,172.77
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,172.77
Rate for Payer: Fidelis Qualified Health Plan	$2,607.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,172.77
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,172.77
Rate for Payer: Healthfirst Commercial	$26,252.00
Rate for Payer: Healthfirst Essential Plan	$4,888.73
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,172.77
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$4,888.73
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$4,888.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,172.77
Rate for Payer: SOMOS Essential	$4,888.73
Rate for Payer: United Healthcare Essential Plan 1&2	$4,888.73
Rate for Payer: United Healthcare Essential Plan 3&4	$4,888.73
Rate for Payer: United Healthcare Medicaid	$2,172.77

APR-DRG 7522: Disorders of personality & impulse control

Facility

$26,252.00

Service Code	APR-DRG 7522
Min. Negotiated Rate	$2,213.37
Max. Negotiated Rate	$26,252.00
Rate for Payer: Affinity Essential Plan 1&2	$2,213.37
Rate for Payer: Affinity Essential Plan 3&4	$2,213.37
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,213.37
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,213.37
Rate for Payer: Fidelis Qualified Health Plan	$2,656.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,213.37
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,213.37
Rate for Payer: Healthfirst Commercial	$26,252.00
Rate for Payer: Healthfirst Essential Plan	$4,980.08
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,213.37
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$4,980.08
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$4,980.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,213.37
Rate for Payer: SOMOS Essential	$4,980.08
Rate for Payer: United Healthcare Essential Plan 1&2	$4,980.08
Rate for Payer: United Healthcare Essential Plan 3&4	$4,980.08
Rate for Payer: United Healthcare Medicaid	$2,213.37

APR-DRG 7523: Disorders of personality & impulse control

Facility

$26,252.00

Service Code	APR-DRG 7523
Min. Negotiated Rate	$2,213.37
Max. Negotiated Rate	$26,252.00
Rate for Payer: Affinity Essential Plan 1&2	$2,213.37
Rate for Payer: Affinity Essential Plan 3&4	$2,213.37
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,213.37
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,213.37
Rate for Payer: Fidelis Qualified Health Plan	$2,656.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,213.37
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,213.37
Rate for Payer: Healthfirst Commercial	$26,252.00
Rate for Payer: Healthfirst Essential Plan	$4,980.08
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,213.37
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$4,980.08
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$4,980.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,213.37
Rate for Payer: SOMOS Essential	$4,980.08
Rate for Payer: United Healthcare Essential Plan 1&2	$4,980.08
Rate for Payer: United Healthcare Essential Plan 3&4	$4,980.08
Rate for Payer: United Healthcare Medicaid	$2,213.37

APR-DRG 7524: Disorders of personality & impulse control

Facility

$26,252.00

Service Code	APR-DRG 7524
Min. Negotiated Rate	$2,213.37
Max. Negotiated Rate	$26,252.00
Rate for Payer: Affinity Essential Plan 1&2	$2,213.37
Rate for Payer: Affinity Essential Plan 3&4	$2,213.37
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,213.37
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,213.37
Rate for Payer: Fidelis Qualified Health Plan	$2,656.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,213.37
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,213.37
Rate for Payer: Healthfirst Commercial	$26,252.00
Rate for Payer: Healthfirst Essential Plan	$4,980.08
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,213.37
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$4,980.08
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$4,980.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,213.37
Rate for Payer: SOMOS Essential	$4,980.08
Rate for Payer: United Healthcare Essential Plan 1&2	$4,980.08
Rate for Payer: United Healthcare Essential Plan 3&4	$4,980.08
Rate for Payer: United Healthcare Medicaid	$2,213.37

APR-DRG 7531: Bipolar disorders

Facility

$16,278.00

Service Code	APR-DRG 7531
Min. Negotiated Rate	$2,158.40
Max. Negotiated Rate	$16,278.00
Rate for Payer: Affinity Essential Plan 1&2	$2,158.40
Rate for Payer: Affinity Essential Plan 3&4	$2,158.40
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,158.40
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,158.40
Rate for Payer: Fidelis Qualified Health Plan	$2,590.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,158.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,158.40
Rate for Payer: Healthfirst Commercial	$16,278.00
Rate for Payer: Healthfirst Essential Plan	$4,856.40
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,158.40
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$4,856.40
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$4,856.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,158.40
Rate for Payer: SOMOS Essential	$4,856.40
Rate for Payer: United Healthcare Essential Plan 1&2	$4,856.40
Rate for Payer: United Healthcare Essential Plan 3&4	$4,856.40
Rate for Payer: United Healthcare Medicaid	$2,158.40

APR-DRG 7532: Bipolar disorders

Facility

$16,278.00

Service Code	APR-DRG 7532
Min. Negotiated Rate	$2,201.06
Max. Negotiated Rate	$16,278.00
Rate for Payer: Affinity Essential Plan 1&2	$2,201.06
Rate for Payer: Affinity Essential Plan 3&4	$2,201.06
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,201.06
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,201.06
Rate for Payer: Fidelis Qualified Health Plan	$2,641.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,201.06
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,201.06
Rate for Payer: Healthfirst Commercial	$16,278.00
Rate for Payer: Healthfirst Essential Plan	$4,952.38
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,201.06
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$4,952.38
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$4,952.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,201.06
Rate for Payer: SOMOS Essential	$4,952.38
Rate for Payer: United Healthcare Essential Plan 1&2	$4,952.38
Rate for Payer: United Healthcare Essential Plan 3&4	$4,952.38
Rate for Payer: United Healthcare Medicaid	$2,201.06

APR-DRG 7533: Bipolar disorders

Facility

$19,688.00

Service Code	APR-DRG 7533
Min. Negotiated Rate	$2,251.49
Max. Negotiated Rate	$19,688.00
Rate for Payer: Affinity Essential Plan 1&2	$2,251.49
Rate for Payer: Affinity Essential Plan 3&4	$2,251.49
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,251.49
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,251.49
Rate for Payer: Fidelis Qualified Health Plan	$2,701.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,251.49
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,251.49
Rate for Payer: Healthfirst Commercial	$19,688.00
Rate for Payer: Healthfirst Essential Plan	$5,065.85
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,251.49
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$5,065.85
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$5,065.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,251.49
Rate for Payer: SOMOS Essential	$5,065.85
Rate for Payer: United Healthcare Essential Plan 1&2	$5,065.85
Rate for Payer: United Healthcare Essential Plan 3&4	$5,065.85
Rate for Payer: United Healthcare Medicaid	$2,251.49

APR-DRG 7534: Bipolar disorders

Facility

$19,688.00

Service Code	APR-DRG 7534
Min. Negotiated Rate	$2,350.74
Max. Negotiated Rate	$19,688.00
Rate for Payer: Affinity Essential Plan 1&2	$2,350.74
Rate for Payer: Affinity Essential Plan 3&4	$2,350.74
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,350.74
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,350.74
Rate for Payer: Fidelis Qualified Health Plan	$2,820.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,350.74
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,350.74
Rate for Payer: Healthfirst Commercial	$19,688.00
Rate for Payer: Healthfirst Essential Plan	$5,289.16
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,350.74
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$5,289.16
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$5,289.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,350.74
Rate for Payer: SOMOS Essential	$5,289.16
Rate for Payer: United Healthcare Essential Plan 1&2	$5,289.16
Rate for Payer: United Healthcare Essential Plan 3&4	$5,289.16
Rate for Payer: United Healthcare Medicaid	$2,350.74

APR-DRG 7541: Depression except major depressive disorder

Facility

$9,529.00

Service Code	APR-DRG 7541
Min. Negotiated Rate	$2,213.59
Max. Negotiated Rate	$9,529.00
Rate for Payer: Affinity Essential Plan 1&2	$2,213.59
Rate for Payer: Affinity Essential Plan 3&4	$2,213.59
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,213.59
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,213.59
Rate for Payer: Fidelis Qualified Health Plan	$2,656.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,213.59
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,213.59
Rate for Payer: Healthfirst Commercial	$9,529.00
Rate for Payer: Healthfirst Essential Plan	$4,980.58
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,213.59
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$4,980.58
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$4,980.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,213.59
Rate for Payer: SOMOS Essential	$4,980.58
Rate for Payer: United Healthcare Essential Plan 1&2	$4,980.58
Rate for Payer: United Healthcare Essential Plan 3&4	$4,980.58
Rate for Payer: United Healthcare Medicaid	$2,213.59

APR-DRG 7542: Depression except major depressive disorder

Facility

$9,529.00

Service Code	APR-DRG 7542
Min. Negotiated Rate	$2,255.27
Max. Negotiated Rate	$9,529.00
Rate for Payer: Affinity Essential Plan 1&2	$2,255.27
Rate for Payer: Affinity Essential Plan 3&4	$2,255.27
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,255.27
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,255.27
Rate for Payer: Fidelis Qualified Health Plan	$2,706.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,255.27
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,255.27
Rate for Payer: Healthfirst Commercial	$9,529.00
Rate for Payer: Healthfirst Essential Plan	$5,074.36
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,255.27
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$5,074.36
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$5,074.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,255.27
Rate for Payer: SOMOS Essential	$5,074.36
Rate for Payer: United Healthcare Essential Plan 1&2	$5,074.36
Rate for Payer: United Healthcare Essential Plan 3&4	$5,074.36
Rate for Payer: United Healthcare Medicaid	$2,255.27

APR-DRG 7543: Depression except major depressive disorder

Facility

$11,233.00

Service Code	APR-DRG 7543
Min. Negotiated Rate	$2,282.60
Max. Negotiated Rate	$11,233.00
Rate for Payer: Affinity Essential Plan 1&2	$2,282.60
Rate for Payer: Affinity Essential Plan 3&4	$2,282.60
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,282.60
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,282.60
Rate for Payer: Fidelis Qualified Health Plan	$2,739.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,282.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,282.60
Rate for Payer: Healthfirst Commercial	$11,233.00
Rate for Payer: Healthfirst Essential Plan	$5,135.85
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,282.60
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$5,135.85
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$5,135.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,282.60
Rate for Payer: SOMOS Essential	$5,135.85
Rate for Payer: United Healthcare Essential Plan 1&2	$5,135.85
Rate for Payer: United Healthcare Essential Plan 3&4	$5,135.85
Rate for Payer: United Healthcare Medicaid	$2,282.60

APR-DRG 7544: Depression except major depressive disorder

Facility

$11,233.00

Service Code	APR-DRG 7544
Min. Negotiated Rate	$2,282.60
Max. Negotiated Rate	$11,233.00
Rate for Payer: Affinity Essential Plan 1&2	$2,282.60
Rate for Payer: Affinity Essential Plan 3&4	$2,282.60
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,282.60
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,282.60
Rate for Payer: Fidelis Qualified Health Plan	$2,739.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,282.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,282.60
Rate for Payer: Healthfirst Commercial	$11,233.00
Rate for Payer: Healthfirst Essential Plan	$5,135.85
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,282.60
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$5,135.85
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$5,135.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,282.60
Rate for Payer: SOMOS Essential	$5,135.85
Rate for Payer: United Healthcare Essential Plan 1&2	$5,135.85
Rate for Payer: United Healthcare Essential Plan 3&4	$5,135.85
Rate for Payer: United Healthcare Medicaid	$2,282.60

APR-DRG 7551: Adjustment disorders & neuroses except depressive diagnoses

Facility

$9,913.00

Service Code	APR-DRG 7551
Min. Negotiated Rate	$2,239.40
Max. Negotiated Rate	$9,913.00
Rate for Payer: Affinity Essential Plan 1&2	$2,239.40
Rate for Payer: Affinity Essential Plan 3&4	$2,239.40
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,239.40
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,239.40
Rate for Payer: Fidelis Qualified Health Plan	$2,687.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,239.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,239.40
Rate for Payer: Healthfirst Commercial	$9,913.00
Rate for Payer: Healthfirst Essential Plan	$5,038.65
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,239.40
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$5,038.65
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$5,038.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,239.40
Rate for Payer: SOMOS Essential	$5,038.65
Rate for Payer: United Healthcare Essential Plan 1&2	$5,038.65
Rate for Payer: United Healthcare Essential Plan 3&4	$5,038.65
Rate for Payer: United Healthcare Medicaid	$2,239.40

APR-DRG 7552: Adjustment disorders & neuroses except depressive diagnoses

Facility

$9,936.00

Service Code	APR-DRG 7552
Min. Negotiated Rate	$2,239.40
Max. Negotiated Rate	$9,936.00
Rate for Payer: Affinity Essential Plan 1&2	$2,239.40
Rate for Payer: Affinity Essential Plan 3&4	$2,239.40
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,239.40
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,239.40
Rate for Payer: Fidelis Qualified Health Plan	$2,687.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,239.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,239.40
Rate for Payer: Healthfirst Commercial	$9,936.00
Rate for Payer: Healthfirst Essential Plan	$5,038.65
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,239.40
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$5,038.65
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$5,038.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,239.40
Rate for Payer: SOMOS Essential	$5,038.65
Rate for Payer: United Healthcare Essential Plan 1&2	$5,038.65
Rate for Payer: United Healthcare Essential Plan 3&4	$5,038.65
Rate for Payer: United Healthcare Medicaid	$2,239.40

APR-DRG 7553: Adjustment disorders & neuroses except depressive diagnoses

Facility

$9,936.00

Service Code	APR-DRG 7553
Min. Negotiated Rate	$2,239.40
Max. Negotiated Rate	$9,936.00
Rate for Payer: Affinity Essential Plan 1&2	$2,239.40
Rate for Payer: Affinity Essential Plan 3&4	$2,239.40
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,239.40
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,239.40
Rate for Payer: Fidelis Qualified Health Plan	$2,687.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,239.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,239.40
Rate for Payer: Healthfirst Commercial	$9,936.00
Rate for Payer: Healthfirst Essential Plan	$5,038.65
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,239.40
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$5,038.65
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$5,038.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,239.40
Rate for Payer: SOMOS Essential	$5,038.65
Rate for Payer: United Healthcare Essential Plan 1&2	$5,038.65
Rate for Payer: United Healthcare Essential Plan 3&4	$5,038.65
Rate for Payer: United Healthcare Medicaid	$2,239.40

APR-DRG 7554: Adjustment disorders & neuroses except depressive diagnoses

Facility

$9,936.00

Service Code	APR-DRG 7554
Min. Negotiated Rate	$2,239.40
Max. Negotiated Rate	$9,936.00
Rate for Payer: Affinity Essential Plan 1&2	$2,239.40
Rate for Payer: Affinity Essential Plan 3&4	$2,239.40
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,239.40
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,239.40
Rate for Payer: Fidelis Qualified Health Plan	$2,687.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,239.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,239.40
Rate for Payer: Healthfirst Commercial	$9,936.00
Rate for Payer: Healthfirst Essential Plan	$5,038.65
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,239.40
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$5,038.65
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$5,038.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,239.40
Rate for Payer: SOMOS Essential	$5,038.65
Rate for Payer: United Healthcare Essential Plan 1&2	$5,038.65
Rate for Payer: United Healthcare Essential Plan 3&4	$5,038.65
Rate for Payer: United Healthcare Medicaid	$2,239.40

APR-DRG 7561: Acute anxiety & delirium states

Facility

$8,912.00

Service Code	APR-DRG 7561
Min. Negotiated Rate	$2,312.83
Max. Negotiated Rate	$8,912.00
Rate for Payer: Affinity Essential Plan 1&2	$2,312.83
Rate for Payer: Affinity Essential Plan 3&4	$2,312.83
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,312.83
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,312.83
Rate for Payer: Fidelis Qualified Health Plan	$2,775.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,312.83
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,312.83
Rate for Payer: Healthfirst Commercial	$8,912.00
Rate for Payer: Healthfirst Essential Plan	$5,203.87
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,312.83
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$5,203.87
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$5,203.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,312.83
Rate for Payer: SOMOS Essential	$5,203.87
Rate for Payer: United Healthcare Essential Plan 1&2	$5,203.87
Rate for Payer: United Healthcare Essential Plan 3&4	$5,203.87
Rate for Payer: United Healthcare Medicaid	$2,312.83

APR-DRG 7562: Acute anxiety & delirium states

Facility

$11,818.00

Service Code	APR-DRG 7562
Min. Negotiated Rate	$2,357.54
Max. Negotiated Rate	$11,818.00
Rate for Payer: Affinity Essential Plan 1&2	$2,357.54
Rate for Payer: Affinity Essential Plan 3&4	$2,357.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,357.54
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,357.54
Rate for Payer: Fidelis Qualified Health Plan	$2,829.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,357.54
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,357.54
Rate for Payer: Healthfirst Commercial	$11,818.00
Rate for Payer: Healthfirst Essential Plan	$5,304.46
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,357.54
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$5,304.46
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$5,304.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,357.54
Rate for Payer: SOMOS Essential	$5,304.46
Rate for Payer: United Healthcare Essential Plan 1&2	$5,304.46
Rate for Payer: United Healthcare Essential Plan 3&4	$5,304.46
Rate for Payer: United Healthcare Medicaid	$2,357.54

APR-DRG 7563: Acute anxiety & delirium states

Facility

$11,818.00

Service Code	APR-DRG 7563
Min. Negotiated Rate	$2,357.54
Max. Negotiated Rate	$11,818.00
Rate for Payer: Affinity Essential Plan 1&2	$2,357.54
Rate for Payer: Affinity Essential Plan 3&4	$2,357.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,357.54
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,357.54
Rate for Payer: Fidelis Qualified Health Plan	$2,829.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,357.54
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,357.54
Rate for Payer: Healthfirst Commercial	$11,818.00
Rate for Payer: Healthfirst Essential Plan	$5,304.46
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,357.54
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$5,304.46
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$5,304.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,357.54
Rate for Payer: SOMOS Essential	$5,304.46
Rate for Payer: United Healthcare Essential Plan 1&2	$5,304.46
Rate for Payer: United Healthcare Essential Plan 3&4	$5,304.46
Rate for Payer: United Healthcare Medicaid	$2,357.54

APR-DRG 7564: Acute anxiety & delirium states

Facility

$11,818.00

Service Code	APR-DRG 7564
Min. Negotiated Rate	$2,357.54
Max. Negotiated Rate	$11,818.00
Rate for Payer: Affinity Essential Plan 1&2	$2,357.54
Rate for Payer: Affinity Essential Plan 3&4	$2,357.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,357.54
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,357.54
Rate for Payer: Fidelis Qualified Health Plan	$2,829.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,357.54
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,357.54
Rate for Payer: Healthfirst Commercial	$11,818.00
Rate for Payer: Healthfirst Essential Plan	$5,304.46
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,357.54
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$5,304.46
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$5,304.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,357.54
Rate for Payer: SOMOS Essential	$5,304.46
Rate for Payer: United Healthcare Essential Plan 1&2	$5,304.46
Rate for Payer: United Healthcare Essential Plan 3&4	$5,304.46
Rate for Payer: United Healthcare Medicaid	$2,357.54

APR-DRG 7571: Organic mental health disturbances

Facility

$13,210.00

Service Code	APR-DRG 7571
Min. Negotiated Rate	$2,204.63
Max. Negotiated Rate	$13,210.00
Rate for Payer: Affinity Essential Plan 1&2	$2,204.63
Rate for Payer: Affinity Essential Plan 3&4	$2,204.63
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,204.63
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,204.63
Rate for Payer: Fidelis Qualified Health Plan	$2,645.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,204.63
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,204.63
Rate for Payer: Healthfirst Commercial	$13,210.00
Rate for Payer: Healthfirst Essential Plan	$4,960.42
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,204.63
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$4,960.42
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$4,960.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,204.63
Rate for Payer: SOMOS Essential	$4,960.42
Rate for Payer: United Healthcare Essential Plan 1&2	$4,960.42
Rate for Payer: United Healthcare Essential Plan 3&4	$4,960.42
Rate for Payer: United Healthcare Medicaid	$2,204.63

APR-DRG 7572: Organic mental health disturbances

Facility

$17,064.00

Service Code	APR-DRG 7572
Min. Negotiated Rate	$2,204.63
Max. Negotiated Rate	$17,064.00
Rate for Payer: Affinity Essential Plan 1&2	$2,204.63
Rate for Payer: Affinity Essential Plan 3&4	$2,204.63
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,204.63
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,204.63
Rate for Payer: Fidelis Qualified Health Plan	$2,645.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,204.63
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,204.63
Rate for Payer: Healthfirst Commercial	$17,064.00
Rate for Payer: Healthfirst Essential Plan	$4,960.42
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,204.63
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$4,960.42
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$4,960.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,204.63
Rate for Payer: SOMOS Essential	$4,960.42
Rate for Payer: United Healthcare Essential Plan 1&2	$4,960.42
Rate for Payer: United Healthcare Essential Plan 3&4	$4,960.42
Rate for Payer: United Healthcare Medicaid	$2,204.63

APR-DRG 7573: Organic mental health disturbances

Facility

$22,988.00

Service Code	APR-DRG 7573
Min. Negotiated Rate	$2,237.99
Max. Negotiated Rate	$22,988.00
Rate for Payer: Affinity Essential Plan 1&2	$2,237.99
Rate for Payer: Affinity Essential Plan 3&4	$2,237.99
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,237.99
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,237.99
Rate for Payer: Fidelis Qualified Health Plan	$2,685.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,237.99
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,237.99
Rate for Payer: Healthfirst Commercial	$22,988.00
Rate for Payer: Healthfirst Essential Plan	$5,035.48
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,237.99
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$5,035.48
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$5,035.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,237.99
Rate for Payer: SOMOS Essential	$5,035.48
Rate for Payer: United Healthcare Essential Plan 1&2	$5,035.48
Rate for Payer: United Healthcare Essential Plan 3&4	$5,035.48
Rate for Payer: United Healthcare Medicaid	$2,237.99

Know your out-of-pocket cost for care.

All Charges