St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

APR-DRG 7574: Organic mental health disturbances

Facility

$22,988.00

Service Code	APR-DRG 7574
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

APR-DRG 7581: Behavioral disorders

Facility

$6,944.00

Service Code	APR-DRG 7581
Min. Negotiated Rate	$2,149.87
Max. Negotiated Rate	$6,944.00
Rate for Payer: Affinity Essential Plan 1&2	$2,149.87
Rate for Payer: Affinity Essential Plan 3&4	$2,149.87
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,149.87
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,149.87
Rate for Payer: Fidelis Qualified Health Plan	$2,579.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,149.87
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,149.87
Rate for Payer: Healthfirst Commercial	$6,944.00
Rate for Payer: Healthfirst Essential Plan	$4,837.21
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,149.87
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$4,837.21
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$4,837.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,149.87
Rate for Payer: SOMOS Essential	$4,837.21
Rate for Payer: United Healthcare Essential Plan 1&2	$4,837.21
Rate for Payer: United Healthcare Essential Plan 3&4	$4,837.21
Rate for Payer: United Healthcare Medicaid	$2,149.87

APR-DRG 7582: Behavioral disorders

Facility

$12,537.00

Service Code	APR-DRG 7582
Min. Negotiated Rate	$2,228.71
Max. Negotiated Rate	$12,537.00
Rate for Payer: Affinity Essential Plan 1&2	$2,228.71
Rate for Payer: Affinity Essential Plan 3&4	$2,228.71
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,228.71
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,228.71
Rate for Payer: Fidelis Qualified Health Plan	$2,674.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,228.71
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,228.71
Rate for Payer: Healthfirst Commercial	$12,537.00
Rate for Payer: Healthfirst Essential Plan	$5,014.60
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,228.71
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$5,014.60
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$5,014.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,228.71
Rate for Payer: SOMOS Essential	$5,014.60
Rate for Payer: United Healthcare Essential Plan 1&2	$5,014.60
Rate for Payer: United Healthcare Essential Plan 3&4	$5,014.60
Rate for Payer: United Healthcare Medicaid	$2,228.71

APR-DRG 7583: Behavioral disorders

Facility

$12,537.00

Service Code	APR-DRG 7583
Min. Negotiated Rate	$2,228.71
Max. Negotiated Rate	$12,537.00
Rate for Payer: Affinity Essential Plan 1&2	$2,228.71
Rate for Payer: Affinity Essential Plan 3&4	$2,228.71
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,228.71
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,228.71
Rate for Payer: Fidelis Qualified Health Plan	$2,674.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,228.71
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,228.71
Rate for Payer: Healthfirst Commercial	$12,537.00
Rate for Payer: Healthfirst Essential Plan	$5,014.60
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,228.71
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$5,014.60
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$5,014.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,228.71
Rate for Payer: SOMOS Essential	$5,014.60
Rate for Payer: United Healthcare Essential Plan 1&2	$5,014.60
Rate for Payer: United Healthcare Essential Plan 3&4	$5,014.60
Rate for Payer: United Healthcare Medicaid	$2,228.71

APR-DRG 7584: Behavioral disorders

Facility

$12,537.00

Service Code	APR-DRG 7584
Min. Negotiated Rate	$2,228.71
Max. Negotiated Rate	$12,537.00
Rate for Payer: Affinity Essential Plan 1&2	$2,228.71
Rate for Payer: Affinity Essential Plan 3&4	$2,228.71
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,228.71
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,228.71
Rate for Payer: Fidelis Qualified Health Plan	$2,674.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,228.71
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,228.71
Rate for Payer: Healthfirst Commercial	$12,537.00
Rate for Payer: Healthfirst Essential Plan	$5,014.60
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,228.71
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$5,014.60
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$5,014.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,228.71
Rate for Payer: SOMOS Essential	$5,014.60
Rate for Payer: United Healthcare Essential Plan 1&2	$5,014.60
Rate for Payer: United Healthcare Essential Plan 3&4	$5,014.60
Rate for Payer: United Healthcare Medicaid	$2,228.71

APR-DRG 7591: Eating disorders

Facility

$15,447.00

Service Code	APR-DRG 7591
Min. Negotiated Rate	$2,040.91
Max. Negotiated Rate	$15,447.00
Rate for Payer: Affinity Essential Plan 1&2	$2,040.91
Rate for Payer: Affinity Essential Plan 3&4	$2,040.91
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,040.91
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,040.91
Rate for Payer: Fidelis Qualified Health Plan	$2,449.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,040.91
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,040.91
Rate for Payer: Healthfirst Commercial	$15,447.00
Rate for Payer: Healthfirst Essential Plan	$4,592.05
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,040.91
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$4,592.05
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$4,592.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,040.91
Rate for Payer: SOMOS Essential	$4,592.05
Rate for Payer: United Healthcare Essential Plan 1&2	$4,592.05
Rate for Payer: United Healthcare Essential Plan 3&4	$4,592.05
Rate for Payer: United Healthcare Medicaid	$2,040.91

APR-DRG 7592: Eating disorders

Facility

$15,447.00

Service Code	APR-DRG 7592
Min. Negotiated Rate	$2,108.94
Max. Negotiated Rate	$15,447.00
Rate for Payer: Affinity Essential Plan 1&2	$2,108.94
Rate for Payer: Affinity Essential Plan 3&4	$2,108.94
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,108.94
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,108.94
Rate for Payer: Fidelis Qualified Health Plan	$2,530.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,108.94
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,108.94
Rate for Payer: Healthfirst Commercial	$15,447.00
Rate for Payer: Healthfirst Essential Plan	$4,745.12
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,108.94
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$4,745.12
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$4,745.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,108.94
Rate for Payer: SOMOS Essential	$4,745.12
Rate for Payer: United Healthcare Essential Plan 1&2	$4,745.12
Rate for Payer: United Healthcare Essential Plan 3&4	$4,745.12
Rate for Payer: United Healthcare Medicaid	$2,108.94

APR-DRG 7593: Eating disorders

Facility

$15,447.00

Service Code	APR-DRG 7593
Min. Negotiated Rate	$2,108.94
Max. Negotiated Rate	$15,447.00
Rate for Payer: Affinity Essential Plan 1&2	$2,108.94
Rate for Payer: Affinity Essential Plan 3&4	$2,108.94
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,108.94
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,108.94
Rate for Payer: Fidelis Qualified Health Plan	$2,530.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,108.94
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,108.94
Rate for Payer: Healthfirst Commercial	$15,447.00
Rate for Payer: Healthfirst Essential Plan	$4,745.12
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,108.94
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$4,745.12
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$4,745.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,108.94
Rate for Payer: SOMOS Essential	$4,745.12
Rate for Payer: United Healthcare Essential Plan 1&2	$4,745.12
Rate for Payer: United Healthcare Essential Plan 3&4	$4,745.12
Rate for Payer: United Healthcare Medicaid	$2,108.94

APR-DRG 7594: Eating disorders

Facility

$15,447.00

Service Code	APR-DRG 7594
Min. Negotiated Rate	$2,108.94
Max. Negotiated Rate	$15,447.00
Rate for Payer: Affinity Essential Plan 1&2	$2,108.94
Rate for Payer: Affinity Essential Plan 3&4	$2,108.94
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,108.94
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,108.94
Rate for Payer: Fidelis Qualified Health Plan	$2,530.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,108.94
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,108.94
Rate for Payer: Healthfirst Commercial	$15,447.00
Rate for Payer: Healthfirst Essential Plan	$4,745.12
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,108.94
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$4,745.12
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$4,745.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,108.94
Rate for Payer: SOMOS Essential	$4,745.12
Rate for Payer: United Healthcare Essential Plan 1&2	$4,745.12
Rate for Payer: United Healthcare Essential Plan 3&4	$4,745.12
Rate for Payer: United Healthcare Medicaid	$2,108.94

APR-DRG 7601: Other mental health disorders

Facility

$9,601.00

Service Code	APR-DRG 7601
Min. Negotiated Rate	$2,180.43
Max. Negotiated Rate	$9,601.00
Rate for Payer: Affinity Essential Plan 1&2	$2,180.43
Rate for Payer: Affinity Essential Plan 3&4	$2,180.43
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,180.43
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,180.43
Rate for Payer: Fidelis Qualified Health Plan	$2,616.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,180.43
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,180.43
Rate for Payer: Healthfirst Commercial	$9,601.00
Rate for Payer: Healthfirst Essential Plan	$4,905.97
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,180.43
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$4,905.97
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$4,905.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,180.43
Rate for Payer: SOMOS Essential	$4,905.97
Rate for Payer: United Healthcare Essential Plan 1&2	$4,905.97
Rate for Payer: United Healthcare Essential Plan 3&4	$4,905.97
Rate for Payer: United Healthcare Medicaid	$2,180.43

APR-DRG 7602: Other mental health disorders

Facility

$10,888.00

Service Code	APR-DRG 7602
Min. Negotiated Rate	$2,180.43
Max. Negotiated Rate	$10,888.00
Rate for Payer: Affinity Essential Plan 1&2	$2,180.43
Rate for Payer: Affinity Essential Plan 3&4	$2,180.43
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,180.43
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,180.43
Rate for Payer: Fidelis Qualified Health Plan	$2,616.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,180.43
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,180.43
Rate for Payer: Healthfirst Commercial	$10,888.00
Rate for Payer: Healthfirst Essential Plan	$4,905.97
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,180.43
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$4,905.97
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$4,905.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,180.43
Rate for Payer: SOMOS Essential	$4,905.97
Rate for Payer: United Healthcare Essential Plan 1&2	$4,905.97
Rate for Payer: United Healthcare Essential Plan 3&4	$4,905.97
Rate for Payer: United Healthcare Medicaid	$2,180.43

APR-DRG 7603: Other mental health disorders

Facility

$12,018.00

Service Code	APR-DRG 7603
Min. Negotiated Rate	$2,180.43
Max. Negotiated Rate	$12,018.00
Rate for Payer: Affinity Essential Plan 1&2	$2,180.43
Rate for Payer: Affinity Essential Plan 3&4	$2,180.43
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,180.43
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,180.43
Rate for Payer: Fidelis Qualified Health Plan	$2,616.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,180.43
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,180.43
Rate for Payer: Healthfirst Commercial	$12,018.00
Rate for Payer: Healthfirst Essential Plan	$4,905.97
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,180.43
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$4,905.97
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$4,905.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,180.43
Rate for Payer: SOMOS Essential	$4,905.97
Rate for Payer: United Healthcare Essential Plan 1&2	$4,905.97
Rate for Payer: United Healthcare Essential Plan 3&4	$4,905.97
Rate for Payer: United Healthcare Medicaid	$2,180.43

APR-DRG 7604: Other mental health disorders

Facility

$12,018.00

Service Code	APR-DRG 7604
Min. Negotiated Rate	$2,180.43
Max. Negotiated Rate	$12,018.00
Rate for Payer: Affinity Essential Plan 1&2	$2,180.43
Rate for Payer: Affinity Essential Plan 3&4	$2,180.43
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,180.43
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,180.43
Rate for Payer: Fidelis Qualified Health Plan	$2,616.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,180.43
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,180.43
Rate for Payer: Healthfirst Commercial	$12,018.00
Rate for Payer: Healthfirst Essential Plan	$4,905.97
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,180.43
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$4,905.97
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$4,905.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,180.43
Rate for Payer: SOMOS Essential	$4,905.97
Rate for Payer: United Healthcare Essential Plan 1&2	$4,905.97
Rate for Payer: United Healthcare Essential Plan 3&4	$4,905.97
Rate for Payer: United Healthcare Medicaid	$2,180.43

APR-DRG 7701: Drug & alcohol abuse or dependence, left against medical advice

Facility

$7,244.00

Service Code	APR-DRG 7701
Min. Negotiated Rate	$2,164.99
Max. Negotiated Rate	$7,244.00
Rate for Payer: Affinity Essential Plan 1&2	$2,164.99
Rate for Payer: Affinity Essential Plan 3&4	$2,164.99
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,164.99
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,164.99
Rate for Payer: Fidelis Qualified Health Plan	$2,597.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,164.99
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,164.99
Rate for Payer: Healthfirst Commercial	$7,244.00
Rate for Payer: Healthfirst Essential Plan	$4,871.23
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,164.99
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$4,871.23
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$4,871.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,164.99
Rate for Payer: SOMOS Essential	$4,871.23
Rate for Payer: United Healthcare Essential Plan 1&2	$4,871.23
Rate for Payer: United Healthcare Essential Plan 3&4	$4,871.23
Rate for Payer: United Healthcare Medicaid	$2,164.99

APR-DRG 7702: Drug & alcohol abuse or dependence, left against medical advice

Facility

$8,443.00

Service Code	APR-DRG 7702
Min. Negotiated Rate	$2,164.99
Max. Negotiated Rate	$8,443.00
Rate for Payer: Affinity Essential Plan 1&2	$2,164.99
Rate for Payer: Affinity Essential Plan 3&4	$2,164.99
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,164.99
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,164.99
Rate for Payer: Fidelis Qualified Health Plan	$2,597.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,164.99
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,164.99
Rate for Payer: Healthfirst Commercial	$8,443.00
Rate for Payer: Healthfirst Essential Plan	$4,871.23
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,164.99
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$4,871.23
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$4,871.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,164.99
Rate for Payer: SOMOS Essential	$4,871.23
Rate for Payer: United Healthcare Essential Plan 1&2	$4,871.23
Rate for Payer: United Healthcare Essential Plan 3&4	$4,871.23
Rate for Payer: United Healthcare Medicaid	$2,164.99

APR-DRG 7703: Drug & alcohol abuse or dependence, left against medical advice

Facility

$12,809.00

Service Code	APR-DRG 7703
Min. Negotiated Rate	$2,164.99
Max. Negotiated Rate	$12,809.00
Rate for Payer: Affinity Essential Plan 1&2	$2,164.99
Rate for Payer: Affinity Essential Plan 3&4	$2,164.99
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,164.99
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,164.99
Rate for Payer: Fidelis Qualified Health Plan	$2,597.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,164.99
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,164.99
Rate for Payer: Healthfirst Commercial	$12,809.00
Rate for Payer: Healthfirst Essential Plan	$4,871.23
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,164.99
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$4,871.23
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$4,871.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,164.99
Rate for Payer: SOMOS Essential	$4,871.23
Rate for Payer: United Healthcare Essential Plan 1&2	$4,871.23
Rate for Payer: United Healthcare Essential Plan 3&4	$4,871.23
Rate for Payer: United Healthcare Medicaid	$2,164.99

APR-DRG 7704: Drug & alcohol abuse or dependence, left against medical advice

Facility

$14,903.00

Service Code	APR-DRG 7704
Min. Negotiated Rate	$2,164.99
Max. Negotiated Rate	$14,903.00
Rate for Payer: Affinity Essential Plan 1&2	$2,164.99
Rate for Payer: Affinity Essential Plan 3&4	$2,164.99
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,164.99
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,164.99
Rate for Payer: Fidelis Qualified Health Plan	$2,597.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,164.99
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,164.99
Rate for Payer: Healthfirst Commercial	$14,903.00
Rate for Payer: Healthfirst Essential Plan	$4,871.23
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,164.99
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$4,871.23
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$4,871.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,164.99
Rate for Payer: SOMOS Essential	$4,871.23
Rate for Payer: United Healthcare Essential Plan 1&2	$4,871.23
Rate for Payer: United Healthcare Essential Plan 3&4	$4,871.23
Rate for Payer: United Healthcare Medicaid	$2,164.99

APR-DRG 7721: Alcohol & drug dependence w rehab or rehab/detox therapy

Facility

$26,091.00

Service Code	APR-DRG 7721
Min. Negotiated Rate	$2,013.59
Max. Negotiated Rate	$26,091.00
Rate for Payer: Affinity Essential Plan 1&2	$2,013.59
Rate for Payer: Affinity Essential Plan 3&4	$2,013.59
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,013.59
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,013.59
Rate for Payer: Fidelis Qualified Health Plan	$2,416.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,013.59
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,013.59
Rate for Payer: Healthfirst Commercial	$26,091.00
Rate for Payer: Healthfirst Essential Plan	$4,530.58
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,013.59
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$4,530.58
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$4,530.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,013.59
Rate for Payer: SOMOS Essential	$4,530.58
Rate for Payer: United Healthcare Essential Plan 1&2	$4,530.58
Rate for Payer: United Healthcare Essential Plan 3&4	$4,530.58
Rate for Payer: United Healthcare Medicaid	$2,013.59

APR-DRG 7722: Alcohol & drug dependence w rehab or rehab/detox therapy

Facility

$26,091.00

Service Code	APR-DRG 7722
Min. Negotiated Rate	$2,013.59
Max. Negotiated Rate	$26,091.00
Rate for Payer: Affinity Essential Plan 1&2	$2,013.59
Rate for Payer: Affinity Essential Plan 3&4	$2,013.59
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,013.59
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,013.59
Rate for Payer: Fidelis Qualified Health Plan	$2,416.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,013.59
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,013.59
Rate for Payer: Healthfirst Commercial	$26,091.00
Rate for Payer: Healthfirst Essential Plan	$4,530.58
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,013.59
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$4,530.58
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$4,530.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,013.59
Rate for Payer: SOMOS Essential	$4,530.58
Rate for Payer: United Healthcare Essential Plan 1&2	$4,530.58
Rate for Payer: United Healthcare Essential Plan 3&4	$4,530.58
Rate for Payer: United Healthcare Medicaid	$2,013.59

APR-DRG 7723: Alcohol & drug dependence w rehab or rehab/detox therapy

Facility

$26,091.00

Service Code	APR-DRG 7723
Min. Negotiated Rate	$2,013.59
Max. Negotiated Rate	$26,091.00
Rate for Payer: Affinity Essential Plan 1&2	$2,013.59
Rate for Payer: Affinity Essential Plan 3&4	$2,013.59
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,013.59
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,013.59
Rate for Payer: Fidelis Qualified Health Plan	$2,416.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,013.59
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,013.59
Rate for Payer: Healthfirst Commercial	$26,091.00
Rate for Payer: Healthfirst Essential Plan	$4,530.58
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,013.59
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$4,530.58
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$4,530.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,013.59
Rate for Payer: SOMOS Essential	$4,530.58
Rate for Payer: United Healthcare Essential Plan 1&2	$4,530.58
Rate for Payer: United Healthcare Essential Plan 3&4	$4,530.58
Rate for Payer: United Healthcare Medicaid	$2,013.59

APR-DRG 7724: Alcohol & drug dependence w rehab or rehab/detox therapy

Facility

$26,091.00

Service Code	APR-DRG 7724
Min. Negotiated Rate	$2,013.59
Max. Negotiated Rate	$26,091.00
Rate for Payer: Affinity Essential Plan 1&2	$2,013.59
Rate for Payer: Affinity Essential Plan 3&4	$2,013.59
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,013.59
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,013.59
Rate for Payer: Fidelis Qualified Health Plan	$2,416.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,013.59
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,013.59
Rate for Payer: Healthfirst Commercial	$26,091.00
Rate for Payer: Healthfirst Essential Plan	$4,530.58
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,013.59
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$4,530.58
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$4,530.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,013.59
Rate for Payer: SOMOS Essential	$4,530.58
Rate for Payer: United Healthcare Essential Plan 1&2	$4,530.58
Rate for Payer: United Healthcare Essential Plan 3&4	$4,530.58
Rate for Payer: United Healthcare Medicaid	$2,013.59

APR-DRG 7731: Opioid abuse & dependence

Facility

$10,470.00

Service Code	APR-DRG 7731
Min. Negotiated Rate	$2,211.32
Max. Negotiated Rate	$10,470.00
Rate for Payer: Affinity Essential Plan 1&2	$2,211.32
Rate for Payer: Affinity Essential Plan 3&4	$2,211.32
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,211.32
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,211.32
Rate for Payer: Fidelis Qualified Health Plan	$2,653.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,211.32
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,211.32
Rate for Payer: Healthfirst Commercial	$10,470.00
Rate for Payer: Healthfirst Essential Plan	$4,975.47
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,211.32
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$4,975.47
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$4,975.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,211.32
Rate for Payer: SOMOS Essential	$4,975.47
Rate for Payer: United Healthcare Essential Plan 1&2	$4,975.47
Rate for Payer: United Healthcare Essential Plan 3&4	$4,975.47
Rate for Payer: United Healthcare Medicaid	$2,211.32

APR-DRG 7732: Opioid abuse & dependence

Facility

$11,246.00

Service Code	APR-DRG 7732
Min. Negotiated Rate	$2,211.32
Max. Negotiated Rate	$11,246.00
Rate for Payer: Affinity Essential Plan 1&2	$2,211.32
Rate for Payer: Affinity Essential Plan 3&4	$2,211.32
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,211.32
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,211.32
Rate for Payer: Fidelis Qualified Health Plan	$2,653.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,211.32
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,211.32
Rate for Payer: Healthfirst Commercial	$11,246.00
Rate for Payer: Healthfirst Essential Plan	$4,975.47
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,211.32
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$4,975.47
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$4,975.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,211.32
Rate for Payer: SOMOS Essential	$4,975.47
Rate for Payer: United Healthcare Essential Plan 1&2	$4,975.47
Rate for Payer: United Healthcare Essential Plan 3&4	$4,975.47
Rate for Payer: United Healthcare Medicaid	$2,211.32

APR-DRG 7733: Opioid abuse & dependence

Facility

$15,436.00

Service Code	APR-DRG 7733
Min. Negotiated Rate	$2,228.28
Max. Negotiated Rate	$15,436.00
Rate for Payer: Affinity Essential Plan 1&2	$2,228.28
Rate for Payer: Affinity Essential Plan 3&4	$2,228.28
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,228.28
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,228.28
Rate for Payer: Fidelis Qualified Health Plan	$2,673.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,228.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,228.28
Rate for Payer: Healthfirst Commercial	$15,436.00
Rate for Payer: Healthfirst Essential Plan	$5,013.63
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,228.28
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$5,013.63
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$5,013.63
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,228.28
Rate for Payer: SOMOS Essential	$5,013.63
Rate for Payer: United Healthcare Essential Plan 1&2	$5,013.63
Rate for Payer: United Healthcare Essential Plan 3&4	$5,013.63
Rate for Payer: United Healthcare Medicaid	$2,228.28

APR-DRG 7734: Opioid abuse & dependence

Facility

$18,934.00

Service Code	APR-DRG 7734
Min. Negotiated Rate	$2,228.28
Max. Negotiated Rate	$18,934.00
Rate for Payer: Affinity Essential Plan 1&2	$2,228.28
Rate for Payer: Affinity Essential Plan 3&4	$2,228.28
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,228.28
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,228.28
Rate for Payer: Fidelis Qualified Health Plan	$2,673.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,228.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,228.28
Rate for Payer: Healthfirst Commercial	$18,934.00
Rate for Payer: Healthfirst Essential Plan	$5,013.63
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,228.28
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$5,013.63
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$5,013.63
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,228.28
Rate for Payer: SOMOS Essential	$5,013.63
Rate for Payer: United Healthcare Essential Plan 1&2	$5,013.63
Rate for Payer: United Healthcare Essential Plan 3&4	$5,013.63
Rate for Payer: United Healthcare Medicaid	$2,228.28

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