St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

APR-DRG 7741: Cocaine abuse & dependence

Facility

$10,811.00

Service Code	APR-DRG 7741
Min. Negotiated Rate	$2,168.45
Max. Negotiated Rate	$10,811.00
Rate for Payer: Affinity Essential Plan 1&2	$2,168.45
Rate for Payer: Affinity Essential Plan 3&4	$2,168.45
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,168.45
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,168.45
Rate for Payer: Fidelis Qualified Health Plan	$2,602.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,168.45
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,168.45
Rate for Payer: Healthfirst Commercial	$10,811.00
Rate for Payer: Healthfirst Essential Plan	$4,879.01
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,168.45
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$4,879.01
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$4,879.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,168.45
Rate for Payer: SOMOS Essential	$4,879.01
Rate for Payer: United Healthcare Essential Plan 1&2	$4,879.01
Rate for Payer: United Healthcare Essential Plan 3&4	$4,879.01
Rate for Payer: United Healthcare Medicaid	$2,168.45

APR-DRG 7742: Cocaine abuse & dependence

Facility

$10,896.00

Service Code	APR-DRG 7742
Min. Negotiated Rate	$2,228.17
Max. Negotiated Rate	$10,896.00
Rate for Payer: Affinity Essential Plan 1&2	$2,228.17
Rate for Payer: Affinity Essential Plan 3&4	$2,228.17
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,228.17
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,228.17
Rate for Payer: Fidelis Qualified Health Plan	$2,673.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,228.17
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,228.17
Rate for Payer: Healthfirst Commercial	$10,896.00
Rate for Payer: Healthfirst Essential Plan	$5,013.38
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,228.17
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$5,013.38
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$5,013.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,228.17
Rate for Payer: SOMOS Essential	$5,013.38
Rate for Payer: United Healthcare Essential Plan 1&2	$5,013.38
Rate for Payer: United Healthcare Essential Plan 3&4	$5,013.38
Rate for Payer: United Healthcare Medicaid	$2,228.17

APR-DRG 7743: Cocaine abuse & dependence

Facility

$13,346.00

Service Code	APR-DRG 7743
Min. Negotiated Rate	$2,244.69
Max. Negotiated Rate	$13,346.00
Rate for Payer: Affinity Essential Plan 1&2	$2,244.69
Rate for Payer: Affinity Essential Plan 3&4	$2,244.69
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,244.69
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,244.69
Rate for Payer: Fidelis Qualified Health Plan	$2,693.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,244.69
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,244.69
Rate for Payer: Healthfirst Commercial	$13,346.00
Rate for Payer: Healthfirst Essential Plan	$5,050.55
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,244.69
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$5,050.55
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$5,050.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,244.69
Rate for Payer: SOMOS Essential	$5,050.55
Rate for Payer: United Healthcare Essential Plan 1&2	$5,050.55
Rate for Payer: United Healthcare Essential Plan 3&4	$5,050.55
Rate for Payer: United Healthcare Medicaid	$2,244.69

APR-DRG 7744: Cocaine abuse & dependence

Facility

$16,488.00

Service Code	APR-DRG 7744
Min. Negotiated Rate	$2,244.69
Max. Negotiated Rate	$16,488.00
Rate for Payer: Affinity Essential Plan 1&2	$2,244.69
Rate for Payer: Affinity Essential Plan 3&4	$2,244.69
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,244.69
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,244.69
Rate for Payer: Fidelis Qualified Health Plan	$2,693.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,244.69
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,244.69
Rate for Payer: Healthfirst Commercial	$16,488.00
Rate for Payer: Healthfirst Essential Plan	$5,050.55
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,244.69
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$5,050.55
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$5,050.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,244.69
Rate for Payer: SOMOS Essential	$5,050.55
Rate for Payer: United Healthcare Essential Plan 1&2	$5,050.55
Rate for Payer: United Healthcare Essential Plan 3&4	$5,050.55
Rate for Payer: United Healthcare Medicaid	$2,244.69

APR-DRG 7751: Alcohol abuse & dependence

Facility

$10,874.00

Service Code	APR-DRG 7751
Min. Negotiated Rate	$2,210.46
Max. Negotiated Rate	$10,874.00
Rate for Payer: Affinity Essential Plan 1&2	$2,210.46
Rate for Payer: Affinity Essential Plan 3&4	$2,210.46
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,210.46
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,210.46
Rate for Payer: Fidelis Qualified Health Plan	$2,652.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,210.46
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,210.46
Rate for Payer: Healthfirst Commercial	$10,874.00
Rate for Payer: Healthfirst Essential Plan	$4,973.54
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,210.46
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$4,973.54
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$4,973.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,210.46
Rate for Payer: SOMOS Essential	$4,973.54
Rate for Payer: United Healthcare Essential Plan 1&2	$4,973.54
Rate for Payer: United Healthcare Essential Plan 3&4	$4,973.54
Rate for Payer: United Healthcare Medicaid	$2,210.46

APR-DRG 7752: Alcohol abuse & dependence

Facility

$12,787.00

Service Code	APR-DRG 7752
Min. Negotiated Rate	$2,265.86
Max. Negotiated Rate	$12,787.00
Rate for Payer: Affinity Essential Plan 1&2	$2,265.86
Rate for Payer: Affinity Essential Plan 3&4	$2,265.86
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,265.86
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,265.86
Rate for Payer: Fidelis Qualified Health Plan	$2,719.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,265.86
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,265.86
Rate for Payer: Healthfirst Commercial	$12,787.00
Rate for Payer: Healthfirst Essential Plan	$5,098.18
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,265.86
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$5,098.18
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$5,098.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,265.86
Rate for Payer: SOMOS Essential	$5,098.18
Rate for Payer: United Healthcare Essential Plan 1&2	$5,098.18
Rate for Payer: United Healthcare Essential Plan 3&4	$5,098.18
Rate for Payer: United Healthcare Medicaid	$2,265.86

APR-DRG 7753: Alcohol abuse & dependence

Facility

$21,528.00

Service Code	APR-DRG 7753
Min. Negotiated Rate	$2,265.86
Max. Negotiated Rate	$21,528.00
Rate for Payer: Affinity Essential Plan 1&2	$2,265.86
Rate for Payer: Affinity Essential Plan 3&4	$2,265.86
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,265.86
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,265.86
Rate for Payer: Fidelis Qualified Health Plan	$2,719.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,265.86
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,265.86
Rate for Payer: Healthfirst Commercial	$21,528.00
Rate for Payer: Healthfirst Essential Plan	$5,098.18
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,265.86
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$5,098.18
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$5,098.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,265.86
Rate for Payer: SOMOS Essential	$5,098.18
Rate for Payer: United Healthcare Essential Plan 1&2	$5,098.18
Rate for Payer: United Healthcare Essential Plan 3&4	$5,098.18
Rate for Payer: United Healthcare Medicaid	$2,265.86

APR-DRG 7754: Alcohol abuse & dependence

Facility

$50,611.00

Service Code	APR-DRG 7754
Min. Negotiated Rate	$2,265.86
Max. Negotiated Rate	$50,611.00
Rate for Payer: Affinity Essential Plan 1&2	$2,265.86
Rate for Payer: Affinity Essential Plan 3&4	$2,265.86
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,265.86
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,265.86
Rate for Payer: Fidelis Qualified Health Plan	$2,719.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,265.86
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,265.86
Rate for Payer: Healthfirst Commercial	$50,611.00
Rate for Payer: Healthfirst Essential Plan	$5,098.18
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,265.86
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$5,098.18
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$5,098.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,265.86
Rate for Payer: SOMOS Essential	$5,098.18
Rate for Payer: United Healthcare Essential Plan 1&2	$5,098.18
Rate for Payer: United Healthcare Essential Plan 3&4	$5,098.18
Rate for Payer: United Healthcare Medicaid	$2,265.86

APR-DRG 7761: Other drug abuse & dependence

Facility

$10,599.00

Service Code	APR-DRG 7761
Min. Negotiated Rate	$2,120.50
Max. Negotiated Rate	$10,599.00
Rate for Payer: Affinity Essential Plan 1&2	$2,120.50
Rate for Payer: Affinity Essential Plan 3&4	$2,120.50
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,120.50
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,120.50
Rate for Payer: Fidelis Qualified Health Plan	$2,544.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,120.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,120.50
Rate for Payer: Healthfirst Commercial	$10,599.00
Rate for Payer: Healthfirst Essential Plan	$4,771.12
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,120.50
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$4,771.12
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$4,771.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,120.50
Rate for Payer: SOMOS Essential	$4,771.12
Rate for Payer: United Healthcare Essential Plan 1&2	$4,771.12
Rate for Payer: United Healthcare Essential Plan 3&4	$4,771.12
Rate for Payer: United Healthcare Medicaid	$2,120.50

APR-DRG 7762: Other drug abuse & dependence

Facility

$11,384.00

Service Code	APR-DRG 7762
Min. Negotiated Rate	$2,289.29
Max. Negotiated Rate	$11,384.00
Rate for Payer: Affinity Essential Plan 1&2	$2,289.29
Rate for Payer: Affinity Essential Plan 3&4	$2,289.29
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,289.29
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,289.29
Rate for Payer: Fidelis Qualified Health Plan	$2,747.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,289.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,289.29
Rate for Payer: Healthfirst Commercial	$11,384.00
Rate for Payer: Healthfirst Essential Plan	$5,150.90
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,289.29
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$5,150.90
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$5,150.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,289.29
Rate for Payer: SOMOS Essential	$5,150.90
Rate for Payer: United Healthcare Essential Plan 1&2	$5,150.90
Rate for Payer: United Healthcare Essential Plan 3&4	$5,150.90
Rate for Payer: United Healthcare Medicaid	$2,289.29

APR-DRG 7763: Other drug abuse & dependence

Facility

$12,648.00

Service Code	APR-DRG 7763
Min. Negotiated Rate	$2,289.29
Max. Negotiated Rate	$12,648.00
Rate for Payer: Affinity Essential Plan 1&2	$2,289.29
Rate for Payer: Affinity Essential Plan 3&4	$2,289.29
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,289.29
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,289.29
Rate for Payer: Fidelis Qualified Health Plan	$2,747.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,289.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,289.29
Rate for Payer: Healthfirst Commercial	$12,648.00
Rate for Payer: Healthfirst Essential Plan	$5,150.90
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,289.29
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$5,150.90
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$5,150.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,289.29
Rate for Payer: SOMOS Essential	$5,150.90
Rate for Payer: United Healthcare Essential Plan 1&2	$5,150.90
Rate for Payer: United Healthcare Essential Plan 3&4	$5,150.90
Rate for Payer: United Healthcare Medicaid	$2,289.29

APR-DRG 7764: Other drug abuse & dependence

Facility

$12,648.00

Service Code	APR-DRG 7764
Min. Negotiated Rate	$2,289.29
Max. Negotiated Rate	$12,648.00
Rate for Payer: Affinity Essential Plan 1&2	$2,289.29
Rate for Payer: Affinity Essential Plan 3&4	$2,289.29
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,289.29
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,289.29
Rate for Payer: Fidelis Qualified Health Plan	$2,747.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,289.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,289.29
Rate for Payer: Healthfirst Commercial	$12,648.00
Rate for Payer: Healthfirst Essential Plan	$5,150.90
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,289.29
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$5,150.90
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$5,150.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,289.29
Rate for Payer: SOMOS Essential	$5,150.90
Rate for Payer: United Healthcare Essential Plan 1&2	$5,150.90
Rate for Payer: United Healthcare Essential Plan 3&4	$5,150.90
Rate for Payer: United Healthcare Medicaid	$2,289.29

APR-DRG 7911: O.R. procedure for other complications of treatment

Facility

$44,557.29

Service Code	APR-DRG 7911
Min. Negotiated Rate	$9,871.00
Max. Negotiated Rate	$44,557.29
Rate for Payer: Affinity Essential Plan 1&2	$44,557.29
Rate for Payer: Affinity Essential Plan 3&4	$44,557.29
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,803.24
Rate for Payer: Amida Care Medicaid	$19,803.24
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,803.24
Rate for Payer: Fidelis Qualified Health Plan	$23,763.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,803.24
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,803.24
Rate for Payer: Healthfirst Commercial	$17,813.00
Rate for Payer: Healthfirst Essential Plan	$44,557.29
Rate for Payer: Healthfirst QHP	$9,871.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,803.24
Rate for Payer: SOMOS Essential	$44,557.29
Rate for Payer: United Healthcare Essential Plan 1&2	$44,557.29
Rate for Payer: United Healthcare Essential Plan 3&4	$44,557.29
Rate for Payer: United Healthcare Medicaid	$19,803.24
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,803.24

APR-DRG 7912: O.R. procedure for other complications of treatment

Facility

$54,675.36

Service Code	APR-DRG 7912
Min. Negotiated Rate	$15,588.00
Max. Negotiated Rate	$54,675.36
Rate for Payer: Affinity Essential Plan 1&2	$54,675.36
Rate for Payer: Affinity Essential Plan 3&4	$54,675.36
Rate for Payer: Affinity Medicaid/CHP/HARP	$24,300.16
Rate for Payer: Amida Care Medicaid	$24,300.16
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,300.16
Rate for Payer: Fidelis Qualified Health Plan	$29,160.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,300.16
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,300.16
Rate for Payer: Healthfirst Commercial	$27,073.00
Rate for Payer: Healthfirst Essential Plan	$54,675.36
Rate for Payer: Healthfirst QHP	$15,588.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,300.16
Rate for Payer: SOMOS Essential	$54,675.36
Rate for Payer: United Healthcare Essential Plan 1&2	$54,675.36
Rate for Payer: United Healthcare Essential Plan 3&4	$54,675.36
Rate for Payer: United Healthcare Medicaid	$24,300.16
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,300.16

APR-DRG 7913: O.R. procedure for other complications of treatment

Facility

$76,673.74

Service Code	APR-DRG 7913
Min. Negotiated Rate	$28,250.00
Max. Negotiated Rate	$76,673.74
Rate for Payer: Affinity Essential Plan 1&2	$76,673.74
Rate for Payer: Affinity Essential Plan 3&4	$76,673.74
Rate for Payer: Affinity Medicaid/CHP/HARP	$34,077.22
Rate for Payer: Amida Care Medicaid	$34,077.22
Rate for Payer: Fidelis CHP/HARP/Medicaid	$34,077.22
Rate for Payer: Fidelis Qualified Health Plan	$40,892.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$34,077.22
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$34,077.22
Rate for Payer: Healthfirst Commercial	$47,217.00
Rate for Payer: Healthfirst Essential Plan	$76,673.74
Rate for Payer: Healthfirst QHP	$28,250.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$34,077.22
Rate for Payer: SOMOS Essential	$76,673.74
Rate for Payer: United Healthcare Essential Plan 1&2	$76,673.74
Rate for Payer: United Healthcare Essential Plan 3&4	$76,673.74
Rate for Payer: United Healthcare Medicaid	$34,077.22
Rate for Payer: Wellcare CHP/FHP/Medicaid	$34,077.22

APR-DRG 7914: O.R. procedure for other complications of treatment

Facility

$145,908.56

Service Code	APR-DRG 7914
Min. Negotiated Rate	$64,848.25
Max. Negotiated Rate	$145,908.56
Rate for Payer: Affinity Essential Plan 1&2	$145,908.56
Rate for Payer: Affinity Essential Plan 3&4	$145,908.56
Rate for Payer: Affinity Medicaid/CHP/HARP	$64,848.25
Rate for Payer: Amida Care Medicaid	$64,848.25
Rate for Payer: Fidelis CHP/HARP/Medicaid	$64,848.25
Rate for Payer: Fidelis Qualified Health Plan	$77,817.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$64,848.25
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$64,848.25
Rate for Payer: Healthfirst Commercial	$113,474.00
Rate for Payer: Healthfirst Essential Plan	$145,908.56
Rate for Payer: Healthfirst QHP	$71,888.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$64,848.25
Rate for Payer: SOMOS Essential	$145,908.56
Rate for Payer: United Healthcare Essential Plan 1&2	$145,908.56
Rate for Payer: United Healthcare Essential Plan 3&4	$145,908.56
Rate for Payer: United Healthcare Medicaid	$64,848.25
Rate for Payer: Wellcare CHP/FHP/Medicaid	$64,848.25

APR-DRG 8111: Allergic reactions

Facility

$35,605.26

Service Code	APR-DRG 8111
Min. Negotiated Rate	$4,206.00
Max. Negotiated Rate	$35,605.26
Rate for Payer: Affinity Essential Plan 1&2	$35,605.26
Rate for Payer: Affinity Essential Plan 3&4	$35,605.26
Rate for Payer: Affinity Medicaid/CHP/HARP	$15,824.56
Rate for Payer: Amida Care Medicaid	$15,824.56
Rate for Payer: Fidelis CHP/HARP/Medicaid	$15,824.56
Rate for Payer: Fidelis Qualified Health Plan	$18,989.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$15,824.56
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$15,824.56
Rate for Payer: Healthfirst Commercial	$7,216.00
Rate for Payer: Healthfirst Essential Plan	$35,605.26
Rate for Payer: Healthfirst QHP	$4,206.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$15,824.56
Rate for Payer: SOMOS Essential	$35,605.26
Rate for Payer: United Healthcare Essential Plan 1&2	$35,605.26
Rate for Payer: United Healthcare Essential Plan 3&4	$35,605.26
Rate for Payer: United Healthcare Medicaid	$15,824.56
Rate for Payer: Wellcare CHP/FHP/Medicaid	$15,824.56

APR-DRG 8112: Allergic reactions

Facility

$37,944.40

Service Code	APR-DRG 8112
Min. Negotiated Rate	$5,300.00
Max. Negotiated Rate	$37,944.40
Rate for Payer: Affinity Essential Plan 1&2	$37,944.40
Rate for Payer: Affinity Essential Plan 3&4	$37,944.40
Rate for Payer: Affinity Medicaid/CHP/HARP	$16,864.18
Rate for Payer: Amida Care Medicaid	$16,864.18
Rate for Payer: Fidelis CHP/HARP/Medicaid	$16,864.18
Rate for Payer: Fidelis Qualified Health Plan	$20,237.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$16,864.18
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16,864.18
Rate for Payer: Healthfirst Commercial	$9,320.00
Rate for Payer: Healthfirst Essential Plan	$37,944.40
Rate for Payer: Healthfirst QHP	$5,300.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$16,864.18
Rate for Payer: SOMOS Essential	$37,944.40
Rate for Payer: United Healthcare Essential Plan 1&2	$37,944.40
Rate for Payer: United Healthcare Essential Plan 3&4	$37,944.40
Rate for Payer: United Healthcare Medicaid	$16,864.18
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,864.18

APR-DRG 8113: Allergic reactions

Facility

$48,064.23

Service Code	APR-DRG 8113
Min. Negotiated Rate	$9,322.00
Max. Negotiated Rate	$48,064.23
Rate for Payer: Affinity Essential Plan 1&2	$48,064.23
Rate for Payer: Affinity Essential Plan 3&4	$48,064.23
Rate for Payer: Affinity Medicaid/CHP/HARP	$21,361.88
Rate for Payer: Amida Care Medicaid	$21,361.88
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,361.88
Rate for Payer: Fidelis Qualified Health Plan	$25,634.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,361.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,361.88
Rate for Payer: Healthfirst Commercial	$17,190.00
Rate for Payer: Healthfirst Essential Plan	$48,064.23
Rate for Payer: Healthfirst QHP	$9,322.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,361.88
Rate for Payer: SOMOS Essential	$48,064.23
Rate for Payer: United Healthcare Essential Plan 1&2	$48,064.23
Rate for Payer: United Healthcare Essential Plan 3&4	$48,064.23
Rate for Payer: United Healthcare Medicaid	$21,361.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,361.88

APR-DRG 8114: Allergic reactions

Facility

$71,170.63

Service Code	APR-DRG 8114
Min. Negotiated Rate	$19,629.00
Max. Negotiated Rate	$71,170.63
Rate for Payer: Affinity Essential Plan 1&2	$71,170.63
Rate for Payer: Affinity Essential Plan 3&4	$71,170.63
Rate for Payer: Affinity Medicaid/CHP/HARP	$31,631.39
Rate for Payer: Amida Care Medicaid	$31,631.39
Rate for Payer: Fidelis CHP/HARP/Medicaid	$31,631.39
Rate for Payer: Fidelis Qualified Health Plan	$37,957.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$31,631.39
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31,631.39
Rate for Payer: Healthfirst Commercial	$47,154.00
Rate for Payer: Healthfirst Essential Plan	$71,170.63
Rate for Payer: Healthfirst QHP	$19,629.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$31,631.39
Rate for Payer: SOMOS Essential	$71,170.63
Rate for Payer: United Healthcare Essential Plan 1&2	$71,170.63
Rate for Payer: United Healthcare Essential Plan 3&4	$71,170.63
Rate for Payer: United Healthcare Medicaid	$31,631.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$31,631.39

APR-DRG 8121: Poisoning of medicinal agents

Facility

$36,845.19

Service Code	APR-DRG 8121
Min. Negotiated Rate	$5,088.00
Max. Negotiated Rate	$36,845.19
Rate for Payer: Affinity Essential Plan 1&2	$36,845.19
Rate for Payer: Affinity Essential Plan 3&4	$36,845.19
Rate for Payer: Affinity Medicaid/CHP/HARP	$16,375.64
Rate for Payer: Amida Care Medicaid	$16,375.64
Rate for Payer: Fidelis CHP/HARP/Medicaid	$16,375.64
Rate for Payer: Fidelis Qualified Health Plan	$19,650.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$16,375.64
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16,375.64
Rate for Payer: Healthfirst Commercial	$8,781.00
Rate for Payer: Healthfirst Essential Plan	$36,845.19
Rate for Payer: Healthfirst QHP	$5,088.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$16,375.64
Rate for Payer: SOMOS Essential	$36,845.19
Rate for Payer: United Healthcare Essential Plan 1&2	$36,845.19
Rate for Payer: United Healthcare Essential Plan 3&4	$36,845.19
Rate for Payer: United Healthcare Medicaid	$16,375.64
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,375.64

APR-DRG 8122: Poisoning of medicinal agents

Facility

$39,180.80

Service Code	APR-DRG 8122
Min. Negotiated Rate	$5,996.00
Max. Negotiated Rate	$39,180.80
Rate for Payer: Affinity Essential Plan 1&2	$39,180.80
Rate for Payer: Affinity Essential Plan 3&4	$39,180.80
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,413.69
Rate for Payer: Amida Care Medicaid	$17,413.69
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,413.69
Rate for Payer: Fidelis Qualified Health Plan	$20,896.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,413.69
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,413.69
Rate for Payer: Healthfirst Commercial	$10,352.00
Rate for Payer: Healthfirst Essential Plan	$39,180.80
Rate for Payer: Healthfirst QHP	$5,996.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,413.69
Rate for Payer: SOMOS Essential	$39,180.80
Rate for Payer: United Healthcare Essential Plan 1&2	$39,180.80
Rate for Payer: United Healthcare Essential Plan 3&4	$39,180.80
Rate for Payer: United Healthcare Medicaid	$17,413.69
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,413.69

APR-DRG 8123: Poisoning of medicinal agents

Facility

$45,823.59

Service Code	APR-DRG 8123
Min. Negotiated Rate	$9,535.00
Max. Negotiated Rate	$45,823.59
Rate for Payer: Affinity Essential Plan 1&2	$45,823.59
Rate for Payer: Affinity Essential Plan 3&4	$45,823.59
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,366.04
Rate for Payer: Amida Care Medicaid	$20,366.04
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,366.04
Rate for Payer: Fidelis Qualified Health Plan	$24,439.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,366.04
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,366.04
Rate for Payer: Healthfirst Commercial	$16,732.00
Rate for Payer: Healthfirst Essential Plan	$45,823.59
Rate for Payer: Healthfirst QHP	$9,535.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,366.04
Rate for Payer: SOMOS Essential	$45,823.59
Rate for Payer: United Healthcare Essential Plan 1&2	$45,823.59
Rate for Payer: United Healthcare Essential Plan 3&4	$45,823.59
Rate for Payer: United Healthcare Medicaid	$20,366.04
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,366.04

APR-DRG 8124: Poisoning of medicinal agents

Facility

$68,096.34

Service Code	APR-DRG 8124
Min. Negotiated Rate	$21,940.00
Max. Negotiated Rate	$68,096.34
Rate for Payer: Affinity Essential Plan 1&2	$68,096.34
Rate for Payer: Affinity Essential Plan 3&4	$68,096.34
Rate for Payer: Affinity Medicaid/CHP/HARP	$30,265.04
Rate for Payer: Amida Care Medicaid	$30,265.04
Rate for Payer: Fidelis CHP/HARP/Medicaid	$30,265.04
Rate for Payer: Fidelis Qualified Health Plan	$36,318.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$30,265.04
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$30,265.04
Rate for Payer: Healthfirst Commercial	$38,463.00
Rate for Payer: Healthfirst Essential Plan	$68,096.34
Rate for Payer: Healthfirst QHP	$21,940.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$30,265.04
Rate for Payer: SOMOS Essential	$68,096.34
Rate for Payer: United Healthcare Essential Plan 1&2	$68,096.34
Rate for Payer: United Healthcare Essential Plan 3&4	$68,096.34
Rate for Payer: United Healthcare Medicaid	$30,265.04
Rate for Payer: Wellcare CHP/FHP/Medicaid	$30,265.04

APR-DRG 8131: Other complications of treatment

Facility

$38,392.88

Service Code	APR-DRG 8131
Min. Negotiated Rate	$5,629.00
Max. Negotiated Rate	$38,392.88
Rate for Payer: Affinity Essential Plan 1&2	$38,392.88
Rate for Payer: Affinity Essential Plan 3&4	$38,392.88
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,063.50
Rate for Payer: Amida Care Medicaid	$17,063.50
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,063.50
Rate for Payer: Fidelis Qualified Health Plan	$20,476.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,063.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,063.50
Rate for Payer: Healthfirst Commercial	$10,152.00
Rate for Payer: Healthfirst Essential Plan	$38,392.88
Rate for Payer: Healthfirst QHP	$5,629.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,063.50
Rate for Payer: SOMOS Essential	$38,392.88
Rate for Payer: United Healthcare Essential Plan 1&2	$38,392.88
Rate for Payer: United Healthcare Essential Plan 3&4	$38,392.88
Rate for Payer: United Healthcare Medicaid	$17,063.50
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,063.50

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