St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

Coronary bypass w/o AMI or complex PDX

Facility

$84,844.12

Service Code	APR-DRG 1661
Min. Negotiated Rate	$29,804.00
Max. Negotiated Rate	$84,844.12
Rate for Payer: Affinity Essential Plan 1&2	$84,844.12
Rate for Payer: Affinity Essential Plan 3&4	$84,844.12
Rate for Payer: Affinity Medicaid/CHP/HARP	$37,708.50
Rate for Payer: Amida Care Medicaid	$37,708.50
Rate for Payer: EmblemHealth Essential Plan 1&2	$84,844.12
Rate for Payer: EmblemHealth Essential Plan 3&4	$37,708.50
Rate for Payer: Fidelis CHP/HARP/Medicaid	$37,708.50
Rate for Payer: Fidelis Qualified Health Plan	$45,250.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$37,708.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$37,708.50
Rate for Payer: Healthfirst Commercial	$48,620.00
Rate for Payer: Healthfirst Essential Plan	$84,844.12
Rate for Payer: Healthfirst QHP	$29,804.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$37,708.50
Rate for Payer: SOMOS Essential	$84,844.12
Rate for Payer: United Healthcare Essential Plan 1&2	$84,844.12
Rate for Payer: United Healthcare Essential Plan 3&4	$84,844.12
Rate for Payer: United Healthcare Medicaid	$37,708.50
Rate for Payer: Wellcare CHP/FHP/Medicaid	$37,708.50

Coronary bypass w/o AMI or complex PDX

Facility

$102,644.39

Service Code	APR-DRG 1663
Min. Negotiated Rate	$41,785.00
Max. Negotiated Rate	$102,644.39
Rate for Payer: Affinity Essential Plan 1&2	$102,644.39
Rate for Payer: Affinity Essential Plan 3&4	$102,644.39
Rate for Payer: Affinity Medicaid/CHP/HARP	$45,619.73
Rate for Payer: Amida Care Medicaid	$45,619.73
Rate for Payer: EmblemHealth Essential Plan 1&2	$102,644.39
Rate for Payer: EmblemHealth Essential Plan 3&4	$45,619.73
Rate for Payer: Fidelis CHP/HARP/Medicaid	$45,619.73
Rate for Payer: Fidelis Qualified Health Plan	$54,743.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$45,619.73
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$45,619.73
Rate for Payer: Healthfirst Commercial	$75,699.00
Rate for Payer: Healthfirst Essential Plan	$102,644.39
Rate for Payer: Healthfirst QHP	$41,785.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$45,619.73
Rate for Payer: SOMOS Essential	$102,644.39
Rate for Payer: United Healthcare Essential Plan 1&2	$102,644.39
Rate for Payer: United Healthcare Essential Plan 3&4	$102,644.39
Rate for Payer: United Healthcare Medicaid	$45,619.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$45,619.73

Coronary bypass w/o AMI or complex PDX

Facility

$89,379.95

Service Code	APR-DRG 1662
Min. Negotiated Rate	$33,191.00
Max. Negotiated Rate	$89,379.95
Rate for Payer: Affinity Essential Plan 1&2	$89,379.95
Rate for Payer: Affinity Essential Plan 3&4	$89,379.95
Rate for Payer: Affinity Medicaid/CHP/HARP	$39,724.42
Rate for Payer: Amida Care Medicaid	$39,724.42
Rate for Payer: EmblemHealth Essential Plan 1&2	$89,379.95
Rate for Payer: EmblemHealth Essential Plan 3&4	$39,724.42
Rate for Payer: Fidelis CHP/HARP/Medicaid	$39,724.42
Rate for Payer: Fidelis Qualified Health Plan	$47,669.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$39,724.42
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$39,724.42
Rate for Payer: Healthfirst Commercial	$55,156.00
Rate for Payer: Healthfirst Essential Plan	$89,379.95
Rate for Payer: Healthfirst QHP	$33,191.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$39,724.42
Rate for Payer: SOMOS Essential	$89,379.95
Rate for Payer: United Healthcare Essential Plan 1&2	$89,379.95
Rate for Payer: United Healthcare Essential Plan 3&4	$89,379.95
Rate for Payer: United Healthcare Medicaid	$39,724.42
Rate for Payer: Wellcare CHP/FHP/Medicaid	$39,724.42

COSYNTROPIN 0.25 MG IJ SOLR

Facility

$96.24

Service Code	HCPCS J0834
Hospital Charge Code	0781344071
Hospital Revenue Code	250
Min. Negotiated Rate	$48.12
Max. Negotiated Rate	$48.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.12

COSYNTROPIN 0.25 MG IJ SOLR

Facility

$96.24

Service Code	HCPCS J0834
Hospital Charge Code	0781344095
Hospital Revenue Code	250
Min. Negotiated Rate	$48.12
Max. Negotiated Rate	$48.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.12

COSYNTROPIN 0.25 MG IJ SOLR

Facility

$96.24

Service Code	HCPCS J0834
Hospital Charge Code	0781344095
Hospital Revenue Code	250
Min. Negotiated Rate	$25.37
Max. Negotiated Rate	$76.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$52.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.63
Rate for Payer: Aetna Government	$35.63
Rate for Payer: Brighton Health Commercial	$72.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$76.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$65.44
Rate for Payer: EmblemHealth Commercial	$48.12
Rate for Payer: Group Health Inc Commercial	$48.12
Rate for Payer: Group Health Inc Medicare	$33.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.12
Rate for Payer: Hamaspik Choice Inc Medicare	$48.12
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$62.56

COSYNTROPIN 0.25 MG IJ SOLR

Facility

$96.24

Service Code	HCPCS J0834
Hospital Charge Code	0781344071
Hospital Revenue Code	250
Min. Negotiated Rate	$25.37
Max. Negotiated Rate	$76.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$52.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.63
Rate for Payer: Aetna Government	$35.63
Rate for Payer: Brighton Health Commercial	$72.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$76.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$65.44
Rate for Payer: EmblemHealth Commercial	$48.12
Rate for Payer: Group Health Inc Commercial	$48.12
Rate for Payer: Group Health Inc Medicare	$33.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.12
Rate for Payer: Hamaspik Choice Inc Medicare	$48.12
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$62.56

COUNSELLING OR INDIVIDUAL BRIEF PSYCHOTHERAPY

Facility

$197.87

Service Code	EAPG 00315
Min. Negotiated Rate	$143.49
Max. Negotiated Rate	$197.87
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$143.49
Rate for Payer: Healthfirst Commercial	$197.87

COVID-19 MRNA VAC-TRIS(PFIZER) 30 MCG/0.3ML IM SUSP

Facility

$460.00

Service Code	HCPCS 91305
Hospital Charge Code	0069236210
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$368.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$253.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$345.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$368.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$312.80
Rate for Payer: EmblemHealth Commercial	$230.00
Rate for Payer: Group Health Inc Commercial	$230.00
Rate for Payer: Group Health Inc Medicare	$161.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$230.00
Rate for Payer: Hamaspik Choice Inc Medicare	$230.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$299.00

COVID-19 MRNA VAC-TRIS(PFIZER) 30 MCG/0.3ML IM SUSP

Facility

$0.00

Service Code	HCPCS 91305
Hospital Charge Code	5926710254
Hospital Revenue Code	250
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00

COVID-19 MRNA VAC-TRIS(PFIZER) 30 MCG/0.3ML IM SUSP

Facility

$460.00

Service Code	HCPCS 91305
Hospital Charge Code	0069236210
Hospital Revenue Code	250
Min. Negotiated Rate	$230.00
Max. Negotiated Rate	$230.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$230.00

COVID-19 MRNA VAC-TRIS(PFIZER) 30 MCG/0.3ML IM SUSP

Facility

$0.00

Service Code	HCPCS 91305
Hospital Charge Code	5926710254
Hospital Revenue Code	250
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.00
Rate for Payer: EmblemHealth Commercial	$0.00
Rate for Payer: Group Health Inc Commercial	$0.00
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00
Rate for Payer: Hamaspik Choice Inc Medicare	$0.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.00

COVID-19 MRNA VAC-TRIS(PFIZER) 30 MCG/0.3ML IM SUSY

Facility

$590.76

Service Code	HCPCS 91320
Hospital Charge Code	0069252801
Hospital Revenue Code	250
Min. Negotiated Rate	$168.37
Max. Negotiated Rate	$472.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$324.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$295.38
Rate for Payer: Aetna Government	$295.38
Rate for Payer: Brighton Health Commercial	$443.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$472.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$401.72
Rate for Payer: EmblemHealth Commercial	$295.38
Rate for Payer: Group Health Inc Commercial	$295.38
Rate for Payer: Group Health Inc Medicare	$206.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$295.38
Rate for Payer: Hamaspik Choice Inc Medicare	$295.38
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$168.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$383.99

COVID-19 MRNA VAC-TRIS(PFIZER) 30 MCG/0.3ML IM SUSY

Facility

$590.76

Service Code	HCPCS 91320
Hospital Charge Code	0069252810
Hospital Revenue Code	250
Min. Negotiated Rate	$295.38
Max. Negotiated Rate	$295.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$295.38

COVID-19 MRNA VAC-TRIS(PFIZER) 30 MCG/0.3ML IM SUSY

Facility

$590.76

Service Code	HCPCS 91320
Hospital Charge Code	0069252801
Hospital Revenue Code	250
Min. Negotiated Rate	$295.38
Max. Negotiated Rate	$295.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$295.38

COVID-19 MRNA VAC-TRIS(PFIZER) 30 MCG/0.3ML IM SUSY

Facility

$590.76

Service Code	HCPCS 91320
Hospital Charge Code	0069252810
Hospital Revenue Code	250
Min. Negotiated Rate	$168.37
Max. Negotiated Rate	$472.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$324.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$295.38
Rate for Payer: Aetna Government	$295.38
Rate for Payer: Brighton Health Commercial	$443.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$472.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$401.72
Rate for Payer: EmblemHealth Commercial	$295.38
Rate for Payer: Group Health Inc Commercial	$295.38
Rate for Payer: Group Health Inc Medicare	$206.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$295.38
Rate for Payer: Hamaspik Choice Inc Medicare	$295.38
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$168.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$383.99

CRANIAL AND SPINAL SHUNT PROCEDURES

Facility

$4,475.86

Service Code	EAPG 00268
Min. Negotiated Rate	$4,475.86
Max. Negotiated Rate	$4,475.86
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$4,475.86

Craniotomy except for trauma

Facility

$79,101.83

Service Code	APR-DRG 0212
Min. Negotiated Rate	$30,190.00
Max. Negotiated Rate	$79,101.83
Rate for Payer: Affinity Essential Plan 1&2	$79,101.83
Rate for Payer: Affinity Essential Plan 3&4	$79,101.83
Rate for Payer: Affinity Medicaid/CHP/HARP	$35,156.37
Rate for Payer: Amida Care Medicaid	$35,156.37
Rate for Payer: EmblemHealth Essential Plan 1&2	$79,101.83
Rate for Payer: EmblemHealth Essential Plan 3&4	$35,156.37
Rate for Payer: Fidelis CHP/HARP/Medicaid	$35,156.37
Rate for Payer: Fidelis Qualified Health Plan	$42,187.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$35,156.37
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$35,156.37
Rate for Payer: Healthfirst Commercial	$49,085.00
Rate for Payer: Healthfirst Essential Plan	$79,101.83
Rate for Payer: Healthfirst QHP	$30,190.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$35,156.37
Rate for Payer: SOMOS Essential	$79,101.83
Rate for Payer: United Healthcare Essential Plan 1&2	$79,101.83
Rate for Payer: United Healthcare Essential Plan 3&4	$79,101.83
Rate for Payer: United Healthcare Medicaid	$35,156.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$35,156.37

Craniotomy except for trauma

Facility

$159,374.52

Service Code	APR-DRG 0214
Min. Negotiated Rate	$70,833.12
Max. Negotiated Rate	$159,374.52
Rate for Payer: Affinity Essential Plan 1&2	$159,374.52
Rate for Payer: Affinity Essential Plan 3&4	$159,374.52
Rate for Payer: Affinity Medicaid/CHP/HARP	$70,833.12
Rate for Payer: Amida Care Medicaid	$70,833.12
Rate for Payer: EmblemHealth Essential Plan 1&2	$159,374.52
Rate for Payer: EmblemHealth Essential Plan 3&4	$70,833.12
Rate for Payer: Fidelis CHP/HARP/Medicaid	$70,833.12
Rate for Payer: Fidelis Qualified Health Plan	$84,999.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$70,833.12
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$70,833.12
Rate for Payer: Healthfirst Commercial	$135,401.00
Rate for Payer: Healthfirst Essential Plan	$159,374.52
Rate for Payer: Healthfirst QHP	$96,015.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$70,833.12
Rate for Payer: SOMOS Essential	$159,374.52
Rate for Payer: United Healthcare Essential Plan 1&2	$159,374.52
Rate for Payer: United Healthcare Essential Plan 3&4	$159,374.52
Rate for Payer: United Healthcare Medicaid	$70,833.12
Rate for Payer: Wellcare CHP/FHP/Medicaid	$70,833.12

Craniotomy except for trauma

Facility

$65,329.09

Service Code	APR-DRG 0211
Min. Negotiated Rate	$22,834.00
Max. Negotiated Rate	$65,329.09
Rate for Payer: Affinity Essential Plan 1&2	$65,329.09
Rate for Payer: Affinity Essential Plan 3&4	$65,329.09
Rate for Payer: Affinity Medicaid/CHP/HARP	$29,035.15
Rate for Payer: Amida Care Medicaid	$29,035.15
Rate for Payer: EmblemHealth Essential Plan 1&2	$65,329.09
Rate for Payer: EmblemHealth Essential Plan 3&4	$29,035.15
Rate for Payer: Fidelis CHP/HARP/Medicaid	$29,035.15
Rate for Payer: Fidelis Qualified Health Plan	$34,842.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$29,035.15
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29,035.15
Rate for Payer: Healthfirst Commercial	$35,835.00
Rate for Payer: Healthfirst Essential Plan	$65,329.09
Rate for Payer: Healthfirst QHP	$22,834.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$29,035.15
Rate for Payer: SOMOS Essential	$65,329.09
Rate for Payer: United Healthcare Essential Plan 1&2	$65,329.09
Rate for Payer: United Healthcare Essential Plan 3&4	$65,329.09
Rate for Payer: United Healthcare Medicaid	$29,035.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$29,035.15

Craniotomy except for trauma

Facility

$108,203.80

Service Code	APR-DRG 0213
Min. Negotiated Rate	$48,090.58
Max. Negotiated Rate	$108,203.80
Rate for Payer: Affinity Essential Plan 1&2	$108,203.80
Rate for Payer: Affinity Essential Plan 3&4	$108,203.80
Rate for Payer: Affinity Medicaid/CHP/HARP	$48,090.58
Rate for Payer: Amida Care Medicaid	$48,090.58
Rate for Payer: EmblemHealth Essential Plan 1&2	$108,203.80
Rate for Payer: EmblemHealth Essential Plan 3&4	$48,090.58
Rate for Payer: Fidelis CHP/HARP/Medicaid	$48,090.58
Rate for Payer: Fidelis Qualified Health Plan	$57,708.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$48,090.58
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$48,090.58
Rate for Payer: Healthfirst Commercial	$78,526.00
Rate for Payer: Healthfirst Essential Plan	$108,203.80
Rate for Payer: Healthfirst QHP	$52,885.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$48,090.58
Rate for Payer: SOMOS Essential	$108,203.80
Rate for Payer: United Healthcare Essential Plan 1&2	$108,203.80
Rate for Payer: United Healthcare Essential Plan 3&4	$108,203.80
Rate for Payer: United Healthcare Medicaid	$48,090.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$48,090.58

Craniotomy for multiple significant trauma

Facility

$98,134.96

Service Code	APR-DRG 9101
Min. Negotiated Rate	$36,049.00
Max. Negotiated Rate	$98,134.96
Rate for Payer: Affinity Essential Plan 1&2	$98,134.96
Rate for Payer: Affinity Essential Plan 3&4	$98,134.96
Rate for Payer: Affinity Medicaid/CHP/HARP	$43,615.54
Rate for Payer: Amida Care Medicaid	$43,615.54
Rate for Payer: EmblemHealth Essential Plan 1&2	$98,134.96
Rate for Payer: EmblemHealth Essential Plan 3&4	$43,615.54
Rate for Payer: Fidelis CHP/HARP/Medicaid	$43,615.54
Rate for Payer: Fidelis Qualified Health Plan	$52,338.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$43,615.54
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$43,615.54
Rate for Payer: Healthfirst Commercial	$47,941.00
Rate for Payer: Healthfirst Essential Plan	$98,134.96
Rate for Payer: Healthfirst QHP	$36,049.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$43,615.54
Rate for Payer: SOMOS Essential	$98,134.96
Rate for Payer: United Healthcare Essential Plan 1&2	$98,134.96
Rate for Payer: United Healthcare Essential Plan 3&4	$98,134.96
Rate for Payer: United Healthcare Medicaid	$43,615.54
Rate for Payer: Wellcare CHP/FHP/Medicaid	$43,615.54

Craniotomy for multiple significant trauma

Facility

$158,338.62

Service Code	APR-DRG 9104
Min. Negotiated Rate	$70,372.72
Max. Negotiated Rate	$158,338.62
Rate for Payer: Affinity Essential Plan 1&2	$158,338.62
Rate for Payer: Affinity Essential Plan 3&4	$158,338.62
Rate for Payer: Affinity Medicaid/CHP/HARP	$70,372.72
Rate for Payer: Amida Care Medicaid	$70,372.72
Rate for Payer: EmblemHealth Essential Plan 1&2	$158,338.62
Rate for Payer: EmblemHealth Essential Plan 3&4	$70,372.72
Rate for Payer: Fidelis CHP/HARP/Medicaid	$70,372.72
Rate for Payer: Fidelis Qualified Health Plan	$84,447.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$70,372.72
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$70,372.72
Rate for Payer: Healthfirst Commercial	$122,264.00
Rate for Payer: Healthfirst Essential Plan	$158,338.62
Rate for Payer: Healthfirst QHP	$84,332.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$70,372.72
Rate for Payer: SOMOS Essential	$158,338.62
Rate for Payer: United Healthcare Essential Plan 1&2	$158,338.62
Rate for Payer: United Healthcare Essential Plan 3&4	$158,338.62
Rate for Payer: United Healthcare Medicaid	$70,372.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$70,372.72

Craniotomy for multiple significant trauma

Facility

$100,205.01

Service Code	APR-DRG 9103
Min. Negotiated Rate	$44,535.56
Max. Negotiated Rate	$100,205.01
Rate for Payer: Affinity Essential Plan 1&2	$100,205.01
Rate for Payer: Affinity Essential Plan 3&4	$100,205.01
Rate for Payer: Affinity Medicaid/CHP/HARP	$44,535.56
Rate for Payer: Amida Care Medicaid	$44,535.56
Rate for Payer: EmblemHealth Essential Plan 1&2	$100,205.01
Rate for Payer: EmblemHealth Essential Plan 3&4	$44,535.56
Rate for Payer: Fidelis CHP/HARP/Medicaid	$44,535.56
Rate for Payer: Fidelis Qualified Health Plan	$53,442.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$44,535.56
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$44,535.56
Rate for Payer: Healthfirst Commercial	$68,166.00
Rate for Payer: Healthfirst Essential Plan	$100,205.01
Rate for Payer: Healthfirst QHP	$45,621.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$44,535.56
Rate for Payer: SOMOS Essential	$100,205.01
Rate for Payer: United Healthcare Essential Plan 1&2	$100,205.01
Rate for Payer: United Healthcare Essential Plan 3&4	$100,205.01
Rate for Payer: United Healthcare Medicaid	$44,535.56
Rate for Payer: Wellcare CHP/FHP/Medicaid	$44,535.56

Craniotomy for multiple significant trauma

Facility

$98,134.96

Service Code	APR-DRG 9102
Min. Negotiated Rate	$36,049.00
Max. Negotiated Rate	$98,134.96
Rate for Payer: Affinity Essential Plan 1&2	$98,134.96
Rate for Payer: Affinity Essential Plan 3&4	$98,134.96
Rate for Payer: Affinity Medicaid/CHP/HARP	$43,615.54
Rate for Payer: Amida Care Medicaid	$43,615.54
Rate for Payer: EmblemHealth Essential Plan 1&2	$98,134.96
Rate for Payer: EmblemHealth Essential Plan 3&4	$43,615.54
Rate for Payer: Fidelis CHP/HARP/Medicaid	$43,615.54
Rate for Payer: Fidelis Qualified Health Plan	$52,338.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$43,615.54
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$43,615.54
Rate for Payer: Healthfirst Commercial	$47,941.00
Rate for Payer: Healthfirst Essential Plan	$98,134.96
Rate for Payer: Healthfirst QHP	$36,049.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$43,615.54
Rate for Payer: SOMOS Essential	$98,134.96
Rate for Payer: United Healthcare Essential Plan 1&2	$98,134.96
Rate for Payer: United Healthcare Essential Plan 3&4	$98,134.96
Rate for Payer: United Healthcare Medicaid	$43,615.54
Rate for Payer: Wellcare CHP/FHP/Medicaid	$43,615.54

Know your out-of-pocket cost for care.

All Charges