St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

DECITABINE 50 MG SUBCUTANEOUS SOLUTION

Facility

$120.00

Service Code	HCPCS J0894
Hospital Charge Code	0143938501
Hospital Revenue Code	250
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.00

DECITABINE 50 MG SUBCUTANEOUS SOLUTION

Facility

$1.00

Service Code	HCPCS J0894
Hospital Charge Code	1672922405
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

DECITABINE 50 MG SUBCUTANEOUS SOLUTION

Facility

$120.00

Service Code	HCPCS J0894
Hospital Charge Code	7128811920
Hospital Revenue Code	250
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.00

DECITABINE 50 MG SUBCUTANEOUS SOLUTION

Facility

$120.00

Service Code	HCPCS J0894
Hospital Charge Code	7128811920
Hospital Revenue Code	250
Min. Negotiated Rate	$3.43
Max. Negotiated Rate	$96.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$66.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.43
Rate for Payer: Aetna Government	$3.43
Rate for Payer: Brighton Health Commercial	$90.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$96.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$81.60
Rate for Payer: EmblemHealth Commercial	$60.00
Rate for Payer: Group Health Inc Commercial	$60.00
Rate for Payer: Group Health Inc Medicare	$42.00
Rate for Payer: Hamaspik Choice Inc Medicare	$60.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$78.00

DEEP LYMPH STRUCTURE PROCEDURES

Facility

$2,499.98

Service Code	EAPG 00115
Min. Negotiated Rate	$1,814.41
Max. Negotiated Rate	$2,499.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,814.41
Rate for Payer: Healthfirst Commercial	$2,499.98

DEGENERATIVE NERVOUS SYSTEM DIAGNOSES EXC MULT SCLEROSIS

Facility

$230.40

Service Code	EAPG 00522
Min. Negotiated Rate	$166.63
Max. Negotiated Rate	$230.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$166.63
Rate for Payer: Healthfirst Commercial	$230.40

Degenerative nervous system disorders exc mult sclerosis

Facility

$21,694.00

Service Code	APR-DRG 0423
Min. Negotiated Rate	$3,266.42
Max. Negotiated Rate	$21,694.00
Rate for Payer: Affinity Essential Plan 1&2	$3,266.42
Rate for Payer: Affinity Essential Plan 3&4	$3,266.42
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,266.42
Rate for Payer: Carelon Behavioral Health HARP/QHP	$3,266.42
Rate for Payer: EmblemHealth Essential Plan 1&2	$7,349.44
Rate for Payer: EmblemHealth Essential Plan 3&4	$3,266.42
Rate for Payer: Fidelis Qualified Health Plan	$3,919.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,266.42
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,266.42
Rate for Payer: Healthfirst Commercial	$21,694.00
Rate for Payer: Healthfirst Essential Plan	$7,349.44
Rate for Payer: Healthfirst QHP	$5,944.88
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$3,266.42
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7,349.44
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7,349.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,266.42
Rate for Payer: SOMOS Essential	$7,349.44
Rate for Payer: United Healthcare Essential Plan 1&2	$7,349.44
Rate for Payer: United Healthcare Essential Plan 3&4	$7,349.44
Rate for Payer: United Healthcare Medicaid	$3,266.42

Degenerative nervous system disorders exc mult sclerosis

Facility

$12,179.00

Service Code	APR-DRG 0421
Min. Negotiated Rate	$3,266.42
Max. Negotiated Rate	$12,179.00
Rate for Payer: Affinity Essential Plan 1&2	$3,266.42
Rate for Payer: Affinity Essential Plan 3&4	$3,266.42
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,266.42
Rate for Payer: Carelon Behavioral Health HARP/QHP	$3,266.42
Rate for Payer: EmblemHealth Essential Plan 1&2	$7,349.44
Rate for Payer: EmblemHealth Essential Plan 3&4	$3,266.42
Rate for Payer: Fidelis Qualified Health Plan	$3,919.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,266.42
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,266.42
Rate for Payer: Healthfirst Commercial	$12,179.00
Rate for Payer: Healthfirst Essential Plan	$7,349.44
Rate for Payer: Healthfirst QHP	$5,944.88
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$3,266.42
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7,349.44
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7,349.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,266.42
Rate for Payer: SOMOS Essential	$7,349.44
Rate for Payer: United Healthcare Essential Plan 1&2	$7,349.44
Rate for Payer: United Healthcare Essential Plan 3&4	$7,349.44
Rate for Payer: United Healthcare Medicaid	$3,266.42

Degenerative nervous system disorders exc mult sclerosis

Facility

$56,848.00

Service Code	APR-DRG 0424
Min. Negotiated Rate	$3,266.42
Max. Negotiated Rate	$56,848.00
Rate for Payer: Affinity Essential Plan 1&2	$3,266.42
Rate for Payer: Affinity Essential Plan 3&4	$3,266.42
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,266.42
Rate for Payer: Carelon Behavioral Health HARP/QHP	$3,266.42
Rate for Payer: EmblemHealth Essential Plan 1&2	$7,349.44
Rate for Payer: EmblemHealth Essential Plan 3&4	$3,266.42
Rate for Payer: Fidelis Qualified Health Plan	$3,919.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,266.42
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,266.42
Rate for Payer: Healthfirst Commercial	$56,848.00
Rate for Payer: Healthfirst Essential Plan	$7,349.44
Rate for Payer: Healthfirst QHP	$5,944.88
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$3,266.42
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7,349.44
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7,349.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,266.42
Rate for Payer: SOMOS Essential	$7,349.44
Rate for Payer: United Healthcare Essential Plan 1&2	$7,349.44
Rate for Payer: United Healthcare Essential Plan 3&4	$7,349.44
Rate for Payer: United Healthcare Medicaid	$3,266.42

Degenerative nervous system disorders exc mult sclerosis

Facility

$15,854.00

Service Code	APR-DRG 0422
Min. Negotiated Rate	$3,266.42
Max. Negotiated Rate	$15,854.00
Rate for Payer: Affinity Essential Plan 1&2	$3,266.42
Rate for Payer: Affinity Essential Plan 3&4	$3,266.42
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,266.42
Rate for Payer: Carelon Behavioral Health HARP/QHP	$3,266.42
Rate for Payer: EmblemHealth Essential Plan 1&2	$7,349.44
Rate for Payer: EmblemHealth Essential Plan 3&4	$3,266.42
Rate for Payer: Fidelis Qualified Health Plan	$3,919.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,266.42
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,266.42
Rate for Payer: Healthfirst Commercial	$15,854.00
Rate for Payer: Healthfirst Essential Plan	$7,349.44
Rate for Payer: Healthfirst QHP	$5,944.88
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$3,266.42
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7,349.44
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7,349.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,266.42
Rate for Payer: SOMOS Essential	$7,349.44
Rate for Payer: United Healthcare Essential Plan 1&2	$7,349.44
Rate for Payer: United Healthcare Essential Plan 3&4	$7,349.44
Rate for Payer: United Healthcare Medicaid	$3,266.42

DENOSUMAB 120 MG/1.7ML SC SOLN

Facility

$2.00

Service Code	HCPCS J0897
Hospital Charge Code	5551373001
Hospital Revenue Code	250
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$29.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$29.38
Rate for Payer: Aetna Government	$29.38
Rate for Payer: Affinity Essential Plan 1&2	$20.57
Rate for Payer: Affinity Essential Plan 3&4	$20.57
Rate for Payer: Affinity Medicaid/CHP/HARP	$20.57
Rate for Payer: Brighton Health Commercial	$1.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$29.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.36
Rate for Payer: Elderplan Medicare Advantage	$29.38
Rate for Payer: EmblemHealth Commercial	$29.38
Rate for Payer: Fidelis CHP/HARP/Medicaid	$26.44
Rate for Payer: Fidelis Essential Plan Aliesa	$24.97
Rate for Payer: Fidelis Essential Plan QHP	$26.15
Rate for Payer: Fidelis Medicare Advantage	$29.38
Rate for Payer: Fidelis Qualified Health Plan	$26.15
Rate for Payer: Group Health Inc Commercial	$29.38
Rate for Payer: Group Health Inc Medicare	$29.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.38
Rate for Payer: Hamaspik Choice Inc Medicare	$29.38
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29.38
Rate for Payer: Healthfirst Medicare Advantage	$24.97
Rate for Payer: Healthfirst QHP	$29.38
Rate for Payer: Humana Medicare	$29.97
Rate for Payer: Senior Whole Health Medicare Advantage	$29.38
Rate for Payer: United Healthcare Medicare Advantage	$29.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$27.91
Rate for Payer: Wellcare Medicare	$27.91

DENOSUMAB 120 MG/1.7ML SC SOLN

Facility

$2.00

Service Code	HCPCS J0897
Hospital Charge Code	5551373001
Hospital Revenue Code	250
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00

DENOSUMAB 60 MG/ML SC SOSY

Facility

$2.00

Service Code	HCPCS J0897
Hospital Charge Code	5551371001
Hospital Revenue Code	250
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$29.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$29.38
Rate for Payer: Aetna Government	$29.38
Rate for Payer: Affinity Essential Plan 1&2	$20.57
Rate for Payer: Affinity Essential Plan 3&4	$20.57
Rate for Payer: Affinity Medicaid/CHP/HARP	$20.57
Rate for Payer: Brighton Health Commercial	$1.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$29.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.36
Rate for Payer: Elderplan Medicare Advantage	$29.38
Rate for Payer: EmblemHealth Commercial	$29.38
Rate for Payer: Fidelis CHP/HARP/Medicaid	$26.44
Rate for Payer: Fidelis Essential Plan Aliesa	$24.97
Rate for Payer: Fidelis Essential Plan QHP	$26.15
Rate for Payer: Fidelis Medicare Advantage	$29.38
Rate for Payer: Fidelis Qualified Health Plan	$26.15
Rate for Payer: Group Health Inc Commercial	$29.38
Rate for Payer: Group Health Inc Medicare	$29.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.38
Rate for Payer: Hamaspik Choice Inc Medicare	$29.38
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29.38
Rate for Payer: Healthfirst Medicare Advantage	$24.97
Rate for Payer: Healthfirst QHP	$29.38
Rate for Payer: Humana Medicare	$29.97
Rate for Payer: Senior Whole Health Medicare Advantage	$29.38
Rate for Payer: United Healthcare Medicare Advantage	$29.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$27.91
Rate for Payer: Wellcare Medicare	$27.91

DENOSUMAB 60 MG/ML SC SOSY

Facility

$2.00

Service Code	HCPCS J0897
Hospital Charge Code	5551371021
Hospital Revenue Code	250
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00

DENOSUMAB 60 MG/ML SC SOSY

Facility

$2.00

Service Code	HCPCS J0897
Hospital Charge Code	5551371021
Hospital Revenue Code	250
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$29.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$29.38
Rate for Payer: Aetna Government	$29.38
Rate for Payer: Affinity Essential Plan 1&2	$20.57
Rate for Payer: Affinity Essential Plan 3&4	$20.57
Rate for Payer: Affinity Medicaid/CHP/HARP	$20.57
Rate for Payer: Brighton Health Commercial	$1.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$29.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.36
Rate for Payer: Elderplan Medicare Advantage	$29.38
Rate for Payer: EmblemHealth Commercial	$29.38
Rate for Payer: Fidelis CHP/HARP/Medicaid	$26.44
Rate for Payer: Fidelis Essential Plan Aliesa	$24.97
Rate for Payer: Fidelis Essential Plan QHP	$26.15
Rate for Payer: Fidelis Medicare Advantage	$29.38
Rate for Payer: Fidelis Qualified Health Plan	$26.15
Rate for Payer: Group Health Inc Commercial	$29.38
Rate for Payer: Group Health Inc Medicare	$29.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.38
Rate for Payer: Hamaspik Choice Inc Medicare	$29.38
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29.38
Rate for Payer: Healthfirst Medicare Advantage	$24.97
Rate for Payer: Healthfirst QHP	$29.38
Rate for Payer: Humana Medicare	$29.97
Rate for Payer: Senior Whole Health Medicare Advantage	$29.38
Rate for Payer: United Healthcare Medicare Advantage	$29.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$27.91
Rate for Payer: Wellcare Medicare	$27.91

DENOSUMAB 60 MG/ML SC SOSY

Facility

$2.00

Service Code	HCPCS J0897
Hospital Charge Code	5551371001
Hospital Revenue Code	250
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00

DENTAL AND ORAL DIAGNOSES AND INJURIES

Facility

$198.16

Service Code	EAPG 00563
Min. Negotiated Rate	$143.49
Max. Negotiated Rate	$198.16
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$143.49
Rate for Payer: Healthfirst Commercial	$198.16

DENTAL ANESTHESIA

Facility

$1,801.48

Service Code	EAPG 00375
Min. Negotiated Rate	$1,307.58
Max. Negotiated Rate	$1,801.48
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,307.58
Rate for Payer: Healthfirst Commercial	$1,801.48

Dental & oral diseases & injuries

Facility

$40,435.79

Service Code	APR-DRG 1141
Min. Negotiated Rate	$5,655.00
Max. Negotiated Rate	$40,435.79
Rate for Payer: Affinity Essential Plan 1&2	$40,435.79
Rate for Payer: Affinity Essential Plan 3&4	$40,435.79
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,971.46
Rate for Payer: Amida Care Medicaid	$17,971.46
Rate for Payer: EmblemHealth Essential Plan 1&2	$40,435.79
Rate for Payer: EmblemHealth Essential Plan 3&4	$17,971.46
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,971.46
Rate for Payer: Fidelis Qualified Health Plan	$21,565.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,971.46
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,971.46
Rate for Payer: Healthfirst Commercial	$9,732.00
Rate for Payer: Healthfirst Essential Plan	$40,435.79
Rate for Payer: Healthfirst QHP	$5,655.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,971.46
Rate for Payer: SOMOS Essential	$40,435.79
Rate for Payer: United Healthcare Essential Plan 1&2	$40,435.79
Rate for Payer: United Healthcare Essential Plan 3&4	$40,435.79
Rate for Payer: United Healthcare Medicaid	$17,971.46
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,971.46

Dental & oral diseases & injuries

Facility

$75,415.50

Service Code	APR-DRG 1144
Min. Negotiated Rate	$12,032.00
Max. Negotiated Rate	$75,415.50
Rate for Payer: Affinity Essential Plan 1&2	$75,415.50
Rate for Payer: Affinity Essential Plan 3&4	$75,415.50
Rate for Payer: Affinity Medicaid/CHP/HARP	$33,518.00
Rate for Payer: Amida Care Medicaid	$33,518.00
Rate for Payer: EmblemHealth Essential Plan 1&2	$75,415.50
Rate for Payer: EmblemHealth Essential Plan 3&4	$33,518.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$33,518.00
Rate for Payer: Fidelis Qualified Health Plan	$40,221.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$33,518.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$33,518.00
Rate for Payer: Healthfirst Commercial	$54,720.00
Rate for Payer: Healthfirst Essential Plan	$75,415.50
Rate for Payer: Healthfirst QHP	$12,032.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$33,518.00
Rate for Payer: SOMOS Essential	$75,415.50
Rate for Payer: United Healthcare Essential Plan 1&2	$75,415.50
Rate for Payer: United Healthcare Essential Plan 3&4	$75,415.50
Rate for Payer: United Healthcare Medicaid	$33,518.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$33,518.00

Dental & oral diseases & injuries

Facility

$53,118.11

Service Code	APR-DRG 1143
Min. Negotiated Rate	$11,789.00
Max. Negotiated Rate	$53,118.11
Rate for Payer: Affinity Essential Plan 1&2	$53,118.11
Rate for Payer: Affinity Essential Plan 3&4	$53,118.11
Rate for Payer: Affinity Medicaid/CHP/HARP	$23,608.05
Rate for Payer: Amida Care Medicaid	$23,608.05
Rate for Payer: EmblemHealth Essential Plan 1&2	$53,118.11
Rate for Payer: EmblemHealth Essential Plan 3&4	$23,608.05
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,608.05
Rate for Payer: Fidelis Qualified Health Plan	$28,329.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,608.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,608.05
Rate for Payer: Healthfirst Commercial	$19,825.00
Rate for Payer: Healthfirst Essential Plan	$53,118.11
Rate for Payer: Healthfirst QHP	$11,789.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,608.05
Rate for Payer: SOMOS Essential	$53,118.11
Rate for Payer: United Healthcare Essential Plan 1&2	$53,118.11
Rate for Payer: United Healthcare Essential Plan 3&4	$53,118.11
Rate for Payer: United Healthcare Medicaid	$23,608.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,608.05

Dental & oral diseases & injuries

Facility

$42,664.12

Service Code	APR-DRG 1142
Min. Negotiated Rate	$6,867.00
Max. Negotiated Rate	$42,664.12
Rate for Payer: Affinity Essential Plan 1&2	$42,664.12
Rate for Payer: Affinity Essential Plan 3&4	$42,664.12
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,961.83
Rate for Payer: Amida Care Medicaid	$18,961.83
Rate for Payer: EmblemHealth Essential Plan 1&2	$42,664.12
Rate for Payer: EmblemHealth Essential Plan 3&4	$18,961.83
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,961.83
Rate for Payer: Fidelis Qualified Health Plan	$22,754.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,961.83
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,961.83
Rate for Payer: Healthfirst Commercial	$11,728.00
Rate for Payer: Healthfirst Essential Plan	$42,664.12
Rate for Payer: Healthfirst QHP	$6,867.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,961.83
Rate for Payer: SOMOS Essential	$42,664.12
Rate for Payer: United Healthcare Essential Plan 1&2	$42,664.12
Rate for Payer: United Healthcare Essential Plan 3&4	$42,664.12
Rate for Payer: United Healthcare Medicaid	$18,961.83
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,961.83

DEPRESSION EXCEPT MAJOR DEPRESSIVE DIAGNOSES

Facility

$211.05

Service Code	EAPG 00824
Min. Negotiated Rate	$152.74
Max. Negotiated Rate	$211.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$152.74
Rate for Payer: Healthfirst Commercial	$211.05

Depression except major depressive disorder

Facility

$11,233.00

Service Code	APR-DRG 7544
Min. Negotiated Rate	$3,433.49
Max. Negotiated Rate	$11,233.00
Rate for Payer: Affinity Essential Plan 1&2	$3,433.49
Rate for Payer: Affinity Essential Plan 3&4	$3,433.49
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,433.49
Rate for Payer: Carelon Behavioral Health HARP/QHP	$3,433.49
Rate for Payer: EmblemHealth Essential Plan 1&2	$7,725.35
Rate for Payer: EmblemHealth Essential Plan 3&4	$3,433.49
Rate for Payer: Fidelis Qualified Health Plan	$4,120.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,433.49
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,433.49
Rate for Payer: Healthfirst Commercial	$11,233.00
Rate for Payer: Healthfirst Essential Plan	$7,725.35
Rate for Payer: Healthfirst QHP	$6,248.95
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$3,433.49
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7,725.35
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7,725.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,433.49
Rate for Payer: SOMOS Essential	$7,725.35
Rate for Payer: United Healthcare Essential Plan 1&2	$7,725.35
Rate for Payer: United Healthcare Essential Plan 3&4	$7,725.35
Rate for Payer: United Healthcare Medicaid	$3,433.49

Depression except major depressive disorder

Facility

$9,529.00

Service Code	APR-DRG 7541
Min. Negotiated Rate	$3,364.48
Max. Negotiated Rate	$9,529.00
Rate for Payer: Affinity Essential Plan 1&2	$3,364.48
Rate for Payer: Affinity Essential Plan 3&4	$3,364.48
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,364.48
Rate for Payer: Carelon Behavioral Health HARP/QHP	$3,364.48
Rate for Payer: EmblemHealth Essential Plan 1&2	$7,570.08
Rate for Payer: EmblemHealth Essential Plan 3&4	$3,364.48
Rate for Payer: Fidelis Qualified Health Plan	$4,037.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,364.48
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,364.48
Rate for Payer: Healthfirst Commercial	$9,529.00
Rate for Payer: Healthfirst Essential Plan	$7,570.08
Rate for Payer: Healthfirst QHP	$6,123.35
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$3,364.48
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7,570.08
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7,570.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,364.48
Rate for Payer: SOMOS Essential	$7,570.08
Rate for Payer: United Healthcare Essential Plan 1&2	$7,570.08
Rate for Payer: United Healthcare Essential Plan 3&4	$7,570.08
Rate for Payer: United Healthcare Medicaid	$3,364.48

Know your out-of-pocket cost for care.

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