St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

Eye procedures except orbit

Facility

$77,332.52

Service Code	APR-DRG 0734
Min. Negotiated Rate	$17,532.00
Max. Negotiated Rate	$77,332.52
Rate for Payer: Affinity Essential Plan 1&2	$77,332.52
Rate for Payer: Affinity Essential Plan 3&4	$77,332.52
Rate for Payer: Affinity Medicaid/CHP/HARP	$34,370.01
Rate for Payer: Amida Care Medicaid	$34,370.01
Rate for Payer: EmblemHealth Essential Plan 1&2	$77,332.52
Rate for Payer: EmblemHealth Essential Plan 3&4	$34,370.01
Rate for Payer: Fidelis CHP/HARP/Medicaid	$34,370.01
Rate for Payer: Fidelis Qualified Health Plan	$41,244.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$34,370.01
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$34,370.01
Rate for Payer: Healthfirst Commercial	$43,317.00
Rate for Payer: Healthfirst Essential Plan	$77,332.52
Rate for Payer: Healthfirst QHP	$17,532.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$34,370.01
Rate for Payer: SOMOS Essential	$77,332.52
Rate for Payer: United Healthcare Essential Plan 1&2	$77,332.52
Rate for Payer: United Healthcare Essential Plan 3&4	$77,332.52
Rate for Payer: United Healthcare Medicaid	$34,370.01
Rate for Payer: Wellcare CHP/FHP/Medicaid	$34,370.01

Eye procedures except orbit

Facility

$43,606.80

Service Code	APR-DRG 0731
Min. Negotiated Rate	$7,534.00
Max. Negotiated Rate	$43,606.80
Rate for Payer: Affinity Essential Plan 1&2	$43,606.80
Rate for Payer: Affinity Essential Plan 3&4	$43,606.80
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,380.80
Rate for Payer: Amida Care Medicaid	$19,380.80
Rate for Payer: EmblemHealth Essential Plan 1&2	$43,606.80
Rate for Payer: EmblemHealth Essential Plan 3&4	$19,380.80
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,380.80
Rate for Payer: Fidelis Qualified Health Plan	$23,256.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,380.80
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,380.80
Rate for Payer: Healthfirst Commercial	$13,274.00
Rate for Payer: Healthfirst Essential Plan	$43,606.80
Rate for Payer: Healthfirst QHP	$7,534.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,380.80
Rate for Payer: SOMOS Essential	$43,606.80
Rate for Payer: United Healthcare Essential Plan 1&2	$43,606.80
Rate for Payer: United Healthcare Essential Plan 3&4	$43,606.80
Rate for Payer: United Healthcare Medicaid	$19,380.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,380.80

Eye procedures except orbit

Facility

$46,895.67

Service Code	APR-DRG 0732
Min. Negotiated Rate	$9,574.00
Max. Negotiated Rate	$46,895.67
Rate for Payer: Affinity Essential Plan 1&2	$46,895.67
Rate for Payer: Affinity Essential Plan 3&4	$46,895.67
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,842.52
Rate for Payer: Amida Care Medicaid	$20,842.52
Rate for Payer: EmblemHealth Essential Plan 1&2	$46,895.67
Rate for Payer: EmblemHealth Essential Plan 3&4	$20,842.52
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,842.52
Rate for Payer: Fidelis Qualified Health Plan	$25,011.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,842.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,842.52
Rate for Payer: Healthfirst Commercial	$16,791.00
Rate for Payer: Healthfirst Essential Plan	$46,895.67
Rate for Payer: Healthfirst QHP	$9,574.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,842.52
Rate for Payer: SOMOS Essential	$46,895.67
Rate for Payer: United Healthcare Essential Plan 1&2	$46,895.67
Rate for Payer: United Healthcare Essential Plan 3&4	$46,895.67
Rate for Payer: United Healthcare Medicaid	$20,842.52
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,842.52

Eye procedures except orbit

Facility

$75,366.25

Service Code	APR-DRG 0733
Min. Negotiated Rate	$16,462.00
Max. Negotiated Rate	$75,366.25
Rate for Payer: Affinity Essential Plan 1&2	$75,366.25
Rate for Payer: Affinity Essential Plan 3&4	$75,366.25
Rate for Payer: Affinity Medicaid/CHP/HARP	$33,496.11
Rate for Payer: Amida Care Medicaid	$33,496.11
Rate for Payer: EmblemHealth Essential Plan 1&2	$75,366.25
Rate for Payer: EmblemHealth Essential Plan 3&4	$33,496.11
Rate for Payer: Fidelis CHP/HARP/Medicaid	$33,496.11
Rate for Payer: Fidelis Qualified Health Plan	$40,195.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$33,496.11
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$33,496.11
Rate for Payer: Healthfirst Commercial	$27,164.00
Rate for Payer: Healthfirst Essential Plan	$75,366.25
Rate for Payer: Healthfirst QHP	$16,462.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$33,496.11
Rate for Payer: SOMOS Essential	$75,366.25
Rate for Payer: United Healthcare Essential Plan 1&2	$75,366.25
Rate for Payer: United Healthcare Essential Plan 3&4	$75,366.25
Rate for Payer: United Healthcare Medicaid	$33,496.11
Rate for Payer: Wellcare CHP/FHP/Medicaid	$33,496.11

EYE WASH OP SOLN

Facility

$0.03

Service Code	NDC 0536122497
Hospital Charge Code	0536122497
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
Rate for Payer: EmblemHealth Commercial	$0.02
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.02

EYE WASH OP SOLN

Facility

$0.02

Service Code	NDC 1011900252
Hospital Charge Code	1011900252
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
Rate for Payer: EmblemHealth Commercial	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.02

EYE WASH OP SOLN

Facility

$0.02

Service Code	NDC 1011900252
Hospital Charge Code	1011900252
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01

EYE WASH OP SOLN

Facility

$0.03

Service Code	NDC 0536122497
Hospital Charge Code	0536122497
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02

Facial bone procedures except major cranial/facial bone procedures

Facility

$56,014.76

Service Code	APR-DRG 0922
Min. Negotiated Rate	$13,455.00
Max. Negotiated Rate	$56,014.76
Rate for Payer: Affinity Essential Plan 1&2	$56,014.76
Rate for Payer: Affinity Essential Plan 3&4	$56,014.76
Rate for Payer: Affinity Medicaid/CHP/HARP	$24,895.45
Rate for Payer: Amida Care Medicaid	$24,895.45
Rate for Payer: EmblemHealth Essential Plan 1&2	$56,014.76
Rate for Payer: EmblemHealth Essential Plan 3&4	$24,895.45
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,895.45
Rate for Payer: Fidelis Qualified Health Plan	$29,874.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,895.45
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,895.45
Rate for Payer: Healthfirst Commercial	$22,414.00
Rate for Payer: Healthfirst Essential Plan	$56,014.76
Rate for Payer: Healthfirst QHP	$13,455.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,895.45
Rate for Payer: SOMOS Essential	$56,014.76
Rate for Payer: United Healthcare Essential Plan 1&2	$56,014.76
Rate for Payer: United Healthcare Essential Plan 3&4	$56,014.76
Rate for Payer: United Healthcare Medicaid	$24,895.45
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,895.45

Facial bone procedures except major cranial/facial bone procedures

Facility

$70,343.26

Service Code	APR-DRG 0923
Min. Negotiated Rate	$23,205.00
Max. Negotiated Rate	$70,343.26
Rate for Payer: Affinity Essential Plan 1&2	$70,343.26
Rate for Payer: Affinity Essential Plan 3&4	$70,343.26
Rate for Payer: Affinity Medicaid/CHP/HARP	$31,263.67
Rate for Payer: Amida Care Medicaid	$31,263.67
Rate for Payer: EmblemHealth Essential Plan 1&2	$70,343.26
Rate for Payer: EmblemHealth Essential Plan 3&4	$31,263.67
Rate for Payer: Fidelis CHP/HARP/Medicaid	$31,263.67
Rate for Payer: Fidelis Qualified Health Plan	$37,516.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$31,263.67
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31,263.67
Rate for Payer: Healthfirst Commercial	$33,618.00
Rate for Payer: Healthfirst Essential Plan	$70,343.26
Rate for Payer: Healthfirst QHP	$23,205.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$31,263.67
Rate for Payer: SOMOS Essential	$70,343.26
Rate for Payer: United Healthcare Essential Plan 1&2	$70,343.26
Rate for Payer: United Healthcare Essential Plan 3&4	$70,343.26
Rate for Payer: United Healthcare Medicaid	$31,263.67
Rate for Payer: Wellcare CHP/FHP/Medicaid	$31,263.67

Facial bone procedures except major cranial/facial bone procedures

Facility

$50,511.64

Service Code	APR-DRG 0921
Min. Negotiated Rate	$11,069.00
Max. Negotiated Rate	$50,511.64
Rate for Payer: Affinity Essential Plan 1&2	$50,511.64
Rate for Payer: Affinity Essential Plan 3&4	$50,511.64
Rate for Payer: Affinity Medicaid/CHP/HARP	$22,449.62
Rate for Payer: Amida Care Medicaid	$22,449.62
Rate for Payer: EmblemHealth Essential Plan 1&2	$50,511.64
Rate for Payer: EmblemHealth Essential Plan 3&4	$22,449.62
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,449.62
Rate for Payer: Fidelis Qualified Health Plan	$26,939.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,449.62
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,449.62
Rate for Payer: Healthfirst Commercial	$19,185.00
Rate for Payer: Healthfirst Essential Plan	$50,511.64
Rate for Payer: Healthfirst QHP	$11,069.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,449.62
Rate for Payer: SOMOS Essential	$50,511.64
Rate for Payer: United Healthcare Essential Plan 1&2	$50,511.64
Rate for Payer: United Healthcare Essential Plan 3&4	$50,511.64
Rate for Payer: United Healthcare Medicaid	$22,449.62
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,449.62

Facial bone procedures except major cranial/facial bone procedures

Facility

$161,344.30

Service Code	APR-DRG 0924
Min. Negotiated Rate	$24,234.00
Max. Negotiated Rate	$161,344.30
Rate for Payer: Affinity Essential Plan 1&2	$161,344.30
Rate for Payer: Affinity Essential Plan 3&4	$161,344.30
Rate for Payer: Affinity Medicaid/CHP/HARP	$71,708.58
Rate for Payer: Amida Care Medicaid	$71,708.58
Rate for Payer: EmblemHealth Essential Plan 1&2	$161,344.30
Rate for Payer: EmblemHealth Essential Plan 3&4	$71,708.58
Rate for Payer: Fidelis CHP/HARP/Medicaid	$71,708.58
Rate for Payer: Fidelis Qualified Health Plan	$86,050.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$71,708.58
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$71,708.58
Rate for Payer: Healthfirst Commercial	$36,803.00
Rate for Payer: Healthfirst Essential Plan	$161,344.30
Rate for Payer: Healthfirst QHP	$24,234.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$71,708.58
Rate for Payer: SOMOS Essential	$161,344.30
Rate for Payer: United Healthcare Essential Plan 1&2	$161,344.30
Rate for Payer: United Healthcare Essential Plan 3&4	$161,344.30
Rate for Payer: United Healthcare Medicaid	$71,708.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$71,708.58

FACTOR IX COMPLEX 1000 UNITS IV SOLR

Facility

$1.78

Service Code	HCPCS J7194
Hospital Charge Code	6851632112
Hospital Revenue Code	258
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$1.73
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.70
Rate for Payer: Aetna Government	$1.70
Rate for Payer: Affinity Essential Plan 1&2	$1.19
Rate for Payer: Affinity Essential Plan 3&4	$1.19
Rate for Payer: Affinity Medicaid/CHP/HARP	$1.19
Rate for Payer: Brighton Health Commercial	$1.33
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.21
Rate for Payer: Elderplan Medicare Advantage	$1.70
Rate for Payer: EmblemHealth Commercial	$1.70
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1.53
Rate for Payer: Fidelis Essential Plan Aliesa	$1.45
Rate for Payer: Fidelis Essential Plan QHP	$1.51
Rate for Payer: Fidelis Medicare Advantage	$1.70
Rate for Payer: Fidelis Qualified Health Plan	$1.51
Rate for Payer: Group Health Inc Commercial	$1.70
Rate for Payer: Group Health Inc Medicare	$1.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.70
Rate for Payer: Hamaspik Choice Inc Medicare	$1.70
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.70
Rate for Payer: Healthfirst Medicare Advantage	$1.45
Rate for Payer: Healthfirst QHP	$1.70
Rate for Payer: Humana Medicare	$1.73
Rate for Payer: Senior Whole Health Medicare Advantage	$1.70
Rate for Payer: United Healthcare Medicare Advantage	$1.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.16
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1.61
Rate for Payer: Wellcare Medicare	$1.61

FACTOR IX COMPLEX 1000 UNITS IV SOLR

Facility

$1.78

Service Code	HCPCS J7194
Hospital Charge Code	6851632052
Hospital Revenue Code	258
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$0.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.89

FACTOR IX COMPLEX 1000 UNITS IV SOLR

Facility

$1.78

Service Code	HCPCS J7194
Hospital Charge Code	6851632112
Hospital Revenue Code	258
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$0.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.89

FACTOR IX COMPLEX 1000 UNITS IV SOLR

Facility

$1.78

Service Code	HCPCS J7194
Hospital Charge Code	6851632052
Hospital Revenue Code	258
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$1.73
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.70
Rate for Payer: Aetna Government	$1.70
Rate for Payer: Affinity Essential Plan 1&2	$1.19
Rate for Payer: Affinity Essential Plan 3&4	$1.19
Rate for Payer: Affinity Medicaid/CHP/HARP	$1.19
Rate for Payer: Brighton Health Commercial	$1.33
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.21
Rate for Payer: Elderplan Medicare Advantage	$1.70
Rate for Payer: EmblemHealth Commercial	$1.70
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1.53
Rate for Payer: Fidelis Essential Plan Aliesa	$1.45
Rate for Payer: Fidelis Essential Plan QHP	$1.51
Rate for Payer: Fidelis Medicare Advantage	$1.70
Rate for Payer: Fidelis Qualified Health Plan	$1.51
Rate for Payer: Group Health Inc Commercial	$1.70
Rate for Payer: Group Health Inc Medicare	$1.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.70
Rate for Payer: Hamaspik Choice Inc Medicare	$1.70
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.70
Rate for Payer: Healthfirst Medicare Advantage	$1.45
Rate for Payer: Healthfirst QHP	$1.70
Rate for Payer: Humana Medicare	$1.73
Rate for Payer: Senior Whole Health Medicare Advantage	$1.70
Rate for Payer: United Healthcare Medicare Advantage	$1.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.16
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1.61
Rate for Payer: Wellcare Medicare	$1.61

False labor

Facility

$37,071.32

Service Code	APR-DRG 5653
Min. Negotiated Rate	$4,065.00
Max. Negotiated Rate	$37,071.32
Rate for Payer: Affinity Essential Plan 1&2	$37,071.32
Rate for Payer: Affinity Essential Plan 3&4	$37,071.32
Rate for Payer: Affinity Medicaid/CHP/HARP	$16,476.14
Rate for Payer: Amida Care Medicaid	$16,476.14
Rate for Payer: EmblemHealth Essential Plan 1&2	$37,071.32
Rate for Payer: EmblemHealth Essential Plan 3&4	$16,476.14
Rate for Payer: Fidelis CHP/HARP/Medicaid	$16,476.14
Rate for Payer: Fidelis Qualified Health Plan	$19,771.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$16,476.14
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16,476.14
Rate for Payer: Healthfirst Commercial	$7,514.00
Rate for Payer: Healthfirst Essential Plan	$37,071.32
Rate for Payer: Healthfirst QHP	$4,065.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$16,476.14
Rate for Payer: SOMOS Essential	$37,071.32
Rate for Payer: United Healthcare Essential Plan 1&2	$37,071.32
Rate for Payer: United Healthcare Essential Plan 3&4	$37,071.32
Rate for Payer: United Healthcare Medicaid	$16,476.14
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,476.14

False labor

Facility

$36,983.36

Service Code	APR-DRG 5652
Min. Negotiated Rate	$4,055.00
Max. Negotiated Rate	$36,983.36
Rate for Payer: Affinity Essential Plan 1&2	$36,983.36
Rate for Payer: Affinity Essential Plan 3&4	$36,983.36
Rate for Payer: Affinity Medicaid/CHP/HARP	$16,437.05
Rate for Payer: Amida Care Medicaid	$16,437.05
Rate for Payer: EmblemHealth Essential Plan 1&2	$36,983.36
Rate for Payer: EmblemHealth Essential Plan 3&4	$16,437.05
Rate for Payer: Fidelis CHP/HARP/Medicaid	$16,437.05
Rate for Payer: Fidelis Qualified Health Plan	$19,724.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$16,437.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16,437.05
Rate for Payer: Healthfirst Commercial	$7,334.00
Rate for Payer: Healthfirst Essential Plan	$36,983.36
Rate for Payer: Healthfirst QHP	$4,055.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$16,437.05
Rate for Payer: SOMOS Essential	$36,983.36
Rate for Payer: United Healthcare Essential Plan 1&2	$36,983.36
Rate for Payer: United Healthcare Essential Plan 3&4	$36,983.36
Rate for Payer: United Healthcare Medicaid	$16,437.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,437.05

False labor

Facility

$37,071.32

Service Code	APR-DRG 5654
Min. Negotiated Rate	$4,065.00
Max. Negotiated Rate	$37,071.32
Rate for Payer: Affinity Essential Plan 1&2	$37,071.32
Rate for Payer: Affinity Essential Plan 3&4	$37,071.32
Rate for Payer: Affinity Medicaid/CHP/HARP	$16,476.14
Rate for Payer: Amida Care Medicaid	$16,476.14
Rate for Payer: EmblemHealth Essential Plan 1&2	$37,071.32
Rate for Payer: EmblemHealth Essential Plan 3&4	$16,476.14
Rate for Payer: Fidelis CHP/HARP/Medicaid	$16,476.14
Rate for Payer: Fidelis Qualified Health Plan	$19,771.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$16,476.14
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16,476.14
Rate for Payer: Healthfirst Commercial	$7,514.00
Rate for Payer: Healthfirst Essential Plan	$37,071.32
Rate for Payer: Healthfirst QHP	$4,065.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$16,476.14
Rate for Payer: SOMOS Essential	$37,071.32
Rate for Payer: United Healthcare Essential Plan 1&2	$37,071.32
Rate for Payer: United Healthcare Essential Plan 3&4	$37,071.32
Rate for Payer: United Healthcare Medicaid	$16,476.14
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,476.14

False labor

Facility

$36,019.57

Service Code	APR-DRG 5651
Min. Negotiated Rate	$3,396.00
Max. Negotiated Rate	$36,019.57
Rate for Payer: Affinity Essential Plan 1&2	$36,019.57
Rate for Payer: Affinity Essential Plan 3&4	$36,019.57
Rate for Payer: Affinity Medicaid/CHP/HARP	$16,008.70
Rate for Payer: Amida Care Medicaid	$16,008.70
Rate for Payer: EmblemHealth Essential Plan 1&2	$36,019.57
Rate for Payer: EmblemHealth Essential Plan 3&4	$16,008.70
Rate for Payer: Fidelis CHP/HARP/Medicaid	$16,008.70
Rate for Payer: Fidelis Qualified Health Plan	$19,210.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$16,008.70
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16,008.70
Rate for Payer: Healthfirst Commercial	$6,158.00
Rate for Payer: Healthfirst Essential Plan	$36,019.57
Rate for Payer: Healthfirst QHP	$3,396.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$16,008.70
Rate for Payer: SOMOS Essential	$36,019.57
Rate for Payer: United Healthcare Essential Plan 1&2	$36,019.57
Rate for Payer: United Healthcare Essential Plan 3&4	$36,019.57
Rate for Payer: United Healthcare Medicaid	$16,008.70
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,008.70

FALSE LABOR

Facility

$349.24

Service Code	EAPG 00764
Min. Negotiated Rate	$254.57
Max. Negotiated Rate	$349.24
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$254.57
Rate for Payer: Healthfirst Commercial	$349.24

FAMILY PSYCHOTHERAPY

Facility

$197.87

Service Code	EAPG 00317
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

FAMOTIDINE 10 MG PO TABS

Facility

$0.09

Service Code	NDC 5511111890
Hospital Charge Code	5511111890
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.06
Rate for Payer: EmblemHealth Commercial	$0.05
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.06

FAMOTIDINE 10 MG PO TABS

Facility

$0.30

Service Code	NDC 0904552987
Hospital Charge Code	0904552987
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15

FAMOTIDINE 10 MG PO TABS

Facility

$0.30

Service Code	NDC 0904552987
Hospital Charge Code	0904552987
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.15
Rate for Payer: Aetna Government	$0.15
Rate for Payer: Brighton Health Commercial	$0.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.20
Rate for Payer: EmblemHealth Commercial	$0.15
Rate for Payer: Group Health Inc Commercial	$0.15
Rate for Payer: Group Health Inc Medicare	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.20

Know your out-of-pocket cost for care.

All Charges