St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HEPATITIS B VAC RECOMBINANT 20 MCG/ML IJ SUSY

Facility

$83.24

Service Code	NDC 5816082143
Hospital Charge Code	5816082143
Hospital Revenue Code	250
Min. Negotiated Rate	$41.62
Max. Negotiated Rate	$41.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.62

HEPATITIS B VAC RECOMBINANT 20 MCG/ML IJ SUSY

Facility

$83.24

Service Code	NDC 5816082143
Hospital Charge Code	5816082143
Hospital Revenue Code	250
Min. Negotiated Rate	$29.13
Max. Negotiated Rate	$66.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$45.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$41.62
Rate for Payer: Aetna Government	$41.62
Rate for Payer: Brighton Health Commercial	$62.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$66.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$56.60
Rate for Payer: EmblemHealth Commercial	$41.62
Rate for Payer: Group Health Inc Commercial	$41.62
Rate for Payer: Group Health Inc Medicare	$29.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.62
Rate for Payer: Hamaspik Choice Inc Medicare	$41.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$54.10

HEPATITIS B VAC RECOMBINANT 40 MCG/ML IJ SUSP

Facility

$217.49

Service Code	HCPCS 90740
Hospital Charge Code	0006499200
Hospital Revenue Code	250
Min. Negotiated Rate	$108.75
Max. Negotiated Rate	$108.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$108.75

HEPATITIS B VAC RECOMBINANT 40 MCG/ML IJ SUSP

Facility

$217.49

Service Code	HCPCS 90740
Hospital Charge Code	0006499200
Hospital Revenue Code	250
Min. Negotiated Rate	$76.12
Max. Negotiated Rate	$173.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$119.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$140.76
Rate for Payer: Aetna Government	$140.76
Rate for Payer: Brighton Health Commercial	$163.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$173.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$147.89
Rate for Payer: EmblemHealth Commercial	$108.75
Rate for Payer: Group Health Inc Commercial	$108.75
Rate for Payer: Group Health Inc Medicare	$76.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$108.75
Rate for Payer: Hamaspik Choice Inc Medicare	$108.75
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$164.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$141.37

HEPATITIS WITHOUT COMA

Facility

$251.84

Service Code	EAPG 00636
Min. Negotiated Rate	$182.83
Max. Negotiated Rate	$251.84
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$182.83
Rate for Payer: Healthfirst Commercial	$251.84

HERNIA

Facility

$211.12

Service Code	EAPG 00631
Min. Negotiated Rate	$152.74
Max. Negotiated Rate	$211.12
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$152.74
Rate for Payer: Healthfirst Commercial	$211.12

Hernia procedures except inguinal, femoral & umbilical

Facility

$55,766.77

Service Code	APR-DRG 2272
Min. Negotiated Rate	$15,095.00
Max. Negotiated Rate	$55,766.77
Rate for Payer: Affinity Essential Plan 1&2	$55,766.77
Rate for Payer: Affinity Essential Plan 3&4	$55,766.77
Rate for Payer: Affinity Medicaid/CHP/HARP	$24,785.23
Rate for Payer: Amida Care Medicaid	$24,785.23
Rate for Payer: EmblemHealth Essential Plan 1&2	$55,766.77
Rate for Payer: EmblemHealth Essential Plan 3&4	$24,785.23
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,785.23
Rate for Payer: Fidelis Qualified Health Plan	$29,742.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,785.23
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,785.23
Rate for Payer: Healthfirst Commercial	$25,641.00
Rate for Payer: Healthfirst Essential Plan	$55,766.77
Rate for Payer: Healthfirst QHP	$15,095.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,785.23
Rate for Payer: SOMOS Essential	$55,766.77
Rate for Payer: United Healthcare Essential Plan 1&2	$55,766.77
Rate for Payer: United Healthcare Essential Plan 3&4	$55,766.77
Rate for Payer: United Healthcare Medicaid	$24,785.23
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,785.23

Hernia procedures except inguinal, femoral & umbilical

Facility

$50,297.08

Service Code	APR-DRG 2271
Min. Negotiated Rate	$11,678.00
Max. Negotiated Rate	$50,297.08
Rate for Payer: Affinity Essential Plan 1&2	$50,297.08
Rate for Payer: Affinity Essential Plan 3&4	$50,297.08
Rate for Payer: Affinity Medicaid/CHP/HARP	$22,354.26
Rate for Payer: Amida Care Medicaid	$22,354.26
Rate for Payer: EmblemHealth Essential Plan 1&2	$50,297.08
Rate for Payer: EmblemHealth Essential Plan 3&4	$22,354.26
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,354.26
Rate for Payer: Fidelis Qualified Health Plan	$26,825.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,354.26
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,354.26
Rate for Payer: Healthfirst Commercial	$20,069.00
Rate for Payer: Healthfirst Essential Plan	$50,297.08
Rate for Payer: Healthfirst QHP	$11,678.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,354.26
Rate for Payer: SOMOS Essential	$50,297.08
Rate for Payer: United Healthcare Essential Plan 1&2	$50,297.08
Rate for Payer: United Healthcare Essential Plan 3&4	$50,297.08
Rate for Payer: United Healthcare Medicaid	$22,354.26
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,354.26

Hernia procedures except inguinal, femoral & umbilical

Facility

$72,791.44

Service Code	APR-DRG 2273
Min. Negotiated Rate	$24,963.00
Max. Negotiated Rate	$72,791.44
Rate for Payer: Affinity Essential Plan 1&2	$72,791.44
Rate for Payer: Affinity Essential Plan 3&4	$72,791.44
Rate for Payer: Affinity Medicaid/CHP/HARP	$32,351.75
Rate for Payer: Amida Care Medicaid	$32,351.75
Rate for Payer: EmblemHealth Essential Plan 1&2	$72,791.44
Rate for Payer: EmblemHealth Essential Plan 3&4	$32,351.75
Rate for Payer: Fidelis CHP/HARP/Medicaid	$32,351.75
Rate for Payer: Fidelis Qualified Health Plan	$38,822.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$32,351.75
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$32,351.75
Rate for Payer: Healthfirst Commercial	$45,021.00
Rate for Payer: Healthfirst Essential Plan	$72,791.44
Rate for Payer: Healthfirst QHP	$24,963.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$32,351.75
Rate for Payer: SOMOS Essential	$72,791.44
Rate for Payer: United Healthcare Essential Plan 1&2	$72,791.44
Rate for Payer: United Healthcare Essential Plan 3&4	$72,791.44
Rate for Payer: United Healthcare Medicaid	$32,351.75
Rate for Payer: Wellcare CHP/FHP/Medicaid	$32,351.75

Hernia procedures except inguinal, femoral & umbilical

Facility

$124,767.68

Service Code	APR-DRG 2274
Min. Negotiated Rate	$55,452.30
Max. Negotiated Rate	$124,767.68
Rate for Payer: Affinity Essential Plan 1&2	$124,767.68
Rate for Payer: Affinity Essential Plan 3&4	$124,767.68
Rate for Payer: Affinity Medicaid/CHP/HARP	$55,452.30
Rate for Payer: Amida Care Medicaid	$55,452.30
Rate for Payer: EmblemHealth Essential Plan 1&2	$124,767.68
Rate for Payer: EmblemHealth Essential Plan 3&4	$55,452.30
Rate for Payer: Fidelis CHP/HARP/Medicaid	$55,452.30
Rate for Payer: Fidelis Qualified Health Plan	$66,542.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$55,452.30
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$55,452.30
Rate for Payer: Healthfirst Commercial	$96,069.00
Rate for Payer: Healthfirst Essential Plan	$124,767.68
Rate for Payer: Healthfirst QHP	$57,796.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$55,452.30
Rate for Payer: SOMOS Essential	$124,767.68
Rate for Payer: United Healthcare Essential Plan 1&2	$124,767.68
Rate for Payer: United Healthcare Essential Plan 3&4	$124,767.68
Rate for Payer: United Healthcare Medicaid	$55,452.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$55,452.30

HERNIA REPAIRS

Facility

$3,552.99

Service Code	EAPG 00139
Min. Negotiated Rate	$2,578.13
Max. Negotiated Rate	$3,552.99
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,578.13
Rate for Payer: Healthfirst Commercial	$3,552.99

HETASTARCH-NACL 6-0.9 % IV SOLN

Facility

$0.06

Service Code	NDC 0264196510
Hospital Charge Code	0264196510
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03

HETASTARCH-NACL 6-0.9 % IV SOLN

Facility

$0.06

Service Code	NDC 0264196510
Hospital Charge Code	0264196510
Hospital Revenue Code	258
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$0.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.04
Rate for Payer: EmblemHealth Commercial	$0.03
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.04

HETASTARCH-NACL 6-0.9 % IV SOLN

Facility

$0.05

Service Code	NDC 0409724803
Hospital Charge Code	0409724803
Hospital Revenue Code	258
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02

HETASTARCH-NACL 6-0.9 % IV SOLN

Facility

$0.05

Service Code	NDC 0409724803
Hospital Charge Code	0409724803
Hospital Revenue Code	258
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$0.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: EmblemHealth Commercial	$0.02
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.02
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	$0.03

Hip and femur fracture repair

Facility

$64,356.50

Service Code	APR-DRG 3082
Min. Negotiated Rate	$19,036.00
Max. Negotiated Rate	$64,356.50
Rate for Payer: Affinity Essential Plan 1&2	$64,356.50
Rate for Payer: Affinity Essential Plan 3&4	$64,356.50
Rate for Payer: Affinity Medicaid/CHP/HARP	$28,602.89
Rate for Payer: Amida Care Medicaid	$28,602.89
Rate for Payer: EmblemHealth Essential Plan 1&2	$64,356.50
Rate for Payer: EmblemHealth Essential Plan 3&4	$28,602.89
Rate for Payer: Fidelis CHP/HARP/Medicaid	$28,602.89
Rate for Payer: Fidelis Qualified Health Plan	$34,323.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$28,602.89
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$28,602.89
Rate for Payer: Healthfirst Commercial	$32,196.00
Rate for Payer: Healthfirst Essential Plan	$64,356.50
Rate for Payer: Healthfirst QHP	$19,036.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$28,602.89
Rate for Payer: SOMOS Essential	$64,356.50
Rate for Payer: United Healthcare Essential Plan 1&2	$64,356.50
Rate for Payer: United Healthcare Essential Plan 3&4	$64,356.50
Rate for Payer: United Healthcare Medicaid	$28,602.89
Rate for Payer: Wellcare CHP/FHP/Medicaid	$28,602.89

Hip and femur fracture repair

Facility

$133,475.22

Service Code	APR-DRG 3084
Min. Negotiated Rate	$53,759.00
Max. Negotiated Rate	$133,475.22
Rate for Payer: Affinity Essential Plan 1&2	$133,475.22
Rate for Payer: Affinity Essential Plan 3&4	$133,475.22
Rate for Payer: Affinity Medicaid/CHP/HARP	$59,322.32
Rate for Payer: Amida Care Medicaid	$59,322.32
Rate for Payer: EmblemHealth Essential Plan 1&2	$133,475.22
Rate for Payer: EmblemHealth Essential Plan 3&4	$59,322.32
Rate for Payer: Fidelis CHP/HARP/Medicaid	$59,322.32
Rate for Payer: Fidelis Qualified Health Plan	$71,186.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$59,322.32
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$59,322.32
Rate for Payer: Healthfirst Commercial	$82,315.00
Rate for Payer: Healthfirst Essential Plan	$133,475.22
Rate for Payer: Healthfirst QHP	$53,759.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$59,322.32
Rate for Payer: SOMOS Essential	$133,475.22
Rate for Payer: United Healthcare Essential Plan 1&2	$133,475.22
Rate for Payer: United Healthcare Essential Plan 3&4	$133,475.22
Rate for Payer: United Healthcare Medicaid	$59,322.32
Rate for Payer: Wellcare CHP/FHP/Medicaid	$59,322.32

Hip and femur fracture repair

Facility

$80,306.57

Service Code	APR-DRG 3083
Min. Negotiated Rate	$28,506.00
Max. Negotiated Rate	$80,306.57
Rate for Payer: Affinity Essential Plan 1&2	$80,306.57
Rate for Payer: Affinity Essential Plan 3&4	$80,306.57
Rate for Payer: Affinity Medicaid/CHP/HARP	$35,691.81
Rate for Payer: Amida Care Medicaid	$35,691.81
Rate for Payer: EmblemHealth Essential Plan 1&2	$80,306.57
Rate for Payer: EmblemHealth Essential Plan 3&4	$35,691.81
Rate for Payer: Fidelis CHP/HARP/Medicaid	$35,691.81
Rate for Payer: Fidelis Qualified Health Plan	$42,830.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$35,691.81
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$35,691.81
Rate for Payer: Healthfirst Commercial	$44,697.00
Rate for Payer: Healthfirst Essential Plan	$80,306.57
Rate for Payer: Healthfirst QHP	$28,506.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$35,691.81
Rate for Payer: SOMOS Essential	$80,306.57
Rate for Payer: United Healthcare Essential Plan 1&2	$80,306.57
Rate for Payer: United Healthcare Essential Plan 3&4	$80,306.57
Rate for Payer: United Healthcare Medicaid	$35,691.81
Rate for Payer: Wellcare CHP/FHP/Medicaid	$35,691.81

Hip and femur fracture repair

Facility

$55,506.49

Service Code	APR-DRG 3081
Min. Negotiated Rate	$14,878.00
Max. Negotiated Rate	$55,506.49
Rate for Payer: Affinity Essential Plan 1&2	$55,506.49
Rate for Payer: Affinity Essential Plan 3&4	$55,506.49
Rate for Payer: Affinity Medicaid/CHP/HARP	$24,669.55
Rate for Payer: Amida Care Medicaid	$24,669.55
Rate for Payer: EmblemHealth Essential Plan 1&2	$55,506.49
Rate for Payer: EmblemHealth Essential Plan 3&4	$24,669.55
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,669.55
Rate for Payer: Fidelis Qualified Health Plan	$29,603.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,669.55
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,669.55
Rate for Payer: Healthfirst Commercial	$26,042.00
Rate for Payer: Healthfirst Essential Plan	$55,506.49
Rate for Payer: Healthfirst QHP	$14,878.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,669.55
Rate for Payer: SOMOS Essential	$55,506.49
Rate for Payer: United Healthcare Essential Plan 1&2	$55,506.49
Rate for Payer: United Healthcare Essential Plan 3&4	$55,506.49
Rate for Payer: United Healthcare Medicaid	$24,669.55
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,669.55

Hip joint replacement

Facility

$76,630.79

Service Code	APR-DRG 3013
Min. Negotiated Rate	$31,107.00
Max. Negotiated Rate	$76,630.79
Rate for Payer: Affinity Essential Plan 1&2	$76,630.79
Rate for Payer: Affinity Essential Plan 3&4	$76,630.79
Rate for Payer: Affinity Medicaid/CHP/HARP	$34,058.13
Rate for Payer: Amida Care Medicaid	$34,058.13
Rate for Payer: EmblemHealth Essential Plan 1&2	$76,630.79
Rate for Payer: EmblemHealth Essential Plan 3&4	$34,058.13
Rate for Payer: Fidelis CHP/HARP/Medicaid	$34,058.13
Rate for Payer: Fidelis Qualified Health Plan	$40,869.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$34,058.13
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$34,058.13
Rate for Payer: Healthfirst Commercial	$50,384.00
Rate for Payer: Healthfirst Essential Plan	$76,630.79
Rate for Payer: Healthfirst QHP	$31,107.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$34,058.13
Rate for Payer: SOMOS Essential	$76,630.79
Rate for Payer: United Healthcare Essential Plan 1&2	$76,630.79
Rate for Payer: United Healthcare Essential Plan 3&4	$76,630.79
Rate for Payer: United Healthcare Medicaid	$34,058.13
Rate for Payer: Wellcare CHP/FHP/Medicaid	$34,058.13

Hip joint replacement

Facility

$138,485.88

Service Code	APR-DRG 3014
Min. Negotiated Rate	$59,937.00
Max. Negotiated Rate	$138,485.88
Rate for Payer: Affinity Essential Plan 1&2	$138,485.88
Rate for Payer: Affinity Essential Plan 3&4	$138,485.88
Rate for Payer: Affinity Medicaid/CHP/HARP	$61,549.28
Rate for Payer: Amida Care Medicaid	$61,549.28
Rate for Payer: EmblemHealth Essential Plan 1&2	$138,485.88
Rate for Payer: EmblemHealth Essential Plan 3&4	$61,549.28
Rate for Payer: Fidelis CHP/HARP/Medicaid	$61,549.28
Rate for Payer: Fidelis Qualified Health Plan	$73,859.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$61,549.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$61,549.28
Rate for Payer: Healthfirst Commercial	$96,497.00
Rate for Payer: Healthfirst Essential Plan	$138,485.88
Rate for Payer: Healthfirst QHP	$59,937.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$61,549.28
Rate for Payer: SOMOS Essential	$138,485.88
Rate for Payer: United Healthcare Essential Plan 1&2	$138,485.88
Rate for Payer: United Healthcare Essential Plan 3&4	$138,485.88
Rate for Payer: United Healthcare Medicaid	$61,549.28
Rate for Payer: Wellcare CHP/FHP/Medicaid	$61,549.28

Hip joint replacement

Facility

$65,747.65

Service Code	APR-DRG 3012
Min. Negotiated Rate	$24,742.00
Max. Negotiated Rate	$65,747.65
Rate for Payer: Affinity Essential Plan 1&2	$65,747.65
Rate for Payer: Affinity Essential Plan 3&4	$65,747.65
Rate for Payer: Affinity Medicaid/CHP/HARP	$29,221.18
Rate for Payer: Amida Care Medicaid	$29,221.18
Rate for Payer: EmblemHealth Essential Plan 1&2	$65,747.65
Rate for Payer: EmblemHealth Essential Plan 3&4	$29,221.18
Rate for Payer: Fidelis CHP/HARP/Medicaid	$29,221.18
Rate for Payer: Fidelis Qualified Health Plan	$35,065.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$29,221.18
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29,221.18
Rate for Payer: Healthfirst Commercial	$39,066.00
Rate for Payer: Healthfirst Essential Plan	$65,747.65
Rate for Payer: Healthfirst QHP	$24,742.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$29,221.18
Rate for Payer: SOMOS Essential	$65,747.65
Rate for Payer: United Healthcare Essential Plan 1&2	$65,747.65
Rate for Payer: United Healthcare Essential Plan 3&4	$65,747.65
Rate for Payer: United Healthcare Medicaid	$29,221.18
Rate for Payer: Wellcare CHP/FHP/Medicaid	$29,221.18

Hip joint replacement

Facility

$64,472.58

Service Code	APR-DRG 3011
Min. Negotiated Rate	$23,799.00
Max. Negotiated Rate	$64,472.58
Rate for Payer: Affinity Essential Plan 1&2	$64,472.58
Rate for Payer: Affinity Essential Plan 3&4	$64,472.58
Rate for Payer: Affinity Medicaid/CHP/HARP	$28,654.48
Rate for Payer: Amida Care Medicaid	$28,654.48
Rate for Payer: EmblemHealth Essential Plan 1&2	$64,472.58
Rate for Payer: EmblemHealth Essential Plan 3&4	$28,654.48
Rate for Payer: Fidelis CHP/HARP/Medicaid	$28,654.48
Rate for Payer: Fidelis Qualified Health Plan	$34,385.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$28,654.48
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$28,654.48
Rate for Payer: Healthfirst Commercial	$37,492.00
Rate for Payer: Healthfirst Essential Plan	$64,472.58
Rate for Payer: Healthfirst QHP	$23,799.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$28,654.48
Rate for Payer: SOMOS Essential	$64,472.58
Rate for Payer: United Healthcare Essential Plan 1&2	$64,472.58
Rate for Payer: United Healthcare Essential Plan 3&4	$64,472.58
Rate for Payer: United Healthcare Medicaid	$28,654.48
Rate for Payer: Wellcare CHP/FHP/Medicaid	$28,654.48

HIV INFECTION

Facility

$255.78

Service Code	EAPG 00880
Min. Negotiated Rate	$185.14
Max. Negotiated Rate	$255.78
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$185.14
Rate for Payer: Healthfirst Commercial	$255.78

HIV PEP STARTER PACK

Facility

$0.01

Service Code	NDC 9999123476
Hospital Charge Code	9999123476
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01

Know your out-of-pocket cost for care.

All Charges