St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

INTELLECTUAL DISABILITY

Facility

$218.35

Service Code	EAPG 00828
Min. Negotiated Rate	$157.37
Max. Negotiated Rate	$218.35
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$157.37
Rate for Payer: Healthfirst Commercial	$218.35

INTENSIVE OUTPATIENT PSYCHIATRIC TREATMENT

Facility

$194.25

Service Code	EAPG 00327
Min. Negotiated Rate	$178.20
Max. Negotiated Rate	$194.25
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$178.20
Rate for Payer: Healthfirst Commercial	$194.25

INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE

Facility

$208.29

Service Code	EAPG 00832
Min. Negotiated Rate	$208.29
Max. Negotiated Rate	$208.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$208.29

INTERFERON BETA-1A 30 MCG/0.5ML IM PSKT

Facility

$9.00

Service Code	HCPCS Q3027
Hospital Charge Code	5962722205
Hospital Revenue Code	250
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$60.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$58.90
Rate for Payer: Aetna Government	$58.90
Rate for Payer: Affinity Essential Plan 1&2	$41.23
Rate for Payer: Affinity Essential Plan 3&4	$41.23
Rate for Payer: Affinity Medicaid/CHP/HARP	$41.23
Rate for Payer: Brighton Health Commercial	$6.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$58.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.12
Rate for Payer: Elderplan Medicare Advantage	$58.90
Rate for Payer: EmblemHealth Commercial	$58.90
Rate for Payer: Fidelis CHP/HARP/Medicaid	$53.01
Rate for Payer: Fidelis Essential Plan Aliesa	$50.06
Rate for Payer: Fidelis Essential Plan QHP	$52.42
Rate for Payer: Fidelis Medicare Advantage	$58.90
Rate for Payer: Fidelis Qualified Health Plan	$52.42
Rate for Payer: Group Health Inc Commercial	$58.90
Rate for Payer: Group Health Inc Medicare	$58.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$58.90
Rate for Payer: Hamaspik Choice Inc Medicare	$58.90
Rate for Payer: Healthfirst Medicare Advantage	$50.06
Rate for Payer: Healthfirst QHP	$58.90
Rate for Payer: Humana Medicare	$60.08
Rate for Payer: Senior Whole Health Medicare Advantage	$58.90
Rate for Payer: United Healthcare Medicare Advantage	$58.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$55.95
Rate for Payer: Wellcare Medicare	$55.95

INTERFERON BETA-1A 30 MCG/0.5ML IM PSKT

Facility

$9.00

Service Code	HCPCS Q3027
Hospital Charge Code	5962722205
Hospital Revenue Code	250
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.50

INTERFERON BETA-1A 44 MCG/0.5ML SC SOSY

Facility

$2.00

Service Code	NDC 4408700443
Hospital Charge Code	4408700443
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.00
Rate for Payer: Aetna Government	$1.00
Rate for Payer: Brighton Health Commercial	$1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.36
Rate for Payer: EmblemHealth Commercial	$1.00
Rate for Payer: Group Health Inc Commercial	$1.00
Rate for Payer: Group Health Inc Medicare	$0.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

INTERFERON BETA-1A 44 MCG/0.5ML SC SOSY

Facility

$2.00

Service Code	NDC 4408700443
Hospital Charge Code	4408700443
Hospital Revenue Code	250
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00

INTERMEDIATE WOUND REPAIR AND TREATMENT

Facility

$881.75

Service Code	EAPG 00017
Min. Negotiated Rate	$881.75
Max. Negotiated Rate	$881.75
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$881.75

Interstitial & alveolar lung diseases

Facility

$47,126.05

Service Code	APR-DRG 1422
Min. Negotiated Rate	$9,568.00
Max. Negotiated Rate	$47,126.05
Rate for Payer: Affinity Essential Plan 1&2	$47,126.05
Rate for Payer: Affinity Essential Plan 3&4	$47,126.05
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,944.91
Rate for Payer: Amida Care Medicaid	$20,944.91
Rate for Payer: EmblemHealth Essential Plan 1&2	$47,126.05
Rate for Payer: EmblemHealth Essential Plan 3&4	$20,944.91
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,944.91
Rate for Payer: Fidelis Qualified Health Plan	$25,133.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,944.91
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,944.91
Rate for Payer: Healthfirst Commercial	$15,112.00
Rate for Payer: Healthfirst Essential Plan	$47,126.05
Rate for Payer: Healthfirst QHP	$9,568.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,944.91
Rate for Payer: SOMOS Essential	$47,126.05
Rate for Payer: United Healthcare Essential Plan 1&2	$47,126.05
Rate for Payer: United Healthcare Essential Plan 3&4	$47,126.05
Rate for Payer: United Healthcare Medicaid	$20,944.91
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,944.91

Interstitial & alveolar lung diseases

Facility

$43,749.27

Service Code	APR-DRG 1421
Min. Negotiated Rate	$8,077.00
Max. Negotiated Rate	$43,749.27
Rate for Payer: Affinity Essential Plan 1&2	$43,749.27
Rate for Payer: Affinity Essential Plan 3&4	$43,749.27
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,444.12
Rate for Payer: Amida Care Medicaid	$19,444.12
Rate for Payer: EmblemHealth Essential Plan 1&2	$43,749.27
Rate for Payer: EmblemHealth Essential Plan 3&4	$19,444.12
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,444.12
Rate for Payer: Fidelis Qualified Health Plan	$23,332.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,444.12
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,444.12
Rate for Payer: Healthfirst Commercial	$12,083.00
Rate for Payer: Healthfirst Essential Plan	$43,749.27
Rate for Payer: Healthfirst QHP	$8,077.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,444.12
Rate for Payer: SOMOS Essential	$43,749.27
Rate for Payer: United Healthcare Essential Plan 1&2	$43,749.27
Rate for Payer: United Healthcare Essential Plan 3&4	$43,749.27
Rate for Payer: United Healthcare Medicaid	$19,444.12
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,444.12

Interstitial & alveolar lung diseases

Facility

$55,422.07

Service Code	APR-DRG 1423
Min. Negotiated Rate	$13,631.00
Max. Negotiated Rate	$55,422.07
Rate for Payer: Affinity Essential Plan 1&2	$55,422.07
Rate for Payer: Affinity Essential Plan 3&4	$55,422.07
Rate for Payer: Affinity Medicaid/CHP/HARP	$24,632.03
Rate for Payer: Amida Care Medicaid	$24,632.03
Rate for Payer: EmblemHealth Essential Plan 1&2	$55,422.07
Rate for Payer: EmblemHealth Essential Plan 3&4	$24,632.03
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,632.03
Rate for Payer: Fidelis Qualified Health Plan	$29,558.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,632.03
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,632.03
Rate for Payer: Healthfirst Commercial	$23,243.00
Rate for Payer: Healthfirst Essential Plan	$55,422.07
Rate for Payer: Healthfirst QHP	$13,631.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,632.03
Rate for Payer: SOMOS Essential	$55,422.07
Rate for Payer: United Healthcare Essential Plan 1&2	$55,422.07
Rate for Payer: United Healthcare Essential Plan 3&4	$55,422.07
Rate for Payer: United Healthcare Medicaid	$24,632.03
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,632.03

Interstitial & alveolar lung diseases

Facility

$80,937.95

Service Code	APR-DRG 1424
Min. Negotiated Rate	$23,284.00
Max. Negotiated Rate	$80,937.95
Rate for Payer: Affinity Essential Plan 1&2	$80,937.95
Rate for Payer: Affinity Essential Plan 3&4	$80,937.95
Rate for Payer: Affinity Medicaid/CHP/HARP	$35,972.42
Rate for Payer: Amida Care Medicaid	$35,972.42
Rate for Payer: EmblemHealth Essential Plan 1&2	$80,937.95
Rate for Payer: EmblemHealth Essential Plan 3&4	$35,972.42
Rate for Payer: Fidelis CHP/HARP/Medicaid	$35,972.42
Rate for Payer: Fidelis Qualified Health Plan	$43,166.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$35,972.42
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$35,972.42
Rate for Payer: Healthfirst Commercial	$45,248.00
Rate for Payer: Healthfirst Essential Plan	$80,937.95
Rate for Payer: Healthfirst QHP	$23,284.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$35,972.42
Rate for Payer: SOMOS Essential	$80,937.95
Rate for Payer: United Healthcare Essential Plan 1&2	$80,937.95
Rate for Payer: United Healthcare Essential Plan 3&4	$80,937.95
Rate for Payer: United Healthcare Medicaid	$35,972.42
Rate for Payer: Wellcare CHP/FHP/Medicaid	$35,972.42

INTERSTITIAL AND ALVEOLAR LUNG DIAGNOSES

Facility

$215.23

Service Code	EAPG 00582
Min. Negotiated Rate	$215.23
Max. Negotiated Rate	$215.23
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$215.23

Intervertebral disc excision & decompression

Facility

$47,175.30

Service Code	APR-DRG 3101
Min. Negotiated Rate	$10,169.00
Max. Negotiated Rate	$47,175.30
Rate for Payer: Affinity Essential Plan 1&2	$47,175.30
Rate for Payer: Affinity Essential Plan 3&4	$47,175.30
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,966.80
Rate for Payer: Amida Care Medicaid	$20,966.80
Rate for Payer: EmblemHealth Essential Plan 1&2	$47,175.30
Rate for Payer: EmblemHealth Essential Plan 3&4	$20,966.80
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,966.80
Rate for Payer: Fidelis Qualified Health Plan	$25,160.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,966.80
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,966.80
Rate for Payer: Healthfirst Commercial	$17,344.00
Rate for Payer: Healthfirst Essential Plan	$47,175.30
Rate for Payer: Healthfirst QHP	$10,169.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,966.80
Rate for Payer: SOMOS Essential	$47,175.30
Rate for Payer: United Healthcare Essential Plan 1&2	$47,175.30
Rate for Payer: United Healthcare Essential Plan 3&4	$47,175.30
Rate for Payer: United Healthcare Medicaid	$20,966.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,966.80

Intervertebral disc excision & decompression

Facility

$53,508.56

Service Code	APR-DRG 3102
Min. Negotiated Rate	$13,707.00
Max. Negotiated Rate	$53,508.56
Rate for Payer: Affinity Essential Plan 1&2	$53,508.56
Rate for Payer: Affinity Essential Plan 3&4	$53,508.56
Rate for Payer: Affinity Medicaid/CHP/HARP	$23,781.58
Rate for Payer: Amida Care Medicaid	$23,781.58
Rate for Payer: EmblemHealth Essential Plan 1&2	$53,508.56
Rate for Payer: EmblemHealth Essential Plan 3&4	$23,781.58
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,781.58
Rate for Payer: Fidelis Qualified Health Plan	$28,537.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,781.58
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,781.58
Rate for Payer: Healthfirst Commercial	$23,832.00
Rate for Payer: Healthfirst Essential Plan	$53,508.56
Rate for Payer: Healthfirst QHP	$13,707.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,781.58
Rate for Payer: SOMOS Essential	$53,508.56
Rate for Payer: United Healthcare Essential Plan 1&2	$53,508.56
Rate for Payer: United Healthcare Essential Plan 3&4	$53,508.56
Rate for Payer: United Healthcare Medicaid	$23,781.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,781.58

Intervertebral disc excision & decompression

Facility

$76,776.75

Service Code	APR-DRG 3103
Min. Negotiated Rate	$24,369.00
Max. Negotiated Rate	$76,776.75
Rate for Payer: Affinity Essential Plan 1&2	$76,776.75
Rate for Payer: Affinity Essential Plan 3&4	$76,776.75
Rate for Payer: Affinity Medicaid/CHP/HARP	$34,123.00
Rate for Payer: Amida Care Medicaid	$34,123.00
Rate for Payer: EmblemHealth Essential Plan 1&2	$76,776.75
Rate for Payer: EmblemHealth Essential Plan 3&4	$34,123.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$34,123.00
Rate for Payer: Fidelis Qualified Health Plan	$40,947.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$34,123.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$34,123.00
Rate for Payer: Healthfirst Commercial	$43,550.00
Rate for Payer: Healthfirst Essential Plan	$76,776.75
Rate for Payer: Healthfirst QHP	$24,369.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$34,123.00
Rate for Payer: SOMOS Essential	$76,776.75
Rate for Payer: United Healthcare Essential Plan 1&2	$76,776.75
Rate for Payer: United Healthcare Essential Plan 3&4	$76,776.75
Rate for Payer: United Healthcare Medicaid	$34,123.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$34,123.00

Intervertebral disc excision & decompression

Facility

$152,353.60

Service Code	APR-DRG 3104
Min. Negotiated Rate	$63,856.00
Max. Negotiated Rate	$152,353.60
Rate for Payer: Affinity Essential Plan 1&2	$152,353.60
Rate for Payer: Affinity Essential Plan 3&4	$152,353.60
Rate for Payer: Affinity Medicaid/CHP/HARP	$67,712.71
Rate for Payer: Amida Care Medicaid	$67,712.71
Rate for Payer: EmblemHealth Essential Plan 1&2	$152,353.60
Rate for Payer: EmblemHealth Essential Plan 3&4	$67,712.71
Rate for Payer: Fidelis CHP/HARP/Medicaid	$67,712.71
Rate for Payer: Fidelis Qualified Health Plan	$81,255.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$67,712.71
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$67,712.71
Rate for Payer: Healthfirst Commercial	$102,905.00
Rate for Payer: Healthfirst Essential Plan	$152,353.60
Rate for Payer: Healthfirst QHP	$63,856.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$67,712.71
Rate for Payer: SOMOS Essential	$152,353.60
Rate for Payer: United Healthcare Essential Plan 1&2	$152,353.60
Rate for Payer: United Healthcare Essential Plan 3&4	$152,353.60
Rate for Payer: United Healthcare Medicaid	$67,712.71
Rate for Payer: Wellcare CHP/FHP/Medicaid	$67,712.71

Intestinal obstruction

Facility

$53,197.25

Service Code	APR-DRG 2473
Min. Negotiated Rate	$11,890.00
Max. Negotiated Rate	$53,197.25
Rate for Payer: Affinity Essential Plan 1&2	$53,197.25
Rate for Payer: Affinity Essential Plan 3&4	$53,197.25
Rate for Payer: Affinity Medicaid/CHP/HARP	$23,643.22
Rate for Payer: Amida Care Medicaid	$23,643.22
Rate for Payer: EmblemHealth Essential Plan 1&2	$53,197.25
Rate for Payer: EmblemHealth Essential Plan 3&4	$23,643.22
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,643.22
Rate for Payer: Fidelis Qualified Health Plan	$28,371.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,643.22
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,643.22
Rate for Payer: Healthfirst Commercial	$20,267.00
Rate for Payer: Healthfirst Essential Plan	$53,197.25
Rate for Payer: Healthfirst QHP	$11,890.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,643.22
Rate for Payer: SOMOS Essential	$53,197.25
Rate for Payer: United Healthcare Essential Plan 1&2	$53,197.25
Rate for Payer: United Healthcare Essential Plan 3&4	$53,197.25
Rate for Payer: United Healthcare Medicaid	$23,643.22
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,643.22

Intestinal obstruction

Facility

$43,853.04

Service Code	APR-DRG 2472
Min. Negotiated Rate	$7,592.00
Max. Negotiated Rate	$43,853.04
Rate for Payer: Affinity Essential Plan 1&2	$43,853.04
Rate for Payer: Affinity Essential Plan 3&4	$43,853.04
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,490.24
Rate for Payer: Amida Care Medicaid	$19,490.24
Rate for Payer: EmblemHealth Essential Plan 1&2	$43,853.04
Rate for Payer: EmblemHealth Essential Plan 3&4	$19,490.24
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,490.24
Rate for Payer: Fidelis Qualified Health Plan	$23,388.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,490.24
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,490.24
Rate for Payer: Healthfirst Commercial	$12,846.00
Rate for Payer: Healthfirst Essential Plan	$43,853.04
Rate for Payer: Healthfirst QHP	$7,592.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,490.24
Rate for Payer: SOMOS Essential	$43,853.04
Rate for Payer: United Healthcare Essential Plan 1&2	$43,853.04
Rate for Payer: United Healthcare Essential Plan 3&4	$43,853.04
Rate for Payer: United Healthcare Medicaid	$19,490.24
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,490.24

Intestinal obstruction

Facility

$76,964.94

Service Code	APR-DRG 2474
Min. Negotiated Rate	$26,788.00
Max. Negotiated Rate	$76,964.94
Rate for Payer: Affinity Essential Plan 1&2	$76,964.94
Rate for Payer: Affinity Essential Plan 3&4	$76,964.94
Rate for Payer: Affinity Medicaid/CHP/HARP	$34,206.64
Rate for Payer: Amida Care Medicaid	$34,206.64
Rate for Payer: EmblemHealth Essential Plan 1&2	$76,964.94
Rate for Payer: EmblemHealth Essential Plan 3&4	$34,206.64
Rate for Payer: Fidelis CHP/HARP/Medicaid	$34,206.64
Rate for Payer: Fidelis Qualified Health Plan	$41,047.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$34,206.64
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$34,206.64
Rate for Payer: Healthfirst Commercial	$43,616.00
Rate for Payer: Healthfirst Essential Plan	$76,964.94
Rate for Payer: Healthfirst QHP	$26,788.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$34,206.64
Rate for Payer: SOMOS Essential	$76,964.94
Rate for Payer: United Healthcare Essential Plan 1&2	$76,964.94
Rate for Payer: United Healthcare Essential Plan 3&4	$76,964.94
Rate for Payer: United Healthcare Medicaid	$34,206.64
Rate for Payer: Wellcare CHP/FHP/Medicaid	$34,206.64

Intestinal obstruction

Facility

$40,643.32

Service Code	APR-DRG 2471
Min. Negotiated Rate	$6,021.00
Max. Negotiated Rate	$40,643.32
Rate for Payer: Affinity Essential Plan 1&2	$40,643.32
Rate for Payer: Affinity Essential Plan 3&4	$40,643.32
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,063.70
Rate for Payer: Amida Care Medicaid	$18,063.70
Rate for Payer: EmblemHealth Essential Plan 1&2	$40,643.32
Rate for Payer: EmblemHealth Essential Plan 3&4	$18,063.70
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,063.70
Rate for Payer: Fidelis Qualified Health Plan	$21,676.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,063.70
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,063.70
Rate for Payer: Healthfirst Commercial	$10,163.00
Rate for Payer: Healthfirst Essential Plan	$40,643.32
Rate for Payer: Healthfirst QHP	$6,021.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,063.70
Rate for Payer: SOMOS Essential	$40,643.32
Rate for Payer: United Healthcare Essential Plan 1&2	$40,643.32
Rate for Payer: United Healthcare Essential Plan 3&4	$40,643.32
Rate for Payer: United Healthcare Medicaid	$18,063.70
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,063.70

INTESTINAL OBSTRUCTION DIAGNOSES

Facility

$173.57

Service Code	EAPG 00618
Min. Negotiated Rate	$173.57
Max. Negotiated Rate	$173.57
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$173.57

Intracranial hemorrhage

Facility

$57,748.88

Service Code	APR-DRG 0442
Min. Negotiated Rate	$14,215.00
Max. Negotiated Rate	$57,748.88
Rate for Payer: Affinity Essential Plan 1&2	$57,748.88
Rate for Payer: Affinity Essential Plan 3&4	$57,748.88
Rate for Payer: Affinity Medicaid/CHP/HARP	$25,666.17
Rate for Payer: Amida Care Medicaid	$25,666.17
Rate for Payer: EmblemHealth Essential Plan 1&2	$57,748.88
Rate for Payer: EmblemHealth Essential Plan 3&4	$25,666.17
Rate for Payer: Fidelis CHP/HARP/Medicaid	$25,666.17
Rate for Payer: Fidelis Qualified Health Plan	$30,799.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$25,666.17
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25,666.17
Rate for Payer: Healthfirst Commercial	$23,320.00
Rate for Payer: Healthfirst Essential Plan	$57,748.88
Rate for Payer: Healthfirst QHP	$14,215.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$25,666.17
Rate for Payer: SOMOS Essential	$57,748.88
Rate for Payer: United Healthcare Essential Plan 1&2	$57,748.88
Rate for Payer: United Healthcare Essential Plan 3&4	$57,748.88
Rate for Payer: United Healthcare Medicaid	$25,666.17
Rate for Payer: Wellcare CHP/FHP/Medicaid	$25,666.17

Intracranial hemorrhage

Facility

$49,605.89

Service Code	APR-DRG 0441
Min. Negotiated Rate	$10,424.00
Max. Negotiated Rate	$49,605.89
Rate for Payer: Affinity Essential Plan 1&2	$49,605.89
Rate for Payer: Affinity Essential Plan 3&4	$49,605.89
Rate for Payer: Affinity Medicaid/CHP/HARP	$22,047.06
Rate for Payer: Amida Care Medicaid	$22,047.06
Rate for Payer: EmblemHealth Essential Plan 1&2	$49,605.89
Rate for Payer: EmblemHealth Essential Plan 3&4	$22,047.06
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,047.06
Rate for Payer: Fidelis Qualified Health Plan	$26,456.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,047.06
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,047.06
Rate for Payer: Healthfirst Commercial	$17,858.00
Rate for Payer: Healthfirst Essential Plan	$49,605.89
Rate for Payer: Healthfirst QHP	$10,424.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,047.06
Rate for Payer: SOMOS Essential	$49,605.89
Rate for Payer: United Healthcare Essential Plan 1&2	$49,605.89
Rate for Payer: United Healthcare Essential Plan 3&4	$49,605.89
Rate for Payer: United Healthcare Medicaid	$22,047.06
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,047.06

Intracranial hemorrhage

Facility

$69,222.94

Service Code	APR-DRG 0443
Min. Negotiated Rate	$18,625.00
Max. Negotiated Rate	$69,222.94
Rate for Payer: Affinity Essential Plan 1&2	$69,222.94
Rate for Payer: Affinity Essential Plan 3&4	$69,222.94
Rate for Payer: Affinity Medicaid/CHP/HARP	$30,765.75
Rate for Payer: Amida Care Medicaid	$30,765.75
Rate for Payer: EmblemHealth Essential Plan 1&2	$69,222.94
Rate for Payer: EmblemHealth Essential Plan 3&4	$30,765.75
Rate for Payer: Fidelis CHP/HARP/Medicaid	$30,765.75
Rate for Payer: Fidelis Qualified Health Plan	$36,918.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$30,765.75
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$30,765.75
Rate for Payer: Healthfirst Commercial	$32,055.00
Rate for Payer: Healthfirst Essential Plan	$69,222.94
Rate for Payer: Healthfirst QHP	$18,625.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$30,765.75
Rate for Payer: SOMOS Essential	$69,222.94
Rate for Payer: United Healthcare Essential Plan 1&2	$69,222.94
Rate for Payer: United Healthcare Essential Plan 3&4	$69,222.94
Rate for Payer: United Healthcare Medicaid	$30,765.75
Rate for Payer: Wellcare CHP/FHP/Medicaid	$30,765.75

Know your out-of-pocket cost for care.

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