St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

MAGNESIUM SULFATE IN D5W 1-5 GM/100ML-% IV SOLN

Facility

$0.10

Service Code	HCPCS J3475
Hospital Charge Code	0409672711
Hospital Revenue Code	258
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05

MAGNETIC RESONANCE ANGIOGRAPHY

Facility

$972.34

Service Code	EAPG 00282
Min. Negotiated Rate	$705.86
Max. Negotiated Rate	$972.34
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$705.86
Rate for Payer: Healthfirst Commercial	$972.34

MAGNETIC RESONANCE IMAGING WITH CONTRAST

Facility

$1,145.21

Service Code	EAPG 00295
Min. Negotiated Rate	$830.83
Max. Negotiated Rate	$1,145.21
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$830.83
Rate for Payer: Healthfirst Commercial	$1,145.21

MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST

Facility

$759.30

Service Code	EAPG 00293
Min. Negotiated Rate	$550.80
Max. Negotiated Rate	$759.30
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$550.80
Rate for Payer: Healthfirst Commercial	$759.30

MAGNETOCEPHALOGRAPHY

Facility

$1,030.34

Service Code	EAPG 00297
Min. Negotiated Rate	$747.52
Max. Negotiated Rate	$1,030.34
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$747.52
Rate for Payer: Healthfirst Commercial	$1,030.34

Major abdominal vascular procedures

Facility

$63,380.39

Service Code	APR-DRG 1691
Min. Negotiated Rate	$19,847.00
Max. Negotiated Rate	$63,380.39
Rate for Payer: Affinity Essential Plan 1&2	$63,380.39
Rate for Payer: Affinity Essential Plan 3&4	$63,380.39
Rate for Payer: Affinity Medicaid/CHP/HARP	$28,169.06
Rate for Payer: Amida Care Medicaid	$28,169.06
Rate for Payer: EmblemHealth Essential Plan 1&2	$63,380.39
Rate for Payer: EmblemHealth Essential Plan 3&4	$28,169.06
Rate for Payer: Fidelis CHP/HARP/Medicaid	$28,169.06
Rate for Payer: Fidelis Qualified Health Plan	$33,802.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$28,169.06
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$28,169.06
Rate for Payer: Healthfirst Commercial	$33,533.00
Rate for Payer: Healthfirst Essential Plan	$63,380.39
Rate for Payer: Healthfirst QHP	$19,847.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$28,169.06
Rate for Payer: SOMOS Essential	$63,380.39
Rate for Payer: United Healthcare Essential Plan 1&2	$63,380.39
Rate for Payer: United Healthcare Essential Plan 3&4	$63,380.39
Rate for Payer: United Healthcare Medicaid	$28,169.06
Rate for Payer: Wellcare CHP/FHP/Medicaid	$28,169.06

Major abdominal vascular procedures

Facility

$97,361.12

Service Code	APR-DRG 1693
Min. Negotiated Rate	$42,527.00
Max. Negotiated Rate	$97,361.12
Rate for Payer: Affinity Essential Plan 1&2	$97,361.12
Rate for Payer: Affinity Essential Plan 3&4	$97,361.12
Rate for Payer: Affinity Medicaid/CHP/HARP	$43,271.61
Rate for Payer: Amida Care Medicaid	$43,271.61
Rate for Payer: EmblemHealth Essential Plan 1&2	$97,361.12
Rate for Payer: EmblemHealth Essential Plan 3&4	$43,271.61
Rate for Payer: Fidelis CHP/HARP/Medicaid	$43,271.61
Rate for Payer: Fidelis Qualified Health Plan	$51,925.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$43,271.61
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$43,271.61
Rate for Payer: Healthfirst Commercial	$71,633.00
Rate for Payer: Healthfirst Essential Plan	$97,361.12
Rate for Payer: Healthfirst QHP	$42,527.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$43,271.61
Rate for Payer: SOMOS Essential	$97,361.12
Rate for Payer: United Healthcare Essential Plan 1&2	$97,361.12
Rate for Payer: United Healthcare Essential Plan 3&4	$97,361.12
Rate for Payer: United Healthcare Medicaid	$43,271.61
Rate for Payer: Wellcare CHP/FHP/Medicaid	$43,271.61

Major abdominal vascular procedures

Facility

$72,263.81

Service Code	APR-DRG 1692
Min. Negotiated Rate	$26,132.00
Max. Negotiated Rate	$72,263.81
Rate for Payer: Affinity Essential Plan 1&2	$72,263.81
Rate for Payer: Affinity Essential Plan 3&4	$72,263.81
Rate for Payer: Affinity Medicaid/CHP/HARP	$32,117.25
Rate for Payer: Amida Care Medicaid	$32,117.25
Rate for Payer: EmblemHealth Essential Plan 1&2	$72,263.81
Rate for Payer: EmblemHealth Essential Plan 3&4	$32,117.25
Rate for Payer: Fidelis CHP/HARP/Medicaid	$32,117.25
Rate for Payer: Fidelis Qualified Health Plan	$38,540.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$32,117.25
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$32,117.25
Rate for Payer: Healthfirst Commercial	$44,838.00
Rate for Payer: Healthfirst Essential Plan	$72,263.81
Rate for Payer: Healthfirst QHP	$26,132.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$32,117.25
Rate for Payer: SOMOS Essential	$72,263.81
Rate for Payer: United Healthcare Essential Plan 1&2	$72,263.81
Rate for Payer: United Healthcare Essential Plan 3&4	$72,263.81
Rate for Payer: United Healthcare Medicaid	$32,117.25
Rate for Payer: Wellcare CHP/FHP/Medicaid	$32,117.25

Major abdominal vascular procedures

Facility

$158,345.66

Service Code	APR-DRG 1694
Min. Negotiated Rate	$70,375.85
Max. Negotiated Rate	$158,345.66
Rate for Payer: Affinity Essential Plan 1&2	$158,345.66
Rate for Payer: Affinity Essential Plan 3&4	$158,345.66
Rate for Payer: Affinity Medicaid/CHP/HARP	$70,375.85
Rate for Payer: Amida Care Medicaid	$70,375.85
Rate for Payer: EmblemHealth Essential Plan 1&2	$158,345.66
Rate for Payer: EmblemHealth Essential Plan 3&4	$70,375.85
Rate for Payer: Fidelis CHP/HARP/Medicaid	$70,375.85
Rate for Payer: Fidelis Qualified Health Plan	$84,451.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$70,375.85
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$70,375.85
Rate for Payer: Healthfirst Commercial	$129,968.00
Rate for Payer: Healthfirst Essential Plan	$158,345.66
Rate for Payer: Healthfirst QHP	$81,947.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$70,375.85
Rate for Payer: SOMOS Essential	$158,345.66
Rate for Payer: United Healthcare Essential Plan 1&2	$158,345.66
Rate for Payer: United Healthcare Essential Plan 3&4	$158,345.66
Rate for Payer: United Healthcare Medicaid	$70,375.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$70,375.85

Major biliary tract procedures

Facility

$67,226.76

Service Code	APR-DRG 2612
Min. Negotiated Rate	$22,616.00
Max. Negotiated Rate	$67,226.76
Rate for Payer: Affinity Essential Plan 1&2	$67,226.76
Rate for Payer: Affinity Essential Plan 3&4	$67,226.76
Rate for Payer: Affinity Medicaid/CHP/HARP	$29,878.56
Rate for Payer: Amida Care Medicaid	$29,878.56
Rate for Payer: EmblemHealth Essential Plan 1&2	$67,226.76
Rate for Payer: EmblemHealth Essential Plan 3&4	$29,878.56
Rate for Payer: Fidelis CHP/HARP/Medicaid	$29,878.56
Rate for Payer: Fidelis Qualified Health Plan	$35,854.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$29,878.56
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29,878.56
Rate for Payer: Healthfirst Commercial	$37,108.00
Rate for Payer: Healthfirst Essential Plan	$67,226.76
Rate for Payer: Healthfirst QHP	$22,616.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$29,878.56
Rate for Payer: SOMOS Essential	$67,226.76
Rate for Payer: United Healthcare Essential Plan 1&2	$67,226.76
Rate for Payer: United Healthcare Essential Plan 3&4	$67,226.76
Rate for Payer: United Healthcare Medicaid	$29,878.56
Rate for Payer: Wellcare CHP/FHP/Medicaid	$29,878.56

Major biliary tract procedures

Facility

$56,609.21

Service Code	APR-DRG 2611
Min. Negotiated Rate	$15,488.00
Max. Negotiated Rate	$56,609.21
Rate for Payer: Affinity Essential Plan 1&2	$56,609.21
Rate for Payer: Affinity Essential Plan 3&4	$56,609.21
Rate for Payer: Affinity Medicaid/CHP/HARP	$25,159.65
Rate for Payer: Amida Care Medicaid	$25,159.65
Rate for Payer: EmblemHealth Essential Plan 1&2	$56,609.21
Rate for Payer: EmblemHealth Essential Plan 3&4	$25,159.65
Rate for Payer: Fidelis CHP/HARP/Medicaid	$25,159.65
Rate for Payer: Fidelis Qualified Health Plan	$30,191.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$25,159.65
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25,159.65
Rate for Payer: Healthfirst Commercial	$27,229.00
Rate for Payer: Healthfirst Essential Plan	$56,609.21
Rate for Payer: Healthfirst QHP	$15,488.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$25,159.65
Rate for Payer: SOMOS Essential	$56,609.21
Rate for Payer: United Healthcare Essential Plan 1&2	$56,609.21
Rate for Payer: United Healthcare Essential Plan 3&4	$56,609.21
Rate for Payer: United Healthcare Medicaid	$25,159.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$25,159.65

Major biliary tract procedures

Facility

$86,332.03

Service Code	APR-DRG 2613
Min. Negotiated Rate	$34,428.00
Max. Negotiated Rate	$86,332.03
Rate for Payer: Affinity Essential Plan 1&2	$86,332.03
Rate for Payer: Affinity Essential Plan 3&4	$86,332.03
Rate for Payer: Affinity Medicaid/CHP/HARP	$38,369.79
Rate for Payer: Amida Care Medicaid	$38,369.79
Rate for Payer: EmblemHealth Essential Plan 1&2	$86,332.03
Rate for Payer: EmblemHealth Essential Plan 3&4	$38,369.79
Rate for Payer: Fidelis CHP/HARP/Medicaid	$38,369.79
Rate for Payer: Fidelis Qualified Health Plan	$46,043.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$38,369.79
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$38,369.79
Rate for Payer: Healthfirst Commercial	$55,654.00
Rate for Payer: Healthfirst Essential Plan	$86,332.03
Rate for Payer: Healthfirst QHP	$34,428.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$38,369.79
Rate for Payer: SOMOS Essential	$86,332.03
Rate for Payer: United Healthcare Essential Plan 1&2	$86,332.03
Rate for Payer: United Healthcare Essential Plan 3&4	$86,332.03
Rate for Payer: United Healthcare Medicaid	$38,369.79
Rate for Payer: Wellcare CHP/FHP/Medicaid	$38,369.79

Major biliary tract procedures

Facility

$140,014.24

Service Code	APR-DRG 2614
Min. Negotiated Rate	$62,228.55
Max. Negotiated Rate	$140,014.24
Rate for Payer: Affinity Essential Plan 1&2	$140,014.24
Rate for Payer: Affinity Essential Plan 3&4	$140,014.24
Rate for Payer: Affinity Medicaid/CHP/HARP	$62,228.55
Rate for Payer: Amida Care Medicaid	$62,228.55
Rate for Payer: EmblemHealth Essential Plan 1&2	$140,014.24
Rate for Payer: EmblemHealth Essential Plan 3&4	$62,228.55
Rate for Payer: Fidelis CHP/HARP/Medicaid	$62,228.55
Rate for Payer: Fidelis Qualified Health Plan	$74,674.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$62,228.55
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$62,228.55
Rate for Payer: Healthfirst Commercial	$100,704.00
Rate for Payer: Healthfirst Essential Plan	$140,014.24
Rate for Payer: Healthfirst QHP	$79,400.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$62,228.55
Rate for Payer: SOMOS Essential	$140,014.24
Rate for Payer: United Healthcare Essential Plan 1&2	$140,014.24
Rate for Payer: United Healthcare Essential Plan 3&4	$140,014.24
Rate for Payer: United Healthcare Medicaid	$62,228.55
Rate for Payer: Wellcare CHP/FHP/Medicaid	$62,228.55

Major bladder procedures

Facility

$54,535.66

Service Code	APR-DRG 4411
Min. Negotiated Rate	$16,755.00
Max. Negotiated Rate	$54,535.66
Rate for Payer: Affinity Essential Plan 1&2	$54,535.66
Rate for Payer: Affinity Essential Plan 3&4	$54,535.66
Rate for Payer: Affinity Medicaid/CHP/HARP	$24,238.07
Rate for Payer: Amida Care Medicaid	$24,238.07
Rate for Payer: EmblemHealth Essential Plan 1&2	$54,535.66
Rate for Payer: EmblemHealth Essential Plan 3&4	$24,238.07
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,238.07
Rate for Payer: Fidelis Qualified Health Plan	$29,085.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,238.07
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,238.07
Rate for Payer: Healthfirst Commercial	$28,659.00
Rate for Payer: Healthfirst Essential Plan	$54,535.66
Rate for Payer: Healthfirst QHP	$16,755.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,238.07
Rate for Payer: SOMOS Essential	$54,535.66
Rate for Payer: United Healthcare Essential Plan 1&2	$54,535.66
Rate for Payer: United Healthcare Essential Plan 3&4	$54,535.66
Rate for Payer: United Healthcare Medicaid	$24,238.07
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,238.07

Major bladder procedures

Facility

$150,965.95

Service Code	APR-DRG 4414
Min. Negotiated Rate	$67,095.98
Max. Negotiated Rate	$150,965.95
Rate for Payer: Affinity Essential Plan 1&2	$150,965.95
Rate for Payer: Affinity Essential Plan 3&4	$150,965.95
Rate for Payer: Affinity Medicaid/CHP/HARP	$67,095.98
Rate for Payer: Amida Care Medicaid	$67,095.98
Rate for Payer: EmblemHealth Essential Plan 1&2	$150,965.95
Rate for Payer: EmblemHealth Essential Plan 3&4	$67,095.98
Rate for Payer: Fidelis CHP/HARP/Medicaid	$67,095.98
Rate for Payer: Fidelis Qualified Health Plan	$80,515.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$67,095.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$67,095.98
Rate for Payer: Healthfirst Commercial	$135,454.00
Rate for Payer: Healthfirst Essential Plan	$150,965.95
Rate for Payer: Healthfirst QHP	$87,340.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$67,095.98
Rate for Payer: SOMOS Essential	$150,965.95
Rate for Payer: United Healthcare Essential Plan 1&2	$150,965.95
Rate for Payer: United Healthcare Essential Plan 3&4	$150,965.95
Rate for Payer: United Healthcare Medicaid	$67,095.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$67,095.98

Major bladder procedures

Facility

$87,376.73

Service Code	APR-DRG 4413
Min. Negotiated Rate	$34,958.00
Max. Negotiated Rate	$87,376.73
Rate for Payer: Affinity Essential Plan 1&2	$87,376.73
Rate for Payer: Affinity Essential Plan 3&4	$87,376.73
Rate for Payer: Affinity Medicaid/CHP/HARP	$38,834.10
Rate for Payer: Amida Care Medicaid	$38,834.10
Rate for Payer: EmblemHealth Essential Plan 1&2	$87,376.73
Rate for Payer: EmblemHealth Essential Plan 3&4	$38,834.10
Rate for Payer: Fidelis CHP/HARP/Medicaid	$38,834.10
Rate for Payer: Fidelis Qualified Health Plan	$46,600.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$38,834.10
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$38,834.10
Rate for Payer: Healthfirst Commercial	$59,934.00
Rate for Payer: Healthfirst Essential Plan	$87,376.73
Rate for Payer: Healthfirst QHP	$34,958.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$38,834.10
Rate for Payer: SOMOS Essential	$87,376.73
Rate for Payer: United Healthcare Essential Plan 1&2	$87,376.73
Rate for Payer: United Healthcare Essential Plan 3&4	$87,376.73
Rate for Payer: United Healthcare Medicaid	$38,834.10
Rate for Payer: Wellcare CHP/FHP/Medicaid	$38,834.10

Major bladder procedures

Facility

$71,171.64

Service Code	APR-DRG 4412
Min. Negotiated Rate	$25,348.00
Max. Negotiated Rate	$71,171.64
Rate for Payer: Affinity Essential Plan 1&2	$71,171.64
Rate for Payer: Affinity Essential Plan 3&4	$71,171.64
Rate for Payer: Affinity Medicaid/CHP/HARP	$31,631.84
Rate for Payer: Amida Care Medicaid	$31,631.84
Rate for Payer: EmblemHealth Essential Plan 1&2	$71,171.64
Rate for Payer: EmblemHealth Essential Plan 3&4	$31,631.84
Rate for Payer: Fidelis CHP/HARP/Medicaid	$31,631.84
Rate for Payer: Fidelis Qualified Health Plan	$37,958.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$31,631.84
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31,631.84
Rate for Payer: Healthfirst Commercial	$42,488.00
Rate for Payer: Healthfirst Essential Plan	$71,171.64
Rate for Payer: Healthfirst QHP	$25,348.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$31,631.84
Rate for Payer: SOMOS Essential	$71,171.64
Rate for Payer: United Healthcare Essential Plan 1&2	$71,171.64
Rate for Payer: United Healthcare Essential Plan 3&4	$71,171.64
Rate for Payer: United Healthcare Medicaid	$31,631.84
Rate for Payer: Wellcare CHP/FHP/Medicaid	$31,631.84

Major cardiothoracic repair of heart anomaly

Facility

$91,775.34

Service Code	APR-DRG 1602
Min. Negotiated Rate	$35,961.00
Max. Negotiated Rate	$91,775.34
Rate for Payer: Affinity Essential Plan 1&2	$91,775.34
Rate for Payer: Affinity Essential Plan 3&4	$91,775.34
Rate for Payer: Affinity Medicaid/CHP/HARP	$40,789.04
Rate for Payer: Amida Care Medicaid	$40,789.04
Rate for Payer: EmblemHealth Essential Plan 1&2	$91,775.34
Rate for Payer: EmblemHealth Essential Plan 3&4	$40,789.04
Rate for Payer: Fidelis CHP/HARP/Medicaid	$40,789.04
Rate for Payer: Fidelis Qualified Health Plan	$48,946.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$40,789.04
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$40,789.04
Rate for Payer: Healthfirst Commercial	$58,631.00
Rate for Payer: Healthfirst Essential Plan	$91,775.34
Rate for Payer: Healthfirst QHP	$35,961.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$40,789.04
Rate for Payer: SOMOS Essential	$91,775.34
Rate for Payer: United Healthcare Essential Plan 1&2	$91,775.34
Rate for Payer: United Healthcare Essential Plan 3&4	$91,775.34
Rate for Payer: United Healthcare Medicaid	$40,789.04
Rate for Payer: Wellcare CHP/FHP/Medicaid	$40,789.04

Major cardiothoracic repair of heart anomaly

Facility

$206,904.64

Service Code	APR-DRG 1604
Min. Negotiated Rate	$91,957.62
Max. Negotiated Rate	$206,904.64
Rate for Payer: Affinity Essential Plan 1&2	$206,904.64
Rate for Payer: Affinity Essential Plan 3&4	$206,904.64
Rate for Payer: Affinity Medicaid/CHP/HARP	$91,957.62
Rate for Payer: Amida Care Medicaid	$91,957.62
Rate for Payer: EmblemHealth Essential Plan 1&2	$206,904.64
Rate for Payer: EmblemHealth Essential Plan 3&4	$91,957.62
Rate for Payer: Fidelis CHP/HARP/Medicaid	$91,957.62
Rate for Payer: Fidelis Qualified Health Plan	$110,349.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$91,957.62
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$91,957.62
Rate for Payer: Healthfirst Commercial	$186,500.00
Rate for Payer: Healthfirst Essential Plan	$206,904.64
Rate for Payer: Healthfirst QHP	$96,615.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$91,957.62
Rate for Payer: SOMOS Essential	$206,904.64
Rate for Payer: United Healthcare Essential Plan 1&2	$206,904.64
Rate for Payer: United Healthcare Essential Plan 3&4	$206,904.64
Rate for Payer: United Healthcare Medicaid	$91,957.62
Rate for Payer: Wellcare CHP/FHP/Medicaid	$91,957.62

Major cardiothoracic repair of heart anomaly

Facility

$116,086.50

Service Code	APR-DRG 1603
Min. Negotiated Rate	$47,540.00
Max. Negotiated Rate	$116,086.50
Rate for Payer: Affinity Essential Plan 1&2	$116,086.50
Rate for Payer: Affinity Essential Plan 3&4	$116,086.50
Rate for Payer: Affinity Medicaid/CHP/HARP	$51,594.00
Rate for Payer: Amida Care Medicaid	$51,594.00
Rate for Payer: EmblemHealth Essential Plan 1&2	$116,086.50
Rate for Payer: EmblemHealth Essential Plan 3&4	$51,594.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$51,594.00
Rate for Payer: Fidelis Qualified Health Plan	$61,912.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$51,594.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$51,594.00
Rate for Payer: Healthfirst Commercial	$74,621.00
Rate for Payer: Healthfirst Essential Plan	$116,086.50
Rate for Payer: Healthfirst QHP	$47,540.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$51,594.00
Rate for Payer: SOMOS Essential	$116,086.50
Rate for Payer: United Healthcare Essential Plan 1&2	$116,086.50
Rate for Payer: United Healthcare Essential Plan 3&4	$116,086.50
Rate for Payer: United Healthcare Medicaid	$51,594.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$51,594.00

Major cardiothoracic repair of heart anomaly

Facility

$87,350.33

Service Code	APR-DRG 1601
Min. Negotiated Rate	$28,535.00
Max. Negotiated Rate	$87,350.33
Rate for Payer: Affinity Essential Plan 1&2	$87,350.33
Rate for Payer: Affinity Essential Plan 3&4	$87,350.33
Rate for Payer: Affinity Medicaid/CHP/HARP	$38,822.37
Rate for Payer: Amida Care Medicaid	$38,822.37
Rate for Payer: EmblemHealth Essential Plan 1&2	$87,350.33
Rate for Payer: EmblemHealth Essential Plan 3&4	$38,822.37
Rate for Payer: Fidelis CHP/HARP/Medicaid	$38,822.37
Rate for Payer: Fidelis Qualified Health Plan	$46,586.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$38,822.37
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$38,822.37
Rate for Payer: Healthfirst Commercial	$49,166.00
Rate for Payer: Healthfirst Essential Plan	$87,350.33
Rate for Payer: Healthfirst QHP	$28,535.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$38,822.37
Rate for Payer: SOMOS Essential	$87,350.33
Rate for Payer: United Healthcare Essential Plan 1&2	$87,350.33
Rate for Payer: United Healthcare Essential Plan 3&4	$87,350.33
Rate for Payer: United Healthcare Medicaid	$38,822.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$38,822.37

MAJOR CHEST AND RESPIRATORY TRAUMA

Facility

$196.72

Service Code	EAPG 00580
Min. Negotiated Rate	$196.72
Max. Negotiated Rate	$196.72
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$196.72

Major chest & respiratory trauma

Facility

$53,591.20

Service Code	APR-DRG 1353
Min. Negotiated Rate	$13,103.00
Max. Negotiated Rate	$53,591.20
Rate for Payer: Affinity Essential Plan 1&2	$53,591.20
Rate for Payer: Affinity Essential Plan 3&4	$53,591.20
Rate for Payer: Affinity Medicaid/CHP/HARP	$23,818.31
Rate for Payer: Amida Care Medicaid	$23,818.31
Rate for Payer: EmblemHealth Essential Plan 1&2	$53,591.20
Rate for Payer: EmblemHealth Essential Plan 3&4	$23,818.31
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,818.31
Rate for Payer: Fidelis Qualified Health Plan	$28,581.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,818.31
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,818.31
Rate for Payer: Healthfirst Commercial	$21,883.00
Rate for Payer: Healthfirst Essential Plan	$53,591.20
Rate for Payer: Healthfirst QHP	$13,103.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,818.31
Rate for Payer: SOMOS Essential	$53,591.20
Rate for Payer: United Healthcare Essential Plan 1&2	$53,591.20
Rate for Payer: United Healthcare Essential Plan 3&4	$53,591.20
Rate for Payer: United Healthcare Medicaid	$23,818.31
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,818.31

Major chest & respiratory trauma

Facility

$63,950.22

Service Code	APR-DRG 1354
Min. Negotiated Rate	$22,830.00
Max. Negotiated Rate	$63,950.22
Rate for Payer: Affinity Essential Plan 1&2	$63,950.22
Rate for Payer: Affinity Essential Plan 3&4	$63,950.22
Rate for Payer: Affinity Medicaid/CHP/HARP	$28,422.32
Rate for Payer: Amida Care Medicaid	$28,422.32
Rate for Payer: EmblemHealth Essential Plan 1&2	$63,950.22
Rate for Payer: EmblemHealth Essential Plan 3&4	$28,422.32
Rate for Payer: Fidelis CHP/HARP/Medicaid	$28,422.32
Rate for Payer: Fidelis Qualified Health Plan	$34,106.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$28,422.32
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$28,422.32
Rate for Payer: Healthfirst Commercial	$38,106.00
Rate for Payer: Healthfirst Essential Plan	$63,950.22
Rate for Payer: Healthfirst QHP	$22,830.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$28,422.32
Rate for Payer: SOMOS Essential	$63,950.22
Rate for Payer: United Healthcare Essential Plan 1&2	$63,950.22
Rate for Payer: United Healthcare Essential Plan 3&4	$63,950.22
Rate for Payer: United Healthcare Medicaid	$28,422.32
Rate for Payer: Wellcare CHP/FHP/Medicaid	$28,422.32

Major chest & respiratory trauma

Facility

$41,119.94

Service Code	APR-DRG 1351
Min. Negotiated Rate	$6,584.00
Max. Negotiated Rate	$41,119.94
Rate for Payer: Affinity Essential Plan 1&2	$41,119.94
Rate for Payer: Affinity Essential Plan 3&4	$41,119.94
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,275.53
Rate for Payer: Amida Care Medicaid	$18,275.53
Rate for Payer: EmblemHealth Essential Plan 1&2	$41,119.94
Rate for Payer: EmblemHealth Essential Plan 3&4	$18,275.53
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,275.53
Rate for Payer: Fidelis Qualified Health Plan	$21,930.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,275.53
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,275.53
Rate for Payer: Healthfirst Commercial	$10,917.00
Rate for Payer: Healthfirst Essential Plan	$41,119.94
Rate for Payer: Healthfirst QHP	$6,584.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,275.53
Rate for Payer: SOMOS Essential	$41,119.94
Rate for Payer: United Healthcare Essential Plan 1&2	$41,119.94
Rate for Payer: United Healthcare Essential Plan 3&4	$41,119.94
Rate for Payer: United Healthcare Medicaid	$18,275.53
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,275.53

Know your out-of-pocket cost for care.

All Charges