St. Barnabas Hospital

All Charges

Charge

Type

Price

APR-DRG 0223: Ventricular shunt procedures

Facility IP

$77,812.00

Service Code	APR-DRG 0223
Min. Negotiated Rate	$34,060.81
Max. Negotiated Rate	$77,812.00
Rate for Payer: Amida Care Medicaid	$34,060.81
Rate for Payer: Fidelis CHP/HARP/Medicaid	$34,060.81
Rate for Payer: Fidelis Qualified Health Plan	$40,872.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$34,060.81
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$34,060.81
Rate for Payer: Healthfirst Commercial	$77,812.00
Rate for Payer: Healthfirst Essential Plan	$76,636.82
Rate for Payer: Healthfirst QHP	$50,560.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$34,060.81
Rate for Payer: SOMOS Essential	$76,636.82
Rate for Payer: Wellcare CHP/FHP/Medicaid	$34,060.81

APR-DRG 0224: Ventricular shunt procedures

Facility IP

$126,760.00

Service Code	APR-DRG 0224
Min. Negotiated Rate	$55,286.92
Max. Negotiated Rate	$126,760.00
Rate for Payer: Amida Care Medicaid	$55,286.92
Rate for Payer: Fidelis CHP/HARP/Medicaid	$55,286.92
Rate for Payer: Fidelis Qualified Health Plan	$66,344.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$55,286.92
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$55,286.92
Rate for Payer: Healthfirst Commercial	$126,760.00
Rate for Payer: Healthfirst Essential Plan	$124,395.57
Rate for Payer: Healthfirst QHP	$87,770.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$55,286.92
Rate for Payer: SOMOS Essential	$124,395.57
Rate for Payer: Wellcare CHP/FHP/Medicaid	$55,286.92

APR-DRG 0231: Spinal procedures

Facility IP

$58,504.14

Service Code	APR-DRG 0231
Min. Negotiated Rate	$18,910.00
Max. Negotiated Rate	$58,504.14
Rate for Payer: Amida Care Medicaid	$26,001.84
Rate for Payer: Fidelis CHP/HARP/Medicaid	$26,001.84
Rate for Payer: Fidelis Qualified Health Plan	$31,202.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$26,001.84
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$26,001.84
Rate for Payer: Healthfirst Commercial	$30,819.00
Rate for Payer: Healthfirst Essential Plan	$58,504.14
Rate for Payer: Healthfirst QHP	$18,910.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26,001.84
Rate for Payer: SOMOS Essential	$58,504.14
Rate for Payer: Wellcare CHP/FHP/Medicaid	$26,001.84

APR-DRG 0232: Spinal procedures

Facility IP

$68,441.06

Service Code	APR-DRG 0232
Min. Negotiated Rate	$24,542.00
Max. Negotiated Rate	$68,441.06
Rate for Payer: Amida Care Medicaid	$30,418.25
Rate for Payer: Fidelis CHP/HARP/Medicaid	$30,418.25
Rate for Payer: Fidelis Qualified Health Plan	$36,501.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$30,418.25
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$30,418.25
Rate for Payer: Healthfirst Commercial	$39,239.00
Rate for Payer: Healthfirst Essential Plan	$68,441.06
Rate for Payer: Healthfirst QHP	$24,542.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$30,418.25
Rate for Payer: SOMOS Essential	$68,441.06
Rate for Payer: Wellcare CHP/FHP/Medicaid	$30,418.25

APR-DRG 0233: Spinal procedures

Facility IP

$105,205.90

Service Code	APR-DRG 0233
Min. Negotiated Rate	$38,406.00
Max. Negotiated Rate	$105,205.90
Rate for Payer: Amida Care Medicaid	$46,758.18
Rate for Payer: Fidelis CHP/HARP/Medicaid	$46,758.18
Rate for Payer: Fidelis Qualified Health Plan	$56,109.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$46,758.18
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$46,758.18
Rate for Payer: Healthfirst Commercial	$73,823.00
Rate for Payer: Healthfirst Essential Plan	$105,205.90
Rate for Payer: Healthfirst QHP	$38,406.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$46,758.18
Rate for Payer: SOMOS Essential	$105,205.90
Rate for Payer: Wellcare CHP/FHP/Medicaid	$46,758.18

APR-DRG 0234: Spinal procedures

Facility IP

$171,786.76

Service Code	APR-DRG 0234
Min. Negotiated Rate	$76,349.67
Max. Negotiated Rate	$171,786.76
Rate for Payer: Amida Care Medicaid	$76,349.67
Rate for Payer: Fidelis CHP/HARP/Medicaid	$76,349.67
Rate for Payer: Fidelis Qualified Health Plan	$91,619.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$76,349.67
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$76,349.67
Rate for Payer: Healthfirst Commercial	$149,434.00
Rate for Payer: Healthfirst Essential Plan	$171,786.76
Rate for Payer: Healthfirst QHP	$87,435.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$76,349.67
Rate for Payer: SOMOS Essential	$171,786.76
Rate for Payer: Wellcare CHP/FHP/Medicaid	$76,349.67

APR-DRG 0241: Extracranial vascular procedures

Facility IP

$56,054.20

Service Code	APR-DRG 0241
Min. Negotiated Rate	$15,222.00
Max. Negotiated Rate	$56,054.20
Rate for Payer: Amida Care Medicaid	$24,912.98
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,912.98
Rate for Payer: Fidelis Qualified Health Plan	$29,895.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,912.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,912.98
Rate for Payer: Healthfirst Commercial	$24,418.00
Rate for Payer: Healthfirst Essential Plan	$56,054.20
Rate for Payer: Healthfirst QHP	$15,222.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,912.98
Rate for Payer: SOMOS Essential	$56,054.20
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,912.98

APR-DRG 0242: Extracranial vascular procedures

Facility IP

$67,113.20

Service Code	APR-DRG 0242
Min. Negotiated Rate	$19,762.00
Max. Negotiated Rate	$67,113.20
Rate for Payer: Amida Care Medicaid	$29,828.09
Rate for Payer: Fidelis CHP/HARP/Medicaid	$29,828.09
Rate for Payer: Fidelis Qualified Health Plan	$35,793.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$29,828.09
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29,828.09
Rate for Payer: Healthfirst Commercial	$35,015.00
Rate for Payer: Healthfirst Essential Plan	$67,113.20
Rate for Payer: Healthfirst QHP	$19,762.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$29,828.09
Rate for Payer: SOMOS Essential	$67,113.20
Rate for Payer: Wellcare CHP/FHP/Medicaid	$29,828.09

APR-DRG 0243: Extracranial vascular procedures

Facility IP

$94,546.12

Service Code	APR-DRG 0243
Min. Negotiated Rate	$40,103.00
Max. Negotiated Rate	$94,546.12
Rate for Payer: Amida Care Medicaid	$42,020.50
Rate for Payer: Fidelis CHP/HARP/Medicaid	$42,020.50
Rate for Payer: Fidelis Qualified Health Plan	$50,424.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$42,020.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$42,020.50
Rate for Payer: Healthfirst Commercial	$68,705.00
Rate for Payer: Healthfirst Essential Plan	$94,546.12
Rate for Payer: Healthfirst QHP	$40,103.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$42,020.50
Rate for Payer: SOMOS Essential	$94,546.12
Rate for Payer: Wellcare CHP/FHP/Medicaid	$42,020.50

APR-DRG 0244: Extracranial vascular procedures

Facility IP

$149,125.30

Service Code	APR-DRG 0244
Min. Negotiated Rate	$66,277.91
Max. Negotiated Rate	$149,125.30
Rate for Payer: Amida Care Medicaid	$66,277.91
Rate for Payer: Fidelis CHP/HARP/Medicaid	$66,277.91
Rate for Payer: Fidelis Qualified Health Plan	$79,533.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$66,277.91
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$66,277.91
Rate for Payer: Healthfirst Commercial	$122,908.00
Rate for Payer: Healthfirst Essential Plan	$149,125.30
Rate for Payer: Healthfirst QHP	$75,011.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$66,277.91
Rate for Payer: SOMOS Essential	$149,125.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$66,277.91

APR-DRG 0261: Other nervous system & related procedures

Facility IP

$51,217.65

Service Code	APR-DRG 0261
Min. Negotiated Rate	$13,284.00
Max. Negotiated Rate	$51,217.65
Rate for Payer: Amida Care Medicaid	$22,763.40
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,763.40
Rate for Payer: Fidelis Qualified Health Plan	$27,316.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,763.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,763.40
Rate for Payer: Healthfirst Commercial	$22,179.00
Rate for Payer: Healthfirst Essential Plan	$51,217.65
Rate for Payer: Healthfirst QHP	$13,284.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,763.40
Rate for Payer: SOMOS Essential	$51,217.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,763.40

APR-DRG 0262: Other nervous system & related procedures

Facility IP

$61,230.20

Service Code	APR-DRG 0262
Min. Negotiated Rate	$21,020.00
Max. Negotiated Rate	$61,230.20
Rate for Payer: Amida Care Medicaid	$27,213.42
Rate for Payer: Fidelis CHP/HARP/Medicaid	$27,213.42
Rate for Payer: Fidelis Qualified Health Plan	$32,656.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$27,213.42
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$27,213.42
Rate for Payer: Healthfirst Commercial	$31,589.00
Rate for Payer: Healthfirst Essential Plan	$61,230.20
Rate for Payer: Healthfirst QHP	$21,020.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$27,213.42
Rate for Payer: SOMOS Essential	$61,230.20
Rate for Payer: Wellcare CHP/FHP/Medicaid	$27,213.42

APR-DRG 0263: Other nervous system & related procedures

Facility IP

$76,573.51

Service Code	APR-DRG 0263
Min. Negotiated Rate	$31,417.00
Max. Negotiated Rate	$76,573.51
Rate for Payer: Amida Care Medicaid	$34,032.67
Rate for Payer: Fidelis CHP/HARP/Medicaid	$34,032.67
Rate for Payer: Fidelis Qualified Health Plan	$40,839.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$34,032.67
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$34,032.67
Rate for Payer: Healthfirst Commercial	$54,323.00
Rate for Payer: Healthfirst Essential Plan	$76,573.51
Rate for Payer: Healthfirst QHP	$31,417.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$34,032.67
Rate for Payer: SOMOS Essential	$76,573.51
Rate for Payer: Wellcare CHP/FHP/Medicaid	$34,032.67

APR-DRG 0264: Other nervous system & related procedures

Facility IP

$140,020.27

Service Code	APR-DRG 0264
Min. Negotiated Rate	$62,231.23
Max. Negotiated Rate	$140,020.27
Rate for Payer: Amida Care Medicaid	$62,231.23
Rate for Payer: Fidelis CHP/HARP/Medicaid	$62,231.23
Rate for Payer: Fidelis Qualified Health Plan	$74,677.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$62,231.23
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$62,231.23
Rate for Payer: Healthfirst Commercial	$115,574.00
Rate for Payer: Healthfirst Essential Plan	$140,020.27
Rate for Payer: Healthfirst QHP	$96,336.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$62,231.23
Rate for Payer: SOMOS Essential	$140,020.27
Rate for Payer: Wellcare CHP/FHP/Medicaid	$62,231.23

APR-DRG 0401: Spinal disorders & injuries

Facility IP

$43,992.72

Service Code	APR-DRG 0401
Min. Negotiated Rate	$8,971.00
Max. Negotiated Rate	$43,992.72
Rate for Payer: Amida Care Medicaid	$19,552.32
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,552.32
Rate for Payer: Fidelis Qualified Health Plan	$23,462.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,552.32
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,552.32
Rate for Payer: Healthfirst Commercial	$15,128.00
Rate for Payer: Healthfirst Essential Plan	$43,992.72
Rate for Payer: Healthfirst QHP	$8,971.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,552.32
Rate for Payer: SOMOS Essential	$43,992.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,552.32

APR-DRG 0402: Spinal disorders & injuries

Facility IP

$52,230.69

Service Code	APR-DRG 0402
Min. Negotiated Rate	$11,718.00
Max. Negotiated Rate	$52,230.69
Rate for Payer: Amida Care Medicaid	$23,213.64
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,213.64
Rate for Payer: Fidelis Qualified Health Plan	$27,856.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,213.64
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,213.64
Rate for Payer: Healthfirst Commercial	$18,208.00
Rate for Payer: Healthfirst Essential Plan	$52,230.69
Rate for Payer: Healthfirst QHP	$11,718.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,213.64
Rate for Payer: SOMOS Essential	$52,230.69
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,213.64

APR-DRG 0403: Spinal disorders & injuries

Facility IP

$70,032.74

Service Code	APR-DRG 0403
Min. Negotiated Rate	$19,725.00
Max. Negotiated Rate	$70,032.74
Rate for Payer: Amida Care Medicaid	$31,125.66
Rate for Payer: Fidelis CHP/HARP/Medicaid	$31,125.66
Rate for Payer: Fidelis Qualified Health Plan	$37,350.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$31,125.66
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31,125.66
Rate for Payer: Healthfirst Commercial	$27,732.00
Rate for Payer: Healthfirst Essential Plan	$70,032.74
Rate for Payer: Healthfirst QHP	$19,725.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$31,125.66
Rate for Payer: SOMOS Essential	$70,032.74
Rate for Payer: Wellcare CHP/FHP/Medicaid	$31,125.66

APR-DRG 0404: Spinal disorders & injuries

Facility IP

$77,410.66

Service Code	APR-DRG 0404
Min. Negotiated Rate	$22,615.00
Max. Negotiated Rate	$77,410.66
Rate for Payer: Amida Care Medicaid	$34,404.74
Rate for Payer: Fidelis CHP/HARP/Medicaid	$34,404.74
Rate for Payer: Fidelis Qualified Health Plan	$41,285.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$34,404.74
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$34,404.74
Rate for Payer: Healthfirst Commercial	$32,919.00
Rate for Payer: Healthfirst Essential Plan	$77,410.66
Rate for Payer: Healthfirst QHP	$22,615.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$34,404.74
Rate for Payer: SOMOS Essential	$77,410.66
Rate for Payer: Wellcare CHP/FHP/Medicaid	$34,404.74

APR-DRG 0411: Nervous system malignancy

Facility IP

$42,847.78

Service Code	APR-DRG 0411
Min. Negotiated Rate	$8,310.00
Max. Negotiated Rate	$42,847.78
Rate for Payer: Amida Care Medicaid	$19,043.46
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,043.46
Rate for Payer: Fidelis Qualified Health Plan	$22,852.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,043.46
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,043.46
Rate for Payer: Healthfirst Commercial	$14,240.00
Rate for Payer: Healthfirst Essential Plan	$42,847.78
Rate for Payer: Healthfirst QHP	$8,310.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,043.46
Rate for Payer: SOMOS Essential	$42,847.78
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,043.46

APR-DRG 0412: Nervous system malignancy

Facility IP

$44,880.91

Service Code	APR-DRG 0412
Min. Negotiated Rate	$9,559.00
Max. Negotiated Rate	$44,880.91
Rate for Payer: Amida Care Medicaid	$19,947.07
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,947.07
Rate for Payer: Fidelis Qualified Health Plan	$23,936.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,947.07
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,947.07
Rate for Payer: Healthfirst Commercial	$16,444.00
Rate for Payer: Healthfirst Essential Plan	$44,880.91
Rate for Payer: Healthfirst QHP	$9,559.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,947.07
Rate for Payer: SOMOS Essential	$44,880.91
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,947.07

APR-DRG 0413: Nervous system malignancy

Facility IP

$55,565.28

Service Code	APR-DRG 0413
Min. Negotiated Rate	$16,361.00
Max. Negotiated Rate	$55,565.28
Rate for Payer: Amida Care Medicaid	$24,695.68
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,695.68
Rate for Payer: Fidelis Qualified Health Plan	$29,634.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,695.68
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,695.68
Rate for Payer: Healthfirst Commercial	$27,098.00
Rate for Payer: Healthfirst Essential Plan	$55,565.28
Rate for Payer: Healthfirst QHP	$16,361.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,695.68
Rate for Payer: SOMOS Essential	$55,565.28
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,695.68

APR-DRG 0414: Nervous system malignancy

Facility IP

$77,679.76

Service Code	APR-DRG 0414
Min. Negotiated Rate	$29,725.00
Max. Negotiated Rate	$77,679.76
Rate for Payer: Amida Care Medicaid	$34,524.34
Rate for Payer: Fidelis CHP/HARP/Medicaid	$34,524.34
Rate for Payer: Fidelis Qualified Health Plan	$41,429.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$34,524.34
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$34,524.34
Rate for Payer: Healthfirst Commercial	$49,081.00
Rate for Payer: Healthfirst Essential Plan	$77,679.76
Rate for Payer: Healthfirst QHP	$29,725.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$34,524.34
Rate for Payer: SOMOS Essential	$77,679.76
Rate for Payer: Wellcare CHP/FHP/Medicaid	$34,524.34

APR-DRG 0421: Degenerative nervous system disorders exc mult sclerosis

Facility IP

$12,179.00

Service Code	APR-DRG 0421
Min. Negotiated Rate	$2,115.53
Max. Negotiated Rate	$12,179.00
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,115.53
Rate for Payer: Fidelis Qualified Health Plan	$2,538.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,115.53
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,115.53
Rate for Payer: Healthfirst Commercial	$12,179.00
Rate for Payer: Healthfirst Essential Plan	$4,759.94
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,115.53
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$4,759.94
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$4,759.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,115.53
Rate for Payer: SOMOS Essential	$4,759.94

APR-DRG 0422: Degenerative nervous system disorders exc mult sclerosis

Facility IP

$15,854.00

Service Code	APR-DRG 0422
Min. Negotiated Rate	$2,115.53
Max. Negotiated Rate	$15,854.00
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,115.53
Rate for Payer: Fidelis Qualified Health Plan	$2,538.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,115.53
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,115.53
Rate for Payer: Healthfirst Commercial	$15,854.00
Rate for Payer: Healthfirst Essential Plan	$4,759.94
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,115.53
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$4,759.94
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$4,759.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,115.53
Rate for Payer: SOMOS Essential	$4,759.94

APR-DRG 0423: Degenerative nervous system disorders exc mult sclerosis

Facility IP

$21,694.00

Service Code	APR-DRG 0423
Min. Negotiated Rate	$2,115.53
Max. Negotiated Rate	$21,694.00
Rate for Payer: Carelon Behavioral Health HARP/QHP	$2,115.53
Rate for Payer: Fidelis Qualified Health Plan	$2,538.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,115.53
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,115.53
Rate for Payer: Healthfirst Commercial	$21,694.00
Rate for Payer: Healthfirst Essential Plan	$4,759.94
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$2,115.53
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$4,759.94
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$4,759.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,115.53
Rate for Payer: SOMOS Essential	$4,759.94

Price Transparency.

All Charges