St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ONDANSETRON HCL 4 MG/5ML PO SOLN

Facility

$3.06

Service Code	HCPCS Q0162
Hospital Charge Code	5026864711
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$2.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$2.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.08
Rate for Payer: EmblemHealth Commercial	$1.53
Rate for Payer: Group Health Inc Commercial	$1.53
Rate for Payer: Group Health Inc Medicare	$1.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.53
Rate for Payer: Hamaspik Choice Inc Medicare	$1.53
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.99

ONDANSETRON HCL 4 MG/5ML PO SOLN

Facility

$3.28

Service Code	HCPCS Q0162
Hospital Charge Code	6068725240
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$2.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$2.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.23
Rate for Payer: EmblemHealth Commercial	$1.64
Rate for Payer: Group Health Inc Commercial	$1.64
Rate for Payer: Group Health Inc Medicare	$1.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.64
Rate for Payer: Hamaspik Choice Inc Medicare	$1.64
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.13

ONDANSETRON HCL 4 MG/5ML PO SOLN

Facility

$3.06

Service Code	HCPCS Q0162
Hospital Charge Code	6809476362
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$2.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$2.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.08
Rate for Payer: EmblemHealth Commercial	$1.53
Rate for Payer: Group Health Inc Commercial	$1.53
Rate for Payer: Group Health Inc Medicare	$1.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.53
Rate for Payer: Hamaspik Choice Inc Medicare	$1.53
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.99

ONDANSETRON HCL 4 MG/5ML PO SOLN

Facility

$3.06

Service Code	HCPCS Q0162
Hospital Charge Code	6809476362
Hospital Revenue Code	250
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$1.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.53

OPEN INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES

Facility

$3,175.22

Service Code	EAPG 00266
Min. Negotiated Rate	$3,175.22
Max. Negotiated Rate	$3,175.22
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,175.22

OPEN OR PERCUTANEOUS TREATMENT OF FRACTURES

Facility

$5,157.69

Service Code	EAPG 00043
Min. Negotiated Rate	$3,744.54
Max. Negotiated Rate	$5,157.69
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,744.54
Rate for Payer: Healthfirst Commercial	$5,157.69

OPEN WOUNDS, PUNCTURES AND OTHER OPEN TRAUMATIC INJURIES

Facility

$307.96

Service Code	EAPG 00674
Min. Negotiated Rate	$224.49
Max. Negotiated Rate	$307.96
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$224.49
Rate for Payer: Healthfirst Commercial	$307.96

OPHTHALMOLOGICAL TESTS AND PROCEDURES

Facility

$341.31

Service Code	EAPG 00230
Min. Negotiated Rate	$247.63
Max. Negotiated Rate	$341.31
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$247.63
Rate for Payer: Healthfirst Commercial	$341.31

OPIOID ABUSE AND DEPENDENCE

Facility

$221.45

Service Code	EAPG 00840
Min. Negotiated Rate	$185.14
Max. Negotiated Rate	$221.45
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$185.14
Rate for Payer: Healthfirst Commercial	$221.45

Opioid abuse & dependence

Facility

$11,246.00

Service Code	APR-DRG 7732
Min. Negotiated Rate	$3,362.21
Max. Negotiated Rate	$11,246.00
Rate for Payer: Affinity Essential Plan 1&2	$3,362.21
Rate for Payer: Affinity Essential Plan 3&4	$3,362.21
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,362.21
Rate for Payer: Carelon Behavioral Health HARP/QHP	$3,362.21
Rate for Payer: EmblemHealth Essential Plan 1&2	$7,564.97
Rate for Payer: EmblemHealth Essential Plan 3&4	$3,362.21
Rate for Payer: Fidelis Qualified Health Plan	$4,034.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,362.21
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,362.21
Rate for Payer: Healthfirst Commercial	$11,246.00
Rate for Payer: Healthfirst Essential Plan	$7,564.97
Rate for Payer: Healthfirst QHP	$6,119.22
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$3,362.21
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7,564.97
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7,564.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,362.21
Rate for Payer: SOMOS Essential	$7,564.97
Rate for Payer: United Healthcare Essential Plan 1&2	$7,564.97
Rate for Payer: United Healthcare Essential Plan 3&4	$7,564.97
Rate for Payer: United Healthcare Medicaid	$3,362.21

Opioid abuse & dependence

Facility

$15,436.00

Service Code	APR-DRG 7733
Min. Negotiated Rate	$3,379.17
Max. Negotiated Rate	$15,436.00
Rate for Payer: Affinity Essential Plan 1&2	$3,379.17
Rate for Payer: Affinity Essential Plan 3&4	$3,379.17
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,379.17
Rate for Payer: Carelon Behavioral Health HARP/QHP	$3,379.17
Rate for Payer: EmblemHealth Essential Plan 1&2	$7,603.13
Rate for Payer: EmblemHealth Essential Plan 3&4	$3,379.17
Rate for Payer: Fidelis Qualified Health Plan	$4,055.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,379.17
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,379.17
Rate for Payer: Healthfirst Commercial	$15,436.00
Rate for Payer: Healthfirst Essential Plan	$7,603.13
Rate for Payer: Healthfirst QHP	$6,150.09
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$3,379.17
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7,603.13
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7,603.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,379.17
Rate for Payer: SOMOS Essential	$7,603.13
Rate for Payer: United Healthcare Essential Plan 1&2	$7,603.13
Rate for Payer: United Healthcare Essential Plan 3&4	$7,603.13
Rate for Payer: United Healthcare Medicaid	$3,379.17

Opioid abuse & dependence

Facility

$10,470.00

Service Code	APR-DRG 7731
Min. Negotiated Rate	$3,362.21
Max. Negotiated Rate	$10,470.00
Rate for Payer: Affinity Essential Plan 1&2	$3,362.21
Rate for Payer: Affinity Essential Plan 3&4	$3,362.21
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,362.21
Rate for Payer: Carelon Behavioral Health HARP/QHP	$3,362.21
Rate for Payer: EmblemHealth Essential Plan 1&2	$7,564.97
Rate for Payer: EmblemHealth Essential Plan 3&4	$3,362.21
Rate for Payer: Fidelis Qualified Health Plan	$4,034.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,362.21
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,362.21
Rate for Payer: Healthfirst Commercial	$10,470.00
Rate for Payer: Healthfirst Essential Plan	$7,564.97
Rate for Payer: Healthfirst QHP	$6,119.22
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$3,362.21
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7,564.97
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7,564.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,362.21
Rate for Payer: SOMOS Essential	$7,564.97
Rate for Payer: United Healthcare Essential Plan 1&2	$7,564.97
Rate for Payer: United Healthcare Essential Plan 3&4	$7,564.97
Rate for Payer: United Healthcare Medicaid	$3,362.21

Opioid abuse & dependence

Facility

$18,934.00

Service Code	APR-DRG 7734
Min. Negotiated Rate	$3,379.17
Max. Negotiated Rate	$18,934.00
Rate for Payer: Affinity Essential Plan 1&2	$3,379.17
Rate for Payer: Affinity Essential Plan 3&4	$3,379.17
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,379.17
Rate for Payer: Carelon Behavioral Health HARP/QHP	$3,379.17
Rate for Payer: EmblemHealth Essential Plan 1&2	$7,603.13
Rate for Payer: EmblemHealth Essential Plan 3&4	$3,379.17
Rate for Payer: Fidelis Qualified Health Plan	$4,055.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,379.17
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,379.17
Rate for Payer: Healthfirst Commercial	$18,934.00
Rate for Payer: Healthfirst Essential Plan	$7,603.13
Rate for Payer: Healthfirst QHP	$6,150.09
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$3,379.17
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7,603.13
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7,603.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,379.17
Rate for Payer: SOMOS Essential	$7,603.13
Rate for Payer: United Healthcare Essential Plan 1&2	$7,603.13
Rate for Payer: United Healthcare Essential Plan 3&4	$7,603.13
Rate for Payer: United Healthcare Medicaid	$3,379.17

ORA-SWEET PO SYRP

Facility

$0.05

Service Code	NDC 0574030416
Hospital Charge Code	0574030416
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02

ORA-SWEET PO SYRP

Facility

$0.05

Service Code	NDC 0574030416
Hospital Charge Code	0574030416
Hospital Revenue Code	250
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	$0.04
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

Orbital procedures

Facility

$67,875.75

Service Code	APR-DRG 0703
Min. Negotiated Rate	$22,562.00
Max. Negotiated Rate	$67,875.75
Rate for Payer: Affinity Essential Plan 1&2	$67,875.75
Rate for Payer: Affinity Essential Plan 3&4	$67,875.75
Rate for Payer: Affinity Medicaid/CHP/HARP	$30,167.00
Rate for Payer: Amida Care Medicaid	$30,167.00
Rate for Payer: EmblemHealth Essential Plan 1&2	$67,875.75
Rate for Payer: EmblemHealth Essential Plan 3&4	$30,167.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$30,167.00
Rate for Payer: Fidelis Qualified Health Plan	$36,200.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$30,167.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$30,167.00
Rate for Payer: Healthfirst Commercial	$30,286.00
Rate for Payer: Healthfirst Essential Plan	$67,875.75
Rate for Payer: Healthfirst QHP	$22,562.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$30,167.00
Rate for Payer: SOMOS Essential	$67,875.75
Rate for Payer: United Healthcare Essential Plan 1&2	$67,875.75
Rate for Payer: United Healthcare Essential Plan 3&4	$67,875.75
Rate for Payer: United Healthcare Medicaid	$30,167.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$30,167.00

Orbital procedures

Facility

$72,831.89

Service Code	APR-DRG 0704
Min. Negotiated Rate	$25,014.00
Max. Negotiated Rate	$72,831.89
Rate for Payer: Affinity Essential Plan 1&2	$72,831.89
Rate for Payer: Affinity Essential Plan 3&4	$72,831.89
Rate for Payer: Affinity Medicaid/CHP/HARP	$32,369.73
Rate for Payer: Amida Care Medicaid	$32,369.73
Rate for Payer: EmblemHealth Essential Plan 1&2	$72,831.89
Rate for Payer: EmblemHealth Essential Plan 3&4	$32,369.73
Rate for Payer: Fidelis CHP/HARP/Medicaid	$32,369.73
Rate for Payer: Fidelis Qualified Health Plan	$38,843.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$32,369.73
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$32,369.73
Rate for Payer: Healthfirst Commercial	$32,939.00
Rate for Payer: Healthfirst Essential Plan	$72,831.89
Rate for Payer: Healthfirst QHP	$25,014.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$32,369.73
Rate for Payer: SOMOS Essential	$72,831.89
Rate for Payer: United Healthcare Essential Plan 1&2	$72,831.89
Rate for Payer: United Healthcare Essential Plan 3&4	$72,831.89
Rate for Payer: United Healthcare Medicaid	$32,369.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$32,369.73

Orbital procedures

Facility

$46,160.50

Service Code	APR-DRG 0701
Min. Negotiated Rate	$8,640.00
Max. Negotiated Rate	$46,160.50
Rate for Payer: Affinity Essential Plan 1&2	$46,160.50
Rate for Payer: Affinity Essential Plan 3&4	$46,160.50
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,515.78
Rate for Payer: Amida Care Medicaid	$20,515.78
Rate for Payer: EmblemHealth Essential Plan 1&2	$46,160.50
Rate for Payer: EmblemHealth Essential Plan 3&4	$20,515.78
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,515.78
Rate for Payer: Fidelis Qualified Health Plan	$24,618.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,515.78
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,515.78
Rate for Payer: Healthfirst Commercial	$15,026.00
Rate for Payer: Healthfirst Essential Plan	$46,160.50
Rate for Payer: Healthfirst QHP	$8,640.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,515.78
Rate for Payer: SOMOS Essential	$46,160.50
Rate for Payer: United Healthcare Essential Plan 1&2	$46,160.50
Rate for Payer: United Healthcare Essential Plan 3&4	$46,160.50
Rate for Payer: United Healthcare Medicaid	$20,515.78
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,515.78

Orbital procedures

Facility

$53,716.07

Service Code	APR-DRG 0702
Min. Negotiated Rate	$12,170.00
Max. Negotiated Rate	$53,716.07
Rate for Payer: Affinity Essential Plan 1&2	$53,716.07
Rate for Payer: Affinity Essential Plan 3&4	$53,716.07
Rate for Payer: Affinity Medicaid/CHP/HARP	$23,873.81
Rate for Payer: Amida Care Medicaid	$23,873.81
Rate for Payer: EmblemHealth Essential Plan 1&2	$53,716.07
Rate for Payer: EmblemHealth Essential Plan 3&4	$23,873.81
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,873.81
Rate for Payer: Fidelis Qualified Health Plan	$28,648.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,873.81
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,873.81
Rate for Payer: Healthfirst Commercial	$20,769.00
Rate for Payer: Healthfirst Essential Plan	$53,716.07
Rate for Payer: Healthfirst QHP	$12,170.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,873.81
Rate for Payer: SOMOS Essential	$53,716.07
Rate for Payer: United Healthcare Essential Plan 1&2	$53,716.07
Rate for Payer: United Healthcare Essential Plan 3&4	$53,716.07
Rate for Payer: United Healthcare Medicaid	$23,873.81
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,873.81

ORGANIC BEHAVIORAL HEALTH DISTURBANCES

Facility

$257.56

Service Code	EAPG 00827
Min. Negotiated Rate	$187.46
Max. Negotiated Rate	$257.56
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$187.46
Rate for Payer: Healthfirst Commercial	$257.56

Organic mental health disturbances

Facility

$22,988.00

Service Code	APR-DRG 7574
Min. Negotiated Rate	$3,388.88
Max. Negotiated Rate	$22,988.00
Rate for Payer: Affinity Essential Plan 1&2	$3,388.88
Rate for Payer: Affinity Essential Plan 3&4	$3,388.88
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,388.88
Rate for Payer: Carelon Behavioral Health HARP/QHP	$3,388.88
Rate for Payer: EmblemHealth Essential Plan 1&2	$7,624.98
Rate for Payer: EmblemHealth Essential Plan 3&4	$3,388.88
Rate for Payer: Fidelis Qualified Health Plan	$4,066.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,388.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,388.88
Rate for Payer: Healthfirst Commercial	$22,988.00
Rate for Payer: Healthfirst Essential Plan	$7,624.98
Rate for Payer: Healthfirst QHP	$6,167.76
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$3,388.88
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7,624.98
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7,624.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,388.88
Rate for Payer: SOMOS Essential	$7,624.98
Rate for Payer: United Healthcare Essential Plan 1&2	$7,624.98
Rate for Payer: United Healthcare Essential Plan 3&4	$7,624.98
Rate for Payer: United Healthcare Medicaid	$3,388.88

Organic mental health disturbances

Facility

$13,210.00

Service Code	APR-DRG 7571
Min. Negotiated Rate	$3,355.52
Max. Negotiated Rate	$13,210.00
Rate for Payer: Affinity Essential Plan 1&2	$3,355.52
Rate for Payer: Affinity Essential Plan 3&4	$3,355.52
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,355.52
Rate for Payer: Carelon Behavioral Health HARP/QHP	$3,355.52
Rate for Payer: EmblemHealth Essential Plan 1&2	$7,549.92
Rate for Payer: EmblemHealth Essential Plan 3&4	$3,355.52
Rate for Payer: Fidelis Qualified Health Plan	$4,026.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,355.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,355.52
Rate for Payer: Healthfirst Commercial	$13,210.00
Rate for Payer: Healthfirst Essential Plan	$7,549.92
Rate for Payer: Healthfirst QHP	$6,107.05
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$3,355.52
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7,549.92
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7,549.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,355.52
Rate for Payer: SOMOS Essential	$7,549.92
Rate for Payer: United Healthcare Essential Plan 1&2	$7,549.92
Rate for Payer: United Healthcare Essential Plan 3&4	$7,549.92
Rate for Payer: United Healthcare Medicaid	$3,355.52

Organic mental health disturbances

Facility

$22,988.00

Service Code	APR-DRG 7573
Min. Negotiated Rate	$3,388.88
Max. Negotiated Rate	$22,988.00
Rate for Payer: Affinity Essential Plan 1&2	$3,388.88
Rate for Payer: Affinity Essential Plan 3&4	$3,388.88
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,388.88
Rate for Payer: Carelon Behavioral Health HARP/QHP	$3,388.88
Rate for Payer: EmblemHealth Essential Plan 1&2	$7,624.98
Rate for Payer: EmblemHealth Essential Plan 3&4	$3,388.88
Rate for Payer: Fidelis Qualified Health Plan	$4,066.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,388.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,388.88
Rate for Payer: Healthfirst Commercial	$22,988.00
Rate for Payer: Healthfirst Essential Plan	$7,624.98
Rate for Payer: Healthfirst QHP	$6,167.76
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$3,388.88
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7,624.98
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7,624.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,388.88
Rate for Payer: SOMOS Essential	$7,624.98
Rate for Payer: United Healthcare Essential Plan 1&2	$7,624.98
Rate for Payer: United Healthcare Essential Plan 3&4	$7,624.98
Rate for Payer: United Healthcare Medicaid	$3,388.88

Organic mental health disturbances

Facility

$17,064.00

Service Code	APR-DRG 7572
Min. Negotiated Rate	$3,355.52
Max. Negotiated Rate	$17,064.00
Rate for Payer: Affinity Essential Plan 1&2	$3,355.52
Rate for Payer: Affinity Essential Plan 3&4	$3,355.52
Rate for Payer: Affinity Medicaid/CHP/HARP	$3,355.52
Rate for Payer: Carelon Behavioral Health HARP/QHP	$3,355.52
Rate for Payer: EmblemHealth Essential Plan 1&2	$7,549.92
Rate for Payer: EmblemHealth Essential Plan 3&4	$3,355.52
Rate for Payer: Fidelis Qualified Health Plan	$4,026.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,355.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3,355.52
Rate for Payer: Healthfirst Commercial	$17,064.00
Rate for Payer: Healthfirst Essential Plan	$7,549.92
Rate for Payer: Healthfirst QHP	$6,107.05
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$3,355.52
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7,549.92
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7,549.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,355.52
Rate for Payer: SOMOS Essential	$7,549.92
Rate for Payer: United Healthcare Essential Plan 1&2	$7,549.92
Rate for Payer: United Healthcare Essential Plan 3&4	$7,549.92
Rate for Payer: United Healthcare Medicaid	$3,355.52

ORGAN OR DISEASE ORIENTED PANELS

Facility

$51.46

Service Code	EAPG 00403
Min. Negotiated Rate	$37.03
Max. Negotiated Rate	$51.46
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$37.03
Rate for Payer: Healthfirst Commercial	$51.46

Know your out-of-pocket cost for care.

All Charges