St. Barnabas Hospital

All Charges

Charge

Type

Price

APR-DRG 0424: Degenerative nervous system disorders exc mult sclerosis

Facility IP

$56,848.00

Service Code	APR-DRG 0424
Min. Negotiated Rate	$2,115.53
Max. Negotiated Rate	$56,848.00
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	$56,848.00
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 0431: Multiple sclerosis & other demyelinating diseases

Facility IP

$43,429.93

Service Code	APR-DRG 0431
Min. Negotiated Rate	$8,100.00
Max. Negotiated Rate	$43,429.93
Rate for Payer: Amida Care Medicaid	$19,302.19
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,302.19
Rate for Payer: Fidelis Qualified Health Plan	$23,162.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,302.19
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,302.19
Rate for Payer: Healthfirst Commercial	$13,205.00
Rate for Payer: Healthfirst Essential Plan	$43,429.93
Rate for Payer: Healthfirst QHP	$8,100.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,302.19
Rate for Payer: SOMOS Essential	$43,429.93
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,302.19

APR-DRG 0432: Multiple sclerosis & other demyelinating diseases

Facility IP

$48,546.14

Service Code	APR-DRG 0432
Min. Negotiated Rate	$9,859.00
Max. Negotiated Rate	$48,546.14
Rate for Payer: Amida Care Medicaid	$21,576.06
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,576.06
Rate for Payer: Fidelis Qualified Health Plan	$25,891.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,576.06
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,576.06
Rate for Payer: Healthfirst Commercial	$17,007.00
Rate for Payer: Healthfirst Essential Plan	$48,546.14
Rate for Payer: Healthfirst QHP	$9,859.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,576.06
Rate for Payer: SOMOS Essential	$48,546.14
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,576.06

APR-DRG 0433: Multiple sclerosis & other demyelinating diseases

Facility IP

$69,357.38

Service Code	APR-DRG 0433
Min. Negotiated Rate	$18,406.00
Max. Negotiated Rate	$69,357.38
Rate for Payer: Amida Care Medicaid	$30,825.50
Rate for Payer: Fidelis CHP/HARP/Medicaid	$30,825.50
Rate for Payer: Fidelis Qualified Health Plan	$36,990.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$30,825.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$30,825.50
Rate for Payer: Healthfirst Commercial	$28,142.00
Rate for Payer: Healthfirst Essential Plan	$69,357.38
Rate for Payer: Healthfirst QHP	$18,406.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$30,825.50
Rate for Payer: SOMOS Essential	$69,357.38
Rate for Payer: Wellcare CHP/FHP/Medicaid	$30,825.50

APR-DRG 0434: Multiple sclerosis & other demyelinating diseases

Facility IP

$133,720.45

Service Code	APR-DRG 0434
Min. Negotiated Rate	$44,630.00
Max. Negotiated Rate	$133,720.45
Rate for Payer: Amida Care Medicaid	$59,431.31
Rate for Payer: Fidelis CHP/HARP/Medicaid	$59,431.31
Rate for Payer: Fidelis Qualified Health Plan	$71,317.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$59,431.31
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$59,431.31
Rate for Payer: Healthfirst Commercial	$80,639.00
Rate for Payer: Healthfirst Essential Plan	$133,720.45
Rate for Payer: Healthfirst QHP	$44,630.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$59,431.31
Rate for Payer: SOMOS Essential	$133,720.45
Rate for Payer: Wellcare CHP/FHP/Medicaid	$59,431.31

APR-DRG 0441: Intracranial hemorrhage

Facility IP

$47,232.34

Service Code	APR-DRG 0441
Min. Negotiated Rate	$10,424.00
Max. Negotiated Rate	$47,232.34
Rate for Payer: Amida Care Medicaid	$20,992.15
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,992.15
Rate for Payer: Fidelis Qualified Health Plan	$25,190.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,992.15
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,992.15
Rate for Payer: Healthfirst Commercial	$17,858.00
Rate for Payer: Healthfirst Essential Plan	$47,232.34
Rate for Payer: Healthfirst QHP	$10,424.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,992.15
Rate for Payer: SOMOS Essential	$47,232.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,992.15

APR-DRG 0442: Intracranial hemorrhage

Facility IP

$55,375.34

Service Code	APR-DRG 0442
Min. Negotiated Rate	$14,215.00
Max. Negotiated Rate	$55,375.34
Rate for Payer: Amida Care Medicaid	$24,611.26
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,611.26
Rate for Payer: Fidelis Qualified Health Plan	$29,533.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,611.26
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,611.26
Rate for Payer: Healthfirst Commercial	$23,320.00
Rate for Payer: Healthfirst Essential Plan	$55,375.34
Rate for Payer: Healthfirst QHP	$14,215.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,611.26
Rate for Payer: SOMOS Essential	$55,375.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,611.26

APR-DRG 0443: Intracranial hemorrhage

Facility IP

$66,849.39

Service Code	APR-DRG 0443
Min. Negotiated Rate	$18,625.00
Max. Negotiated Rate	$66,849.39
Rate for Payer: Amida Care Medicaid	$29,710.84
Rate for Payer: Fidelis CHP/HARP/Medicaid	$29,710.84
Rate for Payer: Fidelis Qualified Health Plan	$35,653.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$29,710.84
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29,710.84
Rate for Payer: Healthfirst Commercial	$32,055.00
Rate for Payer: Healthfirst Essential Plan	$66,849.39
Rate for Payer: Healthfirst QHP	$18,625.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$29,710.84
Rate for Payer: SOMOS Essential	$66,849.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$29,710.84

APR-DRG 0444: Intracranial hemorrhage

Facility IP

$78,513.41

Service Code	APR-DRG 0444
Min. Negotiated Rate	$29,368.00
Max. Negotiated Rate	$78,513.41
Rate for Payer: Amida Care Medicaid	$34,894.85
Rate for Payer: Fidelis CHP/HARP/Medicaid	$34,894.85
Rate for Payer: Fidelis Qualified Health Plan	$41,873.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$34,894.85
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$34,894.85
Rate for Payer: Healthfirst Commercial	$49,052.00
Rate for Payer: Healthfirst Essential Plan	$78,513.41
Rate for Payer: Healthfirst QHP	$29,368.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$34,894.85
Rate for Payer: SOMOS Essential	$78,513.41
Rate for Payer: Wellcare CHP/FHP/Medicaid	$34,894.85

APR-DRG 0451: CVA & precerebral occlusion w infarct

Facility IP

$43,665.62

Service Code	APR-DRG 0451
Min. Negotiated Rate	$8,961.00
Max. Negotiated Rate	$43,665.62
Rate for Payer: Amida Care Medicaid	$19,406.94
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,406.94
Rate for Payer: Fidelis Qualified Health Plan	$23,288.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,406.94
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,406.94
Rate for Payer: Healthfirst Commercial	$14,357.00
Rate for Payer: Healthfirst Essential Plan	$43,665.62
Rate for Payer: Healthfirst QHP	$8,961.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,406.94
Rate for Payer: SOMOS Essential	$43,665.62
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,406.94

APR-DRG 0452: CVA & precerebral occlusion w infarct

Facility IP

$49,188.06

Service Code	APR-DRG 0452
Min. Negotiated Rate	$10,999.00
Max. Negotiated Rate	$49,188.06
Rate for Payer: Amida Care Medicaid	$21,861.36
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,861.36
Rate for Payer: Fidelis Qualified Health Plan	$26,233.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,861.36
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,861.36
Rate for Payer: Healthfirst Commercial	$18,664.00
Rate for Payer: Healthfirst Essential Plan	$49,188.06
Rate for Payer: Healthfirst QHP	$10,999.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,861.36
Rate for Payer: SOMOS Essential	$49,188.06
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,861.36

APR-DRG 0453: CVA & precerebral occlusion w infarct

Facility IP

$59,916.42

Service Code	APR-DRG 0453
Min. Negotiated Rate	$16,333.00
Max. Negotiated Rate	$59,916.42
Rate for Payer: Amida Care Medicaid	$26,629.52
Rate for Payer: Fidelis CHP/HARP/Medicaid	$26,629.52
Rate for Payer: Fidelis Qualified Health Plan	$31,955.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$26,629.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$26,629.52
Rate for Payer: Healthfirst Commercial	$28,308.00
Rate for Payer: Healthfirst Essential Plan	$59,916.42
Rate for Payer: Healthfirst QHP	$16,333.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26,629.52
Rate for Payer: SOMOS Essential	$59,916.42
Rate for Payer: Wellcare CHP/FHP/Medicaid	$26,629.52

APR-DRG 0454: CVA & precerebral occlusion w infarct

Facility IP

$89,795.77

Service Code	APR-DRG 0454
Min. Negotiated Rate	$33,987.00
Max. Negotiated Rate	$89,795.77
Rate for Payer: Amida Care Medicaid	$39,909.23
Rate for Payer: Fidelis CHP/HARP/Medicaid	$39,909.23
Rate for Payer: Fidelis Qualified Health Plan	$47,891.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$39,909.23
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$39,909.23
Rate for Payer: Healthfirst Commercial	$54,910.00
Rate for Payer: Healthfirst Essential Plan	$89,795.77
Rate for Payer: Healthfirst QHP	$33,987.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$39,909.23
Rate for Payer: SOMOS Essential	$89,795.77
Rate for Payer: Wellcare CHP/FHP/Medicaid	$39,909.23

APR-DRG 0461: Nonspecific CVA & precerebral occlusion w/o infarct

Facility IP

$40,749.59

Service Code	APR-DRG 0461
Min. Negotiated Rate	$7,648.00
Max. Negotiated Rate	$40,749.59
Rate for Payer: Amida Care Medicaid	$18,110.93
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,110.93
Rate for Payer: Fidelis Qualified Health Plan	$21,733.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,110.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,110.93
Rate for Payer: Healthfirst Commercial	$13,207.00
Rate for Payer: Healthfirst Essential Plan	$40,749.59
Rate for Payer: Healthfirst QHP	$7,648.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,110.93
Rate for Payer: SOMOS Essential	$40,749.59
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,110.93

APR-DRG 0462: Nonspecific CVA & precerebral occlusion w/o infarct

Facility IP

$44,564.33

Service Code	APR-DRG 0462
Min. Negotiated Rate	$9,099.00
Max. Negotiated Rate	$44,564.33
Rate for Payer: Amida Care Medicaid	$19,806.37
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,806.37
Rate for Payer: Fidelis Qualified Health Plan	$23,767.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,806.37
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,806.37
Rate for Payer: Healthfirst Commercial	$16,008.00
Rate for Payer: Healthfirst Essential Plan	$44,564.33
Rate for Payer: Healthfirst QHP	$9,099.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,806.37
Rate for Payer: SOMOS Essential	$44,564.33
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,806.37

APR-DRG 0463: Nonspecific CVA & precerebral occlusion w/o infarct

Facility IP

$49,091.33

Service Code	APR-DRG 0463
Min. Negotiated Rate	$11,545.00
Max. Negotiated Rate	$49,091.33
Rate for Payer: Amida Care Medicaid	$21,818.37
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,818.37
Rate for Payer: Fidelis Qualified Health Plan	$26,182.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,818.37
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,818.37
Rate for Payer: Healthfirst Commercial	$19,615.00
Rate for Payer: Healthfirst Essential Plan	$49,091.33
Rate for Payer: Healthfirst QHP	$11,545.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,818.37
Rate for Payer: SOMOS Essential	$49,091.33
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,818.37

APR-DRG 0464: Nonspecific CVA & precerebral occlusion w/o infarct

Facility IP

$49,965.44

Service Code	APR-DRG 0464
Min. Negotiated Rate	$11,858.00
Max. Negotiated Rate	$49,965.44
Rate for Payer: Amida Care Medicaid	$22,206.86
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,206.86
Rate for Payer: Fidelis Qualified Health Plan	$26,648.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,206.86
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,206.86
Rate for Payer: Healthfirst Commercial	$20,421.00
Rate for Payer: Healthfirst Essential Plan	$49,965.44
Rate for Payer: Healthfirst QHP	$11,858.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,206.86
Rate for Payer: SOMOS Essential	$49,965.44
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,206.86

APR-DRG 0471: Transient ischemia

Facility IP

$38,672.53

Service Code	APR-DRG 0471
Min. Negotiated Rate	$6,161.00
Max. Negotiated Rate	$38,672.53
Rate for Payer: Amida Care Medicaid	$17,187.79
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,187.79
Rate for Payer: Fidelis Qualified Health Plan	$20,625.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,187.79
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,187.79
Rate for Payer: Healthfirst Commercial	$10,076.00
Rate for Payer: Healthfirst Essential Plan	$38,672.53
Rate for Payer: Healthfirst QHP	$6,161.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,187.79
Rate for Payer: SOMOS Essential	$38,672.53
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,187.79

APR-DRG 0472: Transient ischemia

Facility IP

$40,774.23

Service Code	APR-DRG 0472
Min. Negotiated Rate	$6,944.00
Max. Negotiated Rate	$40,774.23
Rate for Payer: Amida Care Medicaid	$18,121.88
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,121.88
Rate for Payer: Fidelis Qualified Health Plan	$21,746.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,121.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,121.88
Rate for Payer: Healthfirst Commercial	$11,892.00
Rate for Payer: Healthfirst Essential Plan	$40,774.23
Rate for Payer: Healthfirst QHP	$6,944.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,121.88
Rate for Payer: SOMOS Essential	$40,774.23
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,121.88

APR-DRG 0473: Transient ischemia

Facility IP

$45,042.70

Service Code	APR-DRG 0473
Min. Negotiated Rate	$9,078.00
Max. Negotiated Rate	$45,042.70
Rate for Payer: Amida Care Medicaid	$20,018.98
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,018.98
Rate for Payer: Fidelis Qualified Health Plan	$24,022.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,018.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,018.98
Rate for Payer: Healthfirst Commercial	$16,513.00
Rate for Payer: Healthfirst Essential Plan	$45,042.70
Rate for Payer: Healthfirst QHP	$9,078.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,018.98
Rate for Payer: SOMOS Essential	$45,042.70
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,018.98

APR-DRG 0474: Transient ischemia

Facility IP

$45,410.29

Service Code	APR-DRG 0474
Min. Negotiated Rate	$15,811.00
Max. Negotiated Rate	$45,410.29
Rate for Payer: Amida Care Medicaid	$20,182.35
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,182.35
Rate for Payer: Fidelis Qualified Health Plan	$24,218.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,182.35
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,182.35
Rate for Payer: Healthfirst Commercial	$16,914.00
Rate for Payer: Healthfirst Essential Plan	$45,410.29
Rate for Payer: Healthfirst QHP	$15,811.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,182.35
Rate for Payer: SOMOS Essential	$45,410.29
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,182.35

APR-DRG 0481: Peripheral, cranial & autonomic nerve disorders

Facility IP

$39,383.06

Service Code	APR-DRG 0481
Min. Negotiated Rate	$6,396.00
Max. Negotiated Rate	$39,383.06
Rate for Payer: Amida Care Medicaid	$17,503.58
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,503.58
Rate for Payer: Fidelis Qualified Health Plan	$21,004.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,503.58
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,503.58
Rate for Payer: Healthfirst Commercial	$10,455.00
Rate for Payer: Healthfirst Essential Plan	$39,383.06
Rate for Payer: Healthfirst QHP	$6,396.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,503.58
Rate for Payer: SOMOS Essential	$39,383.06
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,503.58

APR-DRG 0482: Peripheral, cranial & autonomic nerve disorders

Facility IP

$42,645.53

Service Code	APR-DRG 0482
Min. Negotiated Rate	$8,151.00
Max. Negotiated Rate	$42,645.53
Rate for Payer: Amida Care Medicaid	$18,953.57
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,953.57
Rate for Payer: Fidelis Qualified Health Plan	$22,744.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,953.57
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,953.57
Rate for Payer: Healthfirst Commercial	$13,595.00
Rate for Payer: Healthfirst Essential Plan	$42,645.53
Rate for Payer: Healthfirst QHP	$8,151.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,953.57
Rate for Payer: SOMOS Essential	$42,645.53
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,953.57

APR-DRG 0483: Peripheral, cranial & autonomic nerve disorders

Facility IP

$49,096.62

Service Code	APR-DRG 0483
Min. Negotiated Rate	$11,395.00
Max. Negotiated Rate	$49,096.62
Rate for Payer: Amida Care Medicaid	$21,820.72
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,820.72
Rate for Payer: Fidelis Qualified Health Plan	$26,184.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,820.72
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,820.72
Rate for Payer: Healthfirst Commercial	$19,982.00
Rate for Payer: Healthfirst Essential Plan	$49,096.62
Rate for Payer: Healthfirst QHP	$11,395.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,820.72
Rate for Payer: SOMOS Essential	$49,096.62
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,820.72

APR-DRG 0484: Peripheral, cranial & autonomic nerve disorders

Facility IP

$90,923.11

Service Code	APR-DRG 0484
Min. Negotiated Rate	$25,438.00
Max. Negotiated Rate	$90,923.11
Rate for Payer: Amida Care Medicaid	$40,410.27
Rate for Payer: Fidelis CHP/HARP/Medicaid	$40,410.27
Rate for Payer: Fidelis Qualified Health Plan	$48,492.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$40,410.27
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$40,410.27
Rate for Payer: Healthfirst Commercial	$42,775.00
Rate for Payer: Healthfirst Essential Plan	$90,923.11
Rate for Payer: Healthfirst QHP	$25,438.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$40,410.27
Rate for Payer: SOMOS Essential	$90,923.11
Rate for Payer: Wellcare CHP/FHP/Medicaid	$40,410.27

Price Transparency.

All Charges