St. Barnabas Hospital

All Charges

Charge

Type

Price

APR-DRG 0552: Head trauma w coma >1 hr or hemorrhage

Facility IP

$45,076.12

Service Code	APR-DRG 0552
Min. Negotiated Rate	$9,980.00
Max. Negotiated Rate	$45,076.12
Rate for Payer: Amida Care Medicaid	$20,033.83
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,033.83
Rate for Payer: Fidelis Qualified Health Plan	$24,040.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,033.83
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,033.83
Rate for Payer: Healthfirst Commercial	$15,978.00
Rate for Payer: Healthfirst Essential Plan	$45,076.12
Rate for Payer: Healthfirst QHP	$9,980.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,033.83
Rate for Payer: SOMOS Essential	$45,076.12
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,033.83

APR-DRG 0553: Head trauma w coma >1 hr or hemorrhage

Facility IP

$56,038.39

Service Code	APR-DRG 0553
Min. Negotiated Rate	$17,160.00
Max. Negotiated Rate	$56,038.39
Rate for Payer: Amida Care Medicaid	$24,905.95
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,905.95
Rate for Payer: Fidelis Qualified Health Plan	$29,887.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,905.95
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,905.95
Rate for Payer: Healthfirst Commercial	$27,084.00
Rate for Payer: Healthfirst Essential Plan	$56,038.39
Rate for Payer: Healthfirst QHP	$17,160.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,905.95
Rate for Payer: SOMOS Essential	$56,038.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,905.95

APR-DRG 0554: Head trauma w coma >1 hr or hemorrhage

Facility IP

$89,145.02

Service Code	APR-DRG 0554
Min. Negotiated Rate	$34,326.00
Max. Negotiated Rate	$89,145.02
Rate for Payer: Amida Care Medicaid	$39,620.01
Rate for Payer: Fidelis CHP/HARP/Medicaid	$39,620.01
Rate for Payer: Fidelis Qualified Health Plan	$47,544.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$39,620.01
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$39,620.01
Rate for Payer: Healthfirst Commercial	$59,454.00
Rate for Payer: Healthfirst Essential Plan	$89,145.02
Rate for Payer: Healthfirst QHP	$34,326.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$39,620.01
Rate for Payer: SOMOS Essential	$89,145.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$39,620.01

APR-DRG 0561: Brain contusion/laceration & complicated skull Fx, coma < 1 hr or no coma

Facility IP

$38,776.30

Service Code	APR-DRG 0561
Min. Negotiated Rate	$6,276.00
Max. Negotiated Rate	$38,776.30
Rate for Payer: Amida Care Medicaid	$17,233.91
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,233.91
Rate for Payer: Fidelis Qualified Health Plan	$20,680.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,233.91
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,233.91
Rate for Payer: Healthfirst Commercial	$10,097.00
Rate for Payer: Healthfirst Essential Plan	$38,776.30
Rate for Payer: Healthfirst QHP	$6,276.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,233.91
Rate for Payer: SOMOS Essential	$38,776.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,233.91

APR-DRG 0562: Brain contusion/laceration & complicated skull Fx, coma < 1 hr or no coma

Facility IP

$43,741.24

Service Code	APR-DRG 0562
Min. Negotiated Rate	$8,707.00
Max. Negotiated Rate	$43,741.24
Rate for Payer: Amida Care Medicaid	$19,440.55
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,440.55
Rate for Payer: Fidelis Qualified Health Plan	$23,328.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,440.55
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,440.55
Rate for Payer: Healthfirst Commercial	$14,748.00
Rate for Payer: Healthfirst Essential Plan	$43,741.24
Rate for Payer: Healthfirst QHP	$8,707.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,440.55
Rate for Payer: SOMOS Essential	$43,741.24
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,440.55

APR-DRG 0563: Brain contusion/laceration & complicated skull Fx, coma < 1 hr or no coma

Facility IP

$54,735.14

Service Code	APR-DRG 0563
Min. Negotiated Rate	$16,480.00
Max. Negotiated Rate	$54,735.14
Rate for Payer: Amida Care Medicaid	$24,326.73
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,326.73
Rate for Payer: Fidelis Qualified Health Plan	$29,192.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,326.73
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,326.73
Rate for Payer: Healthfirst Commercial	$25,023.00
Rate for Payer: Healthfirst Essential Plan	$54,735.14
Rate for Payer: Healthfirst QHP	$16,480.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,326.73
Rate for Payer: SOMOS Essential	$54,735.14
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,326.73

APR-DRG 0564: Brain contusion/laceration & complicated skull Fx, coma < 1 hr or no coma

Facility IP

$96,545.84

Service Code	APR-DRG 0564
Min. Negotiated Rate	$42,909.26
Max. Negotiated Rate	$96,545.84
Rate for Payer: Amida Care Medicaid	$42,909.26
Rate for Payer: Fidelis CHP/HARP/Medicaid	$42,909.26
Rate for Payer: Fidelis Qualified Health Plan	$51,491.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$42,909.26
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$42,909.26
Rate for Payer: Healthfirst Commercial	$73,746.00
Rate for Payer: Healthfirst Essential Plan	$96,545.84
Rate for Payer: Healthfirst QHP	$43,707.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$42,909.26
Rate for Payer: SOMOS Essential	$96,545.84
Rate for Payer: Wellcare CHP/FHP/Medicaid	$42,909.26

APR-DRG 0571: Concussion, closed skull Fx nos,uncomplicated intracranial injury, coma < 1 hr or no coma

Facility IP

$36,623.59

Service Code	APR-DRG 0571
Min. Negotiated Rate	$4,834.00
Max. Negotiated Rate	$36,623.59
Rate for Payer: Amida Care Medicaid	$16,277.15
Rate for Payer: Fidelis CHP/HARP/Medicaid	$16,277.15
Rate for Payer: Fidelis Qualified Health Plan	$19,532.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$16,277.15
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16,277.15
Rate for Payer: Healthfirst Commercial	$8,159.00
Rate for Payer: Healthfirst Essential Plan	$36,623.59
Rate for Payer: Healthfirst QHP	$4,834.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$16,277.15
Rate for Payer: SOMOS Essential	$36,623.59
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,277.15

APR-DRG 0572: Concussion, closed skull Fx nos,uncomplicated intracranial injury, coma < 1 hr or no coma

Facility IP

$39,138.59

Service Code	APR-DRG 0572
Min. Negotiated Rate	$6,441.00
Max. Negotiated Rate	$39,138.59
Rate for Payer: Amida Care Medicaid	$17,394.93
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,394.93
Rate for Payer: Fidelis Qualified Health Plan	$20,873.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,394.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,394.93
Rate for Payer: Healthfirst Commercial	$10,731.00
Rate for Payer: Healthfirst Essential Plan	$39,138.59
Rate for Payer: Healthfirst QHP	$6,441.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,394.93
Rate for Payer: SOMOS Essential	$39,138.59
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,394.93

APR-DRG 0573: Concussion, closed skull Fx nos,uncomplicated intracranial injury, coma < 1 hr or no coma

Facility IP

$46,674.81

Service Code	APR-DRG 0573
Min. Negotiated Rate	$11,748.00
Max. Negotiated Rate	$46,674.81
Rate for Payer: Amida Care Medicaid	$20,744.36
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,744.36
Rate for Payer: Fidelis Qualified Health Plan	$24,893.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,744.36
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,744.36
Rate for Payer: Healthfirst Commercial	$19,940.00
Rate for Payer: Healthfirst Essential Plan	$46,674.81
Rate for Payer: Healthfirst QHP	$11,748.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,744.36
Rate for Payer: SOMOS Essential	$46,674.81
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,744.36

APR-DRG 0574: Concussion, closed skull Fx nos,uncomplicated intracranial injury, coma < 1 hr or no coma

Facility IP

$81,592.96

Service Code	APR-DRG 0574
Min. Negotiated Rate	$27,027.00
Max. Negotiated Rate	$81,592.96
Rate for Payer: Amida Care Medicaid	$36,263.54
Rate for Payer: Fidelis CHP/HARP/Medicaid	$36,263.54
Rate for Payer: Fidelis Qualified Health Plan	$43,516.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$36,263.54
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$36,263.54
Rate for Payer: Healthfirst Commercial	$44,871.00
Rate for Payer: Healthfirst Essential Plan	$81,592.96
Rate for Payer: Healthfirst QHP	$27,027.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$36,263.54
Rate for Payer: SOMOS Essential	$81,592.96
Rate for Payer: Wellcare CHP/FHP/Medicaid	$36,263.54

APR-DRG 0581: Other disorders of nervous system

Facility IP

$39,113.98

Service Code	APR-DRG 0581
Min. Negotiated Rate	$6,448.00
Max. Negotiated Rate	$39,113.98
Rate for Payer: Amida Care Medicaid	$17,383.99
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,383.99
Rate for Payer: Fidelis Qualified Health Plan	$20,860.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,383.99
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,383.99
Rate for Payer: Healthfirst Commercial	$10,791.00
Rate for Payer: Healthfirst Essential Plan	$39,113.98
Rate for Payer: Healthfirst QHP	$6,448.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,383.99
Rate for Payer: SOMOS Essential	$39,113.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,383.99

APR-DRG 0582: Other disorders of nervous system

Facility IP

$43,412.36

Service Code	APR-DRG 0582
Min. Negotiated Rate	$8,723.00
Max. Negotiated Rate	$43,412.36
Rate for Payer: Amida Care Medicaid	$19,294.38
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,294.38
Rate for Payer: Fidelis Qualified Health Plan	$23,153.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,294.38
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,294.38
Rate for Payer: Healthfirst Commercial	$14,441.00
Rate for Payer: Healthfirst Essential Plan	$43,412.36
Rate for Payer: Healthfirst QHP	$8,723.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,294.38
Rate for Payer: SOMOS Essential	$43,412.36
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,294.38

APR-DRG 0583: Other disorders of nervous system

Facility IP

$51,878.95

Service Code	APR-DRG 0583
Min. Negotiated Rate	$12,885.00
Max. Negotiated Rate	$51,878.95
Rate for Payer: Amida Care Medicaid	$23,057.31
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,057.31
Rate for Payer: Fidelis Qualified Health Plan	$27,668.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,057.31
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,057.31
Rate for Payer: Healthfirst Commercial	$22,038.00
Rate for Payer: Healthfirst Essential Plan	$51,878.95
Rate for Payer: Healthfirst QHP	$12,885.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,057.31
Rate for Payer: SOMOS Essential	$51,878.95
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,057.31

APR-DRG 0584: Other disorders of nervous system

Facility IP

$89,234.73

Service Code	APR-DRG 0584
Min. Negotiated Rate	$28,694.00
Max. Negotiated Rate	$89,234.73
Rate for Payer: Amida Care Medicaid	$39,659.88
Rate for Payer: Fidelis CHP/HARP/Medicaid	$39,659.88
Rate for Payer: Fidelis Qualified Health Plan	$47,591.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$39,659.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$39,659.88
Rate for Payer: Healthfirst Commercial	$49,731.00
Rate for Payer: Healthfirst Essential Plan	$89,234.73
Rate for Payer: Healthfirst QHP	$28,694.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$39,659.88
Rate for Payer: SOMOS Essential	$89,234.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$39,659.88

APR-DRG 0701: Orbital procedures

Facility IP

$43,786.96

Service Code	APR-DRG 0701
Min. Negotiated Rate	$8,640.00
Max. Negotiated Rate	$43,786.96
Rate for Payer: Amida Care Medicaid	$19,460.87
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,460.87
Rate for Payer: Fidelis Qualified Health Plan	$23,353.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,460.87
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,460.87
Rate for Payer: Healthfirst Commercial	$15,026.00
Rate for Payer: Healthfirst Essential Plan	$43,786.96
Rate for Payer: Healthfirst QHP	$8,640.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,460.87
Rate for Payer: SOMOS Essential	$43,786.96
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,460.87

APR-DRG 0702: Orbital procedures

Facility IP

$51,342.52

Service Code	APR-DRG 0702
Min. Negotiated Rate	$12,170.00
Max. Negotiated Rate	$51,342.52
Rate for Payer: Amida Care Medicaid	$22,818.90
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,818.90
Rate for Payer: Fidelis Qualified Health Plan	$27,382.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,818.90
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,818.90
Rate for Payer: Healthfirst Commercial	$20,769.00
Rate for Payer: Healthfirst Essential Plan	$51,342.52
Rate for Payer: Healthfirst QHP	$12,170.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,818.90
Rate for Payer: SOMOS Essential	$51,342.52
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,818.90

APR-DRG 0703: Orbital procedures

Facility IP

$65,502.20

Service Code	APR-DRG 0703
Min. Negotiated Rate	$22,562.00
Max. Negotiated Rate	$65,502.20
Rate for Payer: Amida Care Medicaid	$29,112.09
Rate for Payer: Fidelis CHP/HARP/Medicaid	$29,112.09
Rate for Payer: Fidelis Qualified Health Plan	$34,934.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$29,112.09
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29,112.09
Rate for Payer: Healthfirst Commercial	$30,286.00
Rate for Payer: Healthfirst Essential Plan	$65,502.20
Rate for Payer: Healthfirst QHP	$22,562.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$29,112.09
Rate for Payer: SOMOS Essential	$65,502.20
Rate for Payer: Wellcare CHP/FHP/Medicaid	$29,112.09

APR-DRG 0704: Orbital procedures

Facility IP

$70,458.34

Service Code	APR-DRG 0704
Min. Negotiated Rate	$25,014.00
Max. Negotiated Rate	$70,458.34
Rate for Payer: Amida Care Medicaid	$31,314.82
Rate for Payer: Fidelis CHP/HARP/Medicaid	$31,314.82
Rate for Payer: Fidelis Qualified Health Plan	$37,577.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$31,314.82
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31,314.82
Rate for Payer: Healthfirst Commercial	$32,939.00
Rate for Payer: Healthfirst Essential Plan	$70,458.34
Rate for Payer: Healthfirst QHP	$25,014.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$31,314.82
Rate for Payer: SOMOS Essential	$70,458.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$31,314.82

APR-DRG 0731: Eye procedures except orbit

Facility IP

$41,233.25

Service Code	APR-DRG 0731
Min. Negotiated Rate	$7,534.00
Max. Negotiated Rate	$41,233.25
Rate for Payer: Amida Care Medicaid	$18,325.89
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,325.89
Rate for Payer: Fidelis Qualified Health Plan	$21,991.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,325.89
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,325.89
Rate for Payer: Healthfirst Commercial	$13,274.00
Rate for Payer: Healthfirst Essential Plan	$41,233.25
Rate for Payer: Healthfirst QHP	$7,534.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,325.89
Rate for Payer: SOMOS Essential	$41,233.25
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,325.89

APR-DRG 0732: Eye procedures except orbit

Facility IP

$44,522.12

Service Code	APR-DRG 0732
Min. Negotiated Rate	$9,574.00
Max. Negotiated Rate	$44,522.12
Rate for Payer: Amida Care Medicaid	$19,787.61
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,787.61
Rate for Payer: Fidelis Qualified Health Plan	$23,745.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,787.61
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,787.61
Rate for Payer: Healthfirst Commercial	$16,791.00
Rate for Payer: Healthfirst Essential Plan	$44,522.12
Rate for Payer: Healthfirst QHP	$9,574.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,787.61
Rate for Payer: SOMOS Essential	$44,522.12
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,787.61

APR-DRG 0733: Eye procedures except orbit

Facility IP

$72,992.70

Service Code	APR-DRG 0733
Min. Negotiated Rate	$16,462.00
Max. Negotiated Rate	$72,992.70
Rate for Payer: Amida Care Medicaid	$32,441.20
Rate for Payer: Fidelis CHP/HARP/Medicaid	$32,441.20
Rate for Payer: Fidelis Qualified Health Plan	$38,929.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$32,441.20
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$32,441.20
Rate for Payer: Healthfirst Commercial	$27,164.00
Rate for Payer: Healthfirst Essential Plan	$72,992.70
Rate for Payer: Healthfirst QHP	$16,462.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$32,441.20
Rate for Payer: SOMOS Essential	$72,992.70
Rate for Payer: Wellcare CHP/FHP/Medicaid	$32,441.20

APR-DRG 0734: Eye procedures except orbit

Facility IP

$74,958.98

Service Code	APR-DRG 0734
Min. Negotiated Rate	$17,532.00
Max. Negotiated Rate	$74,958.98
Rate for Payer: Amida Care Medicaid	$33,315.10
Rate for Payer: Fidelis CHP/HARP/Medicaid	$33,315.10
Rate for Payer: Fidelis Qualified Health Plan	$39,978.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$33,315.10
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$33,315.10
Rate for Payer: Healthfirst Commercial	$43,317.00
Rate for Payer: Healthfirst Essential Plan	$74,958.98
Rate for Payer: Healthfirst QHP	$17,532.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$33,315.10
Rate for Payer: SOMOS Essential	$74,958.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$33,315.10

APR-DRG 0801: Acute major eye infections

Facility IP

$39,310.94

Service Code	APR-DRG 0801
Min. Negotiated Rate	$5,950.00
Max. Negotiated Rate	$39,310.94
Rate for Payer: Amida Care Medicaid	$17,471.53
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,471.53
Rate for Payer: Fidelis Qualified Health Plan	$20,965.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,471.53
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,471.53
Rate for Payer: Healthfirst Commercial	$10,564.00
Rate for Payer: Healthfirst Essential Plan	$39,310.94
Rate for Payer: Healthfirst QHP	$5,950.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,471.53
Rate for Payer: SOMOS Essential	$39,310.94
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,471.53

APR-DRG 0802: Acute major eye infections

Facility IP

$41,994.79

Service Code	APR-DRG 0802
Min. Negotiated Rate	$7,292.00
Max. Negotiated Rate	$41,994.79
Rate for Payer: Amida Care Medicaid	$18,664.35
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,664.35
Rate for Payer: Fidelis Qualified Health Plan	$22,397.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,664.35
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,664.35
Rate for Payer: Healthfirst Commercial	$13,055.00
Rate for Payer: Healthfirst Essential Plan	$41,994.79
Rate for Payer: Healthfirst QHP	$7,292.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,664.35
Rate for Payer: SOMOS Essential	$41,994.79
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,664.35

Price Transparency.

All Charges