St. Barnabas Hospital

All Charges

Charge

Type

Price

APR-DRG 1141: Dental & oral diseases & injuries

Facility IP

$38,062.24

Service Code	APR-DRG 1141
Min. Negotiated Rate	$5,655.00
Max. Negotiated Rate	$38,062.24
Rate for Payer: Amida Care Medicaid	$16,916.55
Rate for Payer: Fidelis CHP/HARP/Medicaid	$16,916.55
Rate for Payer: Fidelis Qualified Health Plan	$20,299.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$16,916.55
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16,916.55
Rate for Payer: Healthfirst Commercial	$9,732.00
Rate for Payer: Healthfirst Essential Plan	$38,062.24
Rate for Payer: Healthfirst QHP	$5,655.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$16,916.55
Rate for Payer: SOMOS Essential	$38,062.24
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,916.55

APR-DRG 1142: Dental & oral diseases & injuries

Facility IP

$40,290.57

Service Code	APR-DRG 1142
Min. Negotiated Rate	$6,867.00
Max. Negotiated Rate	$40,290.57
Rate for Payer: Amida Care Medicaid	$17,906.92
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,906.92
Rate for Payer: Fidelis Qualified Health Plan	$21,488.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,906.92
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,906.92
Rate for Payer: Healthfirst Commercial	$11,728.00
Rate for Payer: Healthfirst Essential Plan	$40,290.57
Rate for Payer: Healthfirst QHP	$6,867.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,906.92
Rate for Payer: SOMOS Essential	$40,290.57
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,906.92

APR-DRG 1143: Dental & oral diseases & injuries

Facility IP

$50,744.56

Service Code	APR-DRG 1143
Min. Negotiated Rate	$11,789.00
Max. Negotiated Rate	$50,744.56
Rate for Payer: Amida Care Medicaid	$22,553.14
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,553.14
Rate for Payer: Fidelis Qualified Health Plan	$27,063.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,553.14
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,553.14
Rate for Payer: Healthfirst Commercial	$19,825.00
Rate for Payer: Healthfirst Essential Plan	$50,744.56
Rate for Payer: Healthfirst QHP	$11,789.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,553.14
Rate for Payer: SOMOS Essential	$50,744.56
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,553.14

APR-DRG 1144: Dental & oral diseases & injuries

Facility IP

$73,041.95

Service Code	APR-DRG 1144
Min. Negotiated Rate	$12,032.00
Max. Negotiated Rate	$73,041.95
Rate for Payer: Amida Care Medicaid	$32,463.09
Rate for Payer: Fidelis CHP/HARP/Medicaid	$32,463.09
Rate for Payer: Fidelis Qualified Health Plan	$38,955.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$32,463.09
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$32,463.09
Rate for Payer: Healthfirst Commercial	$54,720.00
Rate for Payer: Healthfirst Essential Plan	$73,041.95
Rate for Payer: Healthfirst QHP	$12,032.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$32,463.09
Rate for Payer: SOMOS Essential	$73,041.95
Rate for Payer: Wellcare CHP/FHP/Medicaid	$32,463.09

APR-DRG 1151: Other ear, nose, mouth,throat & cranial/facial diagnoses

Facility IP

$37,409.74

Service Code	APR-DRG 1151
Min. Negotiated Rate	$5,286.00
Max. Negotiated Rate	$37,409.74
Rate for Payer: Amida Care Medicaid	$16,626.55
Rate for Payer: Fidelis CHP/HARP/Medicaid	$16,626.55
Rate for Payer: Fidelis Qualified Health Plan	$19,951.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$16,626.55
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16,626.55
Rate for Payer: Healthfirst Commercial	$9,096.00
Rate for Payer: Healthfirst Essential Plan	$37,409.74
Rate for Payer: Healthfirst QHP	$5,286.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$16,626.55
Rate for Payer: SOMOS Essential	$37,409.74
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,626.55

APR-DRG 1152: Other ear, nose, mouth,throat & cranial/facial diagnoses

Facility IP

$40,220.21

Service Code	APR-DRG 1152
Min. Negotiated Rate	$6,565.00
Max. Negotiated Rate	$40,220.21
Rate for Payer: Amida Care Medicaid	$17,875.65
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,875.65
Rate for Payer: Fidelis Qualified Health Plan	$21,450.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,875.65
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,875.65
Rate for Payer: Healthfirst Commercial	$11,367.00
Rate for Payer: Healthfirst Essential Plan	$40,220.21
Rate for Payer: Healthfirst QHP	$6,565.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,875.65
Rate for Payer: SOMOS Essential	$40,220.21
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,875.65

APR-DRG 1153: Other ear, nose, mouth,throat & cranial/facial diagnoses

Facility IP

$47,107.46

Service Code	APR-DRG 1153
Min. Negotiated Rate	$10,583.00
Max. Negotiated Rate	$47,107.46
Rate for Payer: Amida Care Medicaid	$20,936.65
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,936.65
Rate for Payer: Fidelis Qualified Health Plan	$25,123.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,936.65
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,936.65
Rate for Payer: Healthfirst Commercial	$18,509.00
Rate for Payer: Healthfirst Essential Plan	$47,107.46
Rate for Payer: Healthfirst QHP	$10,583.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,936.65
Rate for Payer: SOMOS Essential	$47,107.46
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,936.65

APR-DRG 1154: Other ear, nose, mouth,throat & cranial/facial diagnoses

Facility IP

$75,753.92

Service Code	APR-DRG 1154
Min. Negotiated Rate	$21,178.00
Max. Negotiated Rate	$75,753.92
Rate for Payer: Amida Care Medicaid	$33,668.41
Rate for Payer: Fidelis CHP/HARP/Medicaid	$33,668.41
Rate for Payer: Fidelis Qualified Health Plan	$40,402.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$33,668.41
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$33,668.41
Rate for Payer: Healthfirst Commercial	$42,624.00
Rate for Payer: Healthfirst Essential Plan	$75,753.92
Rate for Payer: Healthfirst QHP	$21,178.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$33,668.41
Rate for Payer: SOMOS Essential	$75,753.92
Rate for Payer: Wellcare CHP/FHP/Medicaid	$33,668.41

APR-DRG 1201: Major respiratory & chest procedures

Facility IP

$60,116.92

Service Code	APR-DRG 1201
Min. Negotiated Rate	$19,967.00
Max. Negotiated Rate	$60,116.92
Rate for Payer: Amida Care Medicaid	$26,718.63
Rate for Payer: Fidelis CHP/HARP/Medicaid	$26,718.63
Rate for Payer: Fidelis Qualified Health Plan	$32,062.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$26,718.63
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$26,718.63
Rate for Payer: Healthfirst Commercial	$31,420.00
Rate for Payer: Healthfirst Essential Plan	$60,116.92
Rate for Payer: Healthfirst QHP	$19,967.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26,718.63
Rate for Payer: SOMOS Essential	$60,116.92
Rate for Payer: Wellcare CHP/FHP/Medicaid	$26,718.63

APR-DRG 1202: Major respiratory & chest procedures

Facility IP

$66,772.01

Service Code	APR-DRG 1202
Min. Negotiated Rate	$25,039.00
Max. Negotiated Rate	$66,772.01
Rate for Payer: Amida Care Medicaid	$29,676.45
Rate for Payer: Fidelis CHP/HARP/Medicaid	$29,676.45
Rate for Payer: Fidelis Qualified Health Plan	$35,611.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$29,676.45
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29,676.45
Rate for Payer: Healthfirst Commercial	$39,946.00
Rate for Payer: Healthfirst Essential Plan	$66,772.01
Rate for Payer: Healthfirst QHP	$25,039.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$29,676.45
Rate for Payer: SOMOS Essential	$66,772.01
Rate for Payer: Wellcare CHP/FHP/Medicaid	$29,676.45

APR-DRG 1203: Major respiratory & chest procedures

Facility IP

$88,812.63

Service Code	APR-DRG 1203
Min. Negotiated Rate	$38,553.00
Max. Negotiated Rate	$88,812.63
Rate for Payer: Amida Care Medicaid	$39,472.28
Rate for Payer: Fidelis CHP/HARP/Medicaid	$39,472.28
Rate for Payer: Fidelis Qualified Health Plan	$47,366.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$39,472.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$39,472.28
Rate for Payer: Healthfirst Commercial	$62,073.00
Rate for Payer: Healthfirst Essential Plan	$88,812.63
Rate for Payer: Healthfirst QHP	$38,553.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$39,472.28
Rate for Payer: SOMOS Essential	$88,812.63
Rate for Payer: Wellcare CHP/FHP/Medicaid	$39,472.28

APR-DRG 1204: Major respiratory & chest procedures

Facility IP

$136,764.83

Service Code	APR-DRG 1204
Min. Negotiated Rate	$60,784.37
Max. Negotiated Rate	$136,764.83
Rate for Payer: Amida Care Medicaid	$60,784.37
Rate for Payer: Fidelis CHP/HARP/Medicaid	$60,784.37
Rate for Payer: Fidelis Qualified Health Plan	$72,941.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$60,784.37
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$60,784.37
Rate for Payer: Healthfirst Commercial	$115,850.00
Rate for Payer: Healthfirst Essential Plan	$136,764.83
Rate for Payer: Healthfirst QHP	$73,707.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$60,784.37
Rate for Payer: SOMOS Essential	$136,764.83
Rate for Payer: Wellcare CHP/FHP/Medicaid	$60,784.37

APR-DRG 1211: Other respiratory & chest procedures

Facility IP

$50,901.08

Service Code	APR-DRG 1211
Min. Negotiated Rate	$14,928.00
Max. Negotiated Rate	$50,901.08
Rate for Payer: Amida Care Medicaid	$22,622.70
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,622.70
Rate for Payer: Fidelis Qualified Health Plan	$27,147.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,622.70
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,622.70
Rate for Payer: Healthfirst Commercial	$23,526.00
Rate for Payer: Healthfirst Essential Plan	$50,901.08
Rate for Payer: Healthfirst QHP	$14,928.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,622.70
Rate for Payer: SOMOS Essential	$50,901.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,622.70

APR-DRG 1212: Other respiratory & chest procedures

Facility IP

$58,264.96

Service Code	APR-DRG 1212
Min. Negotiated Rate	$19,645.00
Max. Negotiated Rate	$58,264.96
Rate for Payer: Amida Care Medicaid	$25,895.54
Rate for Payer: Fidelis CHP/HARP/Medicaid	$25,895.54
Rate for Payer: Fidelis Qualified Health Plan	$31,074.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$25,895.54
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25,895.54
Rate for Payer: Healthfirst Commercial	$31,009.00
Rate for Payer: Healthfirst Essential Plan	$58,264.96
Rate for Payer: Healthfirst QHP	$19,645.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$25,895.54
Rate for Payer: SOMOS Essential	$58,264.96
Rate for Payer: Wellcare CHP/FHP/Medicaid	$25,895.54

APR-DRG 1213: Other respiratory & chest procedures

Facility IP

$79,654.84

Service Code	APR-DRG 1213
Min. Negotiated Rate	$33,939.00
Max. Negotiated Rate	$79,654.84
Rate for Payer: Amida Care Medicaid	$35,402.15
Rate for Payer: Fidelis CHP/HARP/Medicaid	$35,402.15
Rate for Payer: Fidelis Qualified Health Plan	$42,482.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$35,402.15
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$35,402.15
Rate for Payer: Healthfirst Commercial	$55,561.00
Rate for Payer: Healthfirst Essential Plan	$79,654.84
Rate for Payer: Healthfirst QHP	$33,939.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$35,402.15
Rate for Payer: SOMOS Essential	$79,654.84
Rate for Payer: Wellcare CHP/FHP/Medicaid	$35,402.15

APR-DRG 1214: Other respiratory & chest procedures

Facility IP

$136,172.14

Service Code	APR-DRG 1214
Min. Negotiated Rate	$60,520.95
Max. Negotiated Rate	$136,172.14
Rate for Payer: Amida Care Medicaid	$60,520.95
Rate for Payer: Fidelis CHP/HARP/Medicaid	$60,520.95
Rate for Payer: Fidelis Qualified Health Plan	$72,625.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$60,520.95
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$60,520.95
Rate for Payer: Healthfirst Commercial	$110,268.00
Rate for Payer: Healthfirst Essential Plan	$136,172.14
Rate for Payer: Healthfirst QHP	$67,564.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$60,520.95
Rate for Payer: SOMOS Essential	$136,172.14
Rate for Payer: Wellcare CHP/FHP/Medicaid	$60,520.95

APR-DRG 1301: Respiratory system diagnosis w ventilator support 96+ hours

Facility IP

$89,971.63

Service Code	APR-DRG 1301
Min. Negotiated Rate	$31,811.00
Max. Negotiated Rate	$89,971.63
Rate for Payer: Amida Care Medicaid	$39,987.39
Rate for Payer: Fidelis CHP/HARP/Medicaid	$39,987.39
Rate for Payer: Fidelis Qualified Health Plan	$47,984.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$39,987.39
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$39,987.39
Rate for Payer: Healthfirst Commercial	$54,309.00
Rate for Payer: Healthfirst Essential Plan	$89,971.63
Rate for Payer: Healthfirst QHP	$31,811.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$39,987.39
Rate for Payer: SOMOS Essential	$89,971.63
Rate for Payer: Wellcare CHP/FHP/Medicaid	$39,987.39

APR-DRG 1302: Respiratory system diagnosis w ventilator support 96+ hours

Facility IP

$89,971.63

Service Code	APR-DRG 1302
Min. Negotiated Rate	$34,665.00
Max. Negotiated Rate	$89,971.63
Rate for Payer: Amida Care Medicaid	$39,987.39
Rate for Payer: Fidelis CHP/HARP/Medicaid	$39,987.39
Rate for Payer: Fidelis Qualified Health Plan	$47,984.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$39,987.39
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$39,987.39
Rate for Payer: Healthfirst Commercial	$58,513.00
Rate for Payer: Healthfirst Essential Plan	$89,971.63
Rate for Payer: Healthfirst QHP	$34,665.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$39,987.39
Rate for Payer: SOMOS Essential	$89,971.63
Rate for Payer: Wellcare CHP/FHP/Medicaid	$39,987.39

APR-DRG 1303: Respiratory system diagnosis w ventilator support 96+ hours

Facility IP

$104,906.90

Service Code	APR-DRG 1303
Min. Negotiated Rate	$44,048.00
Max. Negotiated Rate	$104,906.90
Rate for Payer: Amida Care Medicaid	$46,625.29
Rate for Payer: Fidelis CHP/HARP/Medicaid	$46,625.29
Rate for Payer: Fidelis Qualified Health Plan	$55,950.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$46,625.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$46,625.29
Rate for Payer: Healthfirst Commercial	$71,006.00
Rate for Payer: Healthfirst Essential Plan	$104,906.90
Rate for Payer: Healthfirst QHP	$44,048.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$46,625.29
Rate for Payer: SOMOS Essential	$104,906.90
Rate for Payer: Wellcare CHP/FHP/Medicaid	$46,625.29

APR-DRG 1304: Respiratory system diagnosis w ventilator support 96+ hours

Facility IP

$136,448.26

Service Code	APR-DRG 1304
Min. Negotiated Rate	$60,643.67
Max. Negotiated Rate	$136,448.26
Rate for Payer: Amida Care Medicaid	$60,643.67
Rate for Payer: Fidelis CHP/HARP/Medicaid	$60,643.67
Rate for Payer: Fidelis Qualified Health Plan	$72,772.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$60,643.67
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$60,643.67
Rate for Payer: Healthfirst Commercial	$105,969.00
Rate for Payer: Healthfirst Essential Plan	$136,448.26
Rate for Payer: Healthfirst QHP	$63,222.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$60,643.67
Rate for Payer: SOMOS Essential	$136,448.26
Rate for Payer: Wellcare CHP/FHP/Medicaid	$60,643.67

APR-DRG 1311: Cystic fibrosis - pulmonary disease

Facility IP

$53,913.82

Service Code	APR-DRG 1311
Min. Negotiated Rate	$12,993.00
Max. Negotiated Rate	$53,913.82
Rate for Payer: Amida Care Medicaid	$23,961.70
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,961.70
Rate for Payer: Fidelis Qualified Health Plan	$28,754.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,961.70
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,961.70
Rate for Payer: Healthfirst Commercial	$23,449.00
Rate for Payer: Healthfirst Essential Plan	$53,913.82
Rate for Payer: Healthfirst QHP	$12,993.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,961.70
Rate for Payer: SOMOS Essential	$53,913.82
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,961.70

APR-DRG 1312: Cystic fibrosis - pulmonary disease

Facility IP

$60,065.91

Service Code	APR-DRG 1312
Min. Negotiated Rate	$15,707.00
Max. Negotiated Rate	$60,065.91
Rate for Payer: Amida Care Medicaid	$26,695.96
Rate for Payer: Fidelis CHP/HARP/Medicaid	$26,695.96
Rate for Payer: Fidelis Qualified Health Plan	$32,035.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$26,695.96
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$26,695.96
Rate for Payer: Healthfirst Commercial	$27,376.00
Rate for Payer: Healthfirst Essential Plan	$60,065.91
Rate for Payer: Healthfirst QHP	$15,707.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26,695.96
Rate for Payer: SOMOS Essential	$60,065.91
Rate for Payer: Wellcare CHP/FHP/Medicaid	$26,695.96

APR-DRG 1313: Cystic fibrosis - pulmonary disease

Facility IP

$74,550.94

Service Code	APR-DRG 1313
Min. Negotiated Rate	$19,256.00
Max. Negotiated Rate	$74,550.94
Rate for Payer: Amida Care Medicaid	$33,133.75
Rate for Payer: Fidelis CHP/HARP/Medicaid	$33,133.75
Rate for Payer: Fidelis Qualified Health Plan	$39,760.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$33,133.75
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$33,133.75
Rate for Payer: Healthfirst Commercial	$33,240.00
Rate for Payer: Healthfirst Essential Plan	$74,550.94
Rate for Payer: Healthfirst QHP	$19,256.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$33,133.75
Rate for Payer: SOMOS Essential	$74,550.94
Rate for Payer: Wellcare CHP/FHP/Medicaid	$33,133.75

APR-DRG 1314: Cystic fibrosis - pulmonary disease

Facility IP

$77,718.44

Service Code	APR-DRG 1314
Min. Negotiated Rate	$27,551.00
Max. Negotiated Rate	$77,718.44
Rate for Payer: Amida Care Medicaid	$34,541.53
Rate for Payer: Fidelis CHP/HARP/Medicaid	$34,541.53
Rate for Payer: Fidelis Qualified Health Plan	$41,449.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$34,541.53
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$34,541.53
Rate for Payer: Healthfirst Commercial	$49,178.00
Rate for Payer: Healthfirst Essential Plan	$77,718.44
Rate for Payer: Healthfirst QHP	$27,551.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$34,541.53
Rate for Payer: SOMOS Essential	$77,718.44
Rate for Payer: Wellcare CHP/FHP/Medicaid	$34,541.53

APR-DRG 1321: BPD & oth chronic respiratory diseases arising in perinatal period

Facility IP

$40,023.25

Service Code	APR-DRG 1321
Min. Negotiated Rate	$7,497.00
Max. Negotiated Rate	$40,023.25
Rate for Payer: Amida Care Medicaid	$17,788.11
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,788.11
Rate for Payer: Fidelis Qualified Health Plan	$21,345.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,788.11
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,788.11
Rate for Payer: Healthfirst Commercial	$12,698.00
Rate for Payer: Healthfirst Essential Plan	$40,023.25
Rate for Payer: Healthfirst QHP	$7,497.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,788.11
Rate for Payer: SOMOS Essential	$40,023.25
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,788.11

Price Transparency.

All Charges