St. Barnabas Hospital

All Charges

Charge

Type

Price

APR-DRG 1322: BPD & oth chronic respiratory diseases arising in perinatal period

Facility IP

$43,436.97

Service Code	APR-DRG 1322
Min. Negotiated Rate	$9,279.00
Max. Negotiated Rate	$43,436.97
Rate for Payer: Amida Care Medicaid	$19,305.32
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,305.32
Rate for Payer: Fidelis Qualified Health Plan	$23,166.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,305.32
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,305.32
Rate for Payer: Healthfirst Commercial	$15,390.00
Rate for Payer: Healthfirst Essential Plan	$43,436.97
Rate for Payer: Healthfirst QHP	$9,279.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,305.32
Rate for Payer: SOMOS Essential	$43,436.97
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,305.32

APR-DRG 1323: BPD & oth chronic respiratory diseases arising in perinatal period

Facility IP

$52,818.12

Service Code	APR-DRG 1323
Min. Negotiated Rate	$14,354.00
Max. Negotiated Rate	$52,818.12
Rate for Payer: Amida Care Medicaid	$23,474.72
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,474.72
Rate for Payer: Fidelis Qualified Health Plan	$28,169.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,474.72
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,474.72
Rate for Payer: Healthfirst Commercial	$22,727.00
Rate for Payer: Healthfirst Essential Plan	$52,818.12
Rate for Payer: Healthfirst QHP	$14,354.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,474.72
Rate for Payer: SOMOS Essential	$52,818.12
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,474.72

APR-DRG 1324: BPD & oth chronic respiratory diseases arising in perinatal period

Facility IP

$71,867.09

Service Code	APR-DRG 1324
Min. Negotiated Rate	$26,302.00
Max. Negotiated Rate	$71,867.09
Rate for Payer: Amida Care Medicaid	$31,940.93
Rate for Payer: Fidelis CHP/HARP/Medicaid	$31,940.93
Rate for Payer: Fidelis Qualified Health Plan	$38,329.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$31,940.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31,940.93
Rate for Payer: Healthfirst Commercial	$44,693.00
Rate for Payer: Healthfirst Essential Plan	$71,867.09
Rate for Payer: Healthfirst QHP	$26,302.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$31,940.93
Rate for Payer: SOMOS Essential	$71,867.09
Rate for Payer: Wellcare CHP/FHP/Medicaid	$31,940.93

APR-DRG 1331: Respiratory Failure

Facility IP

$45,849.96

Service Code	APR-DRG 1331
Min. Negotiated Rate	$6,522.00
Max. Negotiated Rate	$45,849.96
Rate for Payer: Amida Care Medicaid	$20,377.76
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,377.76
Rate for Payer: Fidelis Qualified Health Plan	$24,453.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,377.76
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,377.76
Rate for Payer: Healthfirst Commercial	$12,692.00
Rate for Payer: Healthfirst Essential Plan	$45,849.96
Rate for Payer: Healthfirst QHP	$6,522.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,377.76
Rate for Payer: SOMOS Essential	$45,849.96
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,377.76

APR-DRG 1332: Respiratory Failure

Facility IP

$45,883.37

Service Code	APR-DRG 1332
Min. Negotiated Rate	$9,943.00
Max. Negotiated Rate	$45,883.37
Rate for Payer: Amida Care Medicaid	$20,392.61
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,392.61
Rate for Payer: Fidelis Qualified Health Plan	$24,471.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,392.61
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,392.61
Rate for Payer: Healthfirst Commercial	$17,049.00
Rate for Payer: Healthfirst Essential Plan	$45,883.37
Rate for Payer: Healthfirst QHP	$9,943.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,392.61
Rate for Payer: SOMOS Essential	$45,883.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,392.61

APR-DRG 1333: Respiratory Failure

Facility IP

$53,681.67

Service Code	APR-DRG 1333
Min. Negotiated Rate	$13,820.00
Max. Negotiated Rate	$53,681.67
Rate for Payer: Amida Care Medicaid	$23,858.52
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,858.52
Rate for Payer: Fidelis Qualified Health Plan	$28,630.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,858.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,858.52
Rate for Payer: Healthfirst Commercial	$24,519.00
Rate for Payer: Healthfirst Essential Plan	$53,681.67
Rate for Payer: Healthfirst QHP	$13,820.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,858.52
Rate for Payer: SOMOS Essential	$53,681.67
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,858.52

APR-DRG 1334: Respiratory Failure

Facility IP

$65,118.78

Service Code	APR-DRG 1334
Min. Negotiated Rate	$19,947.00
Max. Negotiated Rate	$65,118.78
Rate for Payer: Amida Care Medicaid	$28,941.68
Rate for Payer: Fidelis CHP/HARP/Medicaid	$28,941.68
Rate for Payer: Fidelis Qualified Health Plan	$34,730.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$28,941.68
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$28,941.68
Rate for Payer: Healthfirst Commercial	$33,523.00
Rate for Payer: Healthfirst Essential Plan	$65,118.78
Rate for Payer: Healthfirst QHP	$19,947.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$28,941.68
Rate for Payer: SOMOS Essential	$65,118.78
Rate for Payer: Wellcare CHP/FHP/Medicaid	$28,941.68

APR-DRG 1341: Pulmonary embolism

Facility IP

$42,037.00

Service Code	APR-DRG 1341
Min. Negotiated Rate	$9,168.00
Max. Negotiated Rate	$42,037.00
Rate for Payer: Amida Care Medicaid	$18,683.11
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,683.11
Rate for Payer: Fidelis Qualified Health Plan	$22,419.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,683.11
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,683.11
Rate for Payer: Healthfirst Commercial	$14,727.00
Rate for Payer: Healthfirst Essential Plan	$42,037.00
Rate for Payer: Healthfirst QHP	$9,168.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,683.11
Rate for Payer: SOMOS Essential	$42,037.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,683.11

APR-DRG 1342: Pulmonary embolism

Facility IP

$46,089.16

Service Code	APR-DRG 1342
Min. Negotiated Rate	$11,099.00
Max. Negotiated Rate	$46,089.16
Rate for Payer: Amida Care Medicaid	$20,484.07
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,484.07
Rate for Payer: Fidelis Qualified Health Plan	$24,580.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,484.07
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,484.07
Rate for Payer: Healthfirst Commercial	$18,483.00
Rate for Payer: Healthfirst Essential Plan	$46,089.16
Rate for Payer: Healthfirst QHP	$11,099.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,484.07
Rate for Payer: SOMOS Essential	$46,089.16
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,484.07

APR-DRG 1343: Pulmonary embolism

Facility IP

$56,189.63

Service Code	APR-DRG 1343
Min. Negotiated Rate	$15,684.00
Max. Negotiated Rate	$56,189.63
Rate for Payer: Amida Care Medicaid	$24,973.17
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,973.17
Rate for Payer: Fidelis Qualified Health Plan	$29,967.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,973.17
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,973.17
Rate for Payer: Healthfirst Commercial	$26,700.00
Rate for Payer: Healthfirst Essential Plan	$56,189.63
Rate for Payer: Healthfirst QHP	$15,684.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,973.17
Rate for Payer: SOMOS Essential	$56,189.63
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,973.17

APR-DRG 1344: Pulmonary embolism

Facility IP

$74,603.70

Service Code	APR-DRG 1344
Min. Negotiated Rate	$26,951.00
Max. Negotiated Rate	$74,603.70
Rate for Payer: Amida Care Medicaid	$33,157.20
Rate for Payer: Fidelis CHP/HARP/Medicaid	$33,157.20
Rate for Payer: Fidelis Qualified Health Plan	$39,788.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$33,157.20
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$33,157.20
Rate for Payer: Healthfirst Commercial	$45,408.00
Rate for Payer: Healthfirst Essential Plan	$74,603.70
Rate for Payer: Healthfirst QHP	$26,951.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$33,157.20
Rate for Payer: SOMOS Essential	$74,603.70
Rate for Payer: Wellcare CHP/FHP/Medicaid	$33,157.20

APR-DRG 1351: Major chest & respiratory trauma

Facility IP

$38,746.40

Service Code	APR-DRG 1351
Min. Negotiated Rate	$6,584.00
Max. Negotiated Rate	$38,746.40
Rate for Payer: Amida Care Medicaid	$17,220.62
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,220.62
Rate for Payer: Fidelis Qualified Health Plan	$20,664.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,220.62
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,220.62
Rate for Payer: Healthfirst Commercial	$10,917.00
Rate for Payer: Healthfirst Essential Plan	$38,746.40
Rate for Payer: Healthfirst QHP	$6,584.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,220.62
Rate for Payer: SOMOS Essential	$38,746.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,220.62

APR-DRG 1352: Major chest & respiratory trauma

Facility IP

$42,321.92

Service Code	APR-DRG 1352
Min. Negotiated Rate	$8,442.00
Max. Negotiated Rate	$42,321.92
Rate for Payer: Amida Care Medicaid	$18,809.74
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,809.74
Rate for Payer: Fidelis Qualified Health Plan	$22,571.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,809.74
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,809.74
Rate for Payer: Healthfirst Commercial	$14,079.00
Rate for Payer: Healthfirst Essential Plan	$42,321.92
Rate for Payer: Healthfirst QHP	$8,442.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,809.74
Rate for Payer: SOMOS Essential	$42,321.92
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,809.74

APR-DRG 1353: Major chest & respiratory trauma

Facility IP

$51,217.65

Service Code	APR-DRG 1353
Min. Negotiated Rate	$13,103.00
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	$21,883.00
Rate for Payer: Healthfirst Essential Plan	$51,217.65
Rate for Payer: Healthfirst QHP	$13,103.00
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 1354: Major chest & respiratory trauma

Facility IP

$61,576.67

Service Code	APR-DRG 1354
Min. Negotiated Rate	$22,830.00
Max. Negotiated Rate	$61,576.67
Rate for Payer: Amida Care Medicaid	$27,367.41
Rate for Payer: Fidelis CHP/HARP/Medicaid	$27,367.41
Rate for Payer: Fidelis Qualified Health Plan	$32,840.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$27,367.41
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$27,367.41
Rate for Payer: Healthfirst Commercial	$38,106.00
Rate for Payer: Healthfirst Essential Plan	$61,576.67
Rate for Payer: Healthfirst QHP	$22,830.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$27,367.41
Rate for Payer: SOMOS Essential	$61,576.67
Rate for Payer: Wellcare CHP/FHP/Medicaid	$27,367.41

APR-DRG 1361: Respiratory malignancy

Facility IP

$39,650.38

Service Code	APR-DRG 1361
Min. Negotiated Rate	$7,402.00
Max. Negotiated Rate	$39,650.38
Rate for Payer: Amida Care Medicaid	$17,622.39
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,622.39
Rate for Payer: Fidelis Qualified Health Plan	$21,146.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,622.39
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,622.39
Rate for Payer: Healthfirst Commercial	$13,161.00
Rate for Payer: Healthfirst Essential Plan	$39,650.38
Rate for Payer: Healthfirst QHP	$7,402.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,622.39
Rate for Payer: SOMOS Essential	$39,650.38
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,622.39

APR-DRG 1362: Respiratory malignancy

Facility IP

$45,540.43

Service Code	APR-DRG 1362
Min. Negotiated Rate	$10,060.00
Max. Negotiated Rate	$45,540.43
Rate for Payer: Amida Care Medicaid	$20,240.19
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,240.19
Rate for Payer: Fidelis Qualified Health Plan	$24,288.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,240.19
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,240.19
Rate for Payer: Healthfirst Commercial	$16,014.00
Rate for Payer: Healthfirst Essential Plan	$45,540.43
Rate for Payer: Healthfirst QHP	$10,060.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,240.19
Rate for Payer: SOMOS Essential	$45,540.43
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,240.19

APR-DRG 1363: Respiratory malignancy

Facility IP

$57,074.29

Service Code	APR-DRG 1363
Min. Negotiated Rate	$16,998.00
Max. Negotiated Rate	$57,074.29
Rate for Payer: Amida Care Medicaid	$25,366.35
Rate for Payer: Fidelis CHP/HARP/Medicaid	$25,366.35
Rate for Payer: Fidelis Qualified Health Plan	$30,439.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$25,366.35
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25,366.35
Rate for Payer: Healthfirst Commercial	$26,979.00
Rate for Payer: Healthfirst Essential Plan	$57,074.29
Rate for Payer: Healthfirst QHP	$16,998.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$25,366.35
Rate for Payer: SOMOS Essential	$57,074.29
Rate for Payer: Wellcare CHP/FHP/Medicaid	$25,366.35

APR-DRG 1364: Respiratory malignancy

Facility IP

$69,981.73

Service Code	APR-DRG 1364
Min. Negotiated Rate	$27,840.00
Max. Negotiated Rate	$69,981.73
Rate for Payer: Amida Care Medicaid	$31,102.99
Rate for Payer: Fidelis CHP/HARP/Medicaid	$31,102.99
Rate for Payer: Fidelis Qualified Health Plan	$37,323.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$31,102.99
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31,102.99
Rate for Payer: Healthfirst Commercial	$42,127.00
Rate for Payer: Healthfirst Essential Plan	$69,981.73
Rate for Payer: Healthfirst QHP	$27,840.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$31,102.99
Rate for Payer: SOMOS Essential	$69,981.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$31,102.99

APR-DRG 1371: Major respiratory infections & inflammations

Facility IP

$41,880.49

Service Code	APR-DRG 1371
Min. Negotiated Rate	$11,030.00
Max. Negotiated Rate	$41,880.49
Rate for Payer: Amida Care Medicaid	$18,613.55
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,613.55
Rate for Payer: Fidelis Qualified Health Plan	$22,336.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,613.55
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,613.55
Rate for Payer: Healthfirst Commercial	$16,084.00
Rate for Payer: Healthfirst Essential Plan	$41,880.49
Rate for Payer: Healthfirst QHP	$11,030.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,613.55
Rate for Payer: SOMOS Essential	$41,880.49
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,613.55

APR-DRG 1372: Major respiratory infections & inflammations

Facility IP

$47,772.27

Service Code	APR-DRG 1372
Min. Negotiated Rate	$11,489.00
Max. Negotiated Rate	$47,772.27
Rate for Payer: Amida Care Medicaid	$21,232.12
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,232.12
Rate for Payer: Fidelis Qualified Health Plan	$25,478.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,232.12
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,232.12
Rate for Payer: Healthfirst Commercial	$18,948.00
Rate for Payer: Healthfirst Essential Plan	$47,772.27
Rate for Payer: Healthfirst QHP	$11,489.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,232.12
Rate for Payer: SOMOS Essential	$47,772.27
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,232.12

APR-DRG 1373: Major respiratory infections & inflammations

Facility IP

$59,133.78

Service Code	APR-DRG 1373
Min. Negotiated Rate	$16,299.00
Max. Negotiated Rate	$59,133.78
Rate for Payer: Amida Care Medicaid	$26,281.68
Rate for Payer: Fidelis CHP/HARP/Medicaid	$26,281.68
Rate for Payer: Fidelis Qualified Health Plan	$31,538.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$26,281.68
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$26,281.68
Rate for Payer: Healthfirst Commercial	$26,686.00
Rate for Payer: Healthfirst Essential Plan	$59,133.78
Rate for Payer: Healthfirst QHP	$16,299.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26,281.68
Rate for Payer: SOMOS Essential	$59,133.78
Rate for Payer: Wellcare CHP/FHP/Medicaid	$26,281.68

APR-DRG 1374: Major respiratory infections & inflammations

Facility IP

$75,583.33

Service Code	APR-DRG 1374
Min. Negotiated Rate	$25,551.00
Max. Negotiated Rate	$75,583.33
Rate for Payer: Amida Care Medicaid	$33,592.59
Rate for Payer: Fidelis CHP/HARP/Medicaid	$33,592.59
Rate for Payer: Fidelis Qualified Health Plan	$40,311.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$33,592.59
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$33,592.59
Rate for Payer: Healthfirst Commercial	$41,251.00
Rate for Payer: Healthfirst Essential Plan	$75,583.33
Rate for Payer: Healthfirst QHP	$25,551.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$33,592.59
Rate for Payer: SOMOS Essential	$75,583.33
Rate for Payer: Wellcare CHP/FHP/Medicaid	$33,592.59

APR-DRG 1381: Bronchiolitis & RSV pneumonia

Facility IP

$38,220.52

Service Code	APR-DRG 1381
Min. Negotiated Rate	$5,529.00
Max. Negotiated Rate	$38,220.52
Rate for Payer: Amida Care Medicaid	$16,986.90
Rate for Payer: Fidelis CHP/HARP/Medicaid	$16,986.90
Rate for Payer: Fidelis Qualified Health Plan	$20,384.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$16,986.90
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16,986.90
Rate for Payer: Healthfirst Commercial	$9,884.00
Rate for Payer: Healthfirst Essential Plan	$38,220.52
Rate for Payer: Healthfirst QHP	$5,529.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$16,986.90
Rate for Payer: SOMOS Essential	$38,220.52
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,986.90

APR-DRG 1382: Bronchiolitis & RSV pneumonia

Facility IP

$40,728.49

Service Code	APR-DRG 1382
Min. Negotiated Rate	$7,071.00
Max. Negotiated Rate	$40,728.49
Rate for Payer: Amida Care Medicaid	$18,101.55
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,101.55
Rate for Payer: Fidelis Qualified Health Plan	$21,721.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,101.55
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,101.55
Rate for Payer: Healthfirst Commercial	$12,208.00
Rate for Payer: Healthfirst Essential Plan	$40,728.49
Rate for Payer: Healthfirst QHP	$7,071.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,101.55
Rate for Payer: SOMOS Essential	$40,728.49
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,101.55

Price Transparency.

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