St. Barnabas Hospital

All Charges

Charge

Type

Price

APR-DRG 1444: Respiratory signs, symptoms & minor diagnoses

Facility IP

$59,522.47

Service Code	APR-DRG 1444
Min. Negotiated Rate	$13,279.00
Max. Negotiated Rate	$59,522.47
Rate for Payer: Amida Care Medicaid	$26,454.43
Rate for Payer: Fidelis CHP/HARP/Medicaid	$26,454.43
Rate for Payer: Fidelis Qualified Health Plan	$31,745.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$26,454.43
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$26,454.43
Rate for Payer: Healthfirst Commercial	$25,418.00
Rate for Payer: Healthfirst Essential Plan	$59,522.47
Rate for Payer: Healthfirst QHP	$13,279.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26,454.43
Rate for Payer: SOMOS Essential	$59,522.47
Rate for Payer: Wellcare CHP/FHP/Medicaid	$26,454.43

APR-DRG 1601: Major cardiothoracic repair of heart anomaly

Facility IP

$84,976.78

Service Code	APR-DRG 1601
Min. Negotiated Rate	$28,535.00
Max. Negotiated Rate	$84,976.78
Rate for Payer: Amida Care Medicaid	$37,767.46
Rate for Payer: Fidelis CHP/HARP/Medicaid	$37,767.46
Rate for Payer: Fidelis Qualified Health Plan	$45,320.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$37,767.46
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$37,767.46
Rate for Payer: Healthfirst Commercial	$49,166.00
Rate for Payer: Healthfirst Essential Plan	$84,976.78
Rate for Payer: Healthfirst QHP	$28,535.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$37,767.46
Rate for Payer: SOMOS Essential	$84,976.78
Rate for Payer: Wellcare CHP/FHP/Medicaid	$37,767.46

APR-DRG 1602: Major cardiothoracic repair of heart anomaly

Facility IP

$89,401.79

Service Code	APR-DRG 1602
Min. Negotiated Rate	$35,961.00
Max. Negotiated Rate	$89,401.79
Rate for Payer: Amida Care Medicaid	$39,734.13
Rate for Payer: Fidelis CHP/HARP/Medicaid	$39,734.13
Rate for Payer: Fidelis Qualified Health Plan	$47,680.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$39,734.13
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$39,734.13
Rate for Payer: Healthfirst Commercial	$58,631.00
Rate for Payer: Healthfirst Essential Plan	$89,401.79
Rate for Payer: Healthfirst QHP	$35,961.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$39,734.13
Rate for Payer: SOMOS Essential	$89,401.79
Rate for Payer: Wellcare CHP/FHP/Medicaid	$39,734.13

APR-DRG 1603: Major cardiothoracic repair of heart anomaly

Facility IP

$113,712.95

Service Code	APR-DRG 1603
Min. Negotiated Rate	$47,540.00
Max. Negotiated Rate	$113,712.95
Rate for Payer: Amida Care Medicaid	$50,539.09
Rate for Payer: Fidelis CHP/HARP/Medicaid	$50,539.09
Rate for Payer: Fidelis Qualified Health Plan	$60,646.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$50,539.09
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$50,539.09
Rate for Payer: Healthfirst Commercial	$74,621.00
Rate for Payer: Healthfirst Essential Plan	$113,712.95
Rate for Payer: Healthfirst QHP	$47,540.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$50,539.09
Rate for Payer: SOMOS Essential	$113,712.95
Rate for Payer: Wellcare CHP/FHP/Medicaid	$50,539.09

APR-DRG 1604: Major cardiothoracic repair of heart anomaly

Facility IP

$204,531.10

Service Code	APR-DRG 1604
Min. Negotiated Rate	$90,902.71
Max. Negotiated Rate	$204,531.10
Rate for Payer: Amida Care Medicaid	$90,902.71
Rate for Payer: Fidelis CHP/HARP/Medicaid	$90,902.71
Rate for Payer: Fidelis Qualified Health Plan	$109,083.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$90,902.71
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$90,902.71
Rate for Payer: Healthfirst Commercial	$186,500.00
Rate for Payer: Healthfirst Essential Plan	$204,531.10
Rate for Payer: Healthfirst QHP	$96,615.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$90,902.71
Rate for Payer: SOMOS Essential	$204,531.10
Rate for Payer: Wellcare CHP/FHP/Medicaid	$90,902.71

APR-DRG 1611: Cardiac defibrillator & heart assist implant

Facility IP

$100,244.48

Service Code	APR-DRG 1611
Min. Negotiated Rate	$44,553.10
Max. Negotiated Rate	$100,244.48
Rate for Payer: Amida Care Medicaid	$44,553.10
Rate for Payer: Fidelis CHP/HARP/Medicaid	$44,553.10
Rate for Payer: Fidelis Qualified Health Plan	$53,463.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$44,553.10
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$44,553.10
Rate for Payer: Healthfirst Commercial	$77,958.00
Rate for Payer: Healthfirst Essential Plan	$100,244.48
Rate for Payer: Healthfirst QHP	$54,302.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$44,553.10
Rate for Payer: SOMOS Essential	$100,244.48
Rate for Payer: Wellcare CHP/FHP/Medicaid	$44,553.10

APR-DRG 1612: Cardiac defibrillator & heart assist implant

Facility IP

$137,412.04

Service Code	APR-DRG 1612
Min. Negotiated Rate	$61,072.02
Max. Negotiated Rate	$137,412.04
Rate for Payer: Amida Care Medicaid	$61,072.02
Rate for Payer: Fidelis CHP/HARP/Medicaid	$61,072.02
Rate for Payer: Fidelis Qualified Health Plan	$73,286.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$61,072.02
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$61,072.02
Rate for Payer: Healthfirst Commercial	$114,661.00
Rate for Payer: Healthfirst Essential Plan	$137,412.04
Rate for Payer: Healthfirst QHP	$72,175.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$61,072.02
Rate for Payer: SOMOS Essential	$137,412.04
Rate for Payer: Wellcare CHP/FHP/Medicaid	$61,072.02

APR-DRG 1613: Cardiac defibrillator & heart assist implant

Facility IP

$202,696.72

Service Code	APR-DRG 1613
Min. Negotiated Rate	$90,087.43
Max. Negotiated Rate	$202,696.72
Rate for Payer: Amida Care Medicaid	$90,087.43
Rate for Payer: Fidelis CHP/HARP/Medicaid	$90,087.43
Rate for Payer: Fidelis Qualified Health Plan	$108,104.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$90,087.43
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$90,087.43
Rate for Payer: Healthfirst Commercial	$192,154.00
Rate for Payer: Healthfirst Essential Plan	$202,696.72
Rate for Payer: Healthfirst QHP	$112,207.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$90,087.43
Rate for Payer: SOMOS Essential	$202,696.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$90,087.43

APR-DRG 1614: Cardiac defibrillator & heart assist implant

Facility IP

$435,575.84

Service Code	APR-DRG 1614
Min. Negotiated Rate	$193,589.26
Max. Negotiated Rate	$435,575.84
Rate for Payer: Amida Care Medicaid	$193,589.26
Rate for Payer: Fidelis CHP/HARP/Medicaid	$193,589.26
Rate for Payer: Fidelis Qualified Health Plan	$232,307.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$193,589.26
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$193,589.26
Rate for Payer: Healthfirst Commercial	$398,439.00
Rate for Payer: Healthfirst Essential Plan	$435,575.84
Rate for Payer: Healthfirst QHP	$277,689.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$193,589.26
Rate for Payer: SOMOS Essential	$435,575.84
Rate for Payer: Wellcare CHP/FHP/Medicaid	$193,589.26

APR-DRG 1621: Cardiac valve procedures w AMI or complex PDX

Facility IP

$90,532.66

Service Code	APR-DRG 1621
Min. Negotiated Rate	$40,236.74
Max. Negotiated Rate	$90,532.66
Rate for Payer: Amida Care Medicaid	$40,236.74
Rate for Payer: Fidelis CHP/HARP/Medicaid	$40,236.74
Rate for Payer: Fidelis Qualified Health Plan	$48,284.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$40,236.74
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$40,236.74
Rate for Payer: Healthfirst Commercial	$64,101.00
Rate for Payer: Healthfirst Essential Plan	$90,532.66
Rate for Payer: Healthfirst QHP	$43,037.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$40,236.74
Rate for Payer: SOMOS Essential	$90,532.66
Rate for Payer: Wellcare CHP/FHP/Medicaid	$40,236.74

APR-DRG 1622: Cardiac valve procedures w AMI or complex PDX

Facility IP

$108,471.89

Service Code	APR-DRG 1622
Min. Negotiated Rate	$48,209.73
Max. Negotiated Rate	$108,471.89
Rate for Payer: Amida Care Medicaid	$48,209.73
Rate for Payer: Fidelis CHP/HARP/Medicaid	$48,209.73
Rate for Payer: Fidelis Qualified Health Plan	$57,851.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$48,209.73
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$48,209.73
Rate for Payer: Healthfirst Commercial	$74,697.00
Rate for Payer: Healthfirst Essential Plan	$108,471.89
Rate for Payer: Healthfirst QHP	$49,665.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$48,209.73
Rate for Payer: SOMOS Essential	$108,471.89
Rate for Payer: Wellcare CHP/FHP/Medicaid	$48,209.73

APR-DRG 1623: Cardiac valve procedures w AMI or complex PDX

Facility IP

$130,537.12

Service Code	APR-DRG 1623
Min. Negotiated Rate	$58,016.50
Max. Negotiated Rate	$130,537.12
Rate for Payer: Amida Care Medicaid	$58,016.50
Rate for Payer: Fidelis CHP/HARP/Medicaid	$58,016.50
Rate for Payer: Fidelis Qualified Health Plan	$69,619.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$58,016.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$58,016.50
Rate for Payer: Healthfirst Commercial	$100,406.00
Rate for Payer: Healthfirst Essential Plan	$130,537.12
Rate for Payer: Healthfirst QHP	$62,895.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$58,016.50
Rate for Payer: SOMOS Essential	$130,537.12
Rate for Payer: Wellcare CHP/FHP/Medicaid	$58,016.50

APR-DRG 1624: Cardiac valve procedures w AMI or complex PDX

Facility IP

$194,696.19

Service Code	APR-DRG 1624
Min. Negotiated Rate	$86,531.64
Max. Negotiated Rate	$194,696.19
Rate for Payer: Amida Care Medicaid	$86,531.64
Rate for Payer: Fidelis CHP/HARP/Medicaid	$86,531.64
Rate for Payer: Fidelis Qualified Health Plan	$103,837.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$86,531.64
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$86,531.64
Rate for Payer: Healthfirst Commercial	$193,480.00
Rate for Payer: Healthfirst Essential Plan	$194,696.19
Rate for Payer: Healthfirst QHP	$101,280.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$86,531.64
Rate for Payer: SOMOS Essential	$194,696.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$86,531.64

APR-DRG 1631: Cardiac valve procedures w/o AMI or complex PDX

Facility IP

$82,839.92

Service Code	APR-DRG 1631
Min. Negotiated Rate	$35,205.00
Max. Negotiated Rate	$82,839.92
Rate for Payer: Amida Care Medicaid	$36,817.74
Rate for Payer: Fidelis CHP/HARP/Medicaid	$36,817.74
Rate for Payer: Fidelis Qualified Health Plan	$44,181.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$36,817.74
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$36,817.74
Rate for Payer: Healthfirst Commercial	$52,883.00
Rate for Payer: Healthfirst Essential Plan	$82,839.92
Rate for Payer: Healthfirst QHP	$35,205.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$36,817.74
Rate for Payer: SOMOS Essential	$82,839.92
Rate for Payer: Wellcare CHP/FHP/Medicaid	$36,817.74

APR-DRG 1632: Cardiac valve procedures w/o AMI or complex PDX

Facility IP

$94,718.50

Service Code	APR-DRG 1632
Min. Negotiated Rate	$42,097.11
Max. Negotiated Rate	$94,718.50
Rate for Payer: Amida Care Medicaid	$42,097.11
Rate for Payer: Fidelis CHP/HARP/Medicaid	$42,097.11
Rate for Payer: Fidelis Qualified Health Plan	$50,516.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$42,097.11
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$42,097.11
Rate for Payer: Healthfirst Commercial	$65,920.00
Rate for Payer: Healthfirst Essential Plan	$94,718.50
Rate for Payer: Healthfirst QHP	$42,236.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$42,097.11
Rate for Payer: SOMOS Essential	$94,718.50
Rate for Payer: Wellcare CHP/FHP/Medicaid	$42,097.11

APR-DRG 1633: Cardiac valve procedures w/o AMI or complex PDX

Facility IP

$109,588.68

Service Code	APR-DRG 1633
Min. Negotiated Rate	$48,706.08
Max. Negotiated Rate	$109,588.68
Rate for Payer: Amida Care Medicaid	$48,706.08
Rate for Payer: Fidelis CHP/HARP/Medicaid	$48,706.08
Rate for Payer: Fidelis Qualified Health Plan	$58,447.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$48,706.08
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$48,706.08
Rate for Payer: Healthfirst Commercial	$86,061.00
Rate for Payer: Healthfirst Essential Plan	$109,588.68
Rate for Payer: Healthfirst QHP	$51,786.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$48,706.08
Rate for Payer: SOMOS Essential	$109,588.68
Rate for Payer: Wellcare CHP/FHP/Medicaid	$48,706.08

APR-DRG 1634: Cardiac valve procedures w/o AMI or complex PDX

Facility IP

$180,050.00

Service Code	APR-DRG 1634
Min. Negotiated Rate	$68,258.65
Max. Negotiated Rate	$180,050.00
Rate for Payer: Amida Care Medicaid	$68,258.65
Rate for Payer: Fidelis CHP/HARP/Medicaid	$68,258.65
Rate for Payer: Fidelis Qualified Health Plan	$81,910.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$68,258.65
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$68,258.65
Rate for Payer: Healthfirst Commercial	$180,050.00
Rate for Payer: Healthfirst Essential Plan	$153,581.96
Rate for Payer: Healthfirst QHP	$91,720.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$68,258.65
Rate for Payer: SOMOS Essential	$153,581.96
Rate for Payer: Wellcare CHP/FHP/Medicaid	$68,258.65

APR-DRG 1651: Coronary bypass w AMI or complex PDX

Facility IP

$98,823.40

Service Code	APR-DRG 1651
Min. Negotiated Rate	$37,707.00
Max. Negotiated Rate	$98,823.40
Rate for Payer: Amida Care Medicaid	$43,921.51
Rate for Payer: Fidelis CHP/HARP/Medicaid	$43,921.51
Rate for Payer: Fidelis Qualified Health Plan	$52,705.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$43,921.51
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$43,921.51
Rate for Payer: Healthfirst Commercial	$60,839.00
Rate for Payer: Healthfirst Essential Plan	$98,823.40
Rate for Payer: Healthfirst QHP	$37,707.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$43,921.51
Rate for Payer: SOMOS Essential	$98,823.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$43,921.51

APR-DRG 1652: Coronary bypass w AMI or complex PDX

Facility IP

$99,060.84

Service Code	APR-DRG 1652
Min. Negotiated Rate	$41,719.00
Max. Negotiated Rate	$99,060.84
Rate for Payer: Amida Care Medicaid	$44,027.04
Rate for Payer: Fidelis CHP/HARP/Medicaid	$44,027.04
Rate for Payer: Fidelis Qualified Health Plan	$52,832.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$44,027.04
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$44,027.04
Rate for Payer: Healthfirst Commercial	$68,870.00
Rate for Payer: Healthfirst Essential Plan	$99,060.84
Rate for Payer: Healthfirst QHP	$41,719.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$44,027.04
Rate for Payer: SOMOS Essential	$99,060.84
Rate for Payer: Wellcare CHP/FHP/Medicaid	$44,027.04

APR-DRG 1653: Coronary bypass w AMI or complex PDX

Facility IP

$115,142.80

Service Code	APR-DRG 1653
Min. Negotiated Rate	$51,031.00
Max. Negotiated Rate	$115,142.80
Rate for Payer: Amida Care Medicaid	$51,174.58
Rate for Payer: Fidelis CHP/HARP/Medicaid	$51,174.58
Rate for Payer: Fidelis Qualified Health Plan	$61,409.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$51,174.58
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$51,174.58
Rate for Payer: Healthfirst Commercial	$85,480.00
Rate for Payer: Healthfirst Essential Plan	$115,142.80
Rate for Payer: Healthfirst QHP	$51,031.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$51,174.58
Rate for Payer: SOMOS Essential	$115,142.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$51,174.58

APR-DRG 1654: Coronary bypass w AMI or complex PDX

Facility IP

$154,102.57

Service Code	APR-DRG 1654
Min. Negotiated Rate	$68,490.03
Max. Negotiated Rate	$154,102.57
Rate for Payer: Amida Care Medicaid	$68,490.03
Rate for Payer: Fidelis CHP/HARP/Medicaid	$68,490.03
Rate for Payer: Fidelis Qualified Health Plan	$82,188.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$68,490.03
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$68,490.03
Rate for Payer: Healthfirst Commercial	$149,890.00
Rate for Payer: Healthfirst Essential Plan	$154,102.57
Rate for Payer: Healthfirst QHP	$80,090.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$68,490.03
Rate for Payer: SOMOS Essential	$154,102.57
Rate for Payer: Wellcare CHP/FHP/Medicaid	$68,490.03

APR-DRG 1661: Coronary bypass w/o AMI or complex PDX

Facility IP

$82,470.58

Service Code	APR-DRG 1661
Min. Negotiated Rate	$29,804.00
Max. Negotiated Rate	$82,470.58
Rate for Payer: Amida Care Medicaid	$36,653.59
Rate for Payer: Fidelis CHP/HARP/Medicaid	$36,653.59
Rate for Payer: Fidelis Qualified Health Plan	$43,984.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$36,653.59
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$36,653.59
Rate for Payer: Healthfirst Commercial	$48,620.00
Rate for Payer: Healthfirst Essential Plan	$82,470.58
Rate for Payer: Healthfirst QHP	$29,804.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$36,653.59
Rate for Payer: SOMOS Essential	$82,470.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$36,653.59

APR-DRG 1662: Coronary bypass w/o AMI or complex PDX

Facility IP

$87,006.40

Service Code	APR-DRG 1662
Min. Negotiated Rate	$33,191.00
Max. Negotiated Rate	$87,006.40
Rate for Payer: Amida Care Medicaid	$38,669.51
Rate for Payer: Fidelis CHP/HARP/Medicaid	$38,669.51
Rate for Payer: Fidelis Qualified Health Plan	$46,403.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$38,669.51
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$38,669.51
Rate for Payer: Healthfirst Commercial	$55,156.00
Rate for Payer: Healthfirst Essential Plan	$87,006.40
Rate for Payer: Healthfirst QHP	$33,191.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$38,669.51
Rate for Payer: SOMOS Essential	$87,006.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$38,669.51

APR-DRG 1663: Coronary bypass w/o AMI or complex PDX

Facility IP

$100,270.84

Service Code	APR-DRG 1663
Min. Negotiated Rate	$41,785.00
Max. Negotiated Rate	$100,270.84
Rate for Payer: Amida Care Medicaid	$44,564.82
Rate for Payer: Fidelis CHP/HARP/Medicaid	$44,564.82
Rate for Payer: Fidelis Qualified Health Plan	$53,477.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$44,564.82
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$44,564.82
Rate for Payer: Healthfirst Commercial	$75,699.00
Rate for Payer: Healthfirst Essential Plan	$100,270.84
Rate for Payer: Healthfirst QHP	$41,785.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$44,564.82
Rate for Payer: SOMOS Essential	$100,270.84
Rate for Payer: Wellcare CHP/FHP/Medicaid	$44,564.82

APR-DRG 1664: Coronary bypass w/o AMI or complex PDX

Facility IP

$157,774.00

Service Code	APR-DRG 1664
Min. Negotiated Rate	$61,881.83
Max. Negotiated Rate	$157,774.00
Rate for Payer: Amida Care Medicaid	$61,881.83
Rate for Payer: Fidelis CHP/HARP/Medicaid	$61,881.83
Rate for Payer: Fidelis Qualified Health Plan	$74,258.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$61,881.83
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$61,881.83
Rate for Payer: Healthfirst Commercial	$157,774.00
Rate for Payer: Healthfirst Essential Plan	$139,234.12
Rate for Payer: Healthfirst QHP	$71,480.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$61,881.83
Rate for Payer: SOMOS Essential	$139,234.12
Rate for Payer: Wellcare CHP/FHP/Medicaid	$61,881.83

Price Transparency.

All Charges