St. Barnabas Hospital

All Charges

Charge

Type

Price

APR-DRG 6134: Neonate birthwt 1500-1999g w congenital/perinatal infection

Facility IP

$120,712.77

Service Code	APR-DRG 6134
Min. Negotiated Rate	$53,650.12
Max. Negotiated Rate	$120,712.77
Rate for Payer: Amida Care Medicaid	$53,650.12
Rate for Payer: Fidelis CHP/HARP/Medicaid	$53,650.12
Rate for Payer: Fidelis Qualified Health Plan	$64,380.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$53,650.12
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$53,650.12
Rate for Payer: Healthfirst Commercial	$90,994.00
Rate for Payer: Healthfirst Essential Plan	$120,712.77
Rate for Payer: Healthfirst QHP	$57,735.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$53,650.12
Rate for Payer: SOMOS Essential	$120,712.77
Rate for Payer: Wellcare CHP/FHP/Medicaid	$53,650.12

APR-DRG 6141: Neonate bwt 1500-1999g w or w/o other significant condition

Facility IP

$64,723.07

Service Code	APR-DRG 6141
Min. Negotiated Rate	$16,928.00
Max. Negotiated Rate	$64,723.07
Rate for Payer: Amida Care Medicaid	$28,765.81
Rate for Payer: Fidelis CHP/HARP/Medicaid	$28,765.81
Rate for Payer: Fidelis Qualified Health Plan	$34,518.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$28,765.81
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$28,765.81
Rate for Payer: Healthfirst Commercial	$32,234.00
Rate for Payer: Healthfirst Essential Plan	$64,723.07
Rate for Payer: Healthfirst QHP	$16,928.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$28,765.81
Rate for Payer: SOMOS Essential	$64,723.07
Rate for Payer: Wellcare CHP/FHP/Medicaid	$28,765.81

APR-DRG 6142: Neonate bwt 1500-1999g w or w/o other significant condition

Facility IP

$87,651.86

Service Code	APR-DRG 6142
Min. Negotiated Rate	$28,894.00
Max. Negotiated Rate	$87,651.86
Rate for Payer: Amida Care Medicaid	$38,956.38
Rate for Payer: Fidelis CHP/HARP/Medicaid	$38,956.38
Rate for Payer: Fidelis Qualified Health Plan	$46,747.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$38,956.38
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$38,956.38
Rate for Payer: Healthfirst Commercial	$54,832.00
Rate for Payer: Healthfirst Essential Plan	$87,651.86
Rate for Payer: Healthfirst QHP	$28,894.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$38,956.38
Rate for Payer: SOMOS Essential	$87,651.86
Rate for Payer: Wellcare CHP/FHP/Medicaid	$38,956.38

APR-DRG 6143: Neonate bwt 1500-1999g w or w/o other significant condition

Facility IP

$118,215.34

Service Code	APR-DRG 6143
Min. Negotiated Rate	$41,067.00
Max. Negotiated Rate	$118,215.34
Rate for Payer: Amida Care Medicaid	$52,540.15
Rate for Payer: Fidelis CHP/HARP/Medicaid	$52,540.15
Rate for Payer: Fidelis Qualified Health Plan	$63,048.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$52,540.15
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$52,540.15
Rate for Payer: Healthfirst Commercial	$85,240.00
Rate for Payer: Healthfirst Essential Plan	$118,215.34
Rate for Payer: Healthfirst QHP	$41,067.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$52,540.15
Rate for Payer: SOMOS Essential	$118,215.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$52,540.15

APR-DRG 6144: Neonate bwt 1500-1999g w or w/o other significant condition

Facility IP

$118,215.34

Service Code	APR-DRG 6144
Min. Negotiated Rate	$42,555.00
Max. Negotiated Rate	$118,215.34
Rate for Payer: Amida Care Medicaid	$52,540.15
Rate for Payer: Fidelis CHP/HARP/Medicaid	$52,540.15
Rate for Payer: Fidelis Qualified Health Plan	$63,048.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$52,540.15
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$52,540.15
Rate for Payer: Healthfirst Commercial	$88,525.00
Rate for Payer: Healthfirst Essential Plan	$118,215.34
Rate for Payer: Healthfirst QHP	$42,555.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$52,540.15
Rate for Payer: SOMOS Essential	$118,215.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$52,540.15

APR-DRG 6211: Neonate bwt 2000-2499g w major anomaly

Facility IP

$45,607.25

Service Code	APR-DRG 6211
Min. Negotiated Rate	$9,622.00
Max. Negotiated Rate	$45,607.25
Rate for Payer: Amida Care Medicaid	$20,269.89
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,269.89
Rate for Payer: Fidelis Qualified Health Plan	$24,323.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,269.89
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,269.89
Rate for Payer: Healthfirst Commercial	$18,243.00
Rate for Payer: Healthfirst Essential Plan	$45,607.25
Rate for Payer: Healthfirst QHP	$9,622.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,269.89
Rate for Payer: SOMOS Essential	$45,607.25
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,269.89

APR-DRG 6212: Neonate bwt 2000-2499g w major anomaly

Facility IP

$66,471.28

Service Code	APR-DRG 6212
Min. Negotiated Rate	$18,554.00
Max. Negotiated Rate	$66,471.28
Rate for Payer: Amida Care Medicaid	$29,542.79
Rate for Payer: Fidelis CHP/HARP/Medicaid	$29,542.79
Rate for Payer: Fidelis Qualified Health Plan	$35,451.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$29,542.79
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29,542.79
Rate for Payer: Healthfirst Commercial	$36,830.00
Rate for Payer: Healthfirst Essential Plan	$66,471.28
Rate for Payer: Healthfirst QHP	$18,554.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$29,542.79
Rate for Payer: SOMOS Essential	$66,471.28
Rate for Payer: Wellcare CHP/FHP/Medicaid	$29,542.79

APR-DRG 6213: Neonate bwt 2000-2499g w major anomaly

Facility IP

$99,611.32

Service Code	APR-DRG 6213
Min. Negotiated Rate	$31,111.00
Max. Negotiated Rate	$99,611.32
Rate for Payer: Amida Care Medicaid	$44,271.70
Rate for Payer: Fidelis CHP/HARP/Medicaid	$44,271.70
Rate for Payer: Fidelis Qualified Health Plan	$53,126.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$44,271.70
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$44,271.70
Rate for Payer: Healthfirst Commercial	$56,920.00
Rate for Payer: Healthfirst Essential Plan	$99,611.32
Rate for Payer: Healthfirst QHP	$31,111.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$44,271.70
Rate for Payer: SOMOS Essential	$99,611.32
Rate for Payer: Wellcare CHP/FHP/Medicaid	$44,271.70

APR-DRG 6214: Neonate bwt 2000-2499g w major anomaly

Facility IP

$149,098.93

Service Code	APR-DRG 6214
Min. Negotiated Rate	$63,011.00
Max. Negotiated Rate	$149,098.93
Rate for Payer: Amida Care Medicaid	$66,266.19
Rate for Payer: Fidelis CHP/HARP/Medicaid	$66,266.19
Rate for Payer: Fidelis Qualified Health Plan	$79,519.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$66,266.19
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$66,266.19
Rate for Payer: Healthfirst Commercial	$101,107.00
Rate for Payer: Healthfirst Essential Plan	$149,098.93
Rate for Payer: Healthfirst QHP	$63,011.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$66,266.19
Rate for Payer: SOMOS Essential	$149,098.93
Rate for Payer: Wellcare CHP/FHP/Medicaid	$66,266.19

APR-DRG 6221: Neonate bwt 2000-2499g w resp dist synd/oth maj resp cond

Facility IP

$63,715.32

Service Code	APR-DRG 6221
Min. Negotiated Rate	$16,202.00
Max. Negotiated Rate	$63,715.32
Rate for Payer: Amida Care Medicaid	$28,317.92
Rate for Payer: Fidelis CHP/HARP/Medicaid	$28,317.92
Rate for Payer: Fidelis Qualified Health Plan	$33,981.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$28,317.92
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$28,317.92
Rate for Payer: Healthfirst Commercial	$28,080.00
Rate for Payer: Healthfirst Essential Plan	$63,715.32
Rate for Payer: Healthfirst QHP	$16,202.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$28,317.92
Rate for Payer: SOMOS Essential	$63,715.32
Rate for Payer: Wellcare CHP/FHP/Medicaid	$28,317.92

APR-DRG 6222: Neonate bwt 2000-2499g w resp dist synd/oth maj resp cond

Facility IP

$75,905.19

Service Code	APR-DRG 6222
Min. Negotiated Rate	$21,426.00
Max. Negotiated Rate	$75,905.19
Rate for Payer: Amida Care Medicaid	$33,735.64
Rate for Payer: Fidelis CHP/HARP/Medicaid	$33,735.64
Rate for Payer: Fidelis Qualified Health Plan	$40,482.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$33,735.64
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$33,735.64
Rate for Payer: Healthfirst Commercial	$38,014.00
Rate for Payer: Healthfirst Essential Plan	$75,905.19
Rate for Payer: Healthfirst QHP	$21,426.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$33,735.64
Rate for Payer: SOMOS Essential	$75,905.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$33,735.64

APR-DRG 6223: Neonate bwt 2000-2499g w resp dist synd/oth maj resp cond

Facility IP

$93,060.00

Service Code	APR-DRG 6223
Min. Negotiated Rate	$31,405.00
Max. Negotiated Rate	$93,060.00
Rate for Payer: Amida Care Medicaid	$41,360.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$41,360.00
Rate for Payer: Fidelis Qualified Health Plan	$49,632.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$41,360.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$41,360.00
Rate for Payer: Healthfirst Commercial	$53,068.00
Rate for Payer: Healthfirst Essential Plan	$93,060.00
Rate for Payer: Healthfirst QHP	$31,405.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$41,360.00
Rate for Payer: SOMOS Essential	$93,060.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$41,360.00

APR-DRG 6224: Neonate bwt 2000-2499g w resp dist synd/oth maj resp cond

Facility IP

$120,552.70

Service Code	APR-DRG 6224
Min. Negotiated Rate	$43,148.00
Max. Negotiated Rate	$120,552.70
Rate for Payer: Amida Care Medicaid	$53,578.98
Rate for Payer: Fidelis CHP/HARP/Medicaid	$53,578.98
Rate for Payer: Fidelis Qualified Health Plan	$64,294.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$53,578.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$53,578.98
Rate for Payer: Healthfirst Commercial	$84,939.00
Rate for Payer: Healthfirst Essential Plan	$120,552.70
Rate for Payer: Healthfirst QHP	$43,148.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$53,578.98
Rate for Payer: SOMOS Essential	$120,552.70
Rate for Payer: Wellcare CHP/FHP/Medicaid	$53,578.98

APR-DRG 6231: Neonate bwt 2000-2499g w congenital/perinatal infection

Facility IP

$55,231.11

Service Code	APR-DRG 6231
Min. Negotiated Rate	$14,116.00
Max. Negotiated Rate	$55,231.11
Rate for Payer: Amida Care Medicaid	$24,547.16
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,547.16
Rate for Payer: Fidelis Qualified Health Plan	$29,456.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,547.16
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,547.16
Rate for Payer: Healthfirst Commercial	$21,643.00
Rate for Payer: Healthfirst Essential Plan	$55,231.11
Rate for Payer: Healthfirst QHP	$14,116.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,547.16
Rate for Payer: SOMOS Essential	$55,231.11
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,547.16

APR-DRG 6232: Neonate bwt 2000-2499g w congenital/perinatal infection

Facility IP

$67,600.37

Service Code	APR-DRG 6232
Min. Negotiated Rate	$21,757.00
Max. Negotiated Rate	$67,600.37
Rate for Payer: Amida Care Medicaid	$30,044.61
Rate for Payer: Fidelis CHP/HARP/Medicaid	$30,044.61
Rate for Payer: Fidelis Qualified Health Plan	$36,053.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$30,044.61
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$30,044.61
Rate for Payer: Healthfirst Commercial	$32,861.00
Rate for Payer: Healthfirst Essential Plan	$67,600.37
Rate for Payer: Healthfirst QHP	$21,757.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$30,044.61
Rate for Payer: SOMOS Essential	$67,600.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$30,044.61

APR-DRG 6233: Neonate bwt 2000-2499g w congenital/perinatal infection

Facility IP

$84,605.69

Service Code	APR-DRG 6233
Min. Negotiated Rate	$34,398.00
Max. Negotiated Rate	$84,605.69
Rate for Payer: Amida Care Medicaid	$37,602.53
Rate for Payer: Fidelis CHP/HARP/Medicaid	$37,602.53
Rate for Payer: Fidelis Qualified Health Plan	$45,123.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$37,602.53
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$37,602.53
Rate for Payer: Healthfirst Commercial	$65,844.00
Rate for Payer: Healthfirst Essential Plan	$84,605.69
Rate for Payer: Healthfirst QHP	$34,398.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$37,602.53
Rate for Payer: SOMOS Essential	$84,605.69
Rate for Payer: Wellcare CHP/FHP/Medicaid	$37,602.53

APR-DRG 6234: Neonate bwt 2000-2499g w congenital/perinatal infection

Facility IP

$84,605.69

Service Code	APR-DRG 6234
Min. Negotiated Rate	$34,525.00
Max. Negotiated Rate	$84,605.69
Rate for Payer: Amida Care Medicaid	$37,602.53
Rate for Payer: Fidelis CHP/HARP/Medicaid	$37,602.53
Rate for Payer: Fidelis Qualified Health Plan	$45,123.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$37,602.53
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$37,602.53
Rate for Payer: Healthfirst Commercial	$71,248.00
Rate for Payer: Healthfirst Essential Plan	$84,605.69
Rate for Payer: Healthfirst QHP	$34,525.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$37,602.53
Rate for Payer: SOMOS Essential	$84,605.69
Rate for Payer: Wellcare CHP/FHP/Medicaid	$37,602.53

APR-DRG 6251: Neonate bwt 2000-2499g w other significant condition

Facility IP

$57,779.55

Service Code	APR-DRG 6251
Min. Negotiated Rate	$16,482.00
Max. Negotiated Rate	$57,779.55
Rate for Payer: Amida Care Medicaid	$25,679.80
Rate for Payer: Fidelis CHP/HARP/Medicaid	$25,679.80
Rate for Payer: Fidelis Qualified Health Plan	$30,815.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$25,679.80
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25,679.80
Rate for Payer: Healthfirst Commercial	$29,368.00
Rate for Payer: Healthfirst Essential Plan	$57,779.55
Rate for Payer: Healthfirst QHP	$16,482.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$25,679.80
Rate for Payer: SOMOS Essential	$57,779.55
Rate for Payer: Wellcare CHP/FHP/Medicaid	$25,679.80

APR-DRG 6252: Neonate bwt 2000-2499g w other significant condition

Facility IP

$75,147.16

Service Code	APR-DRG 6252
Min. Negotiated Rate	$26,920.00
Max. Negotiated Rate	$75,147.16
Rate for Payer: Amida Care Medicaid	$33,398.74
Rate for Payer: Fidelis CHP/HARP/Medicaid	$33,398.74
Rate for Payer: Fidelis Qualified Health Plan	$40,078.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$33,398.74
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$33,398.74
Rate for Payer: Healthfirst Commercial	$45,555.00
Rate for Payer: Healthfirst Essential Plan	$75,147.16
Rate for Payer: Healthfirst QHP	$26,920.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$33,398.74
Rate for Payer: SOMOS Essential	$75,147.16
Rate for Payer: Wellcare CHP/FHP/Medicaid	$33,398.74

APR-DRG 6253: Neonate bwt 2000-2499g w other significant condition

Facility IP

$87,581.50

Service Code	APR-DRG 6253
Min. Negotiated Rate	$30,548.00
Max. Negotiated Rate	$87,581.50
Rate for Payer: Amida Care Medicaid	$38,925.11
Rate for Payer: Fidelis CHP/HARP/Medicaid	$38,925.11
Rate for Payer: Fidelis Qualified Health Plan	$46,710.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$38,925.11
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$38,925.11
Rate for Payer: Healthfirst Commercial	$62,656.00
Rate for Payer: Healthfirst Essential Plan	$87,581.50
Rate for Payer: Healthfirst QHP	$30,548.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$38,925.11
Rate for Payer: SOMOS Essential	$87,581.50
Rate for Payer: Wellcare CHP/FHP/Medicaid	$38,925.11

APR-DRG 6254: Neonate bwt 2000-2499g w other significant condition

Facility IP

$87,581.50

Service Code	APR-DRG 6254
Min. Negotiated Rate	$32,372.00
Max. Negotiated Rate	$87,581.50
Rate for Payer: Amida Care Medicaid	$38,925.11
Rate for Payer: Fidelis CHP/HARP/Medicaid	$38,925.11
Rate for Payer: Fidelis Qualified Health Plan	$46,710.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$38,925.11
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$38,925.11
Rate for Payer: Healthfirst Commercial	$63,153.00
Rate for Payer: Healthfirst Essential Plan	$87,581.50
Rate for Payer: Healthfirst QHP	$32,372.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$38,925.11
Rate for Payer: SOMOS Essential	$87,581.50
Rate for Payer: Wellcare CHP/FHP/Medicaid	$38,925.11

APR-DRG 6261: Neonate bwt 2000-2499g, normal newborn or neonate w other problem

Facility IP

$33,306.59

Service Code	APR-DRG 6261
Min. Negotiated Rate	$3,253.00
Max. Negotiated Rate	$33,306.59
Rate for Payer: Amida Care Medicaid	$14,802.93
Rate for Payer: Fidelis CHP/HARP/Medicaid	$14,802.93
Rate for Payer: Fidelis Qualified Health Plan	$17,763.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$14,802.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$14,802.93
Rate for Payer: Healthfirst Commercial	$5,811.00
Rate for Payer: Healthfirst Essential Plan	$33,306.59
Rate for Payer: Healthfirst QHP	$3,253.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$14,802.93
Rate for Payer: SOMOS Essential	$33,306.59
Rate for Payer: Wellcare CHP/FHP/Medicaid	$14,802.93

APR-DRG 6262: Neonate bwt 2000-2499g, normal newborn or neonate w other problem

Facility IP

$36,970.06

Service Code	APR-DRG 6262
Min. Negotiated Rate	$5,721.00
Max. Negotiated Rate	$36,970.06
Rate for Payer: Amida Care Medicaid	$16,431.14
Rate for Payer: Fidelis CHP/HARP/Medicaid	$16,431.14
Rate for Payer: Fidelis Qualified Health Plan	$19,717.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$16,431.14
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16,431.14
Rate for Payer: Healthfirst Commercial	$9,768.00
Rate for Payer: Healthfirst Essential Plan	$36,970.06
Rate for Payer: Healthfirst QHP	$5,721.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$16,431.14
Rate for Payer: SOMOS Essential	$36,970.06
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,431.14

APR-DRG 6263: Neonate bwt 2000-2499g, normal newborn or neonate w other problem

Facility IP

$53,173.40

Service Code	APR-DRG 6263
Min. Negotiated Rate	$12,130.00
Max. Negotiated Rate	$53,173.40
Rate for Payer: Amida Care Medicaid	$23,632.62
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,632.62
Rate for Payer: Fidelis Qualified Health Plan	$28,359.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,632.62
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,632.62
Rate for Payer: Healthfirst Commercial	$21,918.00
Rate for Payer: Healthfirst Essential Plan	$53,173.40
Rate for Payer: Healthfirst QHP	$12,130.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,632.62
Rate for Payer: SOMOS Essential	$53,173.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,632.62

APR-DRG 6264: Neonate bwt 2000-2499g, normal newborn or neonate w other problem

Facility IP

$53,199.76

Service Code	APR-DRG 6264
Min. Negotiated Rate	$12,130.00
Max. Negotiated Rate	$53,199.76
Rate for Payer: Amida Care Medicaid	$23,644.34
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,644.34
Rate for Payer: Fidelis Qualified Health Plan	$28,373.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,644.34
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,644.34
Rate for Payer: Healthfirst Commercial	$21,961.00
Rate for Payer: Healthfirst Essential Plan	$53,199.76
Rate for Payer: Healthfirst QHP	$12,130.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,644.34
Rate for Payer: SOMOS Essential	$53,199.76
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,644.34

Price Transparency.

All Charges