St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

APR-DRG 2294: Other digestive system & abdominal procedures

Facility

$131,418.25

Service Code	APR-DRG 2294
Min. Negotiated Rate	$58,408.11
Max. Negotiated Rate	$131,418.25
Rate for Payer: Affinity Essential Plan 1&2	$131,418.25
Rate for Payer: Affinity Essential Plan 3&4	$131,418.25
Rate for Payer: Affinity Medicaid/CHP/HARP	$58,408.11
Rate for Payer: Amida Care Medicaid	$58,408.11
Rate for Payer: Fidelis CHP/HARP/Medicaid	$58,408.11
Rate for Payer: Fidelis Qualified Health Plan	$70,089.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$58,408.11
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$58,408.11
Rate for Payer: Healthfirst Commercial	$104,566.00
Rate for Payer: Healthfirst Essential Plan	$131,418.25
Rate for Payer: Healthfirst QHP	$61,492.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$58,408.11
Rate for Payer: SOMOS Essential	$131,418.25
Rate for Payer: United Healthcare Essential Plan 1&2	$131,418.25
Rate for Payer: United Healthcare Essential Plan 3&4	$131,418.25
Rate for Payer: United Healthcare Medicaid	$58,408.11
Rate for Payer: Wellcare CHP/FHP/Medicaid	$58,408.11

APR-DRG 2401: Digestive malignancy

Facility

$41,950.82

Service Code	APR-DRG 2401
Min. Negotiated Rate	$7,556.00
Max. Negotiated Rate	$41,950.82
Rate for Payer: Affinity Essential Plan 1&2	$41,950.82
Rate for Payer: Affinity Essential Plan 3&4	$41,950.82
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,644.81
Rate for Payer: Amida Care Medicaid	$18,644.81
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,644.81
Rate for Payer: Fidelis Qualified Health Plan	$22,373.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,644.81
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,644.81
Rate for Payer: Healthfirst Commercial	$13,911.00
Rate for Payer: Healthfirst Essential Plan	$41,950.82
Rate for Payer: Healthfirst QHP	$7,556.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,644.81
Rate for Payer: SOMOS Essential	$41,950.82
Rate for Payer: United Healthcare Essential Plan 1&2	$41,950.82
Rate for Payer: United Healthcare Essential Plan 3&4	$41,950.82
Rate for Payer: United Healthcare Medicaid	$18,644.81
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,644.81

APR-DRG 2402: Digestive malignancy

Facility

$46,338.91

Service Code	APR-DRG 2402
Min. Negotiated Rate	$10,040.00
Max. Negotiated Rate	$46,338.91
Rate for Payer: Affinity Essential Plan 1&2	$46,338.91
Rate for Payer: Affinity Essential Plan 3&4	$46,338.91
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,595.07
Rate for Payer: Amida Care Medicaid	$20,595.07
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,595.07
Rate for Payer: Fidelis Qualified Health Plan	$24,714.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,595.07
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,595.07
Rate for Payer: Healthfirst Commercial	$16,998.00
Rate for Payer: Healthfirst Essential Plan	$46,338.91
Rate for Payer: Healthfirst QHP	$10,040.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,595.07
Rate for Payer: SOMOS Essential	$46,338.91
Rate for Payer: United Healthcare Essential Plan 1&2	$46,338.91
Rate for Payer: United Healthcare Essential Plan 3&4	$46,338.91
Rate for Payer: United Healthcare Medicaid	$20,595.07
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,595.07

APR-DRG 2403: Digestive malignancy

Facility

$57,491.10

Service Code	APR-DRG 2403
Min. Negotiated Rate	$17,113.00
Max. Negotiated Rate	$57,491.10
Rate for Payer: Affinity Essential Plan 1&2	$57,491.10
Rate for Payer: Affinity Essential Plan 3&4	$57,491.10
Rate for Payer: Affinity Medicaid/CHP/HARP	$25,551.60
Rate for Payer: Amida Care Medicaid	$25,551.60
Rate for Payer: Fidelis CHP/HARP/Medicaid	$25,551.60
Rate for Payer: Fidelis Qualified Health Plan	$30,661.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$25,551.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25,551.60
Rate for Payer: Healthfirst Commercial	$26,516.00
Rate for Payer: Healthfirst Essential Plan	$57,491.10
Rate for Payer: Healthfirst QHP	$17,113.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$25,551.60
Rate for Payer: SOMOS Essential	$57,491.10
Rate for Payer: United Healthcare Essential Plan 1&2	$57,491.10
Rate for Payer: United Healthcare Essential Plan 3&4	$57,491.10
Rate for Payer: United Healthcare Medicaid	$25,551.60
Rate for Payer: Wellcare CHP/FHP/Medicaid	$25,551.60

APR-DRG 2404: Digestive malignancy

Facility

$81,946.48

Service Code	APR-DRG 2404
Min. Negotiated Rate	$31,040.00
Max. Negotiated Rate	$81,946.48
Rate for Payer: Affinity Essential Plan 1&2	$81,946.48
Rate for Payer: Affinity Essential Plan 3&4	$81,946.48
Rate for Payer: Affinity Medicaid/CHP/HARP	$36,420.66
Rate for Payer: Amida Care Medicaid	$36,420.66
Rate for Payer: Fidelis CHP/HARP/Medicaid	$36,420.66
Rate for Payer: Fidelis Qualified Health Plan	$43,704.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$36,420.66
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$36,420.66
Rate for Payer: Healthfirst Commercial	$51,649.00
Rate for Payer: Healthfirst Essential Plan	$81,946.48
Rate for Payer: Healthfirst QHP	$31,040.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$36,420.66
Rate for Payer: SOMOS Essential	$81,946.48
Rate for Payer: United Healthcare Essential Plan 1&2	$81,946.48
Rate for Payer: United Healthcare Essential Plan 3&4	$81,946.48
Rate for Payer: United Healthcare Medicaid	$36,420.66
Rate for Payer: Wellcare CHP/FHP/Medicaid	$36,420.66

APR-DRG 2411: Peptic ulcer & gastritis

Facility

$39,149.14

Service Code	APR-DRG 2411
Min. Negotiated Rate	$6,103.00
Max. Negotiated Rate	$39,149.14
Rate for Payer: Affinity Essential Plan 1&2	$39,149.14
Rate for Payer: Affinity Essential Plan 3&4	$39,149.14
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,399.62
Rate for Payer: Amida Care Medicaid	$17,399.62
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,399.62
Rate for Payer: Fidelis Qualified Health Plan	$20,879.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,399.62
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,399.62
Rate for Payer: Healthfirst Commercial	$10,395.00
Rate for Payer: Healthfirst Essential Plan	$39,149.14
Rate for Payer: Healthfirst QHP	$6,103.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,399.62
Rate for Payer: SOMOS Essential	$39,149.14
Rate for Payer: United Healthcare Essential Plan 1&2	$39,149.14
Rate for Payer: United Healthcare Essential Plan 3&4	$39,149.14
Rate for Payer: United Healthcare Medicaid	$17,399.62
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,399.62

APR-DRG 2412: Peptic ulcer & gastritis

Facility

$43,285.72

Service Code	APR-DRG 2412
Min. Negotiated Rate	$8,326.00
Max. Negotiated Rate	$43,285.72
Rate for Payer: Affinity Essential Plan 1&2	$43,285.72
Rate for Payer: Affinity Essential Plan 3&4	$43,285.72
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,238.10
Rate for Payer: Amida Care Medicaid	$19,238.10
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,238.10
Rate for Payer: Fidelis Qualified Health Plan	$23,085.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,238.10
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,238.10
Rate for Payer: Healthfirst Commercial	$13,919.00
Rate for Payer: Healthfirst Essential Plan	$43,285.72
Rate for Payer: Healthfirst QHP	$8,326.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,238.10
Rate for Payer: SOMOS Essential	$43,285.72
Rate for Payer: United Healthcare Essential Plan 1&2	$43,285.72
Rate for Payer: United Healthcare Essential Plan 3&4	$43,285.72
Rate for Payer: United Healthcare Medicaid	$19,238.10
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,238.10

APR-DRG 2413: Peptic ulcer & gastritis

Facility

$51,499.06

Service Code	APR-DRG 2413
Min. Negotiated Rate	$12,274.00
Max. Negotiated Rate	$51,499.06
Rate for Payer: Affinity Essential Plan 1&2	$51,499.06
Rate for Payer: Affinity Essential Plan 3&4	$51,499.06
Rate for Payer: Affinity Medicaid/CHP/HARP	$22,888.47
Rate for Payer: Amida Care Medicaid	$22,888.47
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,888.47
Rate for Payer: Fidelis Qualified Health Plan	$27,466.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,888.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,888.47
Rate for Payer: Healthfirst Commercial	$22,085.00
Rate for Payer: Healthfirst Essential Plan	$51,499.06
Rate for Payer: Healthfirst QHP	$12,274.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,888.47
Rate for Payer: SOMOS Essential	$51,499.06
Rate for Payer: United Healthcare Essential Plan 1&2	$51,499.06
Rate for Payer: United Healthcare Essential Plan 3&4	$51,499.06
Rate for Payer: United Healthcare Medicaid	$22,888.47
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,888.47

APR-DRG 2414: Peptic ulcer & gastritis

Facility

$84,686.60

Service Code	APR-DRG 2414
Min. Negotiated Rate	$29,840.00
Max. Negotiated Rate	$84,686.60
Rate for Payer: Affinity Essential Plan 1&2	$84,686.60
Rate for Payer: Affinity Essential Plan 3&4	$84,686.60
Rate for Payer: Affinity Medicaid/CHP/HARP	$37,638.49
Rate for Payer: Amida Care Medicaid	$37,638.49
Rate for Payer: Fidelis CHP/HARP/Medicaid	$37,638.49
Rate for Payer: Fidelis Qualified Health Plan	$45,166.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$37,638.49
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$37,638.49
Rate for Payer: Healthfirst Commercial	$52,351.00
Rate for Payer: Healthfirst Essential Plan	$84,686.60
Rate for Payer: Healthfirst QHP	$29,840.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$37,638.49
Rate for Payer: SOMOS Essential	$84,686.60
Rate for Payer: United Healthcare Essential Plan 1&2	$84,686.60
Rate for Payer: United Healthcare Essential Plan 3&4	$84,686.60
Rate for Payer: United Healthcare Medicaid	$37,638.49
Rate for Payer: Wellcare CHP/FHP/Medicaid	$37,638.49

APR-DRG 2421: Major esophageal disorders

Facility

$39,360.20

Service Code	APR-DRG 2421
Min. Negotiated Rate	$6,542.00
Max. Negotiated Rate	$39,360.20
Rate for Payer: Affinity Essential Plan 1&2	$39,360.20
Rate for Payer: Affinity Essential Plan 3&4	$39,360.20
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,493.42
Rate for Payer: Amida Care Medicaid	$17,493.42
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,493.42
Rate for Payer: Fidelis Qualified Health Plan	$20,992.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,493.42
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,493.42
Rate for Payer: Healthfirst Commercial	$10,630.00
Rate for Payer: Healthfirst Essential Plan	$39,360.20
Rate for Payer: Healthfirst QHP	$6,542.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,493.42
Rate for Payer: SOMOS Essential	$39,360.20
Rate for Payer: United Healthcare Essential Plan 1&2	$39,360.20
Rate for Payer: United Healthcare Essential Plan 3&4	$39,360.20
Rate for Payer: United Healthcare Medicaid	$17,493.42
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,493.42

APR-DRG 2422: Major esophageal disorders

Facility

$43,614.61

Service Code	APR-DRG 2422
Min. Negotiated Rate	$8,803.00
Max. Negotiated Rate	$43,614.61
Rate for Payer: Affinity Essential Plan 1&2	$43,614.61
Rate for Payer: Affinity Essential Plan 3&4	$43,614.61
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,384.27
Rate for Payer: Amida Care Medicaid	$19,384.27
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,384.27
Rate for Payer: Fidelis Qualified Health Plan	$23,261.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,384.27
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,384.27
Rate for Payer: Healthfirst Commercial	$14,217.00
Rate for Payer: Healthfirst Essential Plan	$43,614.61
Rate for Payer: Healthfirst QHP	$8,803.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,384.27
Rate for Payer: SOMOS Essential	$43,614.61
Rate for Payer: United Healthcare Essential Plan 1&2	$43,614.61
Rate for Payer: United Healthcare Essential Plan 3&4	$43,614.61
Rate for Payer: United Healthcare Medicaid	$19,384.27
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,384.27

APR-DRG 2423: Major esophageal disorders

Facility

$51,597.54

Service Code	APR-DRG 2423
Min. Negotiated Rate	$13,425.00
Max. Negotiated Rate	$51,597.54
Rate for Payer: Affinity Essential Plan 1&2	$51,597.54
Rate for Payer: Affinity Essential Plan 3&4	$51,597.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$22,932.24
Rate for Payer: Amida Care Medicaid	$22,932.24
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,932.24
Rate for Payer: Fidelis Qualified Health Plan	$27,518.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,932.24
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,932.24
Rate for Payer: Healthfirst Commercial	$22,511.00
Rate for Payer: Healthfirst Essential Plan	$51,597.54
Rate for Payer: Healthfirst QHP	$13,425.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,932.24
Rate for Payer: SOMOS Essential	$51,597.54
Rate for Payer: United Healthcare Essential Plan 1&2	$51,597.54
Rate for Payer: United Healthcare Essential Plan 3&4	$51,597.54
Rate for Payer: United Healthcare Medicaid	$22,932.24
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,932.24

APR-DRG 2424: Major esophageal disorders

Facility

$85,135.07

Service Code	APR-DRG 2424
Min. Negotiated Rate	$30,566.00
Max. Negotiated Rate	$85,135.07
Rate for Payer: Affinity Essential Plan 1&2	$85,135.07
Rate for Payer: Affinity Essential Plan 3&4	$85,135.07
Rate for Payer: Affinity Medicaid/CHP/HARP	$37,837.81
Rate for Payer: Amida Care Medicaid	$37,837.81
Rate for Payer: Fidelis CHP/HARP/Medicaid	$37,837.81
Rate for Payer: Fidelis Qualified Health Plan	$45,405.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$37,837.81
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$37,837.81
Rate for Payer: Healthfirst Commercial	$48,289.00
Rate for Payer: Healthfirst Essential Plan	$85,135.07
Rate for Payer: Healthfirst QHP	$30,566.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$37,837.81
Rate for Payer: SOMOS Essential	$85,135.07
Rate for Payer: United Healthcare Essential Plan 1&2	$85,135.07
Rate for Payer: United Healthcare Essential Plan 3&4	$85,135.07
Rate for Payer: United Healthcare Medicaid	$37,837.81
Rate for Payer: Wellcare CHP/FHP/Medicaid	$37,837.81

APR-DRG 2431: Other esophageal disorders

Facility

$37,286.64

Service Code	APR-DRG 2431
Min. Negotiated Rate	$5,324.00
Max. Negotiated Rate	$37,286.64
Rate for Payer: Affinity Essential Plan 1&2	$37,286.64
Rate for Payer: Affinity Essential Plan 3&4	$37,286.64
Rate for Payer: Affinity Medicaid/CHP/HARP	$16,571.84
Rate for Payer: Amida Care Medicaid	$16,571.84
Rate for Payer: Fidelis CHP/HARP/Medicaid	$16,571.84
Rate for Payer: Fidelis Qualified Health Plan	$19,886.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$16,571.84
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16,571.84
Rate for Payer: Healthfirst Commercial	$9,030.00
Rate for Payer: Healthfirst Essential Plan	$37,286.64
Rate for Payer: Healthfirst QHP	$5,324.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$16,571.84
Rate for Payer: SOMOS Essential	$37,286.64
Rate for Payer: United Healthcare Essential Plan 1&2	$37,286.64
Rate for Payer: United Healthcare Essential Plan 3&4	$37,286.64
Rate for Payer: United Healthcare Medicaid	$16,571.84
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,571.84

APR-DRG 2432: Other esophageal disorders

Facility

$40,705.63

Service Code	APR-DRG 2432
Min. Negotiated Rate	$6,990.00
Max. Negotiated Rate	$40,705.63
Rate for Payer: Affinity Essential Plan 1&2	$40,705.63
Rate for Payer: Affinity Essential Plan 3&4	$40,705.63
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,091.39
Rate for Payer: Amida Care Medicaid	$18,091.39
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,091.39
Rate for Payer: Fidelis Qualified Health Plan	$21,709.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,091.39
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,091.39
Rate for Payer: Healthfirst Commercial	$11,709.00
Rate for Payer: Healthfirst Essential Plan	$40,705.63
Rate for Payer: Healthfirst QHP	$6,990.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,091.39
Rate for Payer: SOMOS Essential	$40,705.63
Rate for Payer: United Healthcare Essential Plan 1&2	$40,705.63
Rate for Payer: United Healthcare Essential Plan 3&4	$40,705.63
Rate for Payer: United Healthcare Medicaid	$18,091.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,091.39

APR-DRG 2433: Other esophageal disorders

Facility

$48,199.66

Service Code	APR-DRG 2433
Min. Negotiated Rate	$10,746.00
Max. Negotiated Rate	$48,199.66
Rate for Payer: Affinity Essential Plan 1&2	$48,199.66
Rate for Payer: Affinity Essential Plan 3&4	$48,199.66
Rate for Payer: Affinity Medicaid/CHP/HARP	$21,422.07
Rate for Payer: Amida Care Medicaid	$21,422.07
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,422.07
Rate for Payer: Fidelis Qualified Health Plan	$25,706.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,422.07
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,422.07
Rate for Payer: Healthfirst Commercial	$19,314.00
Rate for Payer: Healthfirst Essential Plan	$48,199.66
Rate for Payer: Healthfirst QHP	$10,746.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,422.07
Rate for Payer: SOMOS Essential	$48,199.66
Rate for Payer: United Healthcare Essential Plan 1&2	$48,199.66
Rate for Payer: United Healthcare Essential Plan 3&4	$48,199.66
Rate for Payer: United Healthcare Medicaid	$21,422.07
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,422.07

APR-DRG 2434: Other esophageal disorders

Facility

$70,071.41

Service Code	APR-DRG 2434
Min. Negotiated Rate	$23,798.00
Max. Negotiated Rate	$70,071.41
Rate for Payer: Affinity Essential Plan 1&2	$70,071.41
Rate for Payer: Affinity Essential Plan 3&4	$70,071.41
Rate for Payer: Affinity Medicaid/CHP/HARP	$31,142.85
Rate for Payer: Amida Care Medicaid	$31,142.85
Rate for Payer: Fidelis CHP/HARP/Medicaid	$31,142.85
Rate for Payer: Fidelis Qualified Health Plan	$37,371.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$31,142.85
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31,142.85
Rate for Payer: Healthfirst Commercial	$47,879.00
Rate for Payer: Healthfirst Essential Plan	$70,071.41
Rate for Payer: Healthfirst QHP	$23,798.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$31,142.85
Rate for Payer: SOMOS Essential	$70,071.41
Rate for Payer: United Healthcare Essential Plan 1&2	$70,071.41
Rate for Payer: United Healthcare Essential Plan 3&4	$70,071.41
Rate for Payer: United Healthcare Medicaid	$31,142.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$31,142.85

APR-DRG 2441: Diverticulitis & diverticulosis

Facility

$38,792.12

Service Code	APR-DRG 2441
Min. Negotiated Rate	$6,394.00
Max. Negotiated Rate	$38,792.12
Rate for Payer: Affinity Essential Plan 1&2	$38,792.12
Rate for Payer: Affinity Essential Plan 3&4	$38,792.12
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,240.94
Rate for Payer: Amida Care Medicaid	$17,240.94
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,240.94
Rate for Payer: Fidelis Qualified Health Plan	$20,689.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,240.94
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,240.94
Rate for Payer: Healthfirst Commercial	$10,476.00
Rate for Payer: Healthfirst Essential Plan	$38,792.12
Rate for Payer: Healthfirst QHP	$6,394.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,240.94
Rate for Payer: SOMOS Essential	$38,792.12
Rate for Payer: United Healthcare Essential Plan 1&2	$38,792.12
Rate for Payer: United Healthcare Essential Plan 3&4	$38,792.12
Rate for Payer: United Healthcare Medicaid	$17,240.94
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,240.94

APR-DRG 2442: Diverticulitis & diverticulosis

Facility

$41,840.03

Service Code	APR-DRG 2442
Min. Negotiated Rate	$7,897.00
Max. Negotiated Rate	$41,840.03
Rate for Payer: Affinity Essential Plan 1&2	$41,840.03
Rate for Payer: Affinity Essential Plan 3&4	$41,840.03
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,595.57
Rate for Payer: Amida Care Medicaid	$18,595.57
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,595.57
Rate for Payer: Fidelis Qualified Health Plan	$22,314.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,595.57
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,595.57
Rate for Payer: Healthfirst Commercial	$13,359.00
Rate for Payer: Healthfirst Essential Plan	$41,840.03
Rate for Payer: Healthfirst QHP	$7,897.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,595.57
Rate for Payer: SOMOS Essential	$41,840.03
Rate for Payer: United Healthcare Essential Plan 1&2	$41,840.03
Rate for Payer: United Healthcare Essential Plan 3&4	$41,840.03
Rate for Payer: United Healthcare Medicaid	$18,595.57
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,595.57

APR-DRG 2443: Diverticulitis & diverticulosis

Facility

$50,074.47

Service Code	APR-DRG 2443
Min. Negotiated Rate	$11,589.00
Max. Negotiated Rate	$50,074.47
Rate for Payer: Affinity Essential Plan 1&2	$50,074.47
Rate for Payer: Affinity Essential Plan 3&4	$50,074.47
Rate for Payer: Affinity Medicaid/CHP/HARP	$22,255.32
Rate for Payer: Amida Care Medicaid	$22,255.32
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,255.32
Rate for Payer: Fidelis Qualified Health Plan	$26,706.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,255.32
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,255.32
Rate for Payer: Healthfirst Commercial	$20,937.00
Rate for Payer: Healthfirst Essential Plan	$50,074.47
Rate for Payer: Healthfirst QHP	$11,589.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,255.32
Rate for Payer: SOMOS Essential	$50,074.47
Rate for Payer: United Healthcare Essential Plan 1&2	$50,074.47
Rate for Payer: United Healthcare Essential Plan 3&4	$50,074.47
Rate for Payer: United Healthcare Medicaid	$22,255.32
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,255.32

APR-DRG 2444: Diverticulitis & diverticulosis

Facility

$83,687.62

Service Code	APR-DRG 2444
Min. Negotiated Rate	$23,236.00
Max. Negotiated Rate	$83,687.62
Rate for Payer: Affinity Essential Plan 1&2	$83,687.62
Rate for Payer: Affinity Essential Plan 3&4	$83,687.62
Rate for Payer: Affinity Medicaid/CHP/HARP	$37,194.50
Rate for Payer: Amida Care Medicaid	$37,194.50
Rate for Payer: Fidelis CHP/HARP/Medicaid	$37,194.50
Rate for Payer: Fidelis Qualified Health Plan	$44,633.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$37,194.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$37,194.50
Rate for Payer: Healthfirst Commercial	$47,285.00
Rate for Payer: Healthfirst Essential Plan	$83,687.62
Rate for Payer: Healthfirst QHP	$23,236.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$37,194.50
Rate for Payer: SOMOS Essential	$83,687.62
Rate for Payer: United Healthcare Essential Plan 1&2	$83,687.62
Rate for Payer: United Healthcare Essential Plan 3&4	$83,687.62
Rate for Payer: United Healthcare Medicaid	$37,194.50
Rate for Payer: Wellcare CHP/FHP/Medicaid	$37,194.50

APR-DRG 2451: Inflammatory bowel disease

Facility

$40,630.00

Service Code	APR-DRG 2451
Min. Negotiated Rate	$7,251.00
Max. Negotiated Rate	$40,630.00
Rate for Payer: Affinity Essential Plan 1&2	$40,630.00
Rate for Payer: Affinity Essential Plan 3&4	$40,630.00
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,057.78
Rate for Payer: Amida Care Medicaid	$18,057.78
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,057.78
Rate for Payer: Fidelis Qualified Health Plan	$21,669.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,057.78
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,057.78
Rate for Payer: Healthfirst Commercial	$12,482.00
Rate for Payer: Healthfirst Essential Plan	$40,630.00
Rate for Payer: Healthfirst QHP	$7,251.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,057.78
Rate for Payer: SOMOS Essential	$40,630.00
Rate for Payer: United Healthcare Essential Plan 1&2	$40,630.00
Rate for Payer: United Healthcare Essential Plan 3&4	$40,630.00
Rate for Payer: United Healthcare Medicaid	$18,057.78
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,057.78

APR-DRG 2452: Inflammatory bowel disease

Facility

$43,282.19

Service Code	APR-DRG 2452
Min. Negotiated Rate	$8,753.00
Max. Negotiated Rate	$43,282.19
Rate for Payer: Affinity Essential Plan 1&2	$43,282.19
Rate for Payer: Affinity Essential Plan 3&4	$43,282.19
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,236.53
Rate for Payer: Amida Care Medicaid	$19,236.53
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,236.53
Rate for Payer: Fidelis Qualified Health Plan	$23,083.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,236.53
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,236.53
Rate for Payer: Healthfirst Commercial	$14,401.00
Rate for Payer: Healthfirst Essential Plan	$43,282.19
Rate for Payer: Healthfirst QHP	$8,753.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,236.53
Rate for Payer: SOMOS Essential	$43,282.19
Rate for Payer: United Healthcare Essential Plan 1&2	$43,282.19
Rate for Payer: United Healthcare Essential Plan 3&4	$43,282.19
Rate for Payer: United Healthcare Medicaid	$19,236.53
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,236.53

APR-DRG 2453: Inflammatory bowel disease

Facility

$51,066.40

Service Code	APR-DRG 2453
Min. Negotiated Rate	$13,359.00
Max. Negotiated Rate	$51,066.40
Rate for Payer: Affinity Essential Plan 1&2	$51,066.40
Rate for Payer: Affinity Essential Plan 3&4	$51,066.40
Rate for Payer: Affinity Medicaid/CHP/HARP	$22,696.18
Rate for Payer: Amida Care Medicaid	$22,696.18
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,696.18
Rate for Payer: Fidelis Qualified Health Plan	$27,235.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,696.18
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,696.18
Rate for Payer: Healthfirst Commercial	$21,124.00
Rate for Payer: Healthfirst Essential Plan	$51,066.40
Rate for Payer: Healthfirst QHP	$13,359.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,696.18
Rate for Payer: SOMOS Essential	$51,066.40
Rate for Payer: United Healthcare Essential Plan 1&2	$51,066.40
Rate for Payer: United Healthcare Essential Plan 3&4	$51,066.40
Rate for Payer: United Healthcare Medicaid	$22,696.18
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,696.18

APR-DRG 2454: Inflammatory bowel disease

Facility

$67,551.14

Service Code	APR-DRG 2454
Min. Negotiated Rate	$21,928.00
Max. Negotiated Rate	$67,551.14
Rate for Payer: Affinity Essential Plan 1&2	$67,551.14
Rate for Payer: Affinity Essential Plan 3&4	$67,551.14
Rate for Payer: Affinity Medicaid/CHP/HARP	$30,022.73
Rate for Payer: Amida Care Medicaid	$30,022.73
Rate for Payer: Fidelis CHP/HARP/Medicaid	$30,022.73
Rate for Payer: Fidelis Qualified Health Plan	$36,027.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$30,022.73
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$30,022.73
Rate for Payer: Healthfirst Commercial	$38,546.00
Rate for Payer: Healthfirst Essential Plan	$67,551.14
Rate for Payer: Healthfirst QHP	$21,928.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$30,022.73
Rate for Payer: SOMOS Essential	$67,551.14
Rate for Payer: United Healthcare Essential Plan 1&2	$67,551.14
Rate for Payer: United Healthcare Essential Plan 3&4	$67,551.14
Rate for Payer: United Healthcare Medicaid	$30,022.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$30,022.73

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