St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

APR-DRG 2461: Gastrointestinal vascular insufficiency

Facility

$40,601.86

Service Code	APR-DRG 2461
Min. Negotiated Rate	$7,141.00
Max. Negotiated Rate	$40,601.86
Rate for Payer: Affinity Essential Plan 1&2	$40,601.86
Rate for Payer: Affinity Essential Plan 3&4	$40,601.86
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,045.27
Rate for Payer: Amida Care Medicaid	$18,045.27
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,045.27
Rate for Payer: Fidelis Qualified Health Plan	$21,654.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,045.27
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,045.27
Rate for Payer: Healthfirst Commercial	$11,984.00
Rate for Payer: Healthfirst Essential Plan	$40,601.86
Rate for Payer: Healthfirst QHP	$7,141.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,045.27
Rate for Payer: SOMOS Essential	$40,601.86
Rate for Payer: United Healthcare Essential Plan 1&2	$40,601.86
Rate for Payer: United Healthcare Essential Plan 3&4	$40,601.86
Rate for Payer: United Healthcare Medicaid	$18,045.27
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,045.27

APR-DRG 2462: Gastrointestinal vascular insufficiency

Facility

$43,442.24

Service Code	APR-DRG 2462
Min. Negotiated Rate	$8,891.00
Max. Negotiated Rate	$43,442.24
Rate for Payer: Affinity Essential Plan 1&2	$43,442.24
Rate for Payer: Affinity Essential Plan 3&4	$43,442.24
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,307.66
Rate for Payer: Amida Care Medicaid	$19,307.66
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,307.66
Rate for Payer: Fidelis Qualified Health Plan	$23,169.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,307.66
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,307.66
Rate for Payer: Healthfirst Commercial	$14,665.00
Rate for Payer: Healthfirst Essential Plan	$43,442.24
Rate for Payer: Healthfirst QHP	$8,891.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,307.66
Rate for Payer: SOMOS Essential	$43,442.24
Rate for Payer: United Healthcare Essential Plan 1&2	$43,442.24
Rate for Payer: United Healthcare Essential Plan 3&4	$43,442.24
Rate for Payer: United Healthcare Medicaid	$19,307.66
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,307.66

APR-DRG 2463: Gastrointestinal vascular insufficiency

Facility

$52,378.42

Service Code	APR-DRG 2463
Min. Negotiated Rate	$13,382.00
Max. Negotiated Rate	$52,378.42
Rate for Payer: Affinity Essential Plan 1&2	$52,378.42
Rate for Payer: Affinity Essential Plan 3&4	$52,378.42
Rate for Payer: Affinity Medicaid/CHP/HARP	$23,279.30
Rate for Payer: Amida Care Medicaid	$23,279.30
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,279.30
Rate for Payer: Fidelis Qualified Health Plan	$27,935.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,279.30
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,279.30
Rate for Payer: Healthfirst Commercial	$22,584.00
Rate for Payer: Healthfirst Essential Plan	$52,378.42
Rate for Payer: Healthfirst QHP	$13,382.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,279.30
Rate for Payer: SOMOS Essential	$52,378.42
Rate for Payer: United Healthcare Essential Plan 1&2	$52,378.42
Rate for Payer: United Healthcare Essential Plan 3&4	$52,378.42
Rate for Payer: United Healthcare Medicaid	$23,279.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,279.30

APR-DRG 2464: Gastrointestinal vascular insufficiency

Facility

$79,793.78

Service Code	APR-DRG 2464
Min. Negotiated Rate	$28,900.00
Max. Negotiated Rate	$79,793.78
Rate for Payer: Affinity Essential Plan 1&2	$79,793.78
Rate for Payer: Affinity Essential Plan 3&4	$79,793.78
Rate for Payer: Affinity Medicaid/CHP/HARP	$35,463.90
Rate for Payer: Amida Care Medicaid	$35,463.90
Rate for Payer: Fidelis CHP/HARP/Medicaid	$35,463.90
Rate for Payer: Fidelis Qualified Health Plan	$42,556.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$35,463.90
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$35,463.90
Rate for Payer: Healthfirst Commercial	$33,793.00
Rate for Payer: Healthfirst Essential Plan	$79,793.78
Rate for Payer: Healthfirst QHP	$28,900.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$35,463.90
Rate for Payer: SOMOS Essential	$79,793.78
Rate for Payer: United Healthcare Essential Plan 1&2	$79,793.78
Rate for Payer: United Healthcare Essential Plan 3&4	$79,793.78
Rate for Payer: United Healthcare Medicaid	$35,463.90
Rate for Payer: Wellcare CHP/FHP/Medicaid	$35,463.90

APR-DRG 2471: Intestinal obstruction

Facility

$38,269.78

Service Code	APR-DRG 2471
Min. Negotiated Rate	$6,021.00
Max. Negotiated Rate	$38,269.78
Rate for Payer: Affinity Essential Plan 1&2	$38,269.78
Rate for Payer: Affinity Essential Plan 3&4	$38,269.78
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,008.79
Rate for Payer: Amida Care Medicaid	$17,008.79
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,008.79
Rate for Payer: Fidelis Qualified Health Plan	$20,410.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,008.79
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,008.79
Rate for Payer: Healthfirst Commercial	$10,163.00
Rate for Payer: Healthfirst Essential Plan	$38,269.78
Rate for Payer: Healthfirst QHP	$6,021.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,008.79
Rate for Payer: SOMOS Essential	$38,269.78
Rate for Payer: United Healthcare Essential Plan 1&2	$38,269.78
Rate for Payer: United Healthcare Essential Plan 3&4	$38,269.78
Rate for Payer: United Healthcare Medicaid	$17,008.79
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,008.79

APR-DRG 2472: Intestinal obstruction

Facility

$41,479.49

Service Code	APR-DRG 2472
Min. Negotiated Rate	$7,592.00
Max. Negotiated Rate	$41,479.49
Rate for Payer: Affinity Essential Plan 1&2	$41,479.49
Rate for Payer: Affinity Essential Plan 3&4	$41,479.49
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,435.33
Rate for Payer: Amida Care Medicaid	$18,435.33
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,435.33
Rate for Payer: Fidelis Qualified Health Plan	$22,122.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,435.33
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,435.33
Rate for Payer: Healthfirst Commercial	$12,846.00
Rate for Payer: Healthfirst Essential Plan	$41,479.49
Rate for Payer: Healthfirst QHP	$7,592.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,435.33
Rate for Payer: SOMOS Essential	$41,479.49
Rate for Payer: United Healthcare Essential Plan 1&2	$41,479.49
Rate for Payer: United Healthcare Essential Plan 3&4	$41,479.49
Rate for Payer: United Healthcare Medicaid	$18,435.33
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,435.33

APR-DRG 2473: Intestinal obstruction

Facility

$50,823.70

Service Code	APR-DRG 2473
Min. Negotiated Rate	$11,890.00
Max. Negotiated Rate	$50,823.70
Rate for Payer: Affinity Essential Plan 1&2	$50,823.70
Rate for Payer: Affinity Essential Plan 3&4	$50,823.70
Rate for Payer: Affinity Medicaid/CHP/HARP	$22,588.31
Rate for Payer: Amida Care Medicaid	$22,588.31
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,588.31
Rate for Payer: Fidelis Qualified Health Plan	$27,105.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,588.31
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,588.31
Rate for Payer: Healthfirst Commercial	$20,267.00
Rate for Payer: Healthfirst Essential Plan	$50,823.70
Rate for Payer: Healthfirst QHP	$11,890.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,588.31
Rate for Payer: SOMOS Essential	$50,823.70
Rate for Payer: United Healthcare Essential Plan 1&2	$50,823.70
Rate for Payer: United Healthcare Essential Plan 3&4	$50,823.70
Rate for Payer: United Healthcare Medicaid	$22,588.31
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,588.31

APR-DRG 2474: Intestinal obstruction

Facility

$74,591.39

Service Code	APR-DRG 2474
Min. Negotiated Rate	$26,788.00
Max. Negotiated Rate	$74,591.39
Rate for Payer: Affinity Essential Plan 1&2	$74,591.39
Rate for Payer: Affinity Essential Plan 3&4	$74,591.39
Rate for Payer: Affinity Medicaid/CHP/HARP	$33,151.73
Rate for Payer: Amida Care Medicaid	$33,151.73
Rate for Payer: Fidelis CHP/HARP/Medicaid	$33,151.73
Rate for Payer: Fidelis Qualified Health Plan	$39,782.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$33,151.73
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$33,151.73
Rate for Payer: Healthfirst Commercial	$43,616.00
Rate for Payer: Healthfirst Essential Plan	$74,591.39
Rate for Payer: Healthfirst QHP	$26,788.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$33,151.73
Rate for Payer: SOMOS Essential	$74,591.39
Rate for Payer: United Healthcare Essential Plan 1&2	$74,591.39
Rate for Payer: United Healthcare Essential Plan 3&4	$74,591.39
Rate for Payer: United Healthcare Medicaid	$33,151.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$33,151.73

APR-DRG 2481: Major gastrointestinal & peritoneal infections

Facility

$40,109.42

Service Code	APR-DRG 2481
Min. Negotiated Rate	$6,720.00
Max. Negotiated Rate	$40,109.42
Rate for Payer: Affinity Essential Plan 1&2	$40,109.42
Rate for Payer: Affinity Essential Plan 3&4	$40,109.42
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,826.41
Rate for Payer: Amida Care Medicaid	$17,826.41
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,826.41
Rate for Payer: Fidelis Qualified Health Plan	$21,391.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,826.41
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,826.41
Rate for Payer: Healthfirst Commercial	$11,729.00
Rate for Payer: Healthfirst Essential Plan	$40,109.42
Rate for Payer: Healthfirst QHP	$6,720.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,826.41
Rate for Payer: SOMOS Essential	$40,109.42
Rate for Payer: United Healthcare Essential Plan 1&2	$40,109.42
Rate for Payer: United Healthcare Essential Plan 3&4	$40,109.42
Rate for Payer: United Healthcare Medicaid	$17,826.41
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,826.41

APR-DRG 2482: Major gastrointestinal & peritoneal infections

Facility

$44,529.14

Service Code	APR-DRG 2482
Min. Negotiated Rate	$9,248.00
Max. Negotiated Rate	$44,529.14
Rate for Payer: Affinity Essential Plan 1&2	$44,529.14
Rate for Payer: Affinity Essential Plan 3&4	$44,529.14
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,790.73
Rate for Payer: Amida Care Medicaid	$19,790.73
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,790.73
Rate for Payer: Fidelis Qualified Health Plan	$23,748.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,790.73
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,790.73
Rate for Payer: Healthfirst Commercial	$15,998.00
Rate for Payer: Healthfirst Essential Plan	$44,529.14
Rate for Payer: Healthfirst QHP	$9,248.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,790.73
Rate for Payer: SOMOS Essential	$44,529.14
Rate for Payer: United Healthcare Essential Plan 1&2	$44,529.14
Rate for Payer: United Healthcare Essential Plan 3&4	$44,529.14
Rate for Payer: United Healthcare Medicaid	$19,790.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,790.73

APR-DRG 2483: Major gastrointestinal & peritoneal infections

Facility

$52,839.22

Service Code	APR-DRG 2483
Min. Negotiated Rate	$13,876.00
Max. Negotiated Rate	$52,839.22
Rate for Payer: Affinity Essential Plan 1&2	$52,839.22
Rate for Payer: Affinity Essential Plan 3&4	$52,839.22
Rate for Payer: Affinity Medicaid/CHP/HARP	$23,484.10
Rate for Payer: Amida Care Medicaid	$23,484.10
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,484.10
Rate for Payer: Fidelis Qualified Health Plan	$28,180.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,484.10
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,484.10
Rate for Payer: Healthfirst Commercial	$23,607.00
Rate for Payer: Healthfirst Essential Plan	$52,839.22
Rate for Payer: Healthfirst QHP	$13,876.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,484.10
Rate for Payer: SOMOS Essential	$52,839.22
Rate for Payer: United Healthcare Essential Plan 1&2	$52,839.22
Rate for Payer: United Healthcare Essential Plan 3&4	$52,839.22
Rate for Payer: United Healthcare Medicaid	$23,484.10
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,484.10

APR-DRG 2484: Major gastrointestinal & peritoneal infections

Facility

$86,564.95

Service Code	APR-DRG 2484
Min. Negotiated Rate	$27,562.00
Max. Negotiated Rate	$86,564.95
Rate for Payer: Affinity Essential Plan 1&2	$86,564.95
Rate for Payer: Affinity Essential Plan 3&4	$86,564.95
Rate for Payer: Affinity Medicaid/CHP/HARP	$38,473.31
Rate for Payer: Amida Care Medicaid	$38,473.31
Rate for Payer: Fidelis CHP/HARP/Medicaid	$38,473.31
Rate for Payer: Fidelis Qualified Health Plan	$46,167.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$38,473.31
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$38,473.31
Rate for Payer: Healthfirst Commercial	$47,506.00
Rate for Payer: Healthfirst Essential Plan	$86,564.95
Rate for Payer: Healthfirst QHP	$27,562.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$38,473.31
Rate for Payer: SOMOS Essential	$86,564.95
Rate for Payer: United Healthcare Essential Plan 1&2	$86,564.95
Rate for Payer: United Healthcare Essential Plan 3&4	$86,564.95
Rate for Payer: United Healthcare Medicaid	$38,473.31
Rate for Payer: Wellcare CHP/FHP/Medicaid	$38,473.31

APR-DRG 2491: Other gastroenteritis, nausa & vomiting

Facility

$37,119.56

Service Code	APR-DRG 2491
Min. Negotiated Rate	$4,905.00
Max. Negotiated Rate	$37,119.56
Rate for Payer: Affinity Essential Plan 1&2	$37,119.56
Rate for Payer: Affinity Essential Plan 3&4	$37,119.56
Rate for Payer: Affinity Medicaid/CHP/HARP	$16,497.58
Rate for Payer: Amida Care Medicaid	$16,497.58
Rate for Payer: Fidelis CHP/HARP/Medicaid	$16,497.58
Rate for Payer: Fidelis Qualified Health Plan	$19,797.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$16,497.58
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16,497.58
Rate for Payer: Healthfirst Commercial	$8,706.00
Rate for Payer: Healthfirst Essential Plan	$37,119.56
Rate for Payer: Healthfirst QHP	$4,905.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$16,497.58
Rate for Payer: SOMOS Essential	$37,119.56
Rate for Payer: United Healthcare Essential Plan 1&2	$37,119.56
Rate for Payer: United Healthcare Essential Plan 3&4	$37,119.56
Rate for Payer: United Healthcare Medicaid	$16,497.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,497.58

APR-DRG 2492: Other gastroenteritis, nausa & vomiting

Facility

$39,040.11

Service Code	APR-DRG 2492
Min. Negotiated Rate	$6,045.00
Max. Negotiated Rate	$39,040.11
Rate for Payer: Affinity Essential Plan 1&2	$39,040.11
Rate for Payer: Affinity Essential Plan 3&4	$39,040.11
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,351.16
Rate for Payer: Amida Care Medicaid	$17,351.16
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,351.16
Rate for Payer: Fidelis Qualified Health Plan	$20,821.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,351.16
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,351.16
Rate for Payer: Healthfirst Commercial	$10,472.00
Rate for Payer: Healthfirst Essential Plan	$39,040.11
Rate for Payer: Healthfirst QHP	$6,045.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,351.16
Rate for Payer: SOMOS Essential	$39,040.11
Rate for Payer: United Healthcare Essential Plan 1&2	$39,040.11
Rate for Payer: United Healthcare Essential Plan 3&4	$39,040.11
Rate for Payer: United Healthcare Medicaid	$17,351.16
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,351.16

APR-DRG 2493: Other gastroenteritis, nausa & vomiting

Facility

$44,335.69

Service Code	APR-DRG 2493
Min. Negotiated Rate	$8,284.00
Max. Negotiated Rate	$44,335.69
Rate for Payer: Affinity Essential Plan 1&2	$44,335.69
Rate for Payer: Affinity Essential Plan 3&4	$44,335.69
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,704.75
Rate for Payer: Amida Care Medicaid	$19,704.75
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,704.75
Rate for Payer: Fidelis Qualified Health Plan	$23,645.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,704.75
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,704.75
Rate for Payer: Healthfirst Commercial	$15,435.00
Rate for Payer: Healthfirst Essential Plan	$44,335.69
Rate for Payer: Healthfirst QHP	$8,284.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,704.75
Rate for Payer: SOMOS Essential	$44,335.69
Rate for Payer: United Healthcare Essential Plan 1&2	$44,335.69
Rate for Payer: United Healthcare Essential Plan 3&4	$44,335.69
Rate for Payer: United Healthcare Medicaid	$19,704.75
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,704.75

APR-DRG 2494: Other gastroenteritis, nausa & vomiting

Facility

$65,217.28

Service Code	APR-DRG 2494
Min. Negotiated Rate	$16,040.00
Max. Negotiated Rate	$65,217.28
Rate for Payer: Affinity Essential Plan 1&2	$65,217.28
Rate for Payer: Affinity Essential Plan 3&4	$65,217.28
Rate for Payer: Affinity Medicaid/CHP/HARP	$28,985.46
Rate for Payer: Amida Care Medicaid	$28,985.46
Rate for Payer: Fidelis CHP/HARP/Medicaid	$28,985.46
Rate for Payer: Fidelis Qualified Health Plan	$34,782.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$28,985.46
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$28,985.46
Rate for Payer: Healthfirst Commercial	$34,786.00
Rate for Payer: Healthfirst Essential Plan	$65,217.28
Rate for Payer: Healthfirst QHP	$16,040.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$28,985.46
Rate for Payer: SOMOS Essential	$65,217.28
Rate for Payer: United Healthcare Essential Plan 1&2	$65,217.28
Rate for Payer: United Healthcare Essential Plan 3&4	$65,217.28
Rate for Payer: United Healthcare Medicaid	$28,985.46
Rate for Payer: Wellcare CHP/FHP/Medicaid	$28,985.46

APR-DRG 2511: Abdominal pain

Facility

$37,175.83

Service Code	APR-DRG 2511
Min. Negotiated Rate	$5,201.00
Max. Negotiated Rate	$37,175.83
Rate for Payer: Affinity Essential Plan 1&2	$37,175.83
Rate for Payer: Affinity Essential Plan 3&4	$37,175.83
Rate for Payer: Affinity Medicaid/CHP/HARP	$16,522.59
Rate for Payer: Amida Care Medicaid	$16,522.59
Rate for Payer: Fidelis CHP/HARP/Medicaid	$16,522.59
Rate for Payer: Fidelis Qualified Health Plan	$19,827.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$16,522.59
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16,522.59
Rate for Payer: Healthfirst Commercial	$8,839.00
Rate for Payer: Healthfirst Essential Plan	$37,175.83
Rate for Payer: Healthfirst QHP	$5,201.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$16,522.59
Rate for Payer: SOMOS Essential	$37,175.83
Rate for Payer: United Healthcare Essential Plan 1&2	$37,175.83
Rate for Payer: United Healthcare Essential Plan 3&4	$37,175.83
Rate for Payer: United Healthcare Medicaid	$16,522.59
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,522.59

APR-DRG 2512: Abdominal pain

Facility

$39,613.46

Service Code	APR-DRG 2512
Min. Negotiated Rate	$6,593.00
Max. Negotiated Rate	$39,613.46
Rate for Payer: Affinity Essential Plan 1&2	$39,613.46
Rate for Payer: Affinity Essential Plan 3&4	$39,613.46
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,605.98
Rate for Payer: Amida Care Medicaid	$17,605.98
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,605.98
Rate for Payer: Fidelis Qualified Health Plan	$21,127.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,605.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,605.98
Rate for Payer: Healthfirst Commercial	$11,114.00
Rate for Payer: Healthfirst Essential Plan	$39,613.46
Rate for Payer: Healthfirst QHP	$6,593.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,605.98
Rate for Payer: SOMOS Essential	$39,613.46
Rate for Payer: United Healthcare Essential Plan 1&2	$39,613.46
Rate for Payer: United Healthcare Essential Plan 3&4	$39,613.46
Rate for Payer: United Healthcare Medicaid	$17,605.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,605.98

APR-DRG 2513: Abdominal pain

Facility

$44,546.74

Service Code	APR-DRG 2513
Min. Negotiated Rate	$9,096.00
Max. Negotiated Rate	$44,546.74
Rate for Payer: Affinity Essential Plan 1&2	$44,546.74
Rate for Payer: Affinity Essential Plan 3&4	$44,546.74
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,798.55
Rate for Payer: Amida Care Medicaid	$19,798.55
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,798.55
Rate for Payer: Fidelis Qualified Health Plan	$23,758.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,798.55
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,798.55
Rate for Payer: Healthfirst Commercial	$15,791.00
Rate for Payer: Healthfirst Essential Plan	$44,546.74
Rate for Payer: Healthfirst QHP	$9,096.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,798.55
Rate for Payer: SOMOS Essential	$44,546.74
Rate for Payer: United Healthcare Essential Plan 1&2	$44,546.74
Rate for Payer: United Healthcare Essential Plan 3&4	$44,546.74
Rate for Payer: United Healthcare Medicaid	$19,798.55
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,798.55

APR-DRG 2514: Abdominal pain

Facility

$63,697.72

Service Code	APR-DRG 2514
Min. Negotiated Rate	$15,408.00
Max. Negotiated Rate	$63,697.72
Rate for Payer: Affinity Essential Plan 1&2	$63,697.72
Rate for Payer: Affinity Essential Plan 3&4	$63,697.72
Rate for Payer: Affinity Medicaid/CHP/HARP	$28,310.10
Rate for Payer: Amida Care Medicaid	$28,310.10
Rate for Payer: Fidelis CHP/HARP/Medicaid	$28,310.10
Rate for Payer: Fidelis Qualified Health Plan	$33,972.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$28,310.10
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$28,310.10
Rate for Payer: Healthfirst Commercial	$32,442.00
Rate for Payer: Healthfirst Essential Plan	$63,697.72
Rate for Payer: Healthfirst QHP	$15,408.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$28,310.10
Rate for Payer: SOMOS Essential	$63,697.72
Rate for Payer: United Healthcare Essential Plan 1&2	$63,697.72
Rate for Payer: United Healthcare Essential Plan 3&4	$63,697.72
Rate for Payer: United Healthcare Medicaid	$28,310.10
Rate for Payer: Wellcare CHP/FHP/Medicaid	$28,310.10

APR-DRG 2521: Malfunction, reaction & complication of GI device or procedure

Facility

$40,359.15

Service Code	APR-DRG 2521
Min. Negotiated Rate	$6,540.00
Max. Negotiated Rate	$40,359.15
Rate for Payer: Affinity Essential Plan 1&2	$40,359.15
Rate for Payer: Affinity Essential Plan 3&4	$40,359.15
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,937.40
Rate for Payer: Amida Care Medicaid	$17,937.40
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,937.40
Rate for Payer: Fidelis Qualified Health Plan	$21,524.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,937.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,937.40
Rate for Payer: Healthfirst Commercial	$11,218.00
Rate for Payer: Healthfirst Essential Plan	$40,359.15
Rate for Payer: Healthfirst QHP	$6,540.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,937.40
Rate for Payer: SOMOS Essential	$40,359.15
Rate for Payer: United Healthcare Essential Plan 1&2	$40,359.15
Rate for Payer: United Healthcare Essential Plan 3&4	$40,359.15
Rate for Payer: United Healthcare Medicaid	$17,937.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,937.40

APR-DRG 2522: Malfunction, reaction & complication of GI device or procedure

Facility

$43,375.41

Service Code	APR-DRG 2522
Min. Negotiated Rate	$8,236.00
Max. Negotiated Rate	$43,375.41
Rate for Payer: Affinity Essential Plan 1&2	$43,375.41
Rate for Payer: Affinity Essential Plan 3&4	$43,375.41
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,277.96
Rate for Payer: Amida Care Medicaid	$19,277.96
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,277.96
Rate for Payer: Fidelis Qualified Health Plan	$23,133.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,277.96
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,277.96
Rate for Payer: Healthfirst Commercial	$13,904.00
Rate for Payer: Healthfirst Essential Plan	$43,375.41
Rate for Payer: Healthfirst QHP	$8,236.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,277.96
Rate for Payer: SOMOS Essential	$43,375.41
Rate for Payer: United Healthcare Essential Plan 1&2	$43,375.41
Rate for Payer: United Healthcare Essential Plan 3&4	$43,375.41
Rate for Payer: United Healthcare Medicaid	$19,277.96
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,277.96

APR-DRG 2523: Malfunction, reaction & complication of GI device or procedure

Facility

$51,486.75

Service Code	APR-DRG 2523
Min. Negotiated Rate	$12,360.00
Max. Negotiated Rate	$51,486.75
Rate for Payer: Affinity Essential Plan 1&2	$51,486.75
Rate for Payer: Affinity Essential Plan 3&4	$51,486.75
Rate for Payer: Affinity Medicaid/CHP/HARP	$22,883.00
Rate for Payer: Amida Care Medicaid	$22,883.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,883.00
Rate for Payer: Fidelis Qualified Health Plan	$27,459.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,883.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,883.00
Rate for Payer: Healthfirst Commercial	$21,568.00
Rate for Payer: Healthfirst Essential Plan	$51,486.75
Rate for Payer: Healthfirst QHP	$12,360.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,883.00
Rate for Payer: SOMOS Essential	$51,486.75
Rate for Payer: United Healthcare Essential Plan 1&2	$51,486.75
Rate for Payer: United Healthcare Essential Plan 3&4	$51,486.75
Rate for Payer: United Healthcare Medicaid	$22,883.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,883.00

APR-DRG 2524: Malfunction, reaction & complication of GI device or procedure

Facility

$79,489.51

Service Code	APR-DRG 2524
Min. Negotiated Rate	$24,811.00
Max. Negotiated Rate	$79,489.51
Rate for Payer: Affinity Essential Plan 1&2	$79,489.51
Rate for Payer: Affinity Essential Plan 3&4	$79,489.51
Rate for Payer: Affinity Medicaid/CHP/HARP	$35,328.67
Rate for Payer: Amida Care Medicaid	$35,328.67
Rate for Payer: Fidelis CHP/HARP/Medicaid	$35,328.67
Rate for Payer: Fidelis Qualified Health Plan	$42,394.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$35,328.67
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$35,328.67
Rate for Payer: Healthfirst Commercial	$43,377.00
Rate for Payer: Healthfirst Essential Plan	$79,489.51
Rate for Payer: Healthfirst QHP	$24,811.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$35,328.67
Rate for Payer: SOMOS Essential	$79,489.51
Rate for Payer: United Healthcare Essential Plan 1&2	$79,489.51
Rate for Payer: United Healthcare Essential Plan 3&4	$79,489.51
Rate for Payer: United Healthcare Medicaid	$35,328.67
Rate for Payer: Wellcare CHP/FHP/Medicaid	$35,328.67

APR-DRG 2531: Other & unspecified gastrointestinal hemorrhage

Facility

$40,378.50

Service Code	APR-DRG 2531
Min. Negotiated Rate	$6,607.00
Max. Negotiated Rate	$40,378.50
Rate for Payer: Affinity Essential Plan 1&2	$40,378.50
Rate for Payer: Affinity Essential Plan 3&4	$40,378.50
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,946.00
Rate for Payer: Amida Care Medicaid	$17,946.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,946.00
Rate for Payer: Fidelis Qualified Health Plan	$21,535.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,946.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,946.00
Rate for Payer: Healthfirst Commercial	$11,341.00
Rate for Payer: Healthfirst Essential Plan	$40,378.50
Rate for Payer: Healthfirst QHP	$6,607.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,946.00
Rate for Payer: SOMOS Essential	$40,378.50
Rate for Payer: United Healthcare Essential Plan 1&2	$40,378.50
Rate for Payer: United Healthcare Essential Plan 3&4	$40,378.50
Rate for Payer: United Healthcare Medicaid	$17,946.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,946.00

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