St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

APR-DRG 2532: Other & unspecified gastrointestinal hemorrhage

Facility

$43,982.17

Service Code	APR-DRG 2532
Min. Negotiated Rate	$8,594.00
Max. Negotiated Rate	$43,982.17
Rate for Payer: Affinity Essential Plan 1&2	$43,982.17
Rate for Payer: Affinity Essential Plan 3&4	$43,982.17
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,547.63
Rate for Payer: Amida Care Medicaid	$19,547.63
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,547.63
Rate for Payer: Fidelis Qualified Health Plan	$23,457.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,547.63
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,547.63
Rate for Payer: Healthfirst Commercial	$14,923.00
Rate for Payer: Healthfirst Essential Plan	$43,982.17
Rate for Payer: Healthfirst QHP	$8,594.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,547.63
Rate for Payer: SOMOS Essential	$43,982.17
Rate for Payer: United Healthcare Essential Plan 1&2	$43,982.17
Rate for Payer: United Healthcare Essential Plan 3&4	$43,982.17
Rate for Payer: United Healthcare Medicaid	$19,547.63
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,547.63

APR-DRG 2533: Other & unspecified gastrointestinal hemorrhage

Facility

$53,152.29

Service Code	APR-DRG 2533
Min. Negotiated Rate	$12,697.00
Max. Negotiated Rate	$53,152.29
Rate for Payer: Affinity Essential Plan 1&2	$53,152.29
Rate for Payer: Affinity Essential Plan 3&4	$53,152.29
Rate for Payer: Affinity Medicaid/CHP/HARP	$23,623.24
Rate for Payer: Amida Care Medicaid	$23,623.24
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,623.24
Rate for Payer: Fidelis Qualified Health Plan	$28,347.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,623.24
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,623.24
Rate for Payer: Healthfirst Commercial	$22,554.00
Rate for Payer: Healthfirst Essential Plan	$53,152.29
Rate for Payer: Healthfirst QHP	$12,697.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,623.24
Rate for Payer: SOMOS Essential	$53,152.29
Rate for Payer: United Healthcare Essential Plan 1&2	$53,152.29
Rate for Payer: United Healthcare Essential Plan 3&4	$53,152.29
Rate for Payer: United Healthcare Medicaid	$23,623.24
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,623.24

APR-DRG 2534: Other & unspecified gastrointestinal hemorrhage

Facility

$71,253.29

Service Code	APR-DRG 2534
Min. Negotiated Rate	$23,695.00
Max. Negotiated Rate	$71,253.29
Rate for Payer: Affinity Essential Plan 1&2	$71,253.29
Rate for Payer: Affinity Essential Plan 3&4	$71,253.29
Rate for Payer: Affinity Medicaid/CHP/HARP	$31,668.13
Rate for Payer: Amida Care Medicaid	$31,668.13
Rate for Payer: Fidelis CHP/HARP/Medicaid	$31,668.13
Rate for Payer: Fidelis Qualified Health Plan	$38,001.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$31,668.13
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31,668.13
Rate for Payer: Healthfirst Commercial	$45,126.00
Rate for Payer: Healthfirst Essential Plan	$71,253.29
Rate for Payer: Healthfirst QHP	$23,695.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$31,668.13
Rate for Payer: SOMOS Essential	$71,253.29
Rate for Payer: United Healthcare Essential Plan 1&2	$71,253.29
Rate for Payer: United Healthcare Essential Plan 3&4	$71,253.29
Rate for Payer: United Healthcare Medicaid	$31,668.13
Rate for Payer: Wellcare CHP/FHP/Medicaid	$31,668.13

APR-DRG 2541: Other digestive system diagnoses

Facility

$38,426.31

Service Code	APR-DRG 2541
Min. Negotiated Rate	$5,731.00
Max. Negotiated Rate	$38,426.31
Rate for Payer: Affinity Essential Plan 1&2	$38,426.31
Rate for Payer: Affinity Essential Plan 3&4	$38,426.31
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,078.36
Rate for Payer: Amida Care Medicaid	$17,078.36
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,078.36
Rate for Payer: Fidelis Qualified Health Plan	$20,494.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,078.36
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,078.36
Rate for Payer: Healthfirst Commercial	$9,816.00
Rate for Payer: Healthfirst Essential Plan	$38,426.31
Rate for Payer: Healthfirst QHP	$5,731.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,078.36
Rate for Payer: SOMOS Essential	$38,426.31
Rate for Payer: United Healthcare Essential Plan 1&2	$38,426.31
Rate for Payer: United Healthcare Essential Plan 3&4	$38,426.31
Rate for Payer: United Healthcare Medicaid	$17,078.36
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,078.36

APR-DRG 2542: Other digestive system diagnoses

Facility

$42,336.00

Service Code	APR-DRG 2542
Min. Negotiated Rate	$7,892.00
Max. Negotiated Rate	$42,336.00
Rate for Payer: Affinity Essential Plan 1&2	$42,336.00
Rate for Payer: Affinity Essential Plan 3&4	$42,336.00
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,816.00
Rate for Payer: Amida Care Medicaid	$18,816.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,816.00
Rate for Payer: Fidelis Qualified Health Plan	$22,579.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,816.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,816.00
Rate for Payer: Healthfirst Commercial	$13,329.00
Rate for Payer: Healthfirst Essential Plan	$42,336.00
Rate for Payer: Healthfirst QHP	$7,892.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,816.00
Rate for Payer: SOMOS Essential	$42,336.00
Rate for Payer: United Healthcare Essential Plan 1&2	$42,336.00
Rate for Payer: United Healthcare Essential Plan 3&4	$42,336.00
Rate for Payer: United Healthcare Medicaid	$18,816.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,816.00

APR-DRG 2543: Other digestive system diagnoses

Facility

$50,969.68

Service Code	APR-DRG 2543
Min. Negotiated Rate	$11,515.00
Max. Negotiated Rate	$50,969.68
Rate for Payer: Affinity Essential Plan 1&2	$50,969.68
Rate for Payer: Affinity Essential Plan 3&4	$50,969.68
Rate for Payer: Affinity Medicaid/CHP/HARP	$22,653.19
Rate for Payer: Amida Care Medicaid	$22,653.19
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,653.19
Rate for Payer: Fidelis Qualified Health Plan	$27,183.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,653.19
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,653.19
Rate for Payer: Healthfirst Commercial	$20,319.00
Rate for Payer: Healthfirst Essential Plan	$50,969.68
Rate for Payer: Healthfirst QHP	$11,515.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,653.19
Rate for Payer: SOMOS Essential	$50,969.68
Rate for Payer: United Healthcare Essential Plan 1&2	$50,969.68
Rate for Payer: United Healthcare Essential Plan 3&4	$50,969.68
Rate for Payer: United Healthcare Medicaid	$22,653.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,653.19

APR-DRG 2544: Other digestive system diagnoses

Facility

$75,512.97

Service Code	APR-DRG 2544
Min. Negotiated Rate	$24,418.00
Max. Negotiated Rate	$75,512.97
Rate for Payer: Affinity Essential Plan 1&2	$75,512.97
Rate for Payer: Affinity Essential Plan 3&4	$75,512.97
Rate for Payer: Affinity Medicaid/CHP/HARP	$33,561.32
Rate for Payer: Amida Care Medicaid	$33,561.32
Rate for Payer: Fidelis CHP/HARP/Medicaid	$33,561.32
Rate for Payer: Fidelis Qualified Health Plan	$40,273.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$33,561.32
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$33,561.32
Rate for Payer: Healthfirst Commercial	$41,660.00
Rate for Payer: Healthfirst Essential Plan	$75,512.97
Rate for Payer: Healthfirst QHP	$24,418.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$33,561.32
Rate for Payer: SOMOS Essential	$75,512.97
Rate for Payer: United Healthcare Essential Plan 1&2	$75,512.97
Rate for Payer: United Healthcare Essential Plan 3&4	$75,512.97
Rate for Payer: United Healthcare Medicaid	$33,561.32
Rate for Payer: Wellcare CHP/FHP/Medicaid	$33,561.32

APR-DRG 2601: Major pancreas, liver & shunt procedures

Facility

$55,317.31

Service Code	APR-DRG 2601
Min. Negotiated Rate	$17,534.00
Max. Negotiated Rate	$55,317.31
Rate for Payer: Affinity Essential Plan 1&2	$55,317.31
Rate for Payer: Affinity Essential Plan 3&4	$55,317.31
Rate for Payer: Affinity Medicaid/CHP/HARP	$24,585.47
Rate for Payer: Amida Care Medicaid	$24,585.47
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,585.47
Rate for Payer: Fidelis Qualified Health Plan	$29,502.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,585.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,585.47
Rate for Payer: Healthfirst Commercial	$27,917.00
Rate for Payer: Healthfirst Essential Plan	$55,317.31
Rate for Payer: Healthfirst QHP	$17,534.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,585.47
Rate for Payer: SOMOS Essential	$55,317.31
Rate for Payer: United Healthcare Essential Plan 1&2	$55,317.31
Rate for Payer: United Healthcare Essential Plan 3&4	$55,317.31
Rate for Payer: United Healthcare Medicaid	$24,585.47
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,585.47

APR-DRG 2602: Major pancreas, liver & shunt procedures

Facility

$64,682.62

Service Code	APR-DRG 2602
Min. Negotiated Rate	$23,339.00
Max. Negotiated Rate	$64,682.62
Rate for Payer: Affinity Essential Plan 1&2	$64,682.62
Rate for Payer: Affinity Essential Plan 3&4	$64,682.62
Rate for Payer: Affinity Medicaid/CHP/HARP	$28,747.83
Rate for Payer: Amida Care Medicaid	$28,747.83
Rate for Payer: Fidelis CHP/HARP/Medicaid	$28,747.83
Rate for Payer: Fidelis Qualified Health Plan	$34,497.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$28,747.83
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$28,747.83
Rate for Payer: Healthfirst Commercial	$36,354.00
Rate for Payer: Healthfirst Essential Plan	$64,682.62
Rate for Payer: Healthfirst QHP	$23,339.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$28,747.83
Rate for Payer: SOMOS Essential	$64,682.62
Rate for Payer: United Healthcare Essential Plan 1&2	$64,682.62
Rate for Payer: United Healthcare Essential Plan 3&4	$64,682.62
Rate for Payer: United Healthcare Medicaid	$28,747.83
Rate for Payer: Wellcare CHP/FHP/Medicaid	$28,747.83

APR-DRG 2603: Major pancreas, liver & shunt procedures

Facility

$84,959.21

Service Code	APR-DRG 2603
Min. Negotiated Rate	$37,759.65
Max. Negotiated Rate	$84,959.21
Rate for Payer: Affinity Essential Plan 1&2	$84,959.21
Rate for Payer: Affinity Essential Plan 3&4	$84,959.21
Rate for Payer: Affinity Medicaid/CHP/HARP	$37,759.65
Rate for Payer: Amida Care Medicaid	$37,759.65
Rate for Payer: Fidelis CHP/HARP/Medicaid	$37,759.65
Rate for Payer: Fidelis Qualified Health Plan	$45,311.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$37,759.65
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$37,759.65
Rate for Payer: Healthfirst Commercial	$59,831.00
Rate for Payer: Healthfirst Essential Plan	$84,959.21
Rate for Payer: Healthfirst QHP	$38,127.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$37,759.65
Rate for Payer: SOMOS Essential	$84,959.21
Rate for Payer: United Healthcare Essential Plan 1&2	$84,959.21
Rate for Payer: United Healthcare Essential Plan 3&4	$84,959.21
Rate for Payer: United Healthcare Medicaid	$37,759.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$37,759.65

APR-DRG 2604: Major pancreas, liver & shunt procedures

Facility

$160,256.41

Service Code	APR-DRG 2604
Min. Negotiated Rate	$71,225.07
Max. Negotiated Rate	$160,256.41
Rate for Payer: Affinity Essential Plan 1&2	$160,256.41
Rate for Payer: Affinity Essential Plan 3&4	$160,256.41
Rate for Payer: Affinity Medicaid/CHP/HARP	$71,225.07
Rate for Payer: Amida Care Medicaid	$71,225.07
Rate for Payer: Fidelis CHP/HARP/Medicaid	$71,225.07
Rate for Payer: Fidelis Qualified Health Plan	$85,470.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$71,225.07
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$71,225.07
Rate for Payer: Healthfirst Commercial	$135,978.00
Rate for Payer: Healthfirst Essential Plan	$160,256.41
Rate for Payer: Healthfirst QHP	$84,239.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$71,225.07
Rate for Payer: SOMOS Essential	$160,256.41
Rate for Payer: United Healthcare Essential Plan 1&2	$160,256.41
Rate for Payer: United Healthcare Essential Plan 3&4	$160,256.41
Rate for Payer: United Healthcare Medicaid	$71,225.07
Rate for Payer: Wellcare CHP/FHP/Medicaid	$71,225.07

APR-DRG 2611: Major biliary tract procedures

Facility

$54,235.66

Service Code	APR-DRG 2611
Min. Negotiated Rate	$15,488.00
Max. Negotiated Rate	$54,235.66
Rate for Payer: Affinity Essential Plan 1&2	$54,235.66
Rate for Payer: Affinity Essential Plan 3&4	$54,235.66
Rate for Payer: Affinity Medicaid/CHP/HARP	$24,104.74
Rate for Payer: Amida Care Medicaid	$24,104.74
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,104.74
Rate for Payer: Fidelis Qualified Health Plan	$28,925.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,104.74
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,104.74
Rate for Payer: Healthfirst Commercial	$27,229.00
Rate for Payer: Healthfirst Essential Plan	$54,235.66
Rate for Payer: Healthfirst QHP	$15,488.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,104.74
Rate for Payer: SOMOS Essential	$54,235.66
Rate for Payer: United Healthcare Essential Plan 1&2	$54,235.66
Rate for Payer: United Healthcare Essential Plan 3&4	$54,235.66
Rate for Payer: United Healthcare Medicaid	$24,104.74
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,104.74

APR-DRG 2612: Major biliary tract procedures

Facility

$64,853.21

Service Code	APR-DRG 2612
Min. Negotiated Rate	$22,616.00
Max. Negotiated Rate	$64,853.21
Rate for Payer: Affinity Essential Plan 1&2	$64,853.21
Rate for Payer: Affinity Essential Plan 3&4	$64,853.21
Rate for Payer: Affinity Medicaid/CHP/HARP	$28,823.65
Rate for Payer: Amida Care Medicaid	$28,823.65
Rate for Payer: Fidelis CHP/HARP/Medicaid	$28,823.65
Rate for Payer: Fidelis Qualified Health Plan	$34,588.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$28,823.65
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$28,823.65
Rate for Payer: Healthfirst Commercial	$37,108.00
Rate for Payer: Healthfirst Essential Plan	$64,853.21
Rate for Payer: Healthfirst QHP	$22,616.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$28,823.65
Rate for Payer: SOMOS Essential	$64,853.21
Rate for Payer: United Healthcare Essential Plan 1&2	$64,853.21
Rate for Payer: United Healthcare Essential Plan 3&4	$64,853.21
Rate for Payer: United Healthcare Medicaid	$28,823.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$28,823.65

APR-DRG 2613: Major biliary tract procedures

Facility

$83,958.48

Service Code	APR-DRG 2613
Min. Negotiated Rate	$34,428.00
Max. Negotiated Rate	$83,958.48
Rate for Payer: Affinity Essential Plan 1&2	$83,958.48
Rate for Payer: Affinity Essential Plan 3&4	$83,958.48
Rate for Payer: Affinity Medicaid/CHP/HARP	$37,314.88
Rate for Payer: Amida Care Medicaid	$37,314.88
Rate for Payer: Fidelis CHP/HARP/Medicaid	$37,314.88
Rate for Payer: Fidelis Qualified Health Plan	$44,777.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$37,314.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$37,314.88
Rate for Payer: Healthfirst Commercial	$55,654.00
Rate for Payer: Healthfirst Essential Plan	$83,958.48
Rate for Payer: Healthfirst QHP	$34,428.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$37,314.88
Rate for Payer: SOMOS Essential	$83,958.48
Rate for Payer: United Healthcare Essential Plan 1&2	$83,958.48
Rate for Payer: United Healthcare Essential Plan 3&4	$83,958.48
Rate for Payer: United Healthcare Medicaid	$37,314.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$37,314.88

APR-DRG 2614: Major biliary tract procedures

Facility

$137,640.69

Service Code	APR-DRG 2614
Min. Negotiated Rate	$61,173.64
Max. Negotiated Rate	$137,640.69
Rate for Payer: Affinity Essential Plan 1&2	$137,640.69
Rate for Payer: Affinity Essential Plan 3&4	$137,640.69
Rate for Payer: Affinity Medicaid/CHP/HARP	$61,173.64
Rate for Payer: Amida Care Medicaid	$61,173.64
Rate for Payer: Fidelis CHP/HARP/Medicaid	$61,173.64
Rate for Payer: Fidelis Qualified Health Plan	$73,408.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$61,173.64
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$61,173.64
Rate for Payer: Healthfirst Commercial	$100,704.00
Rate for Payer: Healthfirst Essential Plan	$137,640.69
Rate for Payer: Healthfirst QHP	$79,400.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$61,173.64
Rate for Payer: SOMOS Essential	$137,640.69
Rate for Payer: United Healthcare Essential Plan 1&2	$137,640.69
Rate for Payer: United Healthcare Essential Plan 3&4	$137,640.69
Rate for Payer: United Healthcare Medicaid	$61,173.64
Rate for Payer: Wellcare CHP/FHP/Medicaid	$61,173.64

APR-DRG 2621: Cholecystectomy except laparoscopic

Facility

$52,747.76

Service Code	APR-DRG 2621
Min. Negotiated Rate	$15,053.00
Max. Negotiated Rate	$52,747.76
Rate for Payer: Affinity Essential Plan 1&2	$52,747.76
Rate for Payer: Affinity Essential Plan 3&4	$52,747.76
Rate for Payer: Affinity Medicaid/CHP/HARP	$23,443.45
Rate for Payer: Amida Care Medicaid	$23,443.45
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,443.45
Rate for Payer: Fidelis Qualified Health Plan	$28,132.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,443.45
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,443.45
Rate for Payer: Healthfirst Commercial	$25,071.00
Rate for Payer: Healthfirst Essential Plan	$52,747.76
Rate for Payer: Healthfirst QHP	$15,053.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,443.45
Rate for Payer: SOMOS Essential	$52,747.76
Rate for Payer: United Healthcare Essential Plan 1&2	$52,747.76
Rate for Payer: United Healthcare Essential Plan 3&4	$52,747.76
Rate for Payer: United Healthcare Medicaid	$23,443.45
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,443.45

APR-DRG 2622: Cholecystectomy except laparoscopic

Facility

$57,879.79

Service Code	APR-DRG 2622
Min. Negotiated Rate	$18,640.00
Max. Negotiated Rate	$57,879.79
Rate for Payer: Affinity Essential Plan 1&2	$57,879.79
Rate for Payer: Affinity Essential Plan 3&4	$57,879.79
Rate for Payer: Affinity Medicaid/CHP/HARP	$25,724.35
Rate for Payer: Amida Care Medicaid	$25,724.35
Rate for Payer: Fidelis CHP/HARP/Medicaid	$25,724.35
Rate for Payer: Fidelis Qualified Health Plan	$30,869.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$25,724.35
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25,724.35
Rate for Payer: Healthfirst Commercial	$31,618.00
Rate for Payer: Healthfirst Essential Plan	$57,879.79
Rate for Payer: Healthfirst QHP	$18,640.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$25,724.35
Rate for Payer: SOMOS Essential	$57,879.79
Rate for Payer: United Healthcare Essential Plan 1&2	$57,879.79
Rate for Payer: United Healthcare Essential Plan 3&4	$57,879.79
Rate for Payer: United Healthcare Medicaid	$25,724.35
Rate for Payer: Wellcare CHP/FHP/Medicaid	$25,724.35

APR-DRG 2623: Cholecystectomy except laparoscopic

Facility

$77,780.00

Service Code	APR-DRG 2623
Min. Negotiated Rate	$28,410.00
Max. Negotiated Rate	$77,780.00
Rate for Payer: Affinity Essential Plan 1&2	$77,780.00
Rate for Payer: Affinity Essential Plan 3&4	$77,780.00
Rate for Payer: Affinity Medicaid/CHP/HARP	$34,568.89
Rate for Payer: Amida Care Medicaid	$34,568.89
Rate for Payer: Fidelis CHP/HARP/Medicaid	$34,568.89
Rate for Payer: Fidelis Qualified Health Plan	$41,482.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$34,568.89
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$34,568.89
Rate for Payer: Healthfirst Commercial	$45,651.00
Rate for Payer: Healthfirst Essential Plan	$77,780.00
Rate for Payer: Healthfirst QHP	$28,410.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$34,568.89
Rate for Payer: SOMOS Essential	$77,780.00
Rate for Payer: United Healthcare Essential Plan 1&2	$77,780.00
Rate for Payer: United Healthcare Essential Plan 3&4	$77,780.00
Rate for Payer: United Healthcare Medicaid	$34,568.89
Rate for Payer: Wellcare CHP/FHP/Medicaid	$34,568.89

APR-DRG 2624: Cholecystectomy except laparoscopic

Facility

$136,110.58

Service Code	APR-DRG 2624
Min. Negotiated Rate	$54,072.00
Max. Negotiated Rate	$136,110.58
Rate for Payer: Affinity Essential Plan 1&2	$136,110.58
Rate for Payer: Affinity Essential Plan 3&4	$136,110.58
Rate for Payer: Affinity Medicaid/CHP/HARP	$60,493.59
Rate for Payer: Amida Care Medicaid	$60,493.59
Rate for Payer: Fidelis CHP/HARP/Medicaid	$60,493.59
Rate for Payer: Fidelis Qualified Health Plan	$72,592.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$60,493.59
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$60,493.59
Rate for Payer: Healthfirst Commercial	$87,198.00
Rate for Payer: Healthfirst Essential Plan	$136,110.58
Rate for Payer: Healthfirst QHP	$54,072.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$60,493.59
Rate for Payer: SOMOS Essential	$136,110.58
Rate for Payer: United Healthcare Essential Plan 1&2	$136,110.58
Rate for Payer: United Healthcare Essential Plan 3&4	$136,110.58
Rate for Payer: United Healthcare Medicaid	$60,493.59
Rate for Payer: Wellcare CHP/FHP/Medicaid	$60,493.59

APR-DRG 2631: Laparoscopic cholecystectomy

Facility

$45,200.99

Service Code	APR-DRG 2631
Min. Negotiated Rate	$9,474.00
Max. Negotiated Rate	$45,200.99
Rate for Payer: Affinity Essential Plan 1&2	$45,200.99
Rate for Payer: Affinity Essential Plan 3&4	$45,200.99
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,089.33
Rate for Payer: Amida Care Medicaid	$20,089.33
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,089.33
Rate for Payer: Fidelis Qualified Health Plan	$24,107.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,089.33
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,089.33
Rate for Payer: Healthfirst Commercial	$15,949.00
Rate for Payer: Healthfirst Essential Plan	$45,200.99
Rate for Payer: Healthfirst QHP	$9,474.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,089.33
Rate for Payer: SOMOS Essential	$45,200.99
Rate for Payer: United Healthcare Essential Plan 1&2	$45,200.99
Rate for Payer: United Healthcare Essential Plan 3&4	$45,200.99
Rate for Payer: United Healthcare Medicaid	$20,089.33
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,089.33

APR-DRG 2632: Laparoscopic cholecystectomy

Facility

$50,250.35

Service Code	APR-DRG 2632
Min. Negotiated Rate	$12,231.00
Max. Negotiated Rate	$50,250.35
Rate for Payer: Affinity Essential Plan 1&2	$50,250.35
Rate for Payer: Affinity Essential Plan 3&4	$50,250.35
Rate for Payer: Affinity Medicaid/CHP/HARP	$22,333.49
Rate for Payer: Amida Care Medicaid	$22,333.49
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,333.49
Rate for Payer: Fidelis Qualified Health Plan	$26,800.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,333.49
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,333.49
Rate for Payer: Healthfirst Commercial	$20,581.00
Rate for Payer: Healthfirst Essential Plan	$50,250.35
Rate for Payer: Healthfirst QHP	$12,231.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,333.49
Rate for Payer: SOMOS Essential	$50,250.35
Rate for Payer: United Healthcare Essential Plan 1&2	$50,250.35
Rate for Payer: United Healthcare Essential Plan 3&4	$50,250.35
Rate for Payer: United Healthcare Medicaid	$22,333.49
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,333.49

APR-DRG 2633: Laparoscopic cholecystectomy

Facility

$58,053.92

Service Code	APR-DRG 2633
Min. Negotiated Rate	$17,197.00
Max. Negotiated Rate	$58,053.92
Rate for Payer: Affinity Essential Plan 1&2	$58,053.92
Rate for Payer: Affinity Essential Plan 3&4	$58,053.92
Rate for Payer: Affinity Medicaid/CHP/HARP	$25,801.74
Rate for Payer: Amida Care Medicaid	$25,801.74
Rate for Payer: Fidelis CHP/HARP/Medicaid	$25,801.74
Rate for Payer: Fidelis Qualified Health Plan	$30,962.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$25,801.74
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25,801.74
Rate for Payer: Healthfirst Commercial	$28,725.00
Rate for Payer: Healthfirst Essential Plan	$58,053.92
Rate for Payer: Healthfirst QHP	$17,197.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$25,801.74
Rate for Payer: SOMOS Essential	$58,053.92
Rate for Payer: United Healthcare Essential Plan 1&2	$58,053.92
Rate for Payer: United Healthcare Essential Plan 3&4	$58,053.92
Rate for Payer: United Healthcare Medicaid	$25,801.74
Rate for Payer: Wellcare CHP/FHP/Medicaid	$25,801.74

APR-DRG 2634: Laparoscopic cholecystectomy

Facility

$94,183.83

Service Code	APR-DRG 2634
Min. Negotiated Rate	$32,717.00
Max. Negotiated Rate	$94,183.83
Rate for Payer: Affinity Essential Plan 1&2	$94,183.83
Rate for Payer: Affinity Essential Plan 3&4	$94,183.83
Rate for Payer: Affinity Medicaid/CHP/HARP	$41,859.48
Rate for Payer: Amida Care Medicaid	$41,859.48
Rate for Payer: Fidelis CHP/HARP/Medicaid	$41,859.48
Rate for Payer: Fidelis Qualified Health Plan	$50,231.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$41,859.48
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$41,859.48
Rate for Payer: Healthfirst Commercial	$60,260.00
Rate for Payer: Healthfirst Essential Plan	$94,183.83
Rate for Payer: Healthfirst QHP	$32,717.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$41,859.48
Rate for Payer: SOMOS Essential	$94,183.83
Rate for Payer: United Healthcare Essential Plan 1&2	$94,183.83
Rate for Payer: United Healthcare Essential Plan 3&4	$94,183.83
Rate for Payer: United Healthcare Medicaid	$41,859.48
Rate for Payer: Wellcare CHP/FHP/Medicaid	$41,859.48

APR-DRG 2641: Other hepatobiliary, pancreas & abdominal procedures

Facility

$53,103.04

Service Code	APR-DRG 2641
Min. Negotiated Rate	$14,940.00
Max. Negotiated Rate	$53,103.04
Rate for Payer: Affinity Essential Plan 1&2	$53,103.04
Rate for Payer: Affinity Essential Plan 3&4	$53,103.04
Rate for Payer: Affinity Medicaid/CHP/HARP	$23,601.35
Rate for Payer: Amida Care Medicaid	$23,601.35
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,601.35
Rate for Payer: Fidelis Qualified Health Plan	$28,321.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,601.35
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,601.35
Rate for Payer: Healthfirst Commercial	$23,753.00
Rate for Payer: Healthfirst Essential Plan	$53,103.04
Rate for Payer: Healthfirst QHP	$14,940.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,601.35
Rate for Payer: SOMOS Essential	$53,103.04
Rate for Payer: United Healthcare Essential Plan 1&2	$53,103.04
Rate for Payer: United Healthcare Essential Plan 3&4	$53,103.04
Rate for Payer: United Healthcare Medicaid	$23,601.35
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,601.35

APR-DRG 2642: Other hepatobiliary, pancreas & abdominal procedures

Facility

$56,237.13

Service Code	APR-DRG 2642
Min. Negotiated Rate	$19,086.00
Max. Negotiated Rate	$56,237.13
Rate for Payer: Affinity Essential Plan 1&2	$56,237.13
Rate for Payer: Affinity Essential Plan 3&4	$56,237.13
Rate for Payer: Affinity Medicaid/CHP/HARP	$24,994.28
Rate for Payer: Amida Care Medicaid	$24,994.28
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,994.28
Rate for Payer: Fidelis Qualified Health Plan	$29,993.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,994.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,994.28
Rate for Payer: Healthfirst Commercial	$30,993.00
Rate for Payer: Healthfirst Essential Plan	$56,237.13
Rate for Payer: Healthfirst QHP	$19,086.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,994.28
Rate for Payer: SOMOS Essential	$56,237.13
Rate for Payer: United Healthcare Essential Plan 1&2	$56,237.13
Rate for Payer: United Healthcare Essential Plan 3&4	$56,237.13
Rate for Payer: United Healthcare Medicaid	$24,994.28
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,994.28

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