St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

APR-DRG 4631: Kidney & urinary tract infections

Facility

$38,382.32

Service Code	APR-DRG 4631
Min. Negotiated Rate	$5,883.00
Max. Negotiated Rate	$38,382.32
Rate for Payer: Affinity Essential Plan 1&2	$38,382.32
Rate for Payer: Affinity Essential Plan 3&4	$38,382.32
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,058.81
Rate for Payer: Amida Care Medicaid	$17,058.81
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,058.81
Rate for Payer: Fidelis Qualified Health Plan	$20,470.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,058.81
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,058.81
Rate for Payer: Healthfirst Commercial	$10,218.00
Rate for Payer: Healthfirst Essential Plan	$38,382.32
Rate for Payer: Healthfirst QHP	$5,883.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,058.81
Rate for Payer: SOMOS Essential	$38,382.32
Rate for Payer: United Healthcare Essential Plan 1&2	$38,382.32
Rate for Payer: United Healthcare Essential Plan 3&4	$38,382.32
Rate for Payer: United Healthcare Medicaid	$17,058.81
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,058.81

APR-DRG 4632: Kidney & urinary tract infections

Facility

$40,726.73

Service Code	APR-DRG 4632
Min. Negotiated Rate	$7,081.00
Max. Negotiated Rate	$40,726.73
Rate for Payer: Affinity Essential Plan 1&2	$40,726.73
Rate for Payer: Affinity Essential Plan 3&4	$40,726.73
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,100.77
Rate for Payer: Amida Care Medicaid	$18,100.77
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,100.77
Rate for Payer: Fidelis Qualified Health Plan	$21,720.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,100.77
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,100.77
Rate for Payer: Healthfirst Commercial	$12,176.00
Rate for Payer: Healthfirst Essential Plan	$40,726.73
Rate for Payer: Healthfirst QHP	$7,081.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,100.77
Rate for Payer: SOMOS Essential	$40,726.73
Rate for Payer: United Healthcare Essential Plan 1&2	$40,726.73
Rate for Payer: United Healthcare Essential Plan 3&4	$40,726.73
Rate for Payer: United Healthcare Medicaid	$18,100.77
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,100.77

APR-DRG 4633: Kidney & urinary tract infections

Facility

$47,003.72

Service Code	APR-DRG 4633
Min. Negotiated Rate	$9,981.00
Max. Negotiated Rate	$47,003.72
Rate for Payer: Affinity Essential Plan 1&2	$47,003.72
Rate for Payer: Affinity Essential Plan 3&4	$47,003.72
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,890.54
Rate for Payer: Amida Care Medicaid	$20,890.54
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,890.54
Rate for Payer: Fidelis Qualified Health Plan	$25,068.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,890.54
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,890.54
Rate for Payer: Healthfirst Commercial	$17,568.00
Rate for Payer: Healthfirst Essential Plan	$47,003.72
Rate for Payer: Healthfirst QHP	$9,981.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,890.54
Rate for Payer: SOMOS Essential	$47,003.72
Rate for Payer: United Healthcare Essential Plan 1&2	$47,003.72
Rate for Payer: United Healthcare Essential Plan 3&4	$47,003.72
Rate for Payer: United Healthcare Medicaid	$20,890.54
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,890.54

APR-DRG 4634: Kidney & urinary tract infections

Facility

$68,001.37

Service Code	APR-DRG 4634
Min. Negotiated Rate	$16,775.00
Max. Negotiated Rate	$68,001.37
Rate for Payer: Affinity Essential Plan 1&2	$68,001.37
Rate for Payer: Affinity Essential Plan 3&4	$68,001.37
Rate for Payer: Affinity Medicaid/CHP/HARP	$30,222.83
Rate for Payer: Amida Care Medicaid	$30,222.83
Rate for Payer: Fidelis CHP/HARP/Medicaid	$30,222.83
Rate for Payer: Fidelis Qualified Health Plan	$36,267.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$30,222.83
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$30,222.83
Rate for Payer: Healthfirst Commercial	$33,206.00
Rate for Payer: Healthfirst Essential Plan	$68,001.37
Rate for Payer: Healthfirst QHP	$16,775.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$30,222.83
Rate for Payer: SOMOS Essential	$68,001.37
Rate for Payer: United Healthcare Essential Plan 1&2	$68,001.37
Rate for Payer: United Healthcare Essential Plan 3&4	$68,001.37
Rate for Payer: United Healthcare Medicaid	$30,222.83
Rate for Payer: Wellcare CHP/FHP/Medicaid	$30,222.83

APR-DRG 4651: Urinary stones & acquired upper urinary tract obstruction

Facility

$37,525.82

Service Code	APR-DRG 4651
Min. Negotiated Rate	$5,301.00
Max. Negotiated Rate	$37,525.82
Rate for Payer: Affinity Essential Plan 1&2	$37,525.82
Rate for Payer: Affinity Essential Plan 3&4	$37,525.82
Rate for Payer: Affinity Medicaid/CHP/HARP	$16,678.14
Rate for Payer: Amida Care Medicaid	$16,678.14
Rate for Payer: Fidelis CHP/HARP/Medicaid	$16,678.14
Rate for Payer: Fidelis Qualified Health Plan	$20,013.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$16,678.14
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16,678.14
Rate for Payer: Healthfirst Commercial	$9,131.00
Rate for Payer: Healthfirst Essential Plan	$37,525.82
Rate for Payer: Healthfirst QHP	$5,301.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$16,678.14
Rate for Payer: SOMOS Essential	$37,525.82
Rate for Payer: United Healthcare Essential Plan 1&2	$37,525.82
Rate for Payer: United Healthcare Essential Plan 3&4	$37,525.82
Rate for Payer: United Healthcare Medicaid	$16,678.14
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,678.14

APR-DRG 4652: Urinary stones & acquired upper urinary tract obstruction

Facility

$38,829.06

Service Code	APR-DRG 4652
Min. Negotiated Rate	$6,086.00
Max. Negotiated Rate	$38,829.06
Rate for Payer: Affinity Essential Plan 1&2	$38,829.06
Rate for Payer: Affinity Essential Plan 3&4	$38,829.06
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,257.36
Rate for Payer: Amida Care Medicaid	$17,257.36
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,257.36
Rate for Payer: Fidelis Qualified Health Plan	$20,708.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,257.36
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,257.36
Rate for Payer: Healthfirst Commercial	$10,470.00
Rate for Payer: Healthfirst Essential Plan	$38,829.06
Rate for Payer: Healthfirst QHP	$6,086.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,257.36
Rate for Payer: SOMOS Essential	$38,829.06
Rate for Payer: United Healthcare Essential Plan 1&2	$38,829.06
Rate for Payer: United Healthcare Essential Plan 3&4	$38,829.06
Rate for Payer: United Healthcare Medicaid	$17,257.36
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,257.36

APR-DRG 4653: Urinary stones & acquired upper urinary tract obstruction

Facility

$44,954.78

Service Code	APR-DRG 4653
Min. Negotiated Rate	$8,987.00
Max. Negotiated Rate	$44,954.78
Rate for Payer: Affinity Essential Plan 1&2	$44,954.78
Rate for Payer: Affinity Essential Plan 3&4	$44,954.78
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,979.90
Rate for Payer: Amida Care Medicaid	$19,979.90
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,979.90
Rate for Payer: Fidelis Qualified Health Plan	$23,975.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,979.90
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,979.90
Rate for Payer: Healthfirst Commercial	$16,599.00
Rate for Payer: Healthfirst Essential Plan	$44,954.78
Rate for Payer: Healthfirst QHP	$8,987.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,979.90
Rate for Payer: SOMOS Essential	$44,954.78
Rate for Payer: United Healthcare Essential Plan 1&2	$44,954.78
Rate for Payer: United Healthcare Essential Plan 3&4	$44,954.78
Rate for Payer: United Healthcare Medicaid	$19,979.90
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,979.90

APR-DRG 4654: Urinary stones & acquired upper urinary tract obstruction

Facility

$67,790.32

Service Code	APR-DRG 4654
Min. Negotiated Rate	$16,749.00
Max. Negotiated Rate	$67,790.32
Rate for Payer: Affinity Essential Plan 1&2	$67,790.32
Rate for Payer: Affinity Essential Plan 3&4	$67,790.32
Rate for Payer: Affinity Medicaid/CHP/HARP	$30,129.03
Rate for Payer: Amida Care Medicaid	$30,129.03
Rate for Payer: Fidelis CHP/HARP/Medicaid	$30,129.03
Rate for Payer: Fidelis Qualified Health Plan	$36,154.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$30,129.03
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$30,129.03
Rate for Payer: Healthfirst Commercial	$32,557.00
Rate for Payer: Healthfirst Essential Plan	$67,790.32
Rate for Payer: Healthfirst QHP	$16,749.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$30,129.03
Rate for Payer: SOMOS Essential	$67,790.32
Rate for Payer: United Healthcare Essential Plan 1&2	$67,790.32
Rate for Payer: United Healthcare Essential Plan 3&4	$67,790.32
Rate for Payer: United Healthcare Medicaid	$30,129.03
Rate for Payer: Wellcare CHP/FHP/Medicaid	$30,129.03

APR-DRG 4661: Malfunction, reaction, complic of genitourinary device or proc

Facility

$38,477.30

Service Code	APR-DRG 4661
Min. Negotiated Rate	$5,384.00
Max. Negotiated Rate	$38,477.30
Rate for Payer: Affinity Essential Plan 1&2	$38,477.30
Rate for Payer: Affinity Essential Plan 3&4	$38,477.30
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,101.02
Rate for Payer: Amida Care Medicaid	$17,101.02
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,101.02
Rate for Payer: Fidelis Qualified Health Plan	$20,521.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,101.02
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,101.02
Rate for Payer: Healthfirst Commercial	$8,956.00
Rate for Payer: Healthfirst Essential Plan	$38,477.30
Rate for Payer: Healthfirst QHP	$5,384.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,101.02
Rate for Payer: SOMOS Essential	$38,477.30
Rate for Payer: United Healthcare Essential Plan 1&2	$38,477.30
Rate for Payer: United Healthcare Essential Plan 3&4	$38,477.30
Rate for Payer: United Healthcare Medicaid	$17,101.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,101.02

APR-DRG 4662: Malfunction, reaction, complic of genitourinary device or proc

Facility

$41,917.41

Service Code	APR-DRG 4662
Min. Negotiated Rate	$7,476.00
Max. Negotiated Rate	$41,917.41
Rate for Payer: Affinity Essential Plan 1&2	$41,917.41
Rate for Payer: Affinity Essential Plan 3&4	$41,917.41
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,629.96
Rate for Payer: Amida Care Medicaid	$18,629.96
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,629.96
Rate for Payer: Fidelis Qualified Health Plan	$22,355.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,629.96
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,629.96
Rate for Payer: Healthfirst Commercial	$13,308.00
Rate for Payer: Healthfirst Essential Plan	$41,917.41
Rate for Payer: Healthfirst QHP	$7,476.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,629.96
Rate for Payer: SOMOS Essential	$41,917.41
Rate for Payer: United Healthcare Essential Plan 1&2	$41,917.41
Rate for Payer: United Healthcare Essential Plan 3&4	$41,917.41
Rate for Payer: United Healthcare Medicaid	$18,629.96
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,629.96

APR-DRG 4663: Malfunction, reaction, complic of genitourinary device or proc

Facility

$50,106.13

Service Code	APR-DRG 4663
Min. Negotiated Rate	$11,432.00
Max. Negotiated Rate	$50,106.13
Rate for Payer: Affinity Essential Plan 1&2	$50,106.13
Rate for Payer: Affinity Essential Plan 3&4	$50,106.13
Rate for Payer: Affinity Medicaid/CHP/HARP	$22,269.39
Rate for Payer: Amida Care Medicaid	$22,269.39
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,269.39
Rate for Payer: Fidelis Qualified Health Plan	$26,723.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,269.39
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,269.39
Rate for Payer: Healthfirst Commercial	$21,419.00
Rate for Payer: Healthfirst Essential Plan	$50,106.13
Rate for Payer: Healthfirst QHP	$11,432.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,269.39
Rate for Payer: SOMOS Essential	$50,106.13
Rate for Payer: United Healthcare Essential Plan 1&2	$50,106.13
Rate for Payer: United Healthcare Essential Plan 3&4	$50,106.13
Rate for Payer: United Healthcare Medicaid	$22,269.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,269.39

APR-DRG 4664: Malfunction, reaction, complic of genitourinary device or proc

Facility

$70,581.46

Service Code	APR-DRG 4664
Min. Negotiated Rate	$22,654.00
Max. Negotiated Rate	$70,581.46
Rate for Payer: Affinity Essential Plan 1&2	$70,581.46
Rate for Payer: Affinity Essential Plan 3&4	$70,581.46
Rate for Payer: Affinity Medicaid/CHP/HARP	$31,369.54
Rate for Payer: Amida Care Medicaid	$31,369.54
Rate for Payer: Fidelis CHP/HARP/Medicaid	$31,369.54
Rate for Payer: Fidelis Qualified Health Plan	$37,643.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$31,369.54
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31,369.54
Rate for Payer: Healthfirst Commercial	$43,237.00
Rate for Payer: Healthfirst Essential Plan	$70,581.46
Rate for Payer: Healthfirst QHP	$22,654.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$31,369.54
Rate for Payer: SOMOS Essential	$70,581.46
Rate for Payer: United Healthcare Essential Plan 1&2	$70,581.46
Rate for Payer: United Healthcare Essential Plan 3&4	$70,581.46
Rate for Payer: United Healthcare Medicaid	$31,369.54
Rate for Payer: Wellcare CHP/FHP/Medicaid	$31,369.54

APR-DRG 4681: Other kidney & urinary tract diagnoses, signs & symptoms

Facility

$38,500.16

Service Code	APR-DRG 4681
Min. Negotiated Rate	$5,676.00
Max. Negotiated Rate	$38,500.16
Rate for Payer: Affinity Essential Plan 1&2	$38,500.16
Rate for Payer: Affinity Essential Plan 3&4	$38,500.16
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,111.18
Rate for Payer: Amida Care Medicaid	$17,111.18
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,111.18
Rate for Payer: Fidelis Qualified Health Plan	$20,533.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,111.18
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,111.18
Rate for Payer: Healthfirst Commercial	$10,158.00
Rate for Payer: Healthfirst Essential Plan	$38,500.16
Rate for Payer: Healthfirst QHP	$5,676.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,111.18
Rate for Payer: SOMOS Essential	$38,500.16
Rate for Payer: United Healthcare Essential Plan 1&2	$38,500.16
Rate for Payer: United Healthcare Essential Plan 3&4	$38,500.16
Rate for Payer: United Healthcare Medicaid	$17,111.18
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,111.18

APR-DRG 4682: Other kidney & urinary tract diagnoses, signs & symptoms

Facility

$42,427.44

Service Code	APR-DRG 4682
Min. Negotiated Rate	$8,117.00
Max. Negotiated Rate	$42,427.44
Rate for Payer: Affinity Essential Plan 1&2	$42,427.44
Rate for Payer: Affinity Essential Plan 3&4	$42,427.44
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,856.64
Rate for Payer: Amida Care Medicaid	$18,856.64
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,856.64
Rate for Payer: Fidelis Qualified Health Plan	$22,627.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,856.64
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,856.64
Rate for Payer: Healthfirst Commercial	$13,449.00
Rate for Payer: Healthfirst Essential Plan	$42,427.44
Rate for Payer: Healthfirst QHP	$8,117.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,856.64
Rate for Payer: SOMOS Essential	$42,427.44
Rate for Payer: United Healthcare Essential Plan 1&2	$42,427.44
Rate for Payer: United Healthcare Essential Plan 3&4	$42,427.44
Rate for Payer: United Healthcare Medicaid	$18,856.64
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,856.64

APR-DRG 4683: Other kidney & urinary tract diagnoses, signs & symptoms

Facility

$50,561.64

Service Code	APR-DRG 4683
Min. Negotiated Rate	$11,777.00
Max. Negotiated Rate	$50,561.64
Rate for Payer: Affinity Essential Plan 1&2	$50,561.64
Rate for Payer: Affinity Essential Plan 3&4	$50,561.64
Rate for Payer: Affinity Medicaid/CHP/HARP	$22,471.84
Rate for Payer: Amida Care Medicaid	$22,471.84
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,471.84
Rate for Payer: Fidelis Qualified Health Plan	$26,966.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,471.84
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,471.84
Rate for Payer: Healthfirst Commercial	$20,343.00
Rate for Payer: Healthfirst Essential Plan	$50,561.64
Rate for Payer: Healthfirst QHP	$11,777.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,471.84
Rate for Payer: SOMOS Essential	$50,561.64
Rate for Payer: United Healthcare Essential Plan 1&2	$50,561.64
Rate for Payer: United Healthcare Essential Plan 3&4	$50,561.64
Rate for Payer: United Healthcare Medicaid	$22,471.84
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,471.84

APR-DRG 4684: Other kidney & urinary tract diagnoses, signs & symptoms

Facility

$79,041.02

Service Code	APR-DRG 4684
Min. Negotiated Rate	$28,399.00
Max. Negotiated Rate	$79,041.02
Rate for Payer: Affinity Essential Plan 1&2	$79,041.02
Rate for Payer: Affinity Essential Plan 3&4	$79,041.02
Rate for Payer: Affinity Medicaid/CHP/HARP	$35,129.34
Rate for Payer: Amida Care Medicaid	$35,129.34
Rate for Payer: Fidelis CHP/HARP/Medicaid	$35,129.34
Rate for Payer: Fidelis Qualified Health Plan	$42,155.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$35,129.34
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$35,129.34
Rate for Payer: Healthfirst Commercial	$45,368.00
Rate for Payer: Healthfirst Essential Plan	$79,041.02
Rate for Payer: Healthfirst QHP	$28,399.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$35,129.34
Rate for Payer: SOMOS Essential	$79,041.02
Rate for Payer: United Healthcare Essential Plan 1&2	$79,041.02
Rate for Payer: United Healthcare Essential Plan 3&4	$79,041.02
Rate for Payer: United Healthcare Medicaid	$35,129.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$35,129.34

APR-DRG 4691: Acute Kidney Injury #

Facility

$38,902.93

Service Code	APR-DRG 4691
Min. Negotiated Rate	$17,290.19
Max. Negotiated Rate	$38,902.93
Rate for Payer: Affinity Essential Plan 1&2	$38,902.93
Rate for Payer: Affinity Essential Plan 3&4	$38,902.93
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,290.19
Rate for Payer: Amida Care Medicaid	$17,290.19
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,290.19
Rate for Payer: Fidelis Qualified Health Plan	$20,748.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,290.19
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,290.19
Rate for Payer: Healthfirst Essential Plan	$38,902.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,290.19
Rate for Payer: SOMOS Essential	$38,902.93
Rate for Payer: United Healthcare Essential Plan 1&2	$38,902.93
Rate for Payer: United Healthcare Essential Plan 3&4	$38,902.93
Rate for Payer: United Healthcare Medicaid	$17,290.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,290.19

APR-DRG 4692: Acute Kidney Injury #

Facility

$42,737.00

Service Code	APR-DRG 4692
Min. Negotiated Rate	$18,994.22
Max. Negotiated Rate	$42,737.00
Rate for Payer: Affinity Essential Plan 1&2	$42,737.00
Rate for Payer: Affinity Essential Plan 3&4	$42,737.00
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,994.22
Rate for Payer: Amida Care Medicaid	$18,994.22
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,994.22
Rate for Payer: Fidelis Qualified Health Plan	$22,793.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,994.22
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,994.22
Rate for Payer: Healthfirst Essential Plan	$42,737.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,994.22
Rate for Payer: SOMOS Essential	$42,737.00
Rate for Payer: United Healthcare Essential Plan 1&2	$42,737.00
Rate for Payer: United Healthcare Essential Plan 3&4	$42,737.00
Rate for Payer: United Healthcare Medicaid	$18,994.22
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,994.22

APR-DRG 4693: Acute Kidney Injury #

Facility

$53,530.40

Service Code	APR-DRG 4693
Min. Negotiated Rate	$23,791.29
Max. Negotiated Rate	$53,530.40
Rate for Payer: Affinity Essential Plan 1&2	$53,530.40
Rate for Payer: Affinity Essential Plan 3&4	$53,530.40
Rate for Payer: Affinity Medicaid/CHP/HARP	$23,791.29
Rate for Payer: Amida Care Medicaid	$23,791.29
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,791.29
Rate for Payer: Fidelis Qualified Health Plan	$28,549.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,791.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,791.29
Rate for Payer: Healthfirst Essential Plan	$53,530.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,791.29
Rate for Payer: SOMOS Essential	$53,530.40
Rate for Payer: United Healthcare Essential Plan 1&2	$53,530.40
Rate for Payer: United Healthcare Essential Plan 3&4	$53,530.40
Rate for Payer: United Healthcare Medicaid	$23,791.29
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,791.29

APR-DRG 4694: Acute Kidney Injury #

Facility

$87,704.62

Service Code	APR-DRG 4694
Min. Negotiated Rate	$38,979.83
Max. Negotiated Rate	$87,704.62
Rate for Payer: Affinity Essential Plan 1&2	$87,704.62
Rate for Payer: Affinity Essential Plan 3&4	$87,704.62
Rate for Payer: Affinity Medicaid/CHP/HARP	$38,979.83
Rate for Payer: Amida Care Medicaid	$38,979.83
Rate for Payer: Fidelis CHP/HARP/Medicaid	$38,979.83
Rate for Payer: Fidelis Qualified Health Plan	$46,775.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$38,979.83
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$38,979.83
Rate for Payer: Healthfirst Essential Plan	$87,704.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$38,979.83
Rate for Payer: SOMOS Essential	$87,704.62
Rate for Payer: United Healthcare Essential Plan 1&2	$87,704.62
Rate for Payer: United Healthcare Essential Plan 3&4	$87,704.62
Rate for Payer: United Healthcare Medicaid	$38,979.83
Rate for Payer: Wellcare CHP/FHP/Medicaid	$38,979.83

APR-DRG 4701: Chronic Kidney Disease #

Facility

$38,062.24

Service Code	APR-DRG 4701
Min. Negotiated Rate	$16,916.55
Max. Negotiated Rate	$38,062.24
Rate for Payer: Affinity Essential Plan 1&2	$38,062.24
Rate for Payer: Affinity Essential Plan 3&4	$38,062.24
Rate for Payer: Affinity Medicaid/CHP/HARP	$16,916.55
Rate for Payer: Amida Care Medicaid	$16,916.55
Rate for Payer: Fidelis CHP/HARP/Medicaid	$16,916.55
Rate for Payer: Fidelis Qualified Health Plan	$20,299.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$16,916.55
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16,916.55
Rate for Payer: Healthfirst Essential Plan	$38,062.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$16,916.55
Rate for Payer: SOMOS Essential	$38,062.24
Rate for Payer: United Healthcare Essential Plan 1&2	$38,062.24
Rate for Payer: United Healthcare Essential Plan 3&4	$38,062.24
Rate for Payer: United Healthcare Medicaid	$16,916.55
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,916.55

APR-DRG 4702: Chronic Kidney Disease #

Facility

$41,660.64

Service Code	APR-DRG 4702
Min. Negotiated Rate	$18,515.84
Max. Negotiated Rate	$41,660.64
Rate for Payer: Affinity Essential Plan 1&2	$41,660.64
Rate for Payer: Affinity Essential Plan 3&4	$41,660.64
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,515.84
Rate for Payer: Amida Care Medicaid	$18,515.84
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,515.84
Rate for Payer: Fidelis Qualified Health Plan	$22,219.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,515.84
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,515.84
Rate for Payer: Healthfirst Essential Plan	$41,660.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,515.84
Rate for Payer: SOMOS Essential	$41,660.64
Rate for Payer: United Healthcare Essential Plan 1&2	$41,660.64
Rate for Payer: United Healthcare Essential Plan 3&4	$41,660.64
Rate for Payer: United Healthcare Medicaid	$18,515.84
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,515.84

APR-DRG 4703: Chronic Kidney Disease #

Facility

$50,609.14

Service Code	APR-DRG 4703
Min. Negotiated Rate	$22,492.95
Max. Negotiated Rate	$50,609.14
Rate for Payer: Affinity Essential Plan 1&2	$50,609.14
Rate for Payer: Affinity Essential Plan 3&4	$50,609.14
Rate for Payer: Affinity Medicaid/CHP/HARP	$22,492.95
Rate for Payer: Amida Care Medicaid	$22,492.95
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,492.95
Rate for Payer: Fidelis Qualified Health Plan	$26,991.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,492.95
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,492.95
Rate for Payer: Healthfirst Essential Plan	$50,609.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,492.95
Rate for Payer: SOMOS Essential	$50,609.14
Rate for Payer: United Healthcare Essential Plan 1&2	$50,609.14
Rate for Payer: United Healthcare Essential Plan 3&4	$50,609.14
Rate for Payer: United Healthcare Medicaid	$22,492.95
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,492.95

APR-DRG 4704: Chronic Kidney Disease #

Facility

$76,358.95

Service Code	APR-DRG 4704
Min. Negotiated Rate	$33,937.31
Max. Negotiated Rate	$76,358.95
Rate for Payer: Affinity Essential Plan 1&2	$76,358.95
Rate for Payer: Affinity Essential Plan 3&4	$76,358.95
Rate for Payer: Affinity Medicaid/CHP/HARP	$33,937.31
Rate for Payer: Amida Care Medicaid	$33,937.31
Rate for Payer: Fidelis CHP/HARP/Medicaid	$33,937.31
Rate for Payer: Fidelis Qualified Health Plan	$40,724.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$33,937.31
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$33,937.31
Rate for Payer: Healthfirst Essential Plan	$76,358.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$33,937.31
Rate for Payer: SOMOS Essential	$76,358.95
Rate for Payer: United Healthcare Essential Plan 1&2	$76,358.95
Rate for Payer: United Healthcare Essential Plan 3&4	$76,358.95
Rate for Payer: United Healthcare Medicaid	$33,937.31
Rate for Payer: Wellcare CHP/FHP/Medicaid	$33,937.31

APR-DRG 4801: Major male pelvic procedures

Facility

$48,964.70

Service Code	APR-DRG 4801
Min. Negotiated Rate	$11,471.00
Max. Negotiated Rate	$48,964.70
Rate for Payer: Affinity Essential Plan 1&2	$48,964.70
Rate for Payer: Affinity Essential Plan 3&4	$48,964.70
Rate for Payer: Affinity Medicaid/CHP/HARP	$21,762.09
Rate for Payer: Amida Care Medicaid	$21,762.09
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,762.09
Rate for Payer: Fidelis Qualified Health Plan	$26,114.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,762.09
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,762.09
Rate for Payer: Healthfirst Commercial	$18,982.00
Rate for Payer: Healthfirst Essential Plan	$48,964.70
Rate for Payer: Healthfirst QHP	$11,471.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,762.09
Rate for Payer: SOMOS Essential	$48,964.70
Rate for Payer: United Healthcare Essential Plan 1&2	$48,964.70
Rate for Payer: United Healthcare Essential Plan 3&4	$48,964.70
Rate for Payer: United Healthcare Medicaid	$21,762.09
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,762.09

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