St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

APR-DRG 4802: Major male pelvic procedures

Facility

$51,703.06

Service Code	APR-DRG 4802
Min. Negotiated Rate	$12,489.00
Max. Negotiated Rate	$51,703.06
Rate for Payer: Affinity Essential Plan 1&2	$51,703.06
Rate for Payer: Affinity Essential Plan 3&4	$51,703.06
Rate for Payer: Affinity Medicaid/CHP/HARP	$22,979.14
Rate for Payer: Amida Care Medicaid	$22,979.14
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,979.14
Rate for Payer: Fidelis Qualified Health Plan	$27,574.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,979.14
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,979.14
Rate for Payer: Healthfirst Commercial	$21,533.00
Rate for Payer: Healthfirst Essential Plan	$51,703.06
Rate for Payer: Healthfirst QHP	$12,489.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,979.14
Rate for Payer: SOMOS Essential	$51,703.06
Rate for Payer: United Healthcare Essential Plan 1&2	$51,703.06
Rate for Payer: United Healthcare Essential Plan 3&4	$51,703.06
Rate for Payer: United Healthcare Medicaid	$22,979.14
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,979.14

APR-DRG 4803: Major male pelvic procedures

Facility

$67,584.56

Service Code	APR-DRG 4803
Min. Negotiated Rate	$19,984.00
Max. Negotiated Rate	$67,584.56
Rate for Payer: Affinity Essential Plan 1&2	$67,584.56
Rate for Payer: Affinity Essential Plan 3&4	$67,584.56
Rate for Payer: Affinity Medicaid/CHP/HARP	$30,037.58
Rate for Payer: Amida Care Medicaid	$30,037.58
Rate for Payer: Fidelis CHP/HARP/Medicaid	$30,037.58
Rate for Payer: Fidelis Qualified Health Plan	$36,045.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$30,037.58
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$30,037.58
Rate for Payer: Healthfirst Commercial	$39,094.00
Rate for Payer: Healthfirst Essential Plan	$67,584.56
Rate for Payer: Healthfirst QHP	$19,984.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$30,037.58
Rate for Payer: SOMOS Essential	$67,584.56
Rate for Payer: United Healthcare Essential Plan 1&2	$67,584.56
Rate for Payer: United Healthcare Essential Plan 3&4	$67,584.56
Rate for Payer: United Healthcare Medicaid	$30,037.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$30,037.58

APR-DRG 4804: Major male pelvic procedures

Facility

$75,326.56

Service Code	APR-DRG 4804
Min. Negotiated Rate	$22,769.00
Max. Negotiated Rate	$75,326.56
Rate for Payer: Affinity Essential Plan 1&2	$75,326.56
Rate for Payer: Affinity Essential Plan 3&4	$75,326.56
Rate for Payer: Affinity Medicaid/CHP/HARP	$33,478.47
Rate for Payer: Amida Care Medicaid	$33,478.47
Rate for Payer: Fidelis CHP/HARP/Medicaid	$33,478.47
Rate for Payer: Fidelis Qualified Health Plan	$40,174.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$33,478.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$33,478.47
Rate for Payer: Healthfirst Commercial	$46,549.00
Rate for Payer: Healthfirst Essential Plan	$75,326.56
Rate for Payer: Healthfirst QHP	$22,769.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$33,478.47
Rate for Payer: SOMOS Essential	$75,326.56
Rate for Payer: United Healthcare Essential Plan 1&2	$75,326.56
Rate for Payer: United Healthcare Essential Plan 3&4	$75,326.56
Rate for Payer: United Healthcare Medicaid	$33,478.47
Rate for Payer: Wellcare CHP/FHP/Medicaid	$33,478.47

APR-DRG 4811: Penis procedures

Facility

$42,694.78

Service Code	APR-DRG 4811
Min. Negotiated Rate	$8,285.00
Max. Negotiated Rate	$42,694.78
Rate for Payer: Affinity Essential Plan 1&2	$42,694.78
Rate for Payer: Affinity Essential Plan 3&4	$42,694.78
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,975.46
Rate for Payer: Amida Care Medicaid	$18,975.46
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,975.46
Rate for Payer: Fidelis Qualified Health Plan	$22,770.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,975.46
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,975.46
Rate for Payer: Healthfirst Commercial	$14,916.00
Rate for Payer: Healthfirst Essential Plan	$42,694.78
Rate for Payer: Healthfirst QHP	$8,285.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,975.46
Rate for Payer: SOMOS Essential	$42,694.78
Rate for Payer: United Healthcare Essential Plan 1&2	$42,694.78
Rate for Payer: United Healthcare Essential Plan 3&4	$42,694.78
Rate for Payer: United Healthcare Medicaid	$18,975.46
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,975.46

APR-DRG 4812: Penis procedures

Facility

$51,091.02

Service Code	APR-DRG 4812
Min. Negotiated Rate	$14,220.00
Max. Negotiated Rate	$51,091.02
Rate for Payer: Affinity Essential Plan 1&2	$51,091.02
Rate for Payer: Affinity Essential Plan 3&4	$51,091.02
Rate for Payer: Affinity Medicaid/CHP/HARP	$22,707.12
Rate for Payer: Amida Care Medicaid	$22,707.12
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,707.12
Rate for Payer: Fidelis Qualified Health Plan	$27,248.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,707.12
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,707.12
Rate for Payer: Healthfirst Commercial	$22,568.00
Rate for Payer: Healthfirst Essential Plan	$51,091.02
Rate for Payer: Healthfirst QHP	$14,220.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,707.12
Rate for Payer: SOMOS Essential	$51,091.02
Rate for Payer: United Healthcare Essential Plan 1&2	$51,091.02
Rate for Payer: United Healthcare Essential Plan 3&4	$51,091.02
Rate for Payer: United Healthcare Medicaid	$22,707.12
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,707.12

APR-DRG 4813: Penis procedures

Facility

$64,019.56

Service Code	APR-DRG 4813
Min. Negotiated Rate	$23,493.00
Max. Negotiated Rate	$64,019.56
Rate for Payer: Affinity Essential Plan 1&2	$64,019.56
Rate for Payer: Affinity Essential Plan 3&4	$64,019.56
Rate for Payer: Affinity Medicaid/CHP/HARP	$28,453.14
Rate for Payer: Amida Care Medicaid	$28,453.14
Rate for Payer: Fidelis CHP/HARP/Medicaid	$28,453.14
Rate for Payer: Fidelis Qualified Health Plan	$34,143.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$28,453.14
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$28,453.14
Rate for Payer: Healthfirst Commercial	$46,489.00
Rate for Payer: Healthfirst Essential Plan	$64,019.56
Rate for Payer: Healthfirst QHP	$23,493.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$28,453.14
Rate for Payer: SOMOS Essential	$64,019.56
Rate for Payer: United Healthcare Essential Plan 1&2	$64,019.56
Rate for Payer: United Healthcare Essential Plan 3&4	$64,019.56
Rate for Payer: United Healthcare Medicaid	$28,453.14
Rate for Payer: Wellcare CHP/FHP/Medicaid	$28,453.14

APR-DRG 4814: Penis procedures

Facility

$65,985.86

Service Code	APR-DRG 4814
Min. Negotiated Rate	$29,327.05
Max. Negotiated Rate	$65,985.86
Rate for Payer: Affinity Essential Plan 1&2	$65,985.86
Rate for Payer: Affinity Essential Plan 3&4	$65,985.86
Rate for Payer: Affinity Medicaid/CHP/HARP	$29,327.05
Rate for Payer: Amida Care Medicaid	$29,327.05
Rate for Payer: Fidelis CHP/HARP/Medicaid	$29,327.05
Rate for Payer: Fidelis Qualified Health Plan	$35,192.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$29,327.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29,327.05
Rate for Payer: Healthfirst Commercial	$64,204.00
Rate for Payer: Healthfirst Essential Plan	$65,985.86
Rate for Payer: Healthfirst QHP	$30,778.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$29,327.05
Rate for Payer: SOMOS Essential	$65,985.86
Rate for Payer: United Healthcare Essential Plan 1&2	$65,985.86
Rate for Payer: United Healthcare Essential Plan 3&4	$65,985.86
Rate for Payer: United Healthcare Medicaid	$29,327.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$29,327.05

APR-DRG 4821: Transurethral prostatectomy

Facility

$40,283.53

Service Code	APR-DRG 4821
Min. Negotiated Rate	$6,795.00
Max. Negotiated Rate	$40,283.53
Rate for Payer: Affinity Essential Plan 1&2	$40,283.53
Rate for Payer: Affinity Essential Plan 3&4	$40,283.53
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,903.79
Rate for Payer: Amida Care Medicaid	$17,903.79
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,903.79
Rate for Payer: Fidelis Qualified Health Plan	$21,484.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,903.79
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,903.79
Rate for Payer: Healthfirst Commercial	$11,501.00
Rate for Payer: Healthfirst Essential Plan	$40,283.53
Rate for Payer: Healthfirst QHP	$6,795.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,903.79
Rate for Payer: SOMOS Essential	$40,283.53
Rate for Payer: United Healthcare Essential Plan 1&2	$40,283.53
Rate for Payer: United Healthcare Essential Plan 3&4	$40,283.53
Rate for Payer: United Healthcare Medicaid	$17,903.79
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,903.79

APR-DRG 4822: Transurethral prostatectomy

Facility

$44,553.78

Service Code	APR-DRG 4822
Min. Negotiated Rate	$8,033.00
Max. Negotiated Rate	$44,553.78
Rate for Payer: Affinity Essential Plan 1&2	$44,553.78
Rate for Payer: Affinity Essential Plan 3&4	$44,553.78
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,801.68
Rate for Payer: Amida Care Medicaid	$19,801.68
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,801.68
Rate for Payer: Fidelis Qualified Health Plan	$23,762.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,801.68
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,801.68
Rate for Payer: Healthfirst Commercial	$15,997.00
Rate for Payer: Healthfirst Essential Plan	$44,553.78
Rate for Payer: Healthfirst QHP	$8,033.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,801.68
Rate for Payer: SOMOS Essential	$44,553.78
Rate for Payer: United Healthcare Essential Plan 1&2	$44,553.78
Rate for Payer: United Healthcare Essential Plan 3&4	$44,553.78
Rate for Payer: United Healthcare Medicaid	$19,801.68
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,801.68

APR-DRG 4823: Transurethral prostatectomy

Facility

$71,042.24

Service Code	APR-DRG 4823
Min. Negotiated Rate	$16,520.00
Max. Negotiated Rate	$71,042.24
Rate for Payer: Affinity Essential Plan 1&2	$71,042.24
Rate for Payer: Affinity Essential Plan 3&4	$71,042.24
Rate for Payer: Affinity Medicaid/CHP/HARP	$31,574.33
Rate for Payer: Amida Care Medicaid	$31,574.33
Rate for Payer: Fidelis CHP/HARP/Medicaid	$31,574.33
Rate for Payer: Fidelis Qualified Health Plan	$37,889.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$31,574.33
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31,574.33
Rate for Payer: Healthfirst Commercial	$38,248.00
Rate for Payer: Healthfirst Essential Plan	$71,042.24
Rate for Payer: Healthfirst QHP	$16,520.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$31,574.33
Rate for Payer: SOMOS Essential	$71,042.24
Rate for Payer: United Healthcare Essential Plan 1&2	$71,042.24
Rate for Payer: United Healthcare Essential Plan 3&4	$71,042.24
Rate for Payer: United Healthcare Medicaid	$31,574.33
Rate for Payer: Wellcare CHP/FHP/Medicaid	$31,574.33

APR-DRG 4824: Transurethral prostatectomy

Facility

$77,229.52

Service Code	APR-DRG 4824
Min. Negotiated Rate	$18,345.00
Max. Negotiated Rate	$77,229.52
Rate for Payer: Affinity Essential Plan 1&2	$77,229.52
Rate for Payer: Affinity Essential Plan 3&4	$77,229.52
Rate for Payer: Affinity Medicaid/CHP/HARP	$34,324.23
Rate for Payer: Amida Care Medicaid	$34,324.23
Rate for Payer: Fidelis CHP/HARP/Medicaid	$34,324.23
Rate for Payer: Fidelis Qualified Health Plan	$41,189.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$34,324.23
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$34,324.23
Rate for Payer: Healthfirst Commercial	$42,085.00
Rate for Payer: Healthfirst Essential Plan	$77,229.52
Rate for Payer: Healthfirst QHP	$18,345.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$34,324.23
Rate for Payer: SOMOS Essential	$77,229.52
Rate for Payer: United Healthcare Essential Plan 1&2	$77,229.52
Rate for Payer: United Healthcare Essential Plan 3&4	$77,229.52
Rate for Payer: United Healthcare Medicaid	$34,324.23
Rate for Payer: Wellcare CHP/FHP/Medicaid	$34,324.23

APR-DRG 4831: Testes & scrotal procedures

Facility

$40,753.12

Service Code	APR-DRG 4831
Min. Negotiated Rate	$6,880.00
Max. Negotiated Rate	$40,753.12
Rate for Payer: Affinity Essential Plan 1&2	$40,753.12
Rate for Payer: Affinity Essential Plan 3&4	$40,753.12
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,112.50
Rate for Payer: Amida Care Medicaid	$18,112.50
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,112.50
Rate for Payer: Fidelis Qualified Health Plan	$21,735.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,112.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,112.50
Rate for Payer: Healthfirst Commercial	$11,840.00
Rate for Payer: Healthfirst Essential Plan	$40,753.12
Rate for Payer: Healthfirst QHP	$6,880.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,112.50
Rate for Payer: SOMOS Essential	$40,753.12
Rate for Payer: United Healthcare Essential Plan 1&2	$40,753.12
Rate for Payer: United Healthcare Essential Plan 3&4	$40,753.12
Rate for Payer: United Healthcare Medicaid	$18,112.50
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,112.50

APR-DRG 4832: Testes & scrotal procedures

Facility

$52,172.66

Service Code	APR-DRG 4832
Min. Negotiated Rate	$12,335.00
Max. Negotiated Rate	$52,172.66
Rate for Payer: Affinity Essential Plan 1&2	$52,172.66
Rate for Payer: Affinity Essential Plan 3&4	$52,172.66
Rate for Payer: Affinity Medicaid/CHP/HARP	$23,187.85
Rate for Payer: Amida Care Medicaid	$23,187.85
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,187.85
Rate for Payer: Fidelis Qualified Health Plan	$27,825.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,187.85
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,187.85
Rate for Payer: Healthfirst Commercial	$21,929.00
Rate for Payer: Healthfirst Essential Plan	$52,172.66
Rate for Payer: Healthfirst QHP	$12,335.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,187.85
Rate for Payer: SOMOS Essential	$52,172.66
Rate for Payer: United Healthcare Essential Plan 1&2	$52,172.66
Rate for Payer: United Healthcare Essential Plan 3&4	$52,172.66
Rate for Payer: United Healthcare Medicaid	$23,187.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,187.85

APR-DRG 4833: Testes & scrotal procedures

Facility

$85,597.63

Service Code	APR-DRG 4833
Min. Negotiated Rate	$25,398.00
Max. Negotiated Rate	$85,597.63
Rate for Payer: Affinity Essential Plan 1&2	$85,597.63
Rate for Payer: Affinity Essential Plan 3&4	$85,597.63
Rate for Payer: Affinity Medicaid/CHP/HARP	$38,043.39
Rate for Payer: Amida Care Medicaid	$38,043.39
Rate for Payer: Fidelis CHP/HARP/Medicaid	$38,043.39
Rate for Payer: Fidelis Qualified Health Plan	$45,652.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$38,043.39
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$38,043.39
Rate for Payer: Healthfirst Commercial	$45,797.00
Rate for Payer: Healthfirst Essential Plan	$85,597.63
Rate for Payer: Healthfirst QHP	$25,398.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$38,043.39
Rate for Payer: SOMOS Essential	$85,597.63
Rate for Payer: United Healthcare Essential Plan 1&2	$85,597.63
Rate for Payer: United Healthcare Essential Plan 3&4	$85,597.63
Rate for Payer: United Healthcare Medicaid	$38,043.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$38,043.39

APR-DRG 4834: Testes & scrotal procedures

Facility

$104,882.29

Service Code	APR-DRG 4834
Min. Negotiated Rate	$35,867.00
Max. Negotiated Rate	$104,882.29
Rate for Payer: Affinity Essential Plan 1&2	$104,882.29
Rate for Payer: Affinity Essential Plan 3&4	$104,882.29
Rate for Payer: Affinity Medicaid/CHP/HARP	$46,614.35
Rate for Payer: Amida Care Medicaid	$46,614.35
Rate for Payer: Fidelis CHP/HARP/Medicaid	$46,614.35
Rate for Payer: Fidelis Qualified Health Plan	$55,937.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$46,614.35
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$46,614.35
Rate for Payer: Healthfirst Commercial	$48,352.00
Rate for Payer: Healthfirst Essential Plan	$104,882.29
Rate for Payer: Healthfirst QHP	$35,867.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$46,614.35
Rate for Payer: SOMOS Essential	$104,882.29
Rate for Payer: United Healthcare Essential Plan 1&2	$104,882.29
Rate for Payer: United Healthcare Essential Plan 3&4	$104,882.29
Rate for Payer: United Healthcare Medicaid	$46,614.35
Rate for Payer: Wellcare CHP/FHP/Medicaid	$46,614.35

APR-DRG 4841: Other male reproductive system & related procedures

Facility

$45,091.96

Service Code	APR-DRG 4841
Min. Negotiated Rate	$8,303.00
Max. Negotiated Rate	$45,091.96
Rate for Payer: Affinity Essential Plan 1&2	$45,091.96
Rate for Payer: Affinity Essential Plan 3&4	$45,091.96
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,040.87
Rate for Payer: Amida Care Medicaid	$20,040.87
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,040.87
Rate for Payer: Fidelis Qualified Health Plan	$24,049.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,040.87
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,040.87
Rate for Payer: Healthfirst Commercial	$14,034.00
Rate for Payer: Healthfirst Essential Plan	$45,091.96
Rate for Payer: Healthfirst QHP	$8,303.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,040.87
Rate for Payer: SOMOS Essential	$45,091.96
Rate for Payer: United Healthcare Essential Plan 1&2	$45,091.96
Rate for Payer: United Healthcare Essential Plan 3&4	$45,091.96
Rate for Payer: United Healthcare Medicaid	$20,040.87
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,040.87

APR-DRG 4842: Other male reproductive system & related procedures

Facility

$50,336.53

Service Code	APR-DRG 4842
Min. Negotiated Rate	$12,076.00
Max. Negotiated Rate	$50,336.53
Rate for Payer: Affinity Essential Plan 1&2	$50,336.53
Rate for Payer: Affinity Essential Plan 3&4	$50,336.53
Rate for Payer: Affinity Medicaid/CHP/HARP	$22,371.79
Rate for Payer: Amida Care Medicaid	$22,371.79
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,371.79
Rate for Payer: Fidelis Qualified Health Plan	$26,846.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,371.79
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,371.79
Rate for Payer: Healthfirst Commercial	$22,059.00
Rate for Payer: Healthfirst Essential Plan	$50,336.53
Rate for Payer: Healthfirst QHP	$12,076.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,371.79
Rate for Payer: SOMOS Essential	$50,336.53
Rate for Payer: United Healthcare Essential Plan 1&2	$50,336.53
Rate for Payer: United Healthcare Essential Plan 3&4	$50,336.53
Rate for Payer: United Healthcare Medicaid	$22,371.79
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,371.79

APR-DRG 4843: Other male reproductive system & related procedures

Facility

$64,325.59

Service Code	APR-DRG 4843
Min. Negotiated Rate	$16,906.00
Max. Negotiated Rate	$64,325.59
Rate for Payer: Affinity Essential Plan 1&2	$64,325.59
Rate for Payer: Affinity Essential Plan 3&4	$64,325.59
Rate for Payer: Affinity Medicaid/CHP/HARP	$28,589.15
Rate for Payer: Amida Care Medicaid	$28,589.15
Rate for Payer: Fidelis CHP/HARP/Medicaid	$28,589.15
Rate for Payer: Fidelis Qualified Health Plan	$34,306.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$28,589.15
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$28,589.15
Rate for Payer: Healthfirst Commercial	$30,458.00
Rate for Payer: Healthfirst Essential Plan	$64,325.59
Rate for Payer: Healthfirst QHP	$16,906.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$28,589.15
Rate for Payer: SOMOS Essential	$64,325.59
Rate for Payer: United Healthcare Essential Plan 1&2	$64,325.59
Rate for Payer: United Healthcare Essential Plan 3&4	$64,325.59
Rate for Payer: United Healthcare Medicaid	$28,589.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$28,589.15

APR-DRG 4844: Other male reproductive system & related procedures

Facility

$67,419.22

Service Code	APR-DRG 4844
Min. Negotiated Rate	$19,543.00
Max. Negotiated Rate	$67,419.22
Rate for Payer: Affinity Essential Plan 1&2	$67,419.22
Rate for Payer: Affinity Essential Plan 3&4	$67,419.22
Rate for Payer: Affinity Medicaid/CHP/HARP	$29,964.10
Rate for Payer: Amida Care Medicaid	$29,964.10
Rate for Payer: Fidelis CHP/HARP/Medicaid	$29,964.10
Rate for Payer: Fidelis Qualified Health Plan	$35,956.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$29,964.10
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29,964.10
Rate for Payer: Healthfirst Commercial	$31,526.00
Rate for Payer: Healthfirst Essential Plan	$67,419.22
Rate for Payer: Healthfirst QHP	$19,543.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$29,964.10
Rate for Payer: SOMOS Essential	$67,419.22
Rate for Payer: United Healthcare Essential Plan 1&2	$67,419.22
Rate for Payer: United Healthcare Essential Plan 3&4	$67,419.22
Rate for Payer: United Healthcare Medicaid	$29,964.10
Rate for Payer: Wellcare CHP/FHP/Medicaid	$29,964.10

APR-DRG 5001: Malignancy, male reproductive system

Facility

$37,063.26

Service Code	APR-DRG 5001
Min. Negotiated Rate	$5,507.00
Max. Negotiated Rate	$37,063.26
Rate for Payer: Affinity Essential Plan 1&2	$37,063.26
Rate for Payer: Affinity Essential Plan 3&4	$37,063.26
Rate for Payer: Affinity Medicaid/CHP/HARP	$16,472.56
Rate for Payer: Amida Care Medicaid	$16,472.56
Rate for Payer: Fidelis CHP/HARP/Medicaid	$16,472.56
Rate for Payer: Fidelis Qualified Health Plan	$19,767.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$16,472.56
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16,472.56
Rate for Payer: Healthfirst Commercial	$10,264.00
Rate for Payer: Healthfirst Essential Plan	$37,063.26
Rate for Payer: Healthfirst QHP	$5,507.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$16,472.56
Rate for Payer: SOMOS Essential	$37,063.26
Rate for Payer: United Healthcare Essential Plan 1&2	$37,063.26
Rate for Payer: United Healthcare Essential Plan 3&4	$37,063.26
Rate for Payer: United Healthcare Medicaid	$16,472.56
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,472.56

APR-DRG 5002: Malignancy, male reproductive system

Facility

$46,222.83

Service Code	APR-DRG 5002
Min. Negotiated Rate	$10,273.00
Max. Negotiated Rate	$46,222.83
Rate for Payer: Affinity Essential Plan 1&2	$46,222.83
Rate for Payer: Affinity Essential Plan 3&4	$46,222.83
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,543.48
Rate for Payer: Amida Care Medicaid	$20,543.48
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,543.48
Rate for Payer: Fidelis Qualified Health Plan	$24,652.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,543.48
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,543.48
Rate for Payer: Healthfirst Commercial	$16,493.00
Rate for Payer: Healthfirst Essential Plan	$46,222.83
Rate for Payer: Healthfirst QHP	$10,273.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,543.48
Rate for Payer: SOMOS Essential	$46,222.83
Rate for Payer: United Healthcare Essential Plan 1&2	$46,222.83
Rate for Payer: United Healthcare Essential Plan 3&4	$46,222.83
Rate for Payer: United Healthcare Medicaid	$20,543.48
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,543.48

APR-DRG 5003: Malignancy, male reproductive system

Facility

$57,426.03

Service Code	APR-DRG 5003
Min. Negotiated Rate	$13,208.00
Max. Negotiated Rate	$57,426.03
Rate for Payer: Affinity Essential Plan 1&2	$57,426.03
Rate for Payer: Affinity Essential Plan 3&4	$57,426.03
Rate for Payer: Affinity Medicaid/CHP/HARP	$25,522.68
Rate for Payer: Amida Care Medicaid	$25,522.68
Rate for Payer: Fidelis CHP/HARP/Medicaid	$25,522.68
Rate for Payer: Fidelis Qualified Health Plan	$30,627.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$25,522.68
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25,522.68
Rate for Payer: Healthfirst Commercial	$24,628.00
Rate for Payer: Healthfirst Essential Plan	$57,426.03
Rate for Payer: Healthfirst QHP	$13,208.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$25,522.68
Rate for Payer: SOMOS Essential	$57,426.03
Rate for Payer: United Healthcare Essential Plan 1&2	$57,426.03
Rate for Payer: United Healthcare Essential Plan 3&4	$57,426.03
Rate for Payer: United Healthcare Medicaid	$25,522.68
Rate for Payer: Wellcare CHP/FHP/Medicaid	$25,522.68

APR-DRG 5004: Malignancy, male reproductive system

Facility

$70,609.00

Service Code	APR-DRG 5004
Min. Negotiated Rate	$14,479.00
Max. Negotiated Rate	$70,609.00
Rate for Payer: Affinity Essential Plan 1&2	$62,035.72
Rate for Payer: Affinity Essential Plan 3&4	$62,035.72
Rate for Payer: Affinity Medicaid/CHP/HARP	$27,571.43
Rate for Payer: Amida Care Medicaid	$27,571.43
Rate for Payer: Fidelis CHP/HARP/Medicaid	$27,571.43
Rate for Payer: Fidelis Qualified Health Plan	$33,085.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$27,571.43
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$27,571.43
Rate for Payer: Healthfirst Commercial	$70,609.00
Rate for Payer: Healthfirst Essential Plan	$62,035.72
Rate for Payer: Healthfirst QHP	$14,479.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$27,571.43
Rate for Payer: SOMOS Essential	$62,035.72
Rate for Payer: United Healthcare Essential Plan 1&2	$62,035.72
Rate for Payer: United Healthcare Essential Plan 3&4	$62,035.72
Rate for Payer: United Healthcare Medicaid	$27,571.43
Rate for Payer: Wellcare CHP/FHP/Medicaid	$27,571.43

APR-DRG 5011: Male reproductive system diagnoses except malignancy

Facility

$38,144.90

Service Code	APR-DRG 5011
Min. Negotiated Rate	$5,681.00
Max. Negotiated Rate	$38,144.90
Rate for Payer: Affinity Essential Plan 1&2	$38,144.90
Rate for Payer: Affinity Essential Plan 3&4	$38,144.90
Rate for Payer: Affinity Medicaid/CHP/HARP	$16,953.29
Rate for Payer: Amida Care Medicaid	$16,953.29
Rate for Payer: Fidelis CHP/HARP/Medicaid	$16,953.29
Rate for Payer: Fidelis Qualified Health Plan	$20,343.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$16,953.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16,953.29
Rate for Payer: Healthfirst Commercial	$9,623.00
Rate for Payer: Healthfirst Essential Plan	$38,144.90
Rate for Payer: Healthfirst QHP	$5,681.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$16,953.29
Rate for Payer: SOMOS Essential	$38,144.90
Rate for Payer: United Healthcare Essential Plan 1&2	$38,144.90
Rate for Payer: United Healthcare Essential Plan 3&4	$38,144.90
Rate for Payer: United Healthcare Medicaid	$16,953.29
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,953.29

APR-DRG 5012: Male reproductive system diagnoses except malignancy

Facility

$41,706.36

Service Code	APR-DRG 5012
Min. Negotiated Rate	$7,295.00
Max. Negotiated Rate	$41,706.36
Rate for Payer: Affinity Essential Plan 1&2	$41,706.36
Rate for Payer: Affinity Essential Plan 3&4	$41,706.36
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,536.16
Rate for Payer: Amida Care Medicaid	$18,536.16
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,536.16
Rate for Payer: Fidelis Qualified Health Plan	$22,243.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,536.16
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,536.16
Rate for Payer: Healthfirst Commercial	$12,359.00
Rate for Payer: Healthfirst Essential Plan	$41,706.36
Rate for Payer: Healthfirst QHP	$7,295.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,536.16
Rate for Payer: SOMOS Essential	$41,706.36
Rate for Payer: United Healthcare Essential Plan 1&2	$41,706.36
Rate for Payer: United Healthcare Essential Plan 3&4	$41,706.36
Rate for Payer: United Healthcare Medicaid	$18,536.16
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,536.16

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