St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

APR-DRG 5013: Male reproductive system diagnoses except malignancy

Facility

$49,388.56

Service Code	APR-DRG 5013
Min. Negotiated Rate	$10,221.00
Max. Negotiated Rate	$49,388.56
Rate for Payer: Affinity Essential Plan 1&2	$49,388.56
Rate for Payer: Affinity Essential Plan 3&4	$49,388.56
Rate for Payer: Affinity Medicaid/CHP/HARP	$21,950.47
Rate for Payer: Amida Care Medicaid	$21,950.47
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,950.47
Rate for Payer: Fidelis Qualified Health Plan	$26,340.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,950.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,950.47
Rate for Payer: Healthfirst Commercial	$18,314.00
Rate for Payer: Healthfirst Essential Plan	$49,388.56
Rate for Payer: Healthfirst QHP	$10,221.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,950.47
Rate for Payer: SOMOS Essential	$49,388.56
Rate for Payer: United Healthcare Essential Plan 1&2	$49,388.56
Rate for Payer: United Healthcare Essential Plan 3&4	$49,388.56
Rate for Payer: United Healthcare Medicaid	$21,950.47
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,950.47

APR-DRG 5014: Male reproductive system diagnoses except malignancy

Facility

$67,150.15

Service Code	APR-DRG 5014
Min. Negotiated Rate	$18,508.00
Max. Negotiated Rate	$67,150.15
Rate for Payer: Affinity Essential Plan 1&2	$67,150.15
Rate for Payer: Affinity Essential Plan 3&4	$67,150.15
Rate for Payer: Affinity Medicaid/CHP/HARP	$29,844.51
Rate for Payer: Amida Care Medicaid	$29,844.51
Rate for Payer: Fidelis CHP/HARP/Medicaid	$29,844.51
Rate for Payer: Fidelis Qualified Health Plan	$35,813.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$29,844.51
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29,844.51
Rate for Payer: Healthfirst Commercial	$38,065.00
Rate for Payer: Healthfirst Essential Plan	$67,150.15
Rate for Payer: Healthfirst QHP	$18,508.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$29,844.51
Rate for Payer: SOMOS Essential	$67,150.15
Rate for Payer: United Healthcare Essential Plan 1&2	$67,150.15
Rate for Payer: United Healthcare Essential Plan 3&4	$67,150.15
Rate for Payer: United Healthcare Medicaid	$29,844.51
Rate for Payer: Wellcare CHP/FHP/Medicaid	$29,844.51

APR-DRG 5101: Pelvic evisceration, radical hysterectomy & other radical GYN procs

Facility

$49,418.46

Service Code	APR-DRG 5101
Min. Negotiated Rate	$14,321.00
Max. Negotiated Rate	$49,418.46
Rate for Payer: Affinity Essential Plan 1&2	$49,418.46
Rate for Payer: Affinity Essential Plan 3&4	$49,418.46
Rate for Payer: Affinity Medicaid/CHP/HARP	$21,963.76
Rate for Payer: Amida Care Medicaid	$21,963.76
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,963.76
Rate for Payer: Fidelis Qualified Health Plan	$26,356.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,963.76
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,963.76
Rate for Payer: Healthfirst Commercial	$24,839.00
Rate for Payer: Healthfirst Essential Plan	$49,418.46
Rate for Payer: Healthfirst QHP	$14,321.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,963.76
Rate for Payer: SOMOS Essential	$49,418.46
Rate for Payer: United Healthcare Essential Plan 1&2	$49,418.46
Rate for Payer: United Healthcare Essential Plan 3&4	$49,418.46
Rate for Payer: United Healthcare Medicaid	$21,963.76
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,963.76

APR-DRG 5102: Pelvic evisceration, radical hysterectomy & other radical GYN procs

Facility

$54,860.02

Service Code	APR-DRG 5102
Min. Negotiated Rate	$16,710.00
Max. Negotiated Rate	$54,860.02
Rate for Payer: Affinity Essential Plan 1&2	$54,860.02
Rate for Payer: Affinity Essential Plan 3&4	$54,860.02
Rate for Payer: Affinity Medicaid/CHP/HARP	$24,382.23
Rate for Payer: Amida Care Medicaid	$24,382.23
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,382.23
Rate for Payer: Fidelis Qualified Health Plan	$29,258.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,382.23
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,382.23
Rate for Payer: Healthfirst Commercial	$30,113.00
Rate for Payer: Healthfirst Essential Plan	$54,860.02
Rate for Payer: Healthfirst QHP	$16,710.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,382.23
Rate for Payer: SOMOS Essential	$54,860.02
Rate for Payer: United Healthcare Essential Plan 1&2	$54,860.02
Rate for Payer: United Healthcare Essential Plan 3&4	$54,860.02
Rate for Payer: United Healthcare Medicaid	$24,382.23
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,382.23

APR-DRG 5103: Pelvic evisceration, radical hysterectomy & other radical GYN procs

Facility

$75,921.01

Service Code	APR-DRG 5103
Min. Negotiated Rate	$32,303.00
Max. Negotiated Rate	$75,921.01
Rate for Payer: Affinity Essential Plan 1&2	$75,921.01
Rate for Payer: Affinity Essential Plan 3&4	$75,921.01
Rate for Payer: Affinity Medicaid/CHP/HARP	$33,742.67
Rate for Payer: Amida Care Medicaid	$33,742.67
Rate for Payer: Fidelis CHP/HARP/Medicaid	$33,742.67
Rate for Payer: Fidelis Qualified Health Plan	$40,491.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$33,742.67
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$33,742.67
Rate for Payer: Healthfirst Commercial	$52,787.00
Rate for Payer: Healthfirst Essential Plan	$75,921.01
Rate for Payer: Healthfirst QHP	$32,303.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$33,742.67
Rate for Payer: SOMOS Essential	$75,921.01
Rate for Payer: United Healthcare Essential Plan 1&2	$75,921.01
Rate for Payer: United Healthcare Essential Plan 3&4	$75,921.01
Rate for Payer: United Healthcare Medicaid	$33,742.67
Rate for Payer: Wellcare CHP/FHP/Medicaid	$33,742.67

APR-DRG 5104: Pelvic evisceration, radical hysterectomy & other radical GYN procs

Facility

$142,366.43

Service Code	APR-DRG 5104
Min. Negotiated Rate	$63,273.97
Max. Negotiated Rate	$142,366.43
Rate for Payer: Affinity Essential Plan 1&2	$142,366.43
Rate for Payer: Affinity Essential Plan 3&4	$142,366.43
Rate for Payer: Affinity Medicaid/CHP/HARP	$63,273.97
Rate for Payer: Amida Care Medicaid	$63,273.97
Rate for Payer: Fidelis CHP/HARP/Medicaid	$63,273.97
Rate for Payer: Fidelis Qualified Health Plan	$75,928.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$63,273.97
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$63,273.97
Rate for Payer: Healthfirst Commercial	$96,631.00
Rate for Payer: Healthfirst Essential Plan	$142,366.43
Rate for Payer: Healthfirst QHP	$79,200.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$63,273.97
Rate for Payer: SOMOS Essential	$142,366.43
Rate for Payer: United Healthcare Essential Plan 1&2	$142,366.43
Rate for Payer: United Healthcare Essential Plan 3&4	$142,366.43
Rate for Payer: United Healthcare Medicaid	$63,273.97
Rate for Payer: Wellcare CHP/FHP/Medicaid	$63,273.97

APR-DRG 5111: Uterine & adnexa procedures for ovarian & adnexal malignancy

Facility

$52,170.91

Service Code	APR-DRG 5111
Min. Negotiated Rate	$13,930.00
Max. Negotiated Rate	$52,170.91
Rate for Payer: Affinity Essential Plan 1&2	$52,170.91
Rate for Payer: Affinity Essential Plan 3&4	$52,170.91
Rate for Payer: Affinity Medicaid/CHP/HARP	$23,187.07
Rate for Payer: Amida Care Medicaid	$23,187.07
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,187.07
Rate for Payer: Fidelis Qualified Health Plan	$27,824.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,187.07
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,187.07
Rate for Payer: Healthfirst Commercial	$23,918.00
Rate for Payer: Healthfirst Essential Plan	$52,170.91
Rate for Payer: Healthfirst QHP	$13,930.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,187.07
Rate for Payer: SOMOS Essential	$52,170.91
Rate for Payer: United Healthcare Essential Plan 1&2	$52,170.91
Rate for Payer: United Healthcare Essential Plan 3&4	$52,170.91
Rate for Payer: United Healthcare Medicaid	$23,187.07
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,187.07

APR-DRG 5112: Uterine & adnexa procedures for ovarian & adnexal malignancy

Facility

$56,724.30

Service Code	APR-DRG 5112
Min. Negotiated Rate	$17,390.00
Max. Negotiated Rate	$56,724.30
Rate for Payer: Affinity Essential Plan 1&2	$56,724.30
Rate for Payer: Affinity Essential Plan 3&4	$56,724.30
Rate for Payer: Affinity Medicaid/CHP/HARP	$25,210.80
Rate for Payer: Amida Care Medicaid	$25,210.80
Rate for Payer: Fidelis CHP/HARP/Medicaid	$25,210.80
Rate for Payer: Fidelis Qualified Health Plan	$30,252.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$25,210.80
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25,210.80
Rate for Payer: Healthfirst Commercial	$29,000.00
Rate for Payer: Healthfirst Essential Plan	$56,724.30
Rate for Payer: Healthfirst QHP	$17,390.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$25,210.80
Rate for Payer: SOMOS Essential	$56,724.30
Rate for Payer: United Healthcare Essential Plan 1&2	$56,724.30
Rate for Payer: United Healthcare Essential Plan 3&4	$56,724.30
Rate for Payer: United Healthcare Medicaid	$25,210.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$25,210.80

APR-DRG 5113: Uterine & adnexa procedures for ovarian & adnexal malignancy

Facility

$74,561.49

Service Code	APR-DRG 5113
Min. Negotiated Rate	$29,444.00
Max. Negotiated Rate	$74,561.49
Rate for Payer: Affinity Essential Plan 1&2	$74,561.49
Rate for Payer: Affinity Essential Plan 3&4	$74,561.49
Rate for Payer: Affinity Medicaid/CHP/HARP	$33,138.44
Rate for Payer: Amida Care Medicaid	$33,138.44
Rate for Payer: Fidelis CHP/HARP/Medicaid	$33,138.44
Rate for Payer: Fidelis Qualified Health Plan	$39,766.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$33,138.44
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$33,138.44
Rate for Payer: Healthfirst Commercial	$47,970.00
Rate for Payer: Healthfirst Essential Plan	$74,561.49
Rate for Payer: Healthfirst QHP	$29,444.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$33,138.44
Rate for Payer: SOMOS Essential	$74,561.49
Rate for Payer: United Healthcare Essential Plan 1&2	$74,561.49
Rate for Payer: United Healthcare Essential Plan 3&4	$74,561.49
Rate for Payer: United Healthcare Medicaid	$33,138.44
Rate for Payer: Wellcare CHP/FHP/Medicaid	$33,138.44

APR-DRG 5114: Uterine & adnexa procedures for ovarian & adnexal malignancy

Facility

$139,149.70

Service Code	APR-DRG 5114
Min. Negotiated Rate	$58,738.00
Max. Negotiated Rate	$139,149.70
Rate for Payer: Affinity Essential Plan 1&2	$139,149.70
Rate for Payer: Affinity Essential Plan 3&4	$139,149.70
Rate for Payer: Affinity Medicaid/CHP/HARP	$61,844.31
Rate for Payer: Amida Care Medicaid	$61,844.31
Rate for Payer: Fidelis CHP/HARP/Medicaid	$61,844.31
Rate for Payer: Fidelis Qualified Health Plan	$74,213.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$61,844.31
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$61,844.31
Rate for Payer: Healthfirst Commercial	$102,320.00
Rate for Payer: Healthfirst Essential Plan	$139,149.70
Rate for Payer: Healthfirst QHP	$58,738.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$61,844.31
Rate for Payer: SOMOS Essential	$139,149.70
Rate for Payer: United Healthcare Essential Plan 1&2	$139,149.70
Rate for Payer: United Healthcare Essential Plan 3&4	$139,149.70
Rate for Payer: United Healthcare Medicaid	$61,844.31
Rate for Payer: Wellcare CHP/FHP/Medicaid	$61,844.31

APR-DRG 5121: Uterine & adnexa procedures for non-ovarian & non-adnexal malig

Facility

$48,903.14

Service Code	APR-DRG 5121
Min. Negotiated Rate	$12,321.00
Max. Negotiated Rate	$48,903.14
Rate for Payer: Affinity Essential Plan 1&2	$48,903.14
Rate for Payer: Affinity Essential Plan 3&4	$48,903.14
Rate for Payer: Affinity Medicaid/CHP/HARP	$21,734.73
Rate for Payer: Amida Care Medicaid	$21,734.73
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,734.73
Rate for Payer: Fidelis Qualified Health Plan	$26,081.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,734.73
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,734.73
Rate for Payer: Healthfirst Commercial	$21,280.00
Rate for Payer: Healthfirst Essential Plan	$48,903.14
Rate for Payer: Healthfirst QHP	$12,321.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,734.73
Rate for Payer: SOMOS Essential	$48,903.14
Rate for Payer: United Healthcare Essential Plan 1&2	$48,903.14
Rate for Payer: United Healthcare Essential Plan 3&4	$48,903.14
Rate for Payer: United Healthcare Medicaid	$21,734.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,734.73

APR-DRG 5122: Uterine & adnexa procedures for non-ovarian & non-adnexal malig

Facility

$53,502.28

Service Code	APR-DRG 5122
Min. Negotiated Rate	$14,381.00
Max. Negotiated Rate	$53,502.28
Rate for Payer: Affinity Essential Plan 1&2	$53,502.28
Rate for Payer: Affinity Essential Plan 3&4	$53,502.28
Rate for Payer: Affinity Medicaid/CHP/HARP	$23,778.79
Rate for Payer: Amida Care Medicaid	$23,778.79
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,778.79
Rate for Payer: Fidelis Qualified Health Plan	$28,534.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,778.79
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,778.79
Rate for Payer: Healthfirst Commercial	$25,899.00
Rate for Payer: Healthfirst Essential Plan	$53,502.28
Rate for Payer: Healthfirst QHP	$14,381.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,778.79
Rate for Payer: SOMOS Essential	$53,502.28
Rate for Payer: United Healthcare Essential Plan 1&2	$53,502.28
Rate for Payer: United Healthcare Essential Plan 3&4	$53,502.28
Rate for Payer: United Healthcare Medicaid	$23,778.79
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,778.79

APR-DRG 5123: Uterine & adnexa procedures for non-ovarian & non-adnexal malig

Facility

$70,175.18

Service Code	APR-DRG 5123
Min. Negotiated Rate	$25,414.00
Max. Negotiated Rate	$70,175.18
Rate for Payer: Affinity Essential Plan 1&2	$70,175.18
Rate for Payer: Affinity Essential Plan 3&4	$70,175.18
Rate for Payer: Affinity Medicaid/CHP/HARP	$31,188.97
Rate for Payer: Amida Care Medicaid	$31,188.97
Rate for Payer: Fidelis CHP/HARP/Medicaid	$31,188.97
Rate for Payer: Fidelis Qualified Health Plan	$37,426.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$31,188.97
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31,188.97
Rate for Payer: Healthfirst Commercial	$46,386.00
Rate for Payer: Healthfirst Essential Plan	$70,175.18
Rate for Payer: Healthfirst QHP	$25,414.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$31,188.97
Rate for Payer: SOMOS Essential	$70,175.18
Rate for Payer: United Healthcare Essential Plan 1&2	$70,175.18
Rate for Payer: United Healthcare Essential Plan 3&4	$70,175.18
Rate for Payer: United Healthcare Medicaid	$31,188.97
Rate for Payer: Wellcare CHP/FHP/Medicaid	$31,188.97

APR-DRG 5124: Uterine & adnexa procedures for non-ovarian & non-adnexal malig

Facility

$161,608.88

Service Code	APR-DRG 5124
Min. Negotiated Rate	$59,119.00
Max. Negotiated Rate	$161,608.88
Rate for Payer: Affinity Essential Plan 1&2	$161,608.88
Rate for Payer: Affinity Essential Plan 3&4	$161,608.88
Rate for Payer: Affinity Medicaid/CHP/HARP	$71,826.17
Rate for Payer: Amida Care Medicaid	$71,826.17
Rate for Payer: Fidelis CHP/HARP/Medicaid	$71,826.17
Rate for Payer: Fidelis Qualified Health Plan	$86,191.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$71,826.17
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$71,826.17
Rate for Payer: Healthfirst Commercial	$91,943.00
Rate for Payer: Healthfirst Essential Plan	$161,608.88
Rate for Payer: Healthfirst QHP	$59,119.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$71,826.17
Rate for Payer: SOMOS Essential	$161,608.88
Rate for Payer: United Healthcare Essential Plan 1&2	$161,608.88
Rate for Payer: United Healthcare Essential Plan 3&4	$161,608.88
Rate for Payer: United Healthcare Medicaid	$71,826.17
Rate for Payer: Wellcare CHP/FHP/Medicaid	$71,826.17

APR-DRG 5131: Uterine & adnexa procedures for non-malignancy except leiomyoma

Facility

$44,991.70

Service Code	APR-DRG 5131
Min. Negotiated Rate	$8,747.00
Max. Negotiated Rate	$44,991.70
Rate for Payer: Affinity Essential Plan 1&2	$44,991.70
Rate for Payer: Affinity Essential Plan 3&4	$44,991.70
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,996.31
Rate for Payer: Amida Care Medicaid	$19,996.31
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,996.31
Rate for Payer: Fidelis Qualified Health Plan	$23,995.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,996.31
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,996.31
Rate for Payer: Healthfirst Commercial	$15,352.00
Rate for Payer: Healthfirst Essential Plan	$44,991.70
Rate for Payer: Healthfirst QHP	$8,747.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,996.31
Rate for Payer: SOMOS Essential	$44,991.70
Rate for Payer: United Healthcare Essential Plan 1&2	$44,991.70
Rate for Payer: United Healthcare Essential Plan 3&4	$44,991.70
Rate for Payer: United Healthcare Medicaid	$19,996.31
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,996.31

APR-DRG 5132: Uterine & adnexa procedures for non-malignancy except leiomyoma

Facility

$47,902.43

Service Code	APR-DRG 5132
Min. Negotiated Rate	$10,139.00
Max. Negotiated Rate	$47,902.43
Rate for Payer: Affinity Essential Plan 1&2	$47,902.43
Rate for Payer: Affinity Essential Plan 3&4	$47,902.43
Rate for Payer: Affinity Medicaid/CHP/HARP	$21,289.97
Rate for Payer: Amida Care Medicaid	$21,289.97
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,289.97
Rate for Payer: Fidelis Qualified Health Plan	$25,547.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,289.97
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,289.97
Rate for Payer: Healthfirst Commercial	$18,059.00
Rate for Payer: Healthfirst Essential Plan	$47,902.43
Rate for Payer: Healthfirst QHP	$10,139.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,289.97
Rate for Payer: SOMOS Essential	$47,902.43
Rate for Payer: United Healthcare Essential Plan 1&2	$47,902.43
Rate for Payer: United Healthcare Essential Plan 3&4	$47,902.43
Rate for Payer: United Healthcare Medicaid	$21,289.97
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,289.97

APR-DRG 5133: Uterine & adnexa procedures for non-malignancy except leiomyoma

Facility

$62,183.45

Service Code	APR-DRG 5133
Min. Negotiated Rate	$16,846.00
Max. Negotiated Rate	$62,183.45
Rate for Payer: Affinity Essential Plan 1&2	$62,183.45
Rate for Payer: Affinity Essential Plan 3&4	$62,183.45
Rate for Payer: Affinity Medicaid/CHP/HARP	$27,637.09
Rate for Payer: Amida Care Medicaid	$27,637.09
Rate for Payer: Fidelis CHP/HARP/Medicaid	$27,637.09
Rate for Payer: Fidelis Qualified Health Plan	$33,164.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$27,637.09
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$27,637.09
Rate for Payer: Healthfirst Commercial	$30,255.00
Rate for Payer: Healthfirst Essential Plan	$62,183.45
Rate for Payer: Healthfirst QHP	$16,846.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$27,637.09
Rate for Payer: SOMOS Essential	$62,183.45
Rate for Payer: United Healthcare Essential Plan 1&2	$62,183.45
Rate for Payer: United Healthcare Essential Plan 3&4	$62,183.45
Rate for Payer: United Healthcare Medicaid	$27,637.09
Rate for Payer: Wellcare CHP/FHP/Medicaid	$27,637.09

APR-DRG 5134: Uterine & adnexa procedures for non-malignancy except leiomyoma

Facility

$114,091.09

Service Code	APR-DRG 5134
Min. Negotiated Rate	$43,560.00
Max. Negotiated Rate	$114,091.09
Rate for Payer: Affinity Essential Plan 1&2	$114,091.09
Rate for Payer: Affinity Essential Plan 3&4	$114,091.09
Rate for Payer: Affinity Medicaid/CHP/HARP	$50,707.15
Rate for Payer: Amida Care Medicaid	$50,707.15
Rate for Payer: Fidelis CHP/HARP/Medicaid	$50,707.15
Rate for Payer: Fidelis Qualified Health Plan	$60,848.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$50,707.15
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$50,707.15
Rate for Payer: Healthfirst Commercial	$74,651.00
Rate for Payer: Healthfirst Essential Plan	$114,091.09
Rate for Payer: Healthfirst QHP	$43,560.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$50,707.15
Rate for Payer: SOMOS Essential	$114,091.09
Rate for Payer: United Healthcare Essential Plan 1&2	$114,091.09
Rate for Payer: United Healthcare Essential Plan 3&4	$114,091.09
Rate for Payer: United Healthcare Medicaid	$50,707.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$50,707.15

APR-DRG 5141: Female reproductive system reconstructive procedures

Facility

$47,128.57

Service Code	APR-DRG 5141
Min. Negotiated Rate	$7,516.00
Max. Negotiated Rate	$47,128.57
Rate for Payer: Affinity Essential Plan 1&2	$47,128.57
Rate for Payer: Affinity Essential Plan 3&4	$47,128.57
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,946.03
Rate for Payer: Amida Care Medicaid	$20,946.03
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,946.03
Rate for Payer: Fidelis Qualified Health Plan	$25,135.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,946.03
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,946.03
Rate for Payer: Healthfirst Commercial	$13,621.00
Rate for Payer: Healthfirst Essential Plan	$47,128.57
Rate for Payer: Healthfirst QHP	$7,516.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,946.03
Rate for Payer: SOMOS Essential	$47,128.57
Rate for Payer: United Healthcare Essential Plan 1&2	$47,128.57
Rate for Payer: United Healthcare Essential Plan 3&4	$47,128.57
Rate for Payer: United Healthcare Medicaid	$20,946.03
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,946.03

APR-DRG 5142: Female reproductive system reconstructive procedures

Facility

$47,128.57

Service Code	APR-DRG 5142
Min. Negotiated Rate	$9,670.00
Max. Negotiated Rate	$47,128.57
Rate for Payer: Affinity Essential Plan 1&2	$47,128.57
Rate for Payer: Affinity Essential Plan 3&4	$47,128.57
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,946.03
Rate for Payer: Amida Care Medicaid	$20,946.03
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,946.03
Rate for Payer: Fidelis Qualified Health Plan	$25,135.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,946.03
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,946.03
Rate for Payer: Healthfirst Commercial	$17,202.00
Rate for Payer: Healthfirst Essential Plan	$47,128.57
Rate for Payer: Healthfirst QHP	$9,670.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,946.03
Rate for Payer: SOMOS Essential	$47,128.57
Rate for Payer: United Healthcare Essential Plan 1&2	$47,128.57
Rate for Payer: United Healthcare Essential Plan 3&4	$47,128.57
Rate for Payer: United Healthcare Medicaid	$20,946.03
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,946.03

APR-DRG 5143: Female reproductive system reconstructive procedures

Facility

$47,128.57

Service Code	APR-DRG 5143
Min. Negotiated Rate	$13,411.00
Max. Negotiated Rate	$47,128.57
Rate for Payer: Affinity Essential Plan 1&2	$47,128.57
Rate for Payer: Affinity Essential Plan 3&4	$47,128.57
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,946.03
Rate for Payer: Amida Care Medicaid	$20,946.03
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,946.03
Rate for Payer: Fidelis Qualified Health Plan	$25,135.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,946.03
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,946.03
Rate for Payer: Healthfirst Commercial	$17,357.00
Rate for Payer: Healthfirst Essential Plan	$47,128.57
Rate for Payer: Healthfirst QHP	$13,411.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,946.03
Rate for Payer: SOMOS Essential	$47,128.57
Rate for Payer: United Healthcare Essential Plan 1&2	$47,128.57
Rate for Payer: United Healthcare Essential Plan 3&4	$47,128.57
Rate for Payer: United Healthcare Medicaid	$20,946.03
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,946.03

APR-DRG 5144: Female reproductive system reconstructive procedures

Facility

$84,605.69

Service Code	APR-DRG 5144
Min. Negotiated Rate	$14,617.00
Max. Negotiated Rate	$84,605.69
Rate for Payer: Affinity Essential Plan 1&2	$84,605.69
Rate for Payer: Affinity Essential Plan 3&4	$84,605.69
Rate for Payer: Affinity Medicaid/CHP/HARP	$37,602.53
Rate for Payer: Amida Care Medicaid	$37,602.53
Rate for Payer: Fidelis CHP/HARP/Medicaid	$37,602.53
Rate for Payer: Fidelis Qualified Health Plan	$45,123.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$37,602.53
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$37,602.53
Rate for Payer: Healthfirst Commercial	$31,762.00
Rate for Payer: Healthfirst Essential Plan	$84,605.69
Rate for Payer: Healthfirst QHP	$14,617.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$37,602.53
Rate for Payer: SOMOS Essential	$84,605.69
Rate for Payer: United Healthcare Essential Plan 1&2	$84,605.69
Rate for Payer: United Healthcare Essential Plan 3&4	$84,605.69
Rate for Payer: United Healthcare Medicaid	$37,602.53
Rate for Payer: Wellcare CHP/FHP/Medicaid	$37,602.53

APR-DRG 5171: Dilation & curettage for non-obstetric diagnoses

Facility

$41,386.28

Service Code	APR-DRG 5171
Min. Negotiated Rate	$6,815.00
Max. Negotiated Rate	$41,386.28
Rate for Payer: Affinity Essential Plan 1&2	$41,386.28
Rate for Payer: Affinity Essential Plan 3&4	$41,386.28
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,393.90
Rate for Payer: Amida Care Medicaid	$18,393.90
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,393.90
Rate for Payer: Fidelis Qualified Health Plan	$22,072.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,393.90
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,393.90
Rate for Payer: Healthfirst Commercial	$11,619.00
Rate for Payer: Healthfirst Essential Plan	$41,386.28
Rate for Payer: Healthfirst QHP	$6,815.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,393.90
Rate for Payer: SOMOS Essential	$41,386.28
Rate for Payer: United Healthcare Essential Plan 1&2	$41,386.28
Rate for Payer: United Healthcare Essential Plan 3&4	$41,386.28
Rate for Payer: United Healthcare Medicaid	$18,393.90
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,393.90

APR-DRG 5172: Dilation & curettage for non-obstetric diagnoses

Facility

$46,078.60

Service Code	APR-DRG 5172
Min. Negotiated Rate	$8,729.00
Max. Negotiated Rate	$46,078.60
Rate for Payer: Affinity Essential Plan 1&2	$46,078.60
Rate for Payer: Affinity Essential Plan 3&4	$46,078.60
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,479.38
Rate for Payer: Amida Care Medicaid	$20,479.38
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,479.38
Rate for Payer: Fidelis Qualified Health Plan	$24,575.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,479.38
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,479.38
Rate for Payer: Healthfirst Commercial	$14,874.00
Rate for Payer: Healthfirst Essential Plan	$46,078.60
Rate for Payer: Healthfirst QHP	$8,729.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,479.38
Rate for Payer: SOMOS Essential	$46,078.60
Rate for Payer: United Healthcare Essential Plan 1&2	$46,078.60
Rate for Payer: United Healthcare Essential Plan 3&4	$46,078.60
Rate for Payer: United Healthcare Medicaid	$20,479.38
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,479.38

APR-DRG 5173: Dilation & curettage for non-obstetric diagnoses

Facility

$65,449.44

Service Code	APR-DRG 5173
Min. Negotiated Rate	$16,571.00
Max. Negotiated Rate	$65,449.44
Rate for Payer: Affinity Essential Plan 1&2	$65,449.44
Rate for Payer: Affinity Essential Plan 3&4	$65,449.44
Rate for Payer: Affinity Medicaid/CHP/HARP	$29,088.64
Rate for Payer: Amida Care Medicaid	$29,088.64
Rate for Payer: Fidelis CHP/HARP/Medicaid	$29,088.64
Rate for Payer: Fidelis Qualified Health Plan	$34,906.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$29,088.64
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29,088.64
Rate for Payer: Healthfirst Commercial	$29,470.00
Rate for Payer: Healthfirst Essential Plan	$65,449.44
Rate for Payer: Healthfirst QHP	$16,571.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$29,088.64
Rate for Payer: SOMOS Essential	$65,449.44
Rate for Payer: United Healthcare Essential Plan 1&2	$65,449.44
Rate for Payer: United Healthcare Essential Plan 3&4	$65,449.44
Rate for Payer: United Healthcare Medicaid	$29,088.64
Rate for Payer: Wellcare CHP/FHP/Medicaid	$29,088.64

Know your out-of-pocket cost for care.

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