St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

APR-DRG 5174: Dilation & curettage for non-obstetric diagnoses

Facility

$67,454.42

Service Code	APR-DRG 5174
Min. Negotiated Rate	$17,405.00
Max. Negotiated Rate	$67,454.42
Rate for Payer: Affinity Essential Plan 1&2	$67,454.42
Rate for Payer: Affinity Essential Plan 3&4	$67,454.42
Rate for Payer: Affinity Medicaid/CHP/HARP	$29,979.74
Rate for Payer: Amida Care Medicaid	$29,979.74
Rate for Payer: Fidelis CHP/HARP/Medicaid	$29,979.74
Rate for Payer: Fidelis Qualified Health Plan	$35,975.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$29,979.74
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29,979.74
Rate for Payer: Healthfirst Commercial	$31,244.00
Rate for Payer: Healthfirst Essential Plan	$67,454.42
Rate for Payer: Healthfirst QHP	$17,405.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$29,979.74
Rate for Payer: SOMOS Essential	$67,454.42
Rate for Payer: United Healthcare Essential Plan 1&2	$67,454.42
Rate for Payer: United Healthcare Essential Plan 3&4	$67,454.42
Rate for Payer: United Healthcare Medicaid	$29,979.74
Rate for Payer: Wellcare CHP/FHP/Medicaid	$29,979.74

APR-DRG 5181: Other female reproductive system & related procedures

Facility

$42,937.49

Service Code	APR-DRG 5181
Min. Negotiated Rate	$7,948.00
Max. Negotiated Rate	$42,937.49
Rate for Payer: Affinity Essential Plan 1&2	$42,937.49
Rate for Payer: Affinity Essential Plan 3&4	$42,937.49
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,083.33
Rate for Payer: Amida Care Medicaid	$19,083.33
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,083.33
Rate for Payer: Fidelis Qualified Health Plan	$22,900.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,083.33
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,083.33
Rate for Payer: Healthfirst Commercial	$13,294.00
Rate for Payer: Healthfirst Essential Plan	$42,937.49
Rate for Payer: Healthfirst QHP	$7,948.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,083.33
Rate for Payer: SOMOS Essential	$42,937.49
Rate for Payer: United Healthcare Essential Plan 1&2	$42,937.49
Rate for Payer: United Healthcare Essential Plan 3&4	$42,937.49
Rate for Payer: United Healthcare Medicaid	$19,083.33
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,083.33

APR-DRG 5182: Other female reproductive system & related procedures

Facility

$48,681.54

Service Code	APR-DRG 5182
Min. Negotiated Rate	$10,414.00
Max. Negotiated Rate	$48,681.54
Rate for Payer: Affinity Essential Plan 1&2	$48,681.54
Rate for Payer: Affinity Essential Plan 3&4	$48,681.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$21,636.24
Rate for Payer: Amida Care Medicaid	$21,636.24
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,636.24
Rate for Payer: Fidelis Qualified Health Plan	$25,963.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,636.24
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,636.24
Rate for Payer: Healthfirst Commercial	$18,369.00
Rate for Payer: Healthfirst Essential Plan	$48,681.54
Rate for Payer: Healthfirst QHP	$10,414.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,636.24
Rate for Payer: SOMOS Essential	$48,681.54
Rate for Payer: United Healthcare Essential Plan 1&2	$48,681.54
Rate for Payer: United Healthcare Essential Plan 3&4	$48,681.54
Rate for Payer: United Healthcare Medicaid	$21,636.24
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,636.24

APR-DRG 5183: Other female reproductive system & related procedures

Facility

$66,907.44

Service Code	APR-DRG 5183
Min. Negotiated Rate	$21,472.00
Max. Negotiated Rate	$66,907.44
Rate for Payer: Affinity Essential Plan 1&2	$66,907.44
Rate for Payer: Affinity Essential Plan 3&4	$66,907.44
Rate for Payer: Affinity Medicaid/CHP/HARP	$29,736.64
Rate for Payer: Amida Care Medicaid	$29,736.64
Rate for Payer: Fidelis CHP/HARP/Medicaid	$29,736.64
Rate for Payer: Fidelis Qualified Health Plan	$35,683.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$29,736.64
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29,736.64
Rate for Payer: Healthfirst Commercial	$38,226.00
Rate for Payer: Healthfirst Essential Plan	$66,907.44
Rate for Payer: Healthfirst QHP	$21,472.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$29,736.64
Rate for Payer: SOMOS Essential	$66,907.44
Rate for Payer: United Healthcare Essential Plan 1&2	$66,907.44
Rate for Payer: United Healthcare Essential Plan 3&4	$66,907.44
Rate for Payer: United Healthcare Medicaid	$29,736.64
Rate for Payer: Wellcare CHP/FHP/Medicaid	$29,736.64

APR-DRG 5184: Other female reproductive system & related procedures

Facility

$134,779.21

Service Code	APR-DRG 5184
Min. Negotiated Rate	$47,451.00
Max. Negotiated Rate	$134,779.21
Rate for Payer: Affinity Essential Plan 1&2	$134,779.21
Rate for Payer: Affinity Essential Plan 3&4	$134,779.21
Rate for Payer: Affinity Medicaid/CHP/HARP	$59,901.87
Rate for Payer: Amida Care Medicaid	$59,901.87
Rate for Payer: Fidelis CHP/HARP/Medicaid	$59,901.87
Rate for Payer: Fidelis Qualified Health Plan	$71,882.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$59,901.87
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$59,901.87
Rate for Payer: Healthfirst Commercial	$86,043.00
Rate for Payer: Healthfirst Essential Plan	$134,779.21
Rate for Payer: Healthfirst QHP	$47,451.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$59,901.87
Rate for Payer: SOMOS Essential	$134,779.21
Rate for Payer: United Healthcare Essential Plan 1&2	$134,779.21
Rate for Payer: United Healthcare Essential Plan 3&4	$134,779.21
Rate for Payer: United Healthcare Medicaid	$59,901.87
Rate for Payer: Wellcare CHP/FHP/Medicaid	$59,901.87

APR-DRG 5191: Uterine & adnexa procedures for leiomyoma

Facility

$44,747.24

Service Code	APR-DRG 5191
Min. Negotiated Rate	$8,858.00
Max. Negotiated Rate	$44,747.24
Rate for Payer: Affinity Essential Plan 1&2	$44,747.24
Rate for Payer: Affinity Essential Plan 3&4	$44,747.24
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,887.66
Rate for Payer: Amida Care Medicaid	$19,887.66
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,887.66
Rate for Payer: Fidelis Qualified Health Plan	$23,865.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,887.66
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,887.66
Rate for Payer: Healthfirst Commercial	$15,315.00
Rate for Payer: Healthfirst Essential Plan	$44,747.24
Rate for Payer: Healthfirst QHP	$8,858.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,887.66
Rate for Payer: SOMOS Essential	$44,747.24
Rate for Payer: United Healthcare Essential Plan 1&2	$44,747.24
Rate for Payer: United Healthcare Essential Plan 3&4	$44,747.24
Rate for Payer: United Healthcare Medicaid	$19,887.66
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,887.66

APR-DRG 5192: Uterine & adnexa procedures for leiomyoma

Facility

$48,551.40

Service Code	APR-DRG 5192
Min. Negotiated Rate	$10,454.00
Max. Negotiated Rate	$48,551.40
Rate for Payer: Affinity Essential Plan 1&2	$48,551.40
Rate for Payer: Affinity Essential Plan 3&4	$48,551.40
Rate for Payer: Affinity Medicaid/CHP/HARP	$21,578.40
Rate for Payer: Amida Care Medicaid	$21,578.40
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,578.40
Rate for Payer: Fidelis Qualified Health Plan	$25,894.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,578.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,578.40
Rate for Payer: Healthfirst Commercial	$18,380.00
Rate for Payer: Healthfirst Essential Plan	$48,551.40
Rate for Payer: Healthfirst QHP	$10,454.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,578.40
Rate for Payer: SOMOS Essential	$48,551.40
Rate for Payer: United Healthcare Essential Plan 1&2	$48,551.40
Rate for Payer: United Healthcare Essential Plan 3&4	$48,551.40
Rate for Payer: United Healthcare Medicaid	$21,578.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,578.40

APR-DRG 5193: Uterine & adnexa procedures for leiomyoma

Facility

$64,454.00

Service Code	APR-DRG 5193
Min. Negotiated Rate	$19,090.00
Max. Negotiated Rate	$64,454.00
Rate for Payer: Affinity Essential Plan 1&2	$64,454.00
Rate for Payer: Affinity Essential Plan 3&4	$64,454.00
Rate for Payer: Affinity Medicaid/CHP/HARP	$28,646.22
Rate for Payer: Amida Care Medicaid	$28,646.22
Rate for Payer: Fidelis CHP/HARP/Medicaid	$28,646.22
Rate for Payer: Fidelis Qualified Health Plan	$34,375.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$28,646.22
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$28,646.22
Rate for Payer: Healthfirst Commercial	$36,234.00
Rate for Payer: Healthfirst Essential Plan	$64,454.00
Rate for Payer: Healthfirst QHP	$19,090.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$28,646.22
Rate for Payer: SOMOS Essential	$64,454.00
Rate for Payer: United Healthcare Essential Plan 1&2	$64,454.00
Rate for Payer: United Healthcare Essential Plan 3&4	$64,454.00
Rate for Payer: United Healthcare Medicaid	$28,646.22
Rate for Payer: Wellcare CHP/FHP/Medicaid	$28,646.22

APR-DRG 5194: Uterine & adnexa procedures for leiomyoma

Facility

$136,026.16

Service Code	APR-DRG 5194
Min. Negotiated Rate	$41,268.00
Max. Negotiated Rate	$136,026.16
Rate for Payer: Affinity Essential Plan 1&2	$136,026.16
Rate for Payer: Affinity Essential Plan 3&4	$136,026.16
Rate for Payer: Affinity Medicaid/CHP/HARP	$60,456.07
Rate for Payer: Amida Care Medicaid	$60,456.07
Rate for Payer: Fidelis CHP/HARP/Medicaid	$60,456.07
Rate for Payer: Fidelis Qualified Health Plan	$72,547.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$60,456.07
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$60,456.07
Rate for Payer: Healthfirst Commercial	$63,408.00
Rate for Payer: Healthfirst Essential Plan	$136,026.16
Rate for Payer: Healthfirst QHP	$41,268.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$60,456.07
Rate for Payer: SOMOS Essential	$136,026.16
Rate for Payer: United Healthcare Essential Plan 1&2	$136,026.16
Rate for Payer: United Healthcare Essential Plan 3&4	$136,026.16
Rate for Payer: United Healthcare Medicaid	$60,456.07
Rate for Payer: Wellcare CHP/FHP/Medicaid	$60,456.07

APR-DRG 5301: Female reproductive system malignancy

Facility

$40,374.99

Service Code	APR-DRG 5301
Min. Negotiated Rate	$6,044.00
Max. Negotiated Rate	$40,374.99
Rate for Payer: Affinity Essential Plan 1&2	$40,374.99
Rate for Payer: Affinity Essential Plan 3&4	$40,374.99
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,944.44
Rate for Payer: Amida Care Medicaid	$17,944.44
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,944.44
Rate for Payer: Fidelis Qualified Health Plan	$21,533.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,944.44
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,944.44
Rate for Payer: Healthfirst Commercial	$11,729.00
Rate for Payer: Healthfirst Essential Plan	$40,374.99
Rate for Payer: Healthfirst QHP	$6,044.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,944.44
Rate for Payer: SOMOS Essential	$40,374.99
Rate for Payer: United Healthcare Essential Plan 1&2	$40,374.99
Rate for Payer: United Healthcare Essential Plan 3&4	$40,374.99
Rate for Payer: United Healthcare Medicaid	$17,944.44
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,944.44

APR-DRG 5302: Female reproductive system malignancy

Facility

$43,401.80

Service Code	APR-DRG 5302
Min. Negotiated Rate	$8,372.00
Max. Negotiated Rate	$43,401.80
Rate for Payer: Affinity Essential Plan 1&2	$43,401.80
Rate for Payer: Affinity Essential Plan 3&4	$43,401.80
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,289.69
Rate for Payer: Amida Care Medicaid	$19,289.69
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,289.69
Rate for Payer: Fidelis Qualified Health Plan	$23,147.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,289.69
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,289.69
Rate for Payer: Healthfirst Commercial	$14,091.00
Rate for Payer: Healthfirst Essential Plan	$43,401.80
Rate for Payer: Healthfirst QHP	$8,372.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,289.69
Rate for Payer: SOMOS Essential	$43,401.80
Rate for Payer: United Healthcare Essential Plan 1&2	$43,401.80
Rate for Payer: United Healthcare Essential Plan 3&4	$43,401.80
Rate for Payer: United Healthcare Medicaid	$19,289.69
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,289.69

APR-DRG 5303: Female reproductive system malignancy

Facility

$55,178.35

Service Code	APR-DRG 5303
Min. Negotiated Rate	$15,788.00
Max. Negotiated Rate	$55,178.35
Rate for Payer: Affinity Essential Plan 1&2	$55,178.35
Rate for Payer: Affinity Essential Plan 3&4	$55,178.35
Rate for Payer: Affinity Medicaid/CHP/HARP	$24,523.71
Rate for Payer: Amida Care Medicaid	$24,523.71
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,523.71
Rate for Payer: Fidelis Qualified Health Plan	$29,428.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,523.71
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,523.71
Rate for Payer: Healthfirst Commercial	$25,697.00
Rate for Payer: Healthfirst Essential Plan	$55,178.35
Rate for Payer: Healthfirst QHP	$15,788.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,523.71
Rate for Payer: SOMOS Essential	$55,178.35
Rate for Payer: United Healthcare Essential Plan 1&2	$55,178.35
Rate for Payer: United Healthcare Essential Plan 3&4	$55,178.35
Rate for Payer: United Healthcare Medicaid	$24,523.71
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,523.71

APR-DRG 5304: Female reproductive system malignancy

Facility

$73,736.64

Service Code	APR-DRG 5304
Min. Negotiated Rate	$30,107.00
Max. Negotiated Rate	$73,736.64
Rate for Payer: Affinity Essential Plan 1&2	$73,736.64
Rate for Payer: Affinity Essential Plan 3&4	$73,736.64
Rate for Payer: Affinity Medicaid/CHP/HARP	$32,771.84
Rate for Payer: Amida Care Medicaid	$32,771.84
Rate for Payer: Fidelis CHP/HARP/Medicaid	$32,771.84
Rate for Payer: Fidelis Qualified Health Plan	$39,326.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$32,771.84
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$32,771.84
Rate for Payer: Healthfirst Commercial	$45,153.00
Rate for Payer: Healthfirst Essential Plan	$73,736.64
Rate for Payer: Healthfirst QHP	$30,107.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$32,771.84
Rate for Payer: SOMOS Essential	$73,736.64
Rate for Payer: United Healthcare Essential Plan 1&2	$73,736.64
Rate for Payer: United Healthcare Essential Plan 3&4	$73,736.64
Rate for Payer: United Healthcare Medicaid	$32,771.84
Rate for Payer: Wellcare CHP/FHP/Medicaid	$32,771.84

APR-DRG 5311: Female reproductive system infections

Facility

$39,140.35

Service Code	APR-DRG 5311
Min. Negotiated Rate	$6,223.00
Max. Negotiated Rate	$39,140.35
Rate for Payer: Affinity Essential Plan 1&2	$39,140.35
Rate for Payer: Affinity Essential Plan 3&4	$39,140.35
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,395.71
Rate for Payer: Amida Care Medicaid	$17,395.71
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,395.71
Rate for Payer: Fidelis Qualified Health Plan	$20,874.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,395.71
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,395.71
Rate for Payer: Healthfirst Commercial	$10,390.00
Rate for Payer: Healthfirst Essential Plan	$39,140.35
Rate for Payer: Healthfirst QHP	$6,223.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,395.71
Rate for Payer: SOMOS Essential	$39,140.35
Rate for Payer: United Healthcare Essential Plan 1&2	$39,140.35
Rate for Payer: United Healthcare Essential Plan 3&4	$39,140.35
Rate for Payer: United Healthcare Medicaid	$17,395.71
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,395.71

APR-DRG 5312: Female reproductive system infections

Facility

$42,487.24

Service Code	APR-DRG 5312
Min. Negotiated Rate	$7,761.00
Max. Negotiated Rate	$42,487.24
Rate for Payer: Affinity Essential Plan 1&2	$42,487.24
Rate for Payer: Affinity Essential Plan 3&4	$42,487.24
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,883.22
Rate for Payer: Amida Care Medicaid	$18,883.22
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,883.22
Rate for Payer: Fidelis Qualified Health Plan	$22,659.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,883.22
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,883.22
Rate for Payer: Healthfirst Commercial	$13,038.00
Rate for Payer: Healthfirst Essential Plan	$42,487.24
Rate for Payer: Healthfirst QHP	$7,761.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,883.22
Rate for Payer: SOMOS Essential	$42,487.24
Rate for Payer: United Healthcare Essential Plan 1&2	$42,487.24
Rate for Payer: United Healthcare Essential Plan 3&4	$42,487.24
Rate for Payer: United Healthcare Medicaid	$18,883.22
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,883.22

APR-DRG 5313: Female reproductive system infections

Facility

$50,027.00

Service Code	APR-DRG 5313
Min. Negotiated Rate	$11,377.00
Max. Negotiated Rate	$50,027.00
Rate for Payer: Affinity Essential Plan 1&2	$50,027.00
Rate for Payer: Affinity Essential Plan 3&4	$50,027.00
Rate for Payer: Affinity Medicaid/CHP/HARP	$22,234.22
Rate for Payer: Amida Care Medicaid	$22,234.22
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,234.22
Rate for Payer: Fidelis Qualified Health Plan	$26,681.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,234.22
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,234.22
Rate for Payer: Healthfirst Commercial	$20,491.00
Rate for Payer: Healthfirst Essential Plan	$50,027.00
Rate for Payer: Healthfirst QHP	$11,377.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,234.22
Rate for Payer: SOMOS Essential	$50,027.00
Rate for Payer: United Healthcare Essential Plan 1&2	$50,027.00
Rate for Payer: United Healthcare Essential Plan 3&4	$50,027.00
Rate for Payer: United Healthcare Medicaid	$22,234.22
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,234.22

APR-DRG 5314: Female reproductive system infections

Facility

$52,540.24

Service Code	APR-DRG 5314
Min. Negotiated Rate	$11,825.00
Max. Negotiated Rate	$52,540.24
Rate for Payer: Affinity Essential Plan 1&2	$52,540.24
Rate for Payer: Affinity Essential Plan 3&4	$52,540.24
Rate for Payer: Affinity Medicaid/CHP/HARP	$23,351.22
Rate for Payer: Amida Care Medicaid	$23,351.22
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,351.22
Rate for Payer: Fidelis Qualified Health Plan	$28,021.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,351.22
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,351.22
Rate for Payer: Healthfirst Commercial	$21,124.00
Rate for Payer: Healthfirst Essential Plan	$52,540.24
Rate for Payer: Healthfirst QHP	$11,825.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,351.22
Rate for Payer: SOMOS Essential	$52,540.24
Rate for Payer: United Healthcare Essential Plan 1&2	$52,540.24
Rate for Payer: United Healthcare Essential Plan 3&4	$52,540.24
Rate for Payer: United Healthcare Medicaid	$23,351.22
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,351.22

APR-DRG 5321: Menstrual & other female reproductive system disorders

Facility

$36,743.18

Service Code	APR-DRG 5321
Min. Negotiated Rate	$5,374.00
Max. Negotiated Rate	$36,743.18
Rate for Payer: Affinity Essential Plan 1&2	$36,743.18
Rate for Payer: Affinity Essential Plan 3&4	$36,743.18
Rate for Payer: Affinity Medicaid/CHP/HARP	$16,330.30
Rate for Payer: Amida Care Medicaid	$16,330.30
Rate for Payer: Fidelis CHP/HARP/Medicaid	$16,330.30
Rate for Payer: Fidelis Qualified Health Plan	$19,596.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$16,330.30
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16,330.30
Rate for Payer: Healthfirst Commercial	$9,010.00
Rate for Payer: Healthfirst Essential Plan	$36,743.18
Rate for Payer: Healthfirst QHP	$5,374.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$16,330.30
Rate for Payer: SOMOS Essential	$36,743.18
Rate for Payer: United Healthcare Essential Plan 1&2	$36,743.18
Rate for Payer: United Healthcare Essential Plan 3&4	$36,743.18
Rate for Payer: United Healthcare Medicaid	$16,330.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,330.30

APR-DRG 5322: Menstrual & other female reproductive system disorders

Facility

$39,469.23

Service Code	APR-DRG 5322
Min. Negotiated Rate	$6,325.00
Max. Negotiated Rate	$39,469.23
Rate for Payer: Affinity Essential Plan 1&2	$39,469.23
Rate for Payer: Affinity Essential Plan 3&4	$39,469.23
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,541.88
Rate for Payer: Amida Care Medicaid	$17,541.88
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,541.88
Rate for Payer: Fidelis Qualified Health Plan	$21,050.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,541.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,541.88
Rate for Payer: Healthfirst Commercial	$10,544.00
Rate for Payer: Healthfirst Essential Plan	$39,469.23
Rate for Payer: Healthfirst QHP	$6,325.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,541.88
Rate for Payer: SOMOS Essential	$39,469.23
Rate for Payer: United Healthcare Essential Plan 1&2	$39,469.23
Rate for Payer: United Healthcare Essential Plan 3&4	$39,469.23
Rate for Payer: United Healthcare Medicaid	$17,541.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,541.88

APR-DRG 5323: Menstrual & other female reproductive system disorders

Facility

$46,715.26

Service Code	APR-DRG 5323
Min. Negotiated Rate	$11,123.00
Max. Negotiated Rate	$46,715.26
Rate for Payer: Affinity Essential Plan 1&2	$46,715.26
Rate for Payer: Affinity Essential Plan 3&4	$46,715.26
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,762.34
Rate for Payer: Amida Care Medicaid	$20,762.34
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,762.34
Rate for Payer: Fidelis Qualified Health Plan	$24,914.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,762.34
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,762.34
Rate for Payer: Healthfirst Commercial	$19,456.00
Rate for Payer: Healthfirst Essential Plan	$46,715.26
Rate for Payer: Healthfirst QHP	$11,123.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,762.34
Rate for Payer: SOMOS Essential	$46,715.26
Rate for Payer: United Healthcare Essential Plan 1&2	$46,715.26
Rate for Payer: United Healthcare Essential Plan 3&4	$46,715.26
Rate for Payer: United Healthcare Medicaid	$20,762.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,762.34

APR-DRG 5324: Menstrual & other female reproductive system disorders

Facility

$47,737.10

Service Code	APR-DRG 5324
Min. Negotiated Rate	$11,429.00
Max. Negotiated Rate	$47,737.10
Rate for Payer: Affinity Essential Plan 1&2	$47,737.10
Rate for Payer: Affinity Essential Plan 3&4	$47,737.10
Rate for Payer: Affinity Medicaid/CHP/HARP	$21,216.49
Rate for Payer: Amida Care Medicaid	$21,216.49
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,216.49
Rate for Payer: Fidelis Qualified Health Plan	$25,459.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,216.49
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,216.49
Rate for Payer: Healthfirst Commercial	$19,725.00
Rate for Payer: Healthfirst Essential Plan	$47,737.10
Rate for Payer: Healthfirst QHP	$11,429.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,216.49
Rate for Payer: SOMOS Essential	$47,737.10
Rate for Payer: United Healthcare Essential Plan 1&2	$47,737.10
Rate for Payer: United Healthcare Essential Plan 3&4	$47,737.10
Rate for Payer: United Healthcare Medicaid	$21,216.49
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,216.49

APR-DRG 5401: Cesarean delivery

Facility

$43,732.44

Service Code	APR-DRG 5401
Min. Negotiated Rate	$7,871.00
Max. Negotiated Rate	$43,732.44
Rate for Payer: Affinity Essential Plan 1&2	$43,732.44
Rate for Payer: Affinity Essential Plan 3&4	$43,732.44
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,436.64
Rate for Payer: Amida Care Medicaid	$19,436.64
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,436.64
Rate for Payer: Fidelis Qualified Health Plan	$23,323.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,436.64
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,436.64
Rate for Payer: Healthfirst Commercial	$13,706.00
Rate for Payer: Healthfirst Essential Plan	$43,732.44
Rate for Payer: Healthfirst QHP	$7,871.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,436.64
Rate for Payer: SOMOS Essential	$43,732.44
Rate for Payer: United Healthcare Essential Plan 1&2	$43,732.44
Rate for Payer: United Healthcare Essential Plan 3&4	$43,732.44
Rate for Payer: United Healthcare Medicaid	$19,436.64
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,436.64

APR-DRG 5402: Cesarean delivery

Facility

$45,800.73

Service Code	APR-DRG 5402
Min. Negotiated Rate	$8,879.00
Max. Negotiated Rate	$45,800.73
Rate for Payer: Affinity Essential Plan 1&2	$45,800.73
Rate for Payer: Affinity Essential Plan 3&4	$45,800.73
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,355.88
Rate for Payer: Amida Care Medicaid	$20,355.88
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,355.88
Rate for Payer: Fidelis Qualified Health Plan	$24,427.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,355.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,355.88
Rate for Payer: Healthfirst Commercial	$15,355.00
Rate for Payer: Healthfirst Essential Plan	$45,800.73
Rate for Payer: Healthfirst QHP	$8,879.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,355.88
Rate for Payer: SOMOS Essential	$45,800.73
Rate for Payer: United Healthcare Essential Plan 1&2	$45,800.73
Rate for Payer: United Healthcare Essential Plan 3&4	$45,800.73
Rate for Payer: United Healthcare Medicaid	$20,355.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,355.88

APR-DRG 5403: Cesarean delivery

Facility

$50,333.02

Service Code	APR-DRG 5403
Min. Negotiated Rate	$11,575.00
Max. Negotiated Rate	$50,333.02
Rate for Payer: Affinity Essential Plan 1&2	$50,333.02
Rate for Payer: Affinity Essential Plan 3&4	$50,333.02
Rate for Payer: Affinity Medicaid/CHP/HARP	$22,370.23
Rate for Payer: Amida Care Medicaid	$22,370.23
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,370.23
Rate for Payer: Fidelis Qualified Health Plan	$26,844.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,370.23
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,370.23
Rate for Payer: Healthfirst Commercial	$19,401.00
Rate for Payer: Healthfirst Essential Plan	$50,333.02
Rate for Payer: Healthfirst QHP	$11,575.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,370.23
Rate for Payer: SOMOS Essential	$50,333.02
Rate for Payer: United Healthcare Essential Plan 1&2	$50,333.02
Rate for Payer: United Healthcare Essential Plan 3&4	$50,333.02
Rate for Payer: United Healthcare Medicaid	$22,370.23
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,370.23

APR-DRG 5404: Cesarean delivery

Facility

$77,227.76

Service Code	APR-DRG 5404
Min. Negotiated Rate	$22,467.00
Max. Negotiated Rate	$77,227.76
Rate for Payer: Affinity Essential Plan 1&2	$77,227.76
Rate for Payer: Affinity Essential Plan 3&4	$77,227.76
Rate for Payer: Affinity Medicaid/CHP/HARP	$34,323.45
Rate for Payer: Amida Care Medicaid	$34,323.45
Rate for Payer: Fidelis CHP/HARP/Medicaid	$34,323.45
Rate for Payer: Fidelis Qualified Health Plan	$41,188.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$34,323.45
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$34,323.45
Rate for Payer: Healthfirst Commercial	$40,804.00
Rate for Payer: Healthfirst Essential Plan	$77,227.76
Rate for Payer: Healthfirst QHP	$22,467.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$34,323.45
Rate for Payer: SOMOS Essential	$77,227.76
Rate for Payer: United Healthcare Essential Plan 1&2	$77,227.76
Rate for Payer: United Healthcare Essential Plan 3&4	$77,227.76
Rate for Payer: United Healthcare Medicaid	$34,323.45
Rate for Payer: Wellcare CHP/FHP/Medicaid	$34,323.45

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