St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

APR-DRG 5813: Neonate, transferred < 5 days old, born here

Facility

$34,462.08

Service Code	APR-DRG 5813
Min. Negotiated Rate	$3,631.00
Max. Negotiated Rate	$34,462.08
Rate for Payer: Affinity Essential Plan 1&2	$34,462.08
Rate for Payer: Affinity Essential Plan 3&4	$34,462.08
Rate for Payer: Affinity Medicaid/CHP/HARP	$15,316.48
Rate for Payer: Amida Care Medicaid	$15,316.48
Rate for Payer: Fidelis CHP/HARP/Medicaid	$15,316.48
Rate for Payer: Fidelis Qualified Health Plan	$18,379.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$15,316.48
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$15,316.48
Rate for Payer: Healthfirst Commercial	$6,453.00
Rate for Payer: Healthfirst Essential Plan	$34,462.08
Rate for Payer: Healthfirst QHP	$3,631.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$15,316.48
Rate for Payer: SOMOS Essential	$34,462.08
Rate for Payer: United Healthcare Essential Plan 1&2	$34,462.08
Rate for Payer: United Healthcare Essential Plan 3&4	$34,462.08
Rate for Payer: United Healthcare Medicaid	$15,316.48
Rate for Payer: Wellcare CHP/FHP/Medicaid	$15,316.48

APR-DRG 5814: Neonate, transferred < 5 days old, born here

Facility

$38,341.89

Service Code	APR-DRG 5814
Min. Negotiated Rate	$5,093.00
Max. Negotiated Rate	$38,341.89
Rate for Payer: Affinity Essential Plan 1&2	$38,341.89
Rate for Payer: Affinity Essential Plan 3&4	$38,341.89
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,040.84
Rate for Payer: Amida Care Medicaid	$17,040.84
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,040.84
Rate for Payer: Fidelis Qualified Health Plan	$20,449.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,040.84
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,040.84
Rate for Payer: Healthfirst Commercial	$9,907.00
Rate for Payer: Healthfirst Essential Plan	$38,341.89
Rate for Payer: Healthfirst QHP	$5,093.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,040.84
Rate for Payer: SOMOS Essential	$38,341.89
Rate for Payer: United Healthcare Essential Plan 1&2	$38,341.89
Rate for Payer: United Healthcare Essential Plan 3&4	$38,341.89
Rate for Payer: United Healthcare Medicaid	$17,040.84
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,040.84

APR-DRG 5831: Neonate w ECMO

Facility

$281,486.79

Service Code	APR-DRG 5831
Min. Negotiated Rate	$125,105.24
Max. Negotiated Rate	$281,486.79
Rate for Payer: Affinity Essential Plan 1&2	$281,486.79
Rate for Payer: Affinity Essential Plan 3&4	$281,486.79
Rate for Payer: Affinity Medicaid/CHP/HARP	$125,105.24
Rate for Payer: Amida Care Medicaid	$125,105.24
Rate for Payer: Fidelis CHP/HARP/Medicaid	$125,105.24
Rate for Payer: Fidelis Qualified Health Plan	$150,126.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$125,105.24
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$125,105.24
Rate for Payer: Healthfirst Commercial	$239,949.00
Rate for Payer: Healthfirst Essential Plan	$281,486.79
Rate for Payer: Healthfirst QHP	$178,464.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$125,105.24
Rate for Payer: SOMOS Essential	$281,486.79
Rate for Payer: United Healthcare Essential Plan 1&2	$281,486.79
Rate for Payer: United Healthcare Essential Plan 3&4	$281,486.79
Rate for Payer: United Healthcare Medicaid	$125,105.24
Rate for Payer: Wellcare CHP/FHP/Medicaid	$125,105.24

APR-DRG 5832: Neonate w ECMO

Facility

$281,486.79

Service Code	APR-DRG 5832
Min. Negotiated Rate	$125,105.24
Max. Negotiated Rate	$281,486.79
Rate for Payer: Affinity Essential Plan 1&2	$281,486.79
Rate for Payer: Affinity Essential Plan 3&4	$281,486.79
Rate for Payer: Affinity Medicaid/CHP/HARP	$125,105.24
Rate for Payer: Amida Care Medicaid	$125,105.24
Rate for Payer: Fidelis CHP/HARP/Medicaid	$125,105.24
Rate for Payer: Fidelis Qualified Health Plan	$150,126.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$125,105.24
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$125,105.24
Rate for Payer: Healthfirst Commercial	$239,949.00
Rate for Payer: Healthfirst Essential Plan	$281,486.79
Rate for Payer: Healthfirst QHP	$178,464.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$125,105.24
Rate for Payer: SOMOS Essential	$281,486.79
Rate for Payer: United Healthcare Essential Plan 1&2	$281,486.79
Rate for Payer: United Healthcare Essential Plan 3&4	$281,486.79
Rate for Payer: United Healthcare Medicaid	$125,105.24
Rate for Payer: Wellcare CHP/FHP/Medicaid	$125,105.24

APR-DRG 5833: Neonate w ECMO

Facility

$286,286.40

Service Code	APR-DRG 5833
Min. Negotiated Rate	$127,238.40
Max. Negotiated Rate	$286,286.40
Rate for Payer: Affinity Essential Plan 1&2	$286,286.40
Rate for Payer: Affinity Essential Plan 3&4	$286,286.40
Rate for Payer: Affinity Medicaid/CHP/HARP	$127,238.40
Rate for Payer: Amida Care Medicaid	$127,238.40
Rate for Payer: Fidelis CHP/HARP/Medicaid	$127,238.40
Rate for Payer: Fidelis Qualified Health Plan	$152,686.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$127,238.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$127,238.40
Rate for Payer: Healthfirst Commercial	$240,996.00
Rate for Payer: Healthfirst Essential Plan	$286,286.40
Rate for Payer: Healthfirst QHP	$178,464.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$127,238.40
Rate for Payer: SOMOS Essential	$286,286.40
Rate for Payer: United Healthcare Essential Plan 1&2	$286,286.40
Rate for Payer: United Healthcare Essential Plan 3&4	$286,286.40
Rate for Payer: United Healthcare Medicaid	$127,238.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$127,238.40

APR-DRG 5834: Neonate w ECMO

Facility

$481,389.41

Service Code	APR-DRG 5834
Min. Negotiated Rate	$213,950.85
Max. Negotiated Rate	$481,389.41
Rate for Payer: Affinity Essential Plan 1&2	$481,389.41
Rate for Payer: Affinity Essential Plan 3&4	$481,389.41
Rate for Payer: Affinity Medicaid/CHP/HARP	$213,950.85
Rate for Payer: Amida Care Medicaid	$213,950.85
Rate for Payer: Fidelis CHP/HARP/Medicaid	$213,950.85
Rate for Payer: Fidelis Qualified Health Plan	$256,741.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$213,950.85
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$213,950.85
Rate for Payer: Healthfirst Commercial	$337,304.00
Rate for Payer: Healthfirst Essential Plan	$481,389.41
Rate for Payer: Healthfirst QHP	$245,415.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$213,950.85
Rate for Payer: SOMOS Essential	$481,389.41
Rate for Payer: United Healthcare Essential Plan 1&2	$481,389.41
Rate for Payer: United Healthcare Essential Plan 3&4	$481,389.41
Rate for Payer: United Healthcare Medicaid	$213,950.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$213,950.85

APR-DRG 5881: Neonate bwt <1500g w major procedure

Facility

$369,160.29

Service Code	APR-DRG 5881
Min. Negotiated Rate	$160,731.00
Max. Negotiated Rate	$369,160.29
Rate for Payer: Affinity Essential Plan 1&2	$369,160.29
Rate for Payer: Affinity Essential Plan 3&4	$369,160.29
Rate for Payer: Affinity Medicaid/CHP/HARP	$164,071.24
Rate for Payer: Amida Care Medicaid	$164,071.24
Rate for Payer: Fidelis CHP/HARP/Medicaid	$164,071.24
Rate for Payer: Fidelis Qualified Health Plan	$196,885.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$164,071.24
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$164,071.24
Rate for Payer: Healthfirst Commercial	$324,052.00
Rate for Payer: Healthfirst Essential Plan	$369,160.29
Rate for Payer: Healthfirst QHP	$160,731.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$164,071.24
Rate for Payer: SOMOS Essential	$369,160.29
Rate for Payer: United Healthcare Essential Plan 1&2	$369,160.29
Rate for Payer: United Healthcare Essential Plan 3&4	$369,160.29
Rate for Payer: United Healthcare Medicaid	$164,071.24
Rate for Payer: Wellcare CHP/FHP/Medicaid	$164,071.24

APR-DRG 5882: Neonate bwt <1500g w major procedure

Facility

$369,160.29

Service Code	APR-DRG 5882
Min. Negotiated Rate	$160,731.00
Max. Negotiated Rate	$369,160.29
Rate for Payer: Affinity Essential Plan 1&2	$369,160.29
Rate for Payer: Affinity Essential Plan 3&4	$369,160.29
Rate for Payer: Affinity Medicaid/CHP/HARP	$164,071.24
Rate for Payer: Amida Care Medicaid	$164,071.24
Rate for Payer: Fidelis CHP/HARP/Medicaid	$164,071.24
Rate for Payer: Fidelis Qualified Health Plan	$196,885.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$164,071.24
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$164,071.24
Rate for Payer: Healthfirst Commercial	$324,052.00
Rate for Payer: Healthfirst Essential Plan	$369,160.29
Rate for Payer: Healthfirst QHP	$160,731.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$164,071.24
Rate for Payer: SOMOS Essential	$369,160.29
Rate for Payer: United Healthcare Essential Plan 1&2	$369,160.29
Rate for Payer: United Healthcare Essential Plan 3&4	$369,160.29
Rate for Payer: United Healthcare Medicaid	$164,071.24
Rate for Payer: Wellcare CHP/FHP/Medicaid	$164,071.24

APR-DRG 5883: Neonate bwt <1500g w major procedure

Facility

$473,448.67

Service Code	APR-DRG 5883
Min. Negotiated Rate	$163,085.00
Max. Negotiated Rate	$473,448.67
Rate for Payer: Affinity Essential Plan 1&2	$473,448.67
Rate for Payer: Affinity Essential Plan 3&4	$473,448.67
Rate for Payer: Affinity Medicaid/CHP/HARP	$210,421.63
Rate for Payer: Amida Care Medicaid	$210,421.63
Rate for Payer: Fidelis CHP/HARP/Medicaid	$210,421.63
Rate for Payer: Fidelis Qualified Health Plan	$252,505.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$210,421.63
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$210,421.63
Rate for Payer: Healthfirst Commercial	$332,949.00
Rate for Payer: Healthfirst Essential Plan	$473,448.67
Rate for Payer: Healthfirst QHP	$163,085.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$210,421.63
Rate for Payer: SOMOS Essential	$473,448.67
Rate for Payer: United Healthcare Essential Plan 1&2	$473,448.67
Rate for Payer: United Healthcare Essential Plan 3&4	$473,448.67
Rate for Payer: United Healthcare Medicaid	$210,421.63
Rate for Payer: Wellcare CHP/FHP/Medicaid	$210,421.63

APR-DRG 5884: Neonate bwt <1500g w major procedure

Facility

$473,448.67

Service Code	APR-DRG 5884
Min. Negotiated Rate	$207,179.00
Max. Negotiated Rate	$473,448.67
Rate for Payer: Affinity Essential Plan 1&2	$473,448.67
Rate for Payer: Affinity Essential Plan 3&4	$473,448.67
Rate for Payer: Affinity Medicaid/CHP/HARP	$210,421.63
Rate for Payer: Amida Care Medicaid	$210,421.63
Rate for Payer: Fidelis CHP/HARP/Medicaid	$210,421.63
Rate for Payer: Fidelis Qualified Health Plan	$252,505.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$210,421.63
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$210,421.63
Rate for Payer: Healthfirst Commercial	$446,163.00
Rate for Payer: Healthfirst Essential Plan	$473,448.67
Rate for Payer: Healthfirst QHP	$207,179.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$210,421.63
Rate for Payer: SOMOS Essential	$473,448.67
Rate for Payer: United Healthcare Essential Plan 1&2	$473,448.67
Rate for Payer: United Healthcare Essential Plan 3&4	$473,448.67
Rate for Payer: United Healthcare Medicaid	$210,421.63
Rate for Payer: Wellcare CHP/FHP/Medicaid	$210,421.63

APR-DRG 5891: Neonate bwt <500g or GA <24 weeks

Facility

$243,135.56

Service Code	APR-DRG 5891
Min. Negotiated Rate	$82,660.00
Max. Negotiated Rate	$243,135.56
Rate for Payer: Affinity Essential Plan 1&2	$243,135.56
Rate for Payer: Affinity Essential Plan 3&4	$243,135.56
Rate for Payer: Affinity Medicaid/CHP/HARP	$108,060.25
Rate for Payer: Amida Care Medicaid	$108,060.25
Rate for Payer: Fidelis CHP/HARP/Medicaid	$108,060.25
Rate for Payer: Fidelis Qualified Health Plan	$129,672.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$108,060.25
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$108,060.25
Rate for Payer: Healthfirst Commercial	$158,643.00
Rate for Payer: Healthfirst Essential Plan	$243,135.56
Rate for Payer: Healthfirst QHP	$82,660.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$108,060.25
Rate for Payer: SOMOS Essential	$243,135.56
Rate for Payer: United Healthcare Essential Plan 1&2	$243,135.56
Rate for Payer: United Healthcare Essential Plan 3&4	$243,135.56
Rate for Payer: United Healthcare Medicaid	$108,060.25
Rate for Payer: Wellcare CHP/FHP/Medicaid	$108,060.25

APR-DRG 5892: Neonate bwt <500g or GA <24 weeks

Facility

$243,135.56

Service Code	APR-DRG 5892
Min. Negotiated Rate	$82,660.00
Max. Negotiated Rate	$243,135.56
Rate for Payer: Affinity Essential Plan 1&2	$243,135.56
Rate for Payer: Affinity Essential Plan 3&4	$243,135.56
Rate for Payer: Affinity Medicaid/CHP/HARP	$108,060.25
Rate for Payer: Amida Care Medicaid	$108,060.25
Rate for Payer: Fidelis CHP/HARP/Medicaid	$108,060.25
Rate for Payer: Fidelis Qualified Health Plan	$129,672.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$108,060.25
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$108,060.25
Rate for Payer: Healthfirst Commercial	$158,643.00
Rate for Payer: Healthfirst Essential Plan	$243,135.56
Rate for Payer: Healthfirst QHP	$82,660.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$108,060.25
Rate for Payer: SOMOS Essential	$243,135.56
Rate for Payer: United Healthcare Essential Plan 1&2	$243,135.56
Rate for Payer: United Healthcare Essential Plan 3&4	$243,135.56
Rate for Payer: United Healthcare Medicaid	$108,060.25
Rate for Payer: Wellcare CHP/FHP/Medicaid	$108,060.25

APR-DRG 5893: Neonate bwt <500g or GA <24 weeks

Facility

$107,026.20

Service Code	APR-DRG 5893
Min. Negotiated Rate	$25,253.00
Max. Negotiated Rate	$107,026.20
Rate for Payer: Affinity Essential Plan 1&2	$107,026.20
Rate for Payer: Affinity Essential Plan 3&4	$107,026.20
Rate for Payer: Affinity Medicaid/CHP/HARP	$47,567.20
Rate for Payer: Amida Care Medicaid	$47,567.20
Rate for Payer: Fidelis CHP/HARP/Medicaid	$47,567.20
Rate for Payer: Fidelis Qualified Health Plan	$57,080.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$47,567.20
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$47,567.20
Rate for Payer: Healthfirst Commercial	$86,730.00
Rate for Payer: Healthfirst Essential Plan	$107,026.20
Rate for Payer: Healthfirst QHP	$25,253.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$47,567.20
Rate for Payer: SOMOS Essential	$107,026.20
Rate for Payer: United Healthcare Essential Plan 1&2	$107,026.20
Rate for Payer: United Healthcare Essential Plan 3&4	$107,026.20
Rate for Payer: United Healthcare Medicaid	$47,567.20
Rate for Payer: Wellcare CHP/FHP/Medicaid	$47,567.20

APR-DRG 5894: Neonate bwt <500g or GA <24 weeks

Facility

$31,639.30

Service Code	APR-DRG 5894
Min. Negotiated Rate	$2,472.00
Max. Negotiated Rate	$31,639.30
Rate for Payer: Affinity Essential Plan 1&2	$31,639.30
Rate for Payer: Affinity Essential Plan 3&4	$31,639.30
Rate for Payer: Affinity Medicaid/CHP/HARP	$14,061.91
Rate for Payer: Amida Care Medicaid	$14,061.91
Rate for Payer: Fidelis CHP/HARP/Medicaid	$14,061.91
Rate for Payer: Fidelis Qualified Health Plan	$16,874.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$14,061.91
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$14,061.91
Rate for Payer: Healthfirst Commercial	$4,821.00
Rate for Payer: Healthfirst Essential Plan	$31,639.30
Rate for Payer: Healthfirst QHP	$2,472.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$14,061.91
Rate for Payer: SOMOS Essential	$31,639.30
Rate for Payer: United Healthcare Essential Plan 1&2	$31,639.30
Rate for Payer: United Healthcare Essential Plan 3&4	$31,639.30
Rate for Payer: United Healthcare Medicaid	$14,061.91
Rate for Payer: Wellcare CHP/FHP/Medicaid	$14,061.91

APR-DRG 5911: Neonate birthwt 500-749g w/o major procedure

Facility

$185,985.11

Service Code	APR-DRG 5911
Min. Negotiated Rate	$39,255.00
Max. Negotiated Rate	$185,985.11
Rate for Payer: Affinity Essential Plan 1&2	$185,985.11
Rate for Payer: Affinity Essential Plan 3&4	$185,985.11
Rate for Payer: Affinity Medicaid/CHP/HARP	$82,660.05
Rate for Payer: Amida Care Medicaid	$82,660.05
Rate for Payer: Fidelis CHP/HARP/Medicaid	$82,660.05
Rate for Payer: Fidelis Qualified Health Plan	$99,192.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$82,660.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$82,660.05
Rate for Payer: Healthfirst Commercial	$98,515.00
Rate for Payer: Healthfirst Essential Plan	$185,985.11
Rate for Payer: Healthfirst QHP	$39,255.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$82,660.05
Rate for Payer: SOMOS Essential	$185,985.11
Rate for Payer: United Healthcare Essential Plan 1&2	$185,985.11
Rate for Payer: United Healthcare Essential Plan 3&4	$185,985.11
Rate for Payer: United Healthcare Medicaid	$82,660.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$82,660.05

APR-DRG 5912: Neonate birthwt 500-749g w/o major procedure

Facility

$223,490.36

Service Code	APR-DRG 5912
Min. Negotiated Rate	$45,979.00
Max. Negotiated Rate	$223,490.36
Rate for Payer: Affinity Essential Plan 1&2	$223,490.36
Rate for Payer: Affinity Essential Plan 3&4	$223,490.36
Rate for Payer: Affinity Medicaid/CHP/HARP	$99,329.05
Rate for Payer: Amida Care Medicaid	$99,329.05
Rate for Payer: Fidelis CHP/HARP/Medicaid	$99,329.05
Rate for Payer: Fidelis Qualified Health Plan	$119,194.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$99,329.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$99,329.05
Rate for Payer: Healthfirst Commercial	$123,625.00
Rate for Payer: Healthfirst Essential Plan	$223,490.36
Rate for Payer: Healthfirst QHP	$45,979.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$99,329.05
Rate for Payer: SOMOS Essential	$223,490.36
Rate for Payer: United Healthcare Essential Plan 1&2	$223,490.36
Rate for Payer: United Healthcare Essential Plan 3&4	$223,490.36
Rate for Payer: United Healthcare Medicaid	$99,329.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$99,329.05

APR-DRG 5913: Neonate birthwt 500-749g w/o major procedure

Facility

$237,435.48

Service Code	APR-DRG 5913
Min. Negotiated Rate	$85,080.00
Max. Negotiated Rate	$237,435.48
Rate for Payer: Affinity Essential Plan 1&2	$237,435.48
Rate for Payer: Affinity Essential Plan 3&4	$237,435.48
Rate for Payer: Affinity Medicaid/CHP/HARP	$105,526.88
Rate for Payer: Amida Care Medicaid	$105,526.88
Rate for Payer: Fidelis CHP/HARP/Medicaid	$105,526.88
Rate for Payer: Fidelis Qualified Health Plan	$126,632.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$105,526.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$105,526.88
Rate for Payer: Healthfirst Commercial	$187,437.00
Rate for Payer: Healthfirst Essential Plan	$237,435.48
Rate for Payer: Healthfirst QHP	$85,080.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$105,526.88
Rate for Payer: SOMOS Essential	$237,435.48
Rate for Payer: United Healthcare Essential Plan 1&2	$237,435.48
Rate for Payer: United Healthcare Essential Plan 3&4	$237,435.48
Rate for Payer: United Healthcare Medicaid	$105,526.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$105,526.88

APR-DRG 5914: Neonate birthwt 500-749g w/o major procedure

Facility

$370,391.42

Service Code	APR-DRG 5914
Min. Negotiated Rate	$155,564.00
Max. Negotiated Rate	$370,391.42
Rate for Payer: Affinity Essential Plan 1&2	$370,391.42
Rate for Payer: Affinity Essential Plan 3&4	$370,391.42
Rate for Payer: Affinity Medicaid/CHP/HARP	$164,618.41
Rate for Payer: Amida Care Medicaid	$164,618.41
Rate for Payer: Fidelis CHP/HARP/Medicaid	$164,618.41
Rate for Payer: Fidelis Qualified Health Plan	$197,542.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$164,618.41
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$164,618.41
Rate for Payer: Healthfirst Commercial	$255,573.00
Rate for Payer: Healthfirst Essential Plan	$370,391.42
Rate for Payer: Healthfirst QHP	$155,564.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$164,618.41
Rate for Payer: SOMOS Essential	$370,391.42
Rate for Payer: United Healthcare Essential Plan 1&2	$370,391.42
Rate for Payer: United Healthcare Essential Plan 3&4	$370,391.42
Rate for Payer: United Healthcare Medicaid	$164,618.41
Rate for Payer: Wellcare CHP/FHP/Medicaid	$164,618.41

APR-DRG 5931: Neonate birthwt 750-999g w/o major procedure

Facility

$219,636.97

Service Code	APR-DRG 5931
Min. Negotiated Rate	$80,977.00
Max. Negotiated Rate	$219,636.97
Rate for Payer: Affinity Essential Plan 1&2	$219,636.97
Rate for Payer: Affinity Essential Plan 3&4	$219,636.97
Rate for Payer: Affinity Medicaid/CHP/HARP	$97,616.43
Rate for Payer: Amida Care Medicaid	$97,616.43
Rate for Payer: Fidelis CHP/HARP/Medicaid	$97,616.43
Rate for Payer: Fidelis Qualified Health Plan	$117,139.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$97,616.43
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$97,616.43
Rate for Payer: Healthfirst Commercial	$180,420.00
Rate for Payer: Healthfirst Essential Plan	$219,636.97
Rate for Payer: Healthfirst QHP	$80,977.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$97,616.43
Rate for Payer: SOMOS Essential	$219,636.97
Rate for Payer: United Healthcare Essential Plan 1&2	$219,636.97
Rate for Payer: United Healthcare Essential Plan 3&4	$219,636.97
Rate for Payer: United Healthcare Medicaid	$97,616.43
Rate for Payer: Wellcare CHP/FHP/Medicaid	$97,616.43

APR-DRG 5932: Neonate birthwt 750-999g w/o major procedure

Facility

$225,604.40

Service Code	APR-DRG 5932
Min. Negotiated Rate	$85,061.00
Max. Negotiated Rate	$225,604.40
Rate for Payer: Affinity Essential Plan 1&2	$225,604.40
Rate for Payer: Affinity Essential Plan 3&4	$225,604.40
Rate for Payer: Affinity Medicaid/CHP/HARP	$100,268.62
Rate for Payer: Amida Care Medicaid	$100,268.62
Rate for Payer: Fidelis CHP/HARP/Medicaid	$100,268.62
Rate for Payer: Fidelis Qualified Health Plan	$120,322.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$100,268.62
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$100,268.62
Rate for Payer: Healthfirst Commercial	$181,662.00
Rate for Payer: Healthfirst Essential Plan	$225,604.40
Rate for Payer: Healthfirst QHP	$85,061.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$100,268.62
Rate for Payer: SOMOS Essential	$225,604.40
Rate for Payer: United Healthcare Essential Plan 1&2	$225,604.40
Rate for Payer: United Healthcare Essential Plan 3&4	$225,604.40
Rate for Payer: United Healthcare Medicaid	$100,268.62
Rate for Payer: Wellcare CHP/FHP/Medicaid	$100,268.62

APR-DRG 5933: Neonate birthwt 750-999g w/o major procedure

Facility

$269,149.18

Service Code	APR-DRG 5933
Min. Negotiated Rate	$108,018.00
Max. Negotiated Rate	$269,149.18
Rate for Payer: Affinity Essential Plan 1&2	$269,149.18
Rate for Payer: Affinity Essential Plan 3&4	$269,149.18
Rate for Payer: Affinity Medicaid/CHP/HARP	$119,621.86
Rate for Payer: Amida Care Medicaid	$119,621.86
Rate for Payer: Fidelis CHP/HARP/Medicaid	$119,621.86
Rate for Payer: Fidelis Qualified Health Plan	$143,546.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$119,621.86
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$119,621.86
Rate for Payer: Healthfirst Commercial	$195,470.00
Rate for Payer: Healthfirst Essential Plan	$269,149.18
Rate for Payer: Healthfirst QHP	$108,018.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$119,621.86
Rate for Payer: SOMOS Essential	$269,149.18
Rate for Payer: United Healthcare Essential Plan 1&2	$269,149.18
Rate for Payer: United Healthcare Essential Plan 3&4	$269,149.18
Rate for Payer: United Healthcare Medicaid	$119,621.86
Rate for Payer: Wellcare CHP/FHP/Medicaid	$119,621.86

APR-DRG 5934: Neonate birthwt 750-999g w/o major procedure

Facility

$336,296.36

Service Code	APR-DRG 5934
Min. Negotiated Rate	$143,221.00
Max. Negotiated Rate	$336,296.36
Rate for Payer: Affinity Essential Plan 1&2	$336,296.36
Rate for Payer: Affinity Essential Plan 3&4	$336,296.36
Rate for Payer: Affinity Medicaid/CHP/HARP	$149,465.05
Rate for Payer: Amida Care Medicaid	$149,465.05
Rate for Payer: Fidelis CHP/HARP/Medicaid	$149,465.05
Rate for Payer: Fidelis Qualified Health Plan	$179,358.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$149,465.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$149,465.05
Rate for Payer: Healthfirst Commercial	$242,008.00
Rate for Payer: Healthfirst Essential Plan	$336,296.36
Rate for Payer: Healthfirst QHP	$143,221.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$149,465.05
Rate for Payer: SOMOS Essential	$336,296.36
Rate for Payer: United Healthcare Essential Plan 1&2	$336,296.36
Rate for Payer: United Healthcare Essential Plan 3&4	$336,296.36
Rate for Payer: United Healthcare Medicaid	$149,465.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$149,465.05

APR-DRG 6021: Neonate bwt 1000-1249g w resp dist synd/oth maj resp or maj anom

Facility

$143,833.23

Service Code	APR-DRG 6021
Min. Negotiated Rate	$49,534.00
Max. Negotiated Rate	$143,833.23
Rate for Payer: Affinity Essential Plan 1&2	$143,833.23
Rate for Payer: Affinity Essential Plan 3&4	$143,833.23
Rate for Payer: Affinity Medicaid/CHP/HARP	$63,925.88
Rate for Payer: Amida Care Medicaid	$63,925.88
Rate for Payer: Fidelis CHP/HARP/Medicaid	$63,925.88
Rate for Payer: Fidelis Qualified Health Plan	$76,711.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$63,925.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$63,925.88
Rate for Payer: Healthfirst Commercial	$135,347.00
Rate for Payer: Healthfirst Essential Plan	$143,833.23
Rate for Payer: Healthfirst QHP	$49,534.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$63,925.88
Rate for Payer: SOMOS Essential	$143,833.23
Rate for Payer: United Healthcare Essential Plan 1&2	$143,833.23
Rate for Payer: United Healthcare Essential Plan 3&4	$143,833.23
Rate for Payer: United Healthcare Medicaid	$63,925.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$63,925.88

APR-DRG 6022: Neonate bwt 1000-1249g w resp dist synd/oth maj resp or maj anom

Facility

$196,442.62

Service Code	APR-DRG 6022
Min. Negotiated Rate	$71,360.00
Max. Negotiated Rate	$196,442.62
Rate for Payer: Affinity Essential Plan 1&2	$196,442.62
Rate for Payer: Affinity Essential Plan 3&4	$196,442.62
Rate for Payer: Affinity Medicaid/CHP/HARP	$87,307.83
Rate for Payer: Amida Care Medicaid	$87,307.83
Rate for Payer: Fidelis CHP/HARP/Medicaid	$87,307.83
Rate for Payer: Fidelis Qualified Health Plan	$104,769.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$87,307.83
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$87,307.83
Rate for Payer: Healthfirst Commercial	$137,679.00
Rate for Payer: Healthfirst Essential Plan	$196,442.62
Rate for Payer: Healthfirst QHP	$71,360.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$87,307.83
Rate for Payer: SOMOS Essential	$196,442.62
Rate for Payer: United Healthcare Essential Plan 1&2	$196,442.62
Rate for Payer: United Healthcare Essential Plan 3&4	$196,442.62
Rate for Payer: United Healthcare Medicaid	$87,307.83
Rate for Payer: Wellcare CHP/FHP/Medicaid	$87,307.83

APR-DRG 6023: Neonate bwt 1000-1249g w resp dist synd/oth maj resp or maj anom

Facility

$225,956.14

Service Code	APR-DRG 6023
Min. Negotiated Rate	$93,493.00
Max. Negotiated Rate	$225,956.14
Rate for Payer: Affinity Essential Plan 1&2	$225,956.14
Rate for Payer: Affinity Essential Plan 3&4	$225,956.14
Rate for Payer: Affinity Medicaid/CHP/HARP	$100,424.95
Rate for Payer: Amida Care Medicaid	$100,424.95
Rate for Payer: Fidelis CHP/HARP/Medicaid	$100,424.95
Rate for Payer: Fidelis Qualified Health Plan	$120,509.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$100,424.95
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$100,424.95
Rate for Payer: Healthfirst Commercial	$173,995.00
Rate for Payer: Healthfirst Essential Plan	$225,956.14
Rate for Payer: Healthfirst QHP	$93,493.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$100,424.95
Rate for Payer: SOMOS Essential	$225,956.14
Rate for Payer: United Healthcare Essential Plan 1&2	$225,956.14
Rate for Payer: United Healthcare Essential Plan 3&4	$225,956.14
Rate for Payer: United Healthcare Medicaid	$100,424.95
Rate for Payer: Wellcare CHP/FHP/Medicaid	$100,424.95

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