St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

APR-DRG 6024: Neonate bwt 1000-1249g w resp dist synd/oth maj resp or maj anom

Facility

$295,593.68

Service Code	APR-DRG 6024
Min. Negotiated Rate	$113,640.00
Max. Negotiated Rate	$295,593.68
Rate for Payer: Affinity Essential Plan 1&2	$295,593.68
Rate for Payer: Affinity Essential Plan 3&4	$295,593.68
Rate for Payer: Affinity Medicaid/CHP/HARP	$131,374.97
Rate for Payer: Amida Care Medicaid	$131,374.97
Rate for Payer: Fidelis CHP/HARP/Medicaid	$131,374.97
Rate for Payer: Fidelis Qualified Health Plan	$157,649.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$131,374.97
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$131,374.97
Rate for Payer: Healthfirst Commercial	$202,779.00
Rate for Payer: Healthfirst Essential Plan	$295,593.68
Rate for Payer: Healthfirst QHP	$113,640.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$131,374.97
Rate for Payer: SOMOS Essential	$295,593.68
Rate for Payer: United Healthcare Essential Plan 1&2	$295,593.68
Rate for Payer: United Healthcare Essential Plan 3&4	$295,593.68
Rate for Payer: United Healthcare Medicaid	$131,374.97
Rate for Payer: Wellcare CHP/FHP/Medicaid	$131,374.97

APR-DRG 6031: Neonate birthwt 1000-1249g w or w/o other significant condition

Facility

$120,644.17

Service Code	APR-DRG 6031
Min. Negotiated Rate	$44,928.00
Max. Negotiated Rate	$120,644.17
Rate for Payer: Affinity Essential Plan 1&2	$120,644.17
Rate for Payer: Affinity Essential Plan 3&4	$120,644.17
Rate for Payer: Affinity Medicaid/CHP/HARP	$53,619.63
Rate for Payer: Amida Care Medicaid	$53,619.63
Rate for Payer: Fidelis CHP/HARP/Medicaid	$53,619.63
Rate for Payer: Fidelis Qualified Health Plan	$64,343.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$53,619.63
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$53,619.63
Rate for Payer: Healthfirst Commercial	$95,145.00
Rate for Payer: Healthfirst Essential Plan	$120,644.17
Rate for Payer: Healthfirst QHP	$44,928.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$53,619.63
Rate for Payer: SOMOS Essential	$120,644.17
Rate for Payer: United Healthcare Essential Plan 1&2	$120,644.17
Rate for Payer: United Healthcare Essential Plan 3&4	$120,644.17
Rate for Payer: United Healthcare Medicaid	$53,619.63
Rate for Payer: Wellcare CHP/FHP/Medicaid	$53,619.63

APR-DRG 6032: Neonate birthwt 1000-1249g w or w/o other significant condition

Facility

$150,970.23

Service Code	APR-DRG 6032
Min. Negotiated Rate	$62,863.00
Max. Negotiated Rate	$150,970.23
Rate for Payer: Affinity Essential Plan 1&2	$150,970.23
Rate for Payer: Affinity Essential Plan 3&4	$150,970.23
Rate for Payer: Affinity Medicaid/CHP/HARP	$67,097.88
Rate for Payer: Amida Care Medicaid	$67,097.88
Rate for Payer: Fidelis CHP/HARP/Medicaid	$67,097.88
Rate for Payer: Fidelis Qualified Health Plan	$80,517.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$67,097.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$67,097.88
Rate for Payer: Healthfirst Commercial	$113,885.00
Rate for Payer: Healthfirst Essential Plan	$150,970.23
Rate for Payer: Healthfirst QHP	$62,863.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$67,097.88
Rate for Payer: SOMOS Essential	$150,970.23
Rate for Payer: United Healthcare Essential Plan 1&2	$150,970.23
Rate for Payer: United Healthcare Essential Plan 3&4	$150,970.23
Rate for Payer: United Healthcare Medicaid	$67,097.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$67,097.88

APR-DRG 6033: Neonate birthwt 1000-1249g w or w/o other significant condition

Facility

$187,552.15

Service Code	APR-DRG 6033
Min. Negotiated Rate	$82,692.00
Max. Negotiated Rate	$187,552.15
Rate for Payer: Affinity Essential Plan 1&2	$187,552.15
Rate for Payer: Affinity Essential Plan 3&4	$187,552.15
Rate for Payer: Affinity Medicaid/CHP/HARP	$83,356.51
Rate for Payer: Amida Care Medicaid	$83,356.51
Rate for Payer: Fidelis CHP/HARP/Medicaid	$83,356.51
Rate for Payer: Fidelis Qualified Health Plan	$100,027.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$83,356.51
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$83,356.51
Rate for Payer: Healthfirst Commercial	$147,446.00
Rate for Payer: Healthfirst Essential Plan	$187,552.15
Rate for Payer: Healthfirst QHP	$82,692.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$83,356.51
Rate for Payer: SOMOS Essential	$187,552.15
Rate for Payer: United Healthcare Essential Plan 1&2	$187,552.15
Rate for Payer: United Healthcare Essential Plan 3&4	$187,552.15
Rate for Payer: United Healthcare Medicaid	$83,356.51
Rate for Payer: Wellcare CHP/FHP/Medicaid	$83,356.51

APR-DRG 6034: Neonate birthwt 1000-1249g w or w/o other significant condition

Facility

$274,632.95

Service Code	APR-DRG 6034
Min. Negotiated Rate	$122,059.09
Max. Negotiated Rate	$274,632.95
Rate for Payer: Affinity Essential Plan 1&2	$274,632.95
Rate for Payer: Affinity Essential Plan 3&4	$274,632.95
Rate for Payer: Affinity Medicaid/CHP/HARP	$122,059.09
Rate for Payer: Amida Care Medicaid	$122,059.09
Rate for Payer: Fidelis CHP/HARP/Medicaid	$122,059.09
Rate for Payer: Fidelis Qualified Health Plan	$146,470.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$122,059.09
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$122,059.09
Rate for Payer: Healthfirst Commercial	$182,989.00
Rate for Payer: Healthfirst Essential Plan	$274,632.95
Rate for Payer: Healthfirst QHP	$138,816.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$122,059.09
Rate for Payer: SOMOS Essential	$274,632.95
Rate for Payer: United Healthcare Essential Plan 1&2	$274,632.95
Rate for Payer: United Healthcare Essential Plan 3&4	$274,632.95
Rate for Payer: United Healthcare Medicaid	$122,059.09
Rate for Payer: Wellcare CHP/FHP/Medicaid	$122,059.09

APR-DRG 6071: Neonate bwt 1250-1499g w resp dist synd/oth maj resp or maj anom

Facility

$135,892.51

Service Code	APR-DRG 6071
Min. Negotiated Rate	$41,939.00
Max. Negotiated Rate	$135,892.51
Rate for Payer: Affinity Essential Plan 1&2	$135,892.51
Rate for Payer: Affinity Essential Plan 3&4	$135,892.51
Rate for Payer: Affinity Medicaid/CHP/HARP	$60,396.67
Rate for Payer: Amida Care Medicaid	$60,396.67
Rate for Payer: Fidelis CHP/HARP/Medicaid	$60,396.67
Rate for Payer: Fidelis Qualified Health Plan	$72,476.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$60,396.67
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$60,396.67
Rate for Payer: Healthfirst Commercial	$92,938.00
Rate for Payer: Healthfirst Essential Plan	$135,892.51
Rate for Payer: Healthfirst QHP	$41,939.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$60,396.67
Rate for Payer: SOMOS Essential	$135,892.51
Rate for Payer: United Healthcare Essential Plan 1&2	$135,892.51
Rate for Payer: United Healthcare Essential Plan 3&4	$135,892.51
Rate for Payer: United Healthcare Medicaid	$60,396.67
Rate for Payer: Wellcare CHP/FHP/Medicaid	$60,396.67

APR-DRG 6072: Neonate bwt 1250-1499g w resp dist synd/oth maj resp or maj anom

Facility

$161,169.21

Service Code	APR-DRG 6072
Min. Negotiated Rate	$57,229.00
Max. Negotiated Rate	$161,169.21
Rate for Payer: Affinity Essential Plan 1&2	$161,169.21
Rate for Payer: Affinity Essential Plan 3&4	$161,169.21
Rate for Payer: Affinity Medicaid/CHP/HARP	$71,630.76
Rate for Payer: Amida Care Medicaid	$71,630.76
Rate for Payer: Fidelis CHP/HARP/Medicaid	$71,630.76
Rate for Payer: Fidelis Qualified Health Plan	$85,956.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$71,630.76
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$71,630.76
Rate for Payer: Healthfirst Commercial	$108,927.00
Rate for Payer: Healthfirst Essential Plan	$161,169.21
Rate for Payer: Healthfirst QHP	$57,229.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$71,630.76
Rate for Payer: SOMOS Essential	$161,169.21
Rate for Payer: United Healthcare Essential Plan 1&2	$161,169.21
Rate for Payer: United Healthcare Essential Plan 3&4	$161,169.21
Rate for Payer: United Healthcare Medicaid	$71,630.76
Rate for Payer: Wellcare CHP/FHP/Medicaid	$71,630.76

APR-DRG 6073: Neonate bwt 1250-1499g w resp dist synd/oth maj resp or maj anom

Facility

$190,552.57

Service Code	APR-DRG 6073
Min. Negotiated Rate	$71,158.00
Max. Negotiated Rate	$190,552.57
Rate for Payer: Affinity Essential Plan 1&2	$190,552.57
Rate for Payer: Affinity Essential Plan 3&4	$190,552.57
Rate for Payer: Affinity Medicaid/CHP/HARP	$84,690.03
Rate for Payer: Amida Care Medicaid	$84,690.03
Rate for Payer: Fidelis CHP/HARP/Medicaid	$84,690.03
Rate for Payer: Fidelis Qualified Health Plan	$101,628.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$84,690.03
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$84,690.03
Rate for Payer: Healthfirst Commercial	$134,278.00
Rate for Payer: Healthfirst Essential Plan	$190,552.57
Rate for Payer: Healthfirst QHP	$71,158.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$84,690.03
Rate for Payer: SOMOS Essential	$190,552.57
Rate for Payer: United Healthcare Essential Plan 1&2	$190,552.57
Rate for Payer: United Healthcare Essential Plan 3&4	$190,552.57
Rate for Payer: United Healthcare Medicaid	$84,690.03
Rate for Payer: Wellcare CHP/FHP/Medicaid	$84,690.03

APR-DRG 6074: Neonate bwt 1250-1499g w resp dist synd/oth maj resp or maj anom

Facility

$246,770.89

Service Code	APR-DRG 6074
Min. Negotiated Rate	$89,136.00
Max. Negotiated Rate	$246,770.89
Rate for Payer: Affinity Essential Plan 1&2	$246,770.89
Rate for Payer: Affinity Essential Plan 3&4	$246,770.89
Rate for Payer: Affinity Medicaid/CHP/HARP	$109,675.95
Rate for Payer: Amida Care Medicaid	$109,675.95
Rate for Payer: Fidelis CHP/HARP/Medicaid	$109,675.95
Rate for Payer: Fidelis Qualified Health Plan	$131,611.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$109,675.95
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$109,675.95
Rate for Payer: Healthfirst Commercial	$189,814.00
Rate for Payer: Healthfirst Essential Plan	$246,770.89
Rate for Payer: Healthfirst QHP	$89,136.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$109,675.95
Rate for Payer: SOMOS Essential	$246,770.89
Rate for Payer: United Healthcare Essential Plan 1&2	$246,770.89
Rate for Payer: United Healthcare Essential Plan 3&4	$246,770.89
Rate for Payer: United Healthcare Medicaid	$109,675.95
Rate for Payer: Wellcare CHP/FHP/Medicaid	$109,675.95

APR-DRG 6081: Neonate bwt 1250-1499g w or w/o other significant condition

Facility

$104,291.35

Service Code	APR-DRG 6081
Min. Negotiated Rate	$33,433.00
Max. Negotiated Rate	$104,291.35
Rate for Payer: Affinity Essential Plan 1&2	$104,291.35
Rate for Payer: Affinity Essential Plan 3&4	$104,291.35
Rate for Payer: Affinity Medicaid/CHP/HARP	$46,351.71
Rate for Payer: Amida Care Medicaid	$46,351.71
Rate for Payer: Fidelis CHP/HARP/Medicaid	$46,351.71
Rate for Payer: Fidelis Qualified Health Plan	$55,622.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$46,351.71
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$46,351.71
Rate for Payer: Healthfirst Commercial	$69,870.00
Rate for Payer: Healthfirst Essential Plan	$104,291.35
Rate for Payer: Healthfirst QHP	$33,433.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$46,351.71
Rate for Payer: SOMOS Essential	$104,291.35
Rate for Payer: United Healthcare Essential Plan 1&2	$104,291.35
Rate for Payer: United Healthcare Essential Plan 3&4	$104,291.35
Rate for Payer: United Healthcare Medicaid	$46,351.71
Rate for Payer: Wellcare CHP/FHP/Medicaid	$46,351.71

APR-DRG 6082: Neonate bwt 1250-1499g w or w/o other significant condition

Facility

$129,645.43

Service Code	APR-DRG 6082
Min. Negotiated Rate	$48,612.00
Max. Negotiated Rate	$129,645.43
Rate for Payer: Affinity Essential Plan 1&2	$129,645.43
Rate for Payer: Affinity Essential Plan 3&4	$129,645.43
Rate for Payer: Affinity Medicaid/CHP/HARP	$57,620.19
Rate for Payer: Amida Care Medicaid	$57,620.19
Rate for Payer: Fidelis CHP/HARP/Medicaid	$57,620.19
Rate for Payer: Fidelis Qualified Health Plan	$69,144.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$57,620.19
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$57,620.19
Rate for Payer: Healthfirst Commercial	$92,493.00
Rate for Payer: Healthfirst Essential Plan	$129,645.43
Rate for Payer: Healthfirst QHP	$48,612.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$57,620.19
Rate for Payer: SOMOS Essential	$129,645.43
Rate for Payer: United Healthcare Essential Plan 1&2	$129,645.43
Rate for Payer: United Healthcare Essential Plan 3&4	$129,645.43
Rate for Payer: United Healthcare Medicaid	$57,620.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$57,620.19

APR-DRG 6083: Neonate bwt 1250-1499g w or w/o other significant condition

Facility

$149,652.92

Service Code	APR-DRG 6083
Min. Negotiated Rate	$66,512.41
Max. Negotiated Rate	$149,652.92
Rate for Payer: Affinity Essential Plan 1&2	$149,652.92
Rate for Payer: Affinity Essential Plan 3&4	$149,652.92
Rate for Payer: Affinity Medicaid/CHP/HARP	$66,512.41
Rate for Payer: Amida Care Medicaid	$66,512.41
Rate for Payer: Fidelis CHP/HARP/Medicaid	$66,512.41
Rate for Payer: Fidelis Qualified Health Plan	$79,814.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$66,512.41
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$66,512.41
Rate for Payer: Healthfirst Commercial	$112,810.00
Rate for Payer: Healthfirst Essential Plan	$149,652.92
Rate for Payer: Healthfirst QHP	$69,310.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$66,512.41
Rate for Payer: SOMOS Essential	$149,652.92
Rate for Payer: United Healthcare Essential Plan 1&2	$149,652.92
Rate for Payer: United Healthcare Essential Plan 3&4	$149,652.92
Rate for Payer: United Healthcare Medicaid	$66,512.41
Rate for Payer: Wellcare CHP/FHP/Medicaid	$66,512.41

APR-DRG 6084: Neonate bwt 1250-1499g w or w/o other significant condition

Facility

$155,963.32

Service Code	APR-DRG 6084
Min. Negotiated Rate	$69,317.03
Max. Negotiated Rate	$155,963.32
Rate for Payer: Affinity Essential Plan 1&2	$155,963.32
Rate for Payer: Affinity Essential Plan 3&4	$155,963.32
Rate for Payer: Affinity Medicaid/CHP/HARP	$69,317.03
Rate for Payer: Amida Care Medicaid	$69,317.03
Rate for Payer: Fidelis CHP/HARP/Medicaid	$69,317.03
Rate for Payer: Fidelis Qualified Health Plan	$83,180.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$69,317.03
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$69,317.03
Rate for Payer: Healthfirst Commercial	$121,433.00
Rate for Payer: Healthfirst Essential Plan	$155,963.32
Rate for Payer: Healthfirst QHP	$90,920.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$69,317.03
Rate for Payer: SOMOS Essential	$155,963.32
Rate for Payer: United Healthcare Essential Plan 1&2	$155,963.32
Rate for Payer: United Healthcare Essential Plan 3&4	$155,963.32
Rate for Payer: United Healthcare Medicaid	$69,317.03
Rate for Payer: Wellcare CHP/FHP/Medicaid	$69,317.03

APR-DRG 6091: Neonate bwt 1500-2499g w major procedure

Facility

$92,389.90

Service Code	APR-DRG 6091
Min. Negotiated Rate	$35,120.00
Max. Negotiated Rate	$92,389.90
Rate for Payer: Affinity Essential Plan 1&2	$92,389.90
Rate for Payer: Affinity Essential Plan 3&4	$92,389.90
Rate for Payer: Affinity Medicaid/CHP/HARP	$41,062.18
Rate for Payer: Amida Care Medicaid	$41,062.18
Rate for Payer: Fidelis CHP/HARP/Medicaid	$41,062.18
Rate for Payer: Fidelis Qualified Health Plan	$49,274.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$41,062.18
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$41,062.18
Rate for Payer: Healthfirst Commercial	$65,904.00
Rate for Payer: Healthfirst Essential Plan	$92,389.90
Rate for Payer: Healthfirst QHP	$35,120.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$41,062.18
Rate for Payer: SOMOS Essential	$92,389.90
Rate for Payer: United Healthcare Essential Plan 1&2	$92,389.90
Rate for Payer: United Healthcare Essential Plan 3&4	$92,389.90
Rate for Payer: United Healthcare Medicaid	$41,062.18
Rate for Payer: Wellcare CHP/FHP/Medicaid	$41,062.18

APR-DRG 6092: Neonate bwt 1500-2499g w major procedure

Facility

$92,871.81

Service Code	APR-DRG 6092
Min. Negotiated Rate	$35,856.00
Max. Negotiated Rate	$92,871.81
Rate for Payer: Affinity Essential Plan 1&2	$92,871.81
Rate for Payer: Affinity Essential Plan 3&4	$92,871.81
Rate for Payer: Affinity Medicaid/CHP/HARP	$41,276.36
Rate for Payer: Amida Care Medicaid	$41,276.36
Rate for Payer: Fidelis CHP/HARP/Medicaid	$41,276.36
Rate for Payer: Fidelis Qualified Health Plan	$49,531.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$41,276.36
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$41,276.36
Rate for Payer: Healthfirst Commercial	$67,528.00
Rate for Payer: Healthfirst Essential Plan	$92,871.81
Rate for Payer: Healthfirst QHP	$35,856.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$41,276.36
Rate for Payer: SOMOS Essential	$92,871.81
Rate for Payer: United Healthcare Essential Plan 1&2	$92,871.81
Rate for Payer: United Healthcare Essential Plan 3&4	$92,871.81
Rate for Payer: United Healthcare Medicaid	$41,276.36
Rate for Payer: Wellcare CHP/FHP/Medicaid	$41,276.36

APR-DRG 6093: Neonate bwt 1500-2499g w major procedure

Facility

$157,734.36

Service Code	APR-DRG 6093
Min. Negotiated Rate	$62,030.00
Max. Negotiated Rate	$157,734.36
Rate for Payer: Affinity Essential Plan 1&2	$157,734.36
Rate for Payer: Affinity Essential Plan 3&4	$157,734.36
Rate for Payer: Affinity Medicaid/CHP/HARP	$70,104.16
Rate for Payer: Amida Care Medicaid	$70,104.16
Rate for Payer: Fidelis CHP/HARP/Medicaid	$70,104.16
Rate for Payer: Fidelis Qualified Health Plan	$84,124.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$70,104.16
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$70,104.16
Rate for Payer: Healthfirst Commercial	$120,451.00
Rate for Payer: Healthfirst Essential Plan	$157,734.36
Rate for Payer: Healthfirst QHP	$62,030.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$70,104.16
Rate for Payer: SOMOS Essential	$157,734.36
Rate for Payer: United Healthcare Essential Plan 1&2	$157,734.36
Rate for Payer: United Healthcare Essential Plan 3&4	$157,734.36
Rate for Payer: United Healthcare Medicaid	$70,104.16
Rate for Payer: Wellcare CHP/FHP/Medicaid	$70,104.16

APR-DRG 6094: Neonate bwt 1500-2499g w major procedure

Facility

$310,412.88

Service Code	APR-DRG 6094
Min. Negotiated Rate	$119,970.00
Max. Negotiated Rate	$310,412.88
Rate for Payer: Affinity Essential Plan 1&2	$310,412.88
Rate for Payer: Affinity Essential Plan 3&4	$310,412.88
Rate for Payer: Affinity Medicaid/CHP/HARP	$137,961.28
Rate for Payer: Amida Care Medicaid	$137,961.28
Rate for Payer: Fidelis CHP/HARP/Medicaid	$137,961.28
Rate for Payer: Fidelis Qualified Health Plan	$165,553.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$137,961.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$137,961.28
Rate for Payer: Healthfirst Commercial	$302,348.00
Rate for Payer: Healthfirst Essential Plan	$310,412.88
Rate for Payer: Healthfirst QHP	$119,970.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$137,961.28
Rate for Payer: SOMOS Essential	$310,412.88
Rate for Payer: United Healthcare Essential Plan 1&2	$310,412.88
Rate for Payer: United Healthcare Essential Plan 3&4	$310,412.88
Rate for Payer: United Healthcare Medicaid	$137,961.28
Rate for Payer: Wellcare CHP/FHP/Medicaid	$137,961.28

APR-DRG 6111: Neonate birthwt 1500-1999g w major anomaly

Facility

$73,699.72

Service Code	APR-DRG 6111
Min. Negotiated Rate	$21,815.00
Max. Negotiated Rate	$73,699.72
Rate for Payer: Affinity Essential Plan 1&2	$73,699.72
Rate for Payer: Affinity Essential Plan 3&4	$73,699.72
Rate for Payer: Affinity Medicaid/CHP/HARP	$32,755.43
Rate for Payer: Amida Care Medicaid	$32,755.43
Rate for Payer: Fidelis CHP/HARP/Medicaid	$32,755.43
Rate for Payer: Fidelis Qualified Health Plan	$39,306.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$32,755.43
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$32,755.43
Rate for Payer: Healthfirst Commercial	$50,024.00
Rate for Payer: Healthfirst Essential Plan	$73,699.72
Rate for Payer: Healthfirst QHP	$21,815.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$32,755.43
Rate for Payer: SOMOS Essential	$73,699.72
Rate for Payer: United Healthcare Essential Plan 1&2	$73,699.72
Rate for Payer: United Healthcare Essential Plan 3&4	$73,699.72
Rate for Payer: United Healthcare Medicaid	$32,755.43
Rate for Payer: Wellcare CHP/FHP/Medicaid	$32,755.43

APR-DRG 6112: Neonate birthwt 1500-1999g w major anomaly

Facility

$100,606.77

Service Code	APR-DRG 6112
Min. Negotiated Rate	$34,989.00
Max. Negotiated Rate	$100,606.77
Rate for Payer: Affinity Essential Plan 1&2	$100,606.77
Rate for Payer: Affinity Essential Plan 3&4	$100,606.77
Rate for Payer: Affinity Medicaid/CHP/HARP	$44,714.12
Rate for Payer: Amida Care Medicaid	$44,714.12
Rate for Payer: Fidelis CHP/HARP/Medicaid	$44,714.12
Rate for Payer: Fidelis Qualified Health Plan	$53,656.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$44,714.12
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$44,714.12
Rate for Payer: Healthfirst Commercial	$69,400.00
Rate for Payer: Healthfirst Essential Plan	$100,606.77
Rate for Payer: Healthfirst QHP	$34,989.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$44,714.12
Rate for Payer: SOMOS Essential	$100,606.77
Rate for Payer: United Healthcare Essential Plan 1&2	$100,606.77
Rate for Payer: United Healthcare Essential Plan 3&4	$100,606.77
Rate for Payer: United Healthcare Medicaid	$44,714.12
Rate for Payer: Wellcare CHP/FHP/Medicaid	$44,714.12

APR-DRG 6113: Neonate birthwt 1500-1999g w major anomaly

Facility

$139,842.65

Service Code	APR-DRG 6113
Min. Negotiated Rate	$47,982.00
Max. Negotiated Rate	$139,842.65
Rate for Payer: Affinity Essential Plan 1&2	$139,842.65
Rate for Payer: Affinity Essential Plan 3&4	$139,842.65
Rate for Payer: Affinity Medicaid/CHP/HARP	$62,152.29
Rate for Payer: Amida Care Medicaid	$62,152.29
Rate for Payer: Fidelis CHP/HARP/Medicaid	$62,152.29
Rate for Payer: Fidelis Qualified Health Plan	$74,582.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$62,152.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$62,152.29
Rate for Payer: Healthfirst Commercial	$95,751.00
Rate for Payer: Healthfirst Essential Plan	$139,842.65
Rate for Payer: Healthfirst QHP	$47,982.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$62,152.29
Rate for Payer: SOMOS Essential	$139,842.65
Rate for Payer: United Healthcare Essential Plan 1&2	$139,842.65
Rate for Payer: United Healthcare Essential Plan 3&4	$139,842.65
Rate for Payer: United Healthcare Medicaid	$62,152.29
Rate for Payer: Wellcare CHP/FHP/Medicaid	$62,152.29

APR-DRG 6114: Neonate birthwt 1500-1999g w major anomaly

Facility

$174,101.26

Service Code	APR-DRG 6114
Min. Negotiated Rate	$60,655.00
Max. Negotiated Rate	$174,101.26
Rate for Payer: Affinity Essential Plan 1&2	$174,101.26
Rate for Payer: Affinity Essential Plan 3&4	$174,101.26
Rate for Payer: Affinity Medicaid/CHP/HARP	$77,378.34
Rate for Payer: Amida Care Medicaid	$77,378.34
Rate for Payer: Fidelis CHP/HARP/Medicaid	$77,378.34
Rate for Payer: Fidelis Qualified Health Plan	$92,854.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$77,378.34
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$77,378.34
Rate for Payer: Healthfirst Commercial	$169,471.00
Rate for Payer: Healthfirst Essential Plan	$174,101.26
Rate for Payer: Healthfirst QHP	$60,655.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$77,378.34
Rate for Payer: SOMOS Essential	$174,101.26
Rate for Payer: United Healthcare Essential Plan 1&2	$174,101.26
Rate for Payer: United Healthcare Essential Plan 3&4	$174,101.26
Rate for Payer: United Healthcare Medicaid	$77,378.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$77,378.34

APR-DRG 6121: Neonate bwt 1500-1999g w resp dist synd/oth maj resp cond

Facility

$91,519.34

Service Code	APR-DRG 6121
Min. Negotiated Rate	$28,520.00
Max. Negotiated Rate	$91,519.34
Rate for Payer: Affinity Essential Plan 1&2	$91,519.34
Rate for Payer: Affinity Essential Plan 3&4	$91,519.34
Rate for Payer: Affinity Medicaid/CHP/HARP	$40,675.26
Rate for Payer: Amida Care Medicaid	$40,675.26
Rate for Payer: Fidelis CHP/HARP/Medicaid	$40,675.26
Rate for Payer: Fidelis Qualified Health Plan	$48,810.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$40,675.26
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$40,675.26
Rate for Payer: Healthfirst Commercial	$54,035.00
Rate for Payer: Healthfirst Essential Plan	$91,519.34
Rate for Payer: Healthfirst QHP	$28,520.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$40,675.26
Rate for Payer: SOMOS Essential	$91,519.34
Rate for Payer: United Healthcare Essential Plan 1&2	$91,519.34
Rate for Payer: United Healthcare Essential Plan 3&4	$91,519.34
Rate for Payer: United Healthcare Medicaid	$40,675.26
Rate for Payer: Wellcare CHP/FHP/Medicaid	$40,675.26

APR-DRG 6122: Neonate bwt 1500-1999g w resp dist synd/oth maj resp cond

Facility

$109,667.84

Service Code	APR-DRG 6122
Min. Negotiated Rate	$37,359.00
Max. Negotiated Rate	$109,667.84
Rate for Payer: Affinity Essential Plan 1&2	$109,667.84
Rate for Payer: Affinity Essential Plan 3&4	$109,667.84
Rate for Payer: Affinity Medicaid/CHP/HARP	$48,741.26
Rate for Payer: Amida Care Medicaid	$48,741.26
Rate for Payer: Fidelis CHP/HARP/Medicaid	$48,741.26
Rate for Payer: Fidelis Qualified Health Plan	$58,489.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$48,741.26
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$48,741.26
Rate for Payer: Healthfirst Commercial	$64,973.00
Rate for Payer: Healthfirst Essential Plan	$109,667.84
Rate for Payer: Healthfirst QHP	$37,359.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$48,741.26
Rate for Payer: SOMOS Essential	$109,667.84
Rate for Payer: United Healthcare Essential Plan 1&2	$109,667.84
Rate for Payer: United Healthcare Essential Plan 3&4	$109,667.84
Rate for Payer: United Healthcare Medicaid	$48,741.26
Rate for Payer: Wellcare CHP/FHP/Medicaid	$48,741.26

APR-DRG 6123: Neonate bwt 1500-1999g w resp dist synd/oth maj resp cond

Facility

$141,200.39

Service Code	APR-DRG 6123
Min. Negotiated Rate	$51,727.00
Max. Negotiated Rate	$141,200.39
Rate for Payer: Affinity Essential Plan 1&2	$141,200.39
Rate for Payer: Affinity Essential Plan 3&4	$141,200.39
Rate for Payer: Affinity Medicaid/CHP/HARP	$62,755.73
Rate for Payer: Amida Care Medicaid	$62,755.73
Rate for Payer: Fidelis CHP/HARP/Medicaid	$62,755.73
Rate for Payer: Fidelis Qualified Health Plan	$75,306.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$62,755.73
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$62,755.73
Rate for Payer: Healthfirst Commercial	$93,403.00
Rate for Payer: Healthfirst Essential Plan	$141,200.39
Rate for Payer: Healthfirst QHP	$51,727.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$62,755.73
Rate for Payer: SOMOS Essential	$141,200.39
Rate for Payer: United Healthcare Essential Plan 1&2	$141,200.39
Rate for Payer: United Healthcare Essential Plan 3&4	$141,200.39
Rate for Payer: United Healthcare Medicaid	$62,755.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$62,755.73

APR-DRG 6124: Neonate bwt 1500-1999g w resp dist synd/oth maj resp cond

Facility

$178,672.25

Service Code	APR-DRG 6124
Min. Negotiated Rate	$65,956.00
Max. Negotiated Rate	$178,672.25
Rate for Payer: Affinity Essential Plan 1&2	$178,672.25
Rate for Payer: Affinity Essential Plan 3&4	$178,672.25
Rate for Payer: Affinity Medicaid/CHP/HARP	$79,409.89
Rate for Payer: Amida Care Medicaid	$79,409.89
Rate for Payer: Fidelis CHP/HARP/Medicaid	$79,409.89
Rate for Payer: Fidelis Qualified Health Plan	$95,291.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$79,409.89
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$79,409.89
Rate for Payer: Healthfirst Commercial	$130,927.00
Rate for Payer: Healthfirst Essential Plan	$178,672.25
Rate for Payer: Healthfirst QHP	$65,956.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$79,409.89
Rate for Payer: SOMOS Essential	$178,672.25
Rate for Payer: United Healthcare Essential Plan 1&2	$178,672.25
Rate for Payer: United Healthcare Essential Plan 3&4	$178,672.25
Rate for Payer: United Healthcare Medicaid	$79,409.89
Rate for Payer: Wellcare CHP/FHP/Medicaid	$79,409.89

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