St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

APR-DRG 6393: Neonate birthwt >2499g w other significant condition

Facility

$62,420.87

Service Code	APR-DRG 6393
Min. Negotiated Rate	$16,201.00
Max. Negotiated Rate	$62,420.87
Rate for Payer: Affinity Essential Plan 1&2	$62,420.87
Rate for Payer: Affinity Essential Plan 3&4	$62,420.87
Rate for Payer: Affinity Medicaid/CHP/HARP	$27,742.61
Rate for Payer: Amida Care Medicaid	$27,742.61
Rate for Payer: Fidelis CHP/HARP/Medicaid	$27,742.61
Rate for Payer: Fidelis Qualified Health Plan	$33,291.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$27,742.61
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$27,742.61
Rate for Payer: Healthfirst Commercial	$32,160.00
Rate for Payer: Healthfirst Essential Plan	$62,420.87
Rate for Payer: Healthfirst QHP	$16,201.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$27,742.61
Rate for Payer: SOMOS Essential	$62,420.87
Rate for Payer: United Healthcare Essential Plan 1&2	$62,420.87
Rate for Payer: United Healthcare Essential Plan 3&4	$62,420.87
Rate for Payer: United Healthcare Medicaid	$27,742.61
Rate for Payer: Wellcare CHP/FHP/Medicaid	$27,742.61

APR-DRG 6394: Neonate birthwt >2499g w other significant condition

Facility

$97,078.72

Service Code	APR-DRG 6394
Min. Negotiated Rate	$24,364.00
Max. Negotiated Rate	$97,078.72
Rate for Payer: Affinity Essential Plan 1&2	$97,078.72
Rate for Payer: Affinity Essential Plan 3&4	$97,078.72
Rate for Payer: Affinity Medicaid/CHP/HARP	$43,146.10
Rate for Payer: Amida Care Medicaid	$43,146.10
Rate for Payer: Fidelis CHP/HARP/Medicaid	$43,146.10
Rate for Payer: Fidelis Qualified Health Plan	$51,775.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$43,146.10
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$43,146.10
Rate for Payer: Healthfirst Commercial	$53,562.00
Rate for Payer: Healthfirst Essential Plan	$97,078.72
Rate for Payer: Healthfirst QHP	$24,364.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$43,146.10
Rate for Payer: SOMOS Essential	$97,078.72
Rate for Payer: United Healthcare Essential Plan 1&2	$97,078.72
Rate for Payer: United Healthcare Essential Plan 3&4	$97,078.72
Rate for Payer: United Healthcare Medicaid	$43,146.10
Rate for Payer: Wellcare CHP/FHP/Medicaid	$43,146.10

APR-DRG 6401: Neonate birthwt >2499g, normal newborn or neonate w other problem

Facility

$32,719.16

Service Code	APR-DRG 6401
Min. Negotiated Rate	$3,008.00
Max. Negotiated Rate	$32,719.16
Rate for Payer: Affinity Essential Plan 1&2	$32,719.16
Rate for Payer: Affinity Essential Plan 3&4	$32,719.16
Rate for Payer: Affinity Medicaid/CHP/HARP	$14,541.85
Rate for Payer: Amida Care Medicaid	$14,541.85
Rate for Payer: Fidelis CHP/HARP/Medicaid	$14,541.85
Rate for Payer: Fidelis Qualified Health Plan	$17,450.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$14,541.85
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$14,541.85
Rate for Payer: Healthfirst Commercial	$5,367.00
Rate for Payer: Healthfirst Essential Plan	$32,719.16
Rate for Payer: Healthfirst QHP	$3,008.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$14,541.85
Rate for Payer: SOMOS Essential	$32,719.16
Rate for Payer: United Healthcare Essential Plan 1&2	$32,719.16
Rate for Payer: United Healthcare Essential Plan 3&4	$32,719.16
Rate for Payer: United Healthcare Medicaid	$14,541.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$14,541.85

APR-DRG 6402: Neonate birthwt >2499g, normal newborn or neonate w other problem

Facility

$33,916.88

Service Code	APR-DRG 6402
Min. Negotiated Rate	$3,620.00
Max. Negotiated Rate	$33,916.88
Rate for Payer: Affinity Essential Plan 1&2	$33,916.88
Rate for Payer: Affinity Essential Plan 3&4	$33,916.88
Rate for Payer: Affinity Medicaid/CHP/HARP	$15,074.17
Rate for Payer: Amida Care Medicaid	$15,074.17
Rate for Payer: Fidelis CHP/HARP/Medicaid	$15,074.17
Rate for Payer: Fidelis Qualified Health Plan	$18,089.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$15,074.17
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$15,074.17
Rate for Payer: Healthfirst Commercial	$6,450.00
Rate for Payer: Healthfirst Essential Plan	$33,916.88
Rate for Payer: Healthfirst QHP	$3,620.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$15,074.17
Rate for Payer: SOMOS Essential	$33,916.88
Rate for Payer: United Healthcare Essential Plan 1&2	$33,916.88
Rate for Payer: United Healthcare Essential Plan 3&4	$33,916.88
Rate for Payer: United Healthcare Medicaid	$15,074.17
Rate for Payer: Wellcare CHP/FHP/Medicaid	$15,074.17

APR-DRG 6403: Neonate birthwt >2499g, normal newborn or neonate w other problem

Facility

$39,142.10

Service Code	APR-DRG 6403
Min. Negotiated Rate	$6,316.00
Max. Negotiated Rate	$39,142.10
Rate for Payer: Affinity Essential Plan 1&2	$39,142.10
Rate for Payer: Affinity Essential Plan 3&4	$39,142.10
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,396.49
Rate for Payer: Amida Care Medicaid	$17,396.49
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,396.49
Rate for Payer: Fidelis Qualified Health Plan	$20,875.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,396.49
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,396.49
Rate for Payer: Healthfirst Commercial	$10,885.00
Rate for Payer: Healthfirst Essential Plan	$39,142.10
Rate for Payer: Healthfirst QHP	$6,316.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,396.49
Rate for Payer: SOMOS Essential	$39,142.10
Rate for Payer: United Healthcare Essential Plan 1&2	$39,142.10
Rate for Payer: United Healthcare Essential Plan 3&4	$39,142.10
Rate for Payer: United Healthcare Medicaid	$17,396.49
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,396.49

APR-DRG 6404: Neonate birthwt >2499g, normal newborn or neonate w other problem

Facility

$39,152.66

Service Code	APR-DRG 6404
Min. Negotiated Rate	$6,319.00
Max. Negotiated Rate	$39,152.66
Rate for Payer: Affinity Essential Plan 1&2	$39,152.66
Rate for Payer: Affinity Essential Plan 3&4	$39,152.66
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,401.18
Rate for Payer: Amida Care Medicaid	$17,401.18
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,401.18
Rate for Payer: Fidelis Qualified Health Plan	$20,881.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,401.18
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,401.18
Rate for Payer: Healthfirst Commercial	$10,894.00
Rate for Payer: Healthfirst Essential Plan	$39,152.66
Rate for Payer: Healthfirst QHP	$6,319.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,401.18
Rate for Payer: SOMOS Essential	$39,152.66
Rate for Payer: United Healthcare Essential Plan 1&2	$39,152.66
Rate for Payer: United Healthcare Essential Plan 3&4	$39,152.66
Rate for Payer: United Healthcare Medicaid	$17,401.18
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,401.18

APR-DRG 6501: Splenectomy

Facility

$52,494.50

Service Code	APR-DRG 6501
Min. Negotiated Rate	$15,238.00
Max. Negotiated Rate	$52,494.50
Rate for Payer: Affinity Essential Plan 1&2	$52,494.50
Rate for Payer: Affinity Essential Plan 3&4	$52,494.50
Rate for Payer: Affinity Medicaid/CHP/HARP	$23,330.89
Rate for Payer: Amida Care Medicaid	$23,330.89
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,330.89
Rate for Payer: Fidelis Qualified Health Plan	$27,997.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,330.89
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,330.89
Rate for Payer: Healthfirst Commercial	$24,714.00
Rate for Payer: Healthfirst Essential Plan	$52,494.50
Rate for Payer: Healthfirst QHP	$15,238.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,330.89
Rate for Payer: SOMOS Essential	$52,494.50
Rate for Payer: United Healthcare Essential Plan 1&2	$52,494.50
Rate for Payer: United Healthcare Essential Plan 3&4	$52,494.50
Rate for Payer: United Healthcare Medicaid	$23,330.89
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,330.89

APR-DRG 6502: Splenectomy

Facility

$64,543.68

Service Code	APR-DRG 6502
Min. Negotiated Rate	$20,122.00
Max. Negotiated Rate	$64,543.68
Rate for Payer: Affinity Essential Plan 1&2	$64,543.68
Rate for Payer: Affinity Essential Plan 3&4	$64,543.68
Rate for Payer: Affinity Medicaid/CHP/HARP	$28,686.08
Rate for Payer: Amida Care Medicaid	$28,686.08
Rate for Payer: Fidelis CHP/HARP/Medicaid	$28,686.08
Rate for Payer: Fidelis Qualified Health Plan	$34,423.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$28,686.08
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$28,686.08
Rate for Payer: Healthfirst Commercial	$34,090.00
Rate for Payer: Healthfirst Essential Plan	$64,543.68
Rate for Payer: Healthfirst QHP	$20,122.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$28,686.08
Rate for Payer: SOMOS Essential	$64,543.68
Rate for Payer: United Healthcare Essential Plan 1&2	$64,543.68
Rate for Payer: United Healthcare Essential Plan 3&4	$64,543.68
Rate for Payer: United Healthcare Medicaid	$28,686.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$28,686.08

APR-DRG 6503: Splenectomy

Facility

$71,700.03

Service Code	APR-DRG 6503
Min. Negotiated Rate	$29,363.00
Max. Negotiated Rate	$71,700.03
Rate for Payer: Affinity Essential Plan 1&2	$71,700.03
Rate for Payer: Affinity Essential Plan 3&4	$71,700.03
Rate for Payer: Affinity Medicaid/CHP/HARP	$31,866.68
Rate for Payer: Amida Care Medicaid	$31,866.68
Rate for Payer: Fidelis CHP/HARP/Medicaid	$31,866.68
Rate for Payer: Fidelis Qualified Health Plan	$38,240.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$31,866.68
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31,866.68
Rate for Payer: Healthfirst Commercial	$47,052.00
Rate for Payer: Healthfirst Essential Plan	$71,700.03
Rate for Payer: Healthfirst QHP	$29,363.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$31,866.68
Rate for Payer: SOMOS Essential	$71,700.03
Rate for Payer: United Healthcare Essential Plan 1&2	$71,700.03
Rate for Payer: United Healthcare Essential Plan 3&4	$71,700.03
Rate for Payer: United Healthcare Medicaid	$31,866.68
Rate for Payer: Wellcare CHP/FHP/Medicaid	$31,866.68

APR-DRG 6504: Splenectomy

Facility

$129,944.41

Service Code	APR-DRG 6504
Min. Negotiated Rate	$57,753.07
Max. Negotiated Rate	$129,944.41
Rate for Payer: Affinity Essential Plan 1&2	$129,944.41
Rate for Payer: Affinity Essential Plan 3&4	$129,944.41
Rate for Payer: Affinity Medicaid/CHP/HARP	$57,753.07
Rate for Payer: Amida Care Medicaid	$57,753.07
Rate for Payer: Fidelis CHP/HARP/Medicaid	$57,753.07
Rate for Payer: Fidelis Qualified Health Plan	$69,303.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$57,753.07
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$57,753.07
Rate for Payer: Healthfirst Commercial	$115,696.00
Rate for Payer: Healthfirst Essential Plan	$129,944.41
Rate for Payer: Healthfirst QHP	$70,063.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$57,753.07
Rate for Payer: SOMOS Essential	$129,944.41
Rate for Payer: United Healthcare Essential Plan 1&2	$129,944.41
Rate for Payer: United Healthcare Essential Plan 3&4	$129,944.41
Rate for Payer: United Healthcare Medicaid	$57,753.07
Rate for Payer: Wellcare CHP/FHP/Medicaid	$57,753.07

APR-DRG 6511: Other procedures of blood & blood-forming organs

Facility

$47,956.95

Service Code	APR-DRG 6511
Min. Negotiated Rate	$11,779.00
Max. Negotiated Rate	$47,956.95
Rate for Payer: Affinity Essential Plan 1&2	$47,956.95
Rate for Payer: Affinity Essential Plan 3&4	$47,956.95
Rate for Payer: Affinity Medicaid/CHP/HARP	$21,314.20
Rate for Payer: Amida Care Medicaid	$21,314.20
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,314.20
Rate for Payer: Fidelis Qualified Health Plan	$25,577.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,314.20
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,314.20
Rate for Payer: Healthfirst Commercial	$18,672.00
Rate for Payer: Healthfirst Essential Plan	$47,956.95
Rate for Payer: Healthfirst QHP	$11,779.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,314.20
Rate for Payer: SOMOS Essential	$47,956.95
Rate for Payer: United Healthcare Essential Plan 1&2	$47,956.95
Rate for Payer: United Healthcare Essential Plan 3&4	$47,956.95
Rate for Payer: United Healthcare Medicaid	$21,314.20
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,314.20

APR-DRG 6512: Other procedures of blood & blood-forming organs

Facility

$53,929.64

Service Code	APR-DRG 6512
Min. Negotiated Rate	$16,720.00
Max. Negotiated Rate	$53,929.64
Rate for Payer: Affinity Essential Plan 1&2	$53,929.64
Rate for Payer: Affinity Essential Plan 3&4	$53,929.64
Rate for Payer: Affinity Medicaid/CHP/HARP	$23,968.73
Rate for Payer: Amida Care Medicaid	$23,968.73
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,968.73
Rate for Payer: Fidelis Qualified Health Plan	$28,762.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,968.73
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,968.73
Rate for Payer: Healthfirst Commercial	$29,207.00
Rate for Payer: Healthfirst Essential Plan	$53,929.64
Rate for Payer: Healthfirst QHP	$16,720.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,968.73
Rate for Payer: SOMOS Essential	$53,929.64
Rate for Payer: United Healthcare Essential Plan 1&2	$53,929.64
Rate for Payer: United Healthcare Essential Plan 3&4	$53,929.64
Rate for Payer: United Healthcare Medicaid	$23,968.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,968.73

APR-DRG 6513: Other procedures of blood & blood-forming organs

Facility

$75,495.40

Service Code	APR-DRG 6513
Min. Negotiated Rate	$29,884.00
Max. Negotiated Rate	$75,495.40
Rate for Payer: Affinity Essential Plan 1&2	$75,495.40
Rate for Payer: Affinity Essential Plan 3&4	$75,495.40
Rate for Payer: Affinity Medicaid/CHP/HARP	$33,553.51
Rate for Payer: Amida Care Medicaid	$33,553.51
Rate for Payer: Fidelis CHP/HARP/Medicaid	$33,553.51
Rate for Payer: Fidelis Qualified Health Plan	$40,264.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$33,553.51
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$33,553.51
Rate for Payer: Healthfirst Commercial	$51,338.00
Rate for Payer: Healthfirst Essential Plan	$75,495.40
Rate for Payer: Healthfirst QHP	$29,884.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$33,553.51
Rate for Payer: SOMOS Essential	$75,495.40
Rate for Payer: United Healthcare Essential Plan 1&2	$75,495.40
Rate for Payer: United Healthcare Essential Plan 3&4	$75,495.40
Rate for Payer: United Healthcare Medicaid	$33,553.51
Rate for Payer: Wellcare CHP/FHP/Medicaid	$33,553.51

APR-DRG 6514: Other procedures of blood & blood-forming organs

Facility

$130,862.00

Service Code	APR-DRG 6514
Min. Negotiated Rate	$42,658.34
Max. Negotiated Rate	$130,862.00
Rate for Payer: Affinity Essential Plan 1&2	$95,981.26
Rate for Payer: Affinity Essential Plan 3&4	$95,981.26
Rate for Payer: Affinity Medicaid/CHP/HARP	$42,658.34
Rate for Payer: Amida Care Medicaid	$42,658.34
Rate for Payer: Fidelis CHP/HARP/Medicaid	$42,658.34
Rate for Payer: Fidelis Qualified Health Plan	$51,190.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$42,658.34
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$42,658.34
Rate for Payer: Healthfirst Commercial	$130,862.00
Rate for Payer: Healthfirst Essential Plan	$95,981.26
Rate for Payer: Healthfirst QHP	$117,526.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$42,658.34
Rate for Payer: SOMOS Essential	$95,981.26
Rate for Payer: United Healthcare Essential Plan 1&2	$95,981.26
Rate for Payer: United Healthcare Essential Plan 3&4	$95,981.26
Rate for Payer: United Healthcare Medicaid	$42,658.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$42,658.34

APR-DRG 6601: Major hematologic/immunologic diag exc sickle cell crisis & coagul

Facility

$41,906.86

Service Code	APR-DRG 6601
Min. Negotiated Rate	$8,312.00
Max. Negotiated Rate	$41,906.86
Rate for Payer: Affinity Essential Plan 1&2	$41,906.86
Rate for Payer: Affinity Essential Plan 3&4	$41,906.86
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,625.27
Rate for Payer: Amida Care Medicaid	$18,625.27
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,625.27
Rate for Payer: Fidelis Qualified Health Plan	$22,350.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,625.27
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,625.27
Rate for Payer: Healthfirst Commercial	$13,651.00
Rate for Payer: Healthfirst Essential Plan	$41,906.86
Rate for Payer: Healthfirst QHP	$8,312.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,625.27
Rate for Payer: SOMOS Essential	$41,906.86
Rate for Payer: United Healthcare Essential Plan 1&2	$41,906.86
Rate for Payer: United Healthcare Essential Plan 3&4	$41,906.86
Rate for Payer: United Healthcare Medicaid	$18,625.27
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,625.27

APR-DRG 6602: Major hematologic/immunologic diag exc sickle cell crisis & coagul

Facility

$45,470.07

Service Code	APR-DRG 6602
Min. Negotiated Rate	$11,299.00
Max. Negotiated Rate	$45,470.07
Rate for Payer: Affinity Essential Plan 1&2	$45,470.07
Rate for Payer: Affinity Essential Plan 3&4	$45,470.07
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,208.92
Rate for Payer: Amida Care Medicaid	$20,208.92
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,208.92
Rate for Payer: Fidelis Qualified Health Plan	$24,250.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,208.92
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,208.92
Rate for Payer: Healthfirst Commercial	$18,295.00
Rate for Payer: Healthfirst Essential Plan	$45,470.07
Rate for Payer: Healthfirst QHP	$11,299.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,208.92
Rate for Payer: SOMOS Essential	$45,470.07
Rate for Payer: United Healthcare Essential Plan 1&2	$45,470.07
Rate for Payer: United Healthcare Essential Plan 3&4	$45,470.07
Rate for Payer: United Healthcare Medicaid	$20,208.92
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,208.92

APR-DRG 6603: Major hematologic/immunologic diag exc sickle cell crisis & coagul

Facility

$56,405.97

Service Code	APR-DRG 6603
Min. Negotiated Rate	$19,220.00
Max. Negotiated Rate	$56,405.97
Rate for Payer: Affinity Essential Plan 1&2	$56,405.97
Rate for Payer: Affinity Essential Plan 3&4	$56,405.97
Rate for Payer: Affinity Medicaid/CHP/HARP	$25,069.32
Rate for Payer: Amida Care Medicaid	$25,069.32
Rate for Payer: Fidelis CHP/HARP/Medicaid	$25,069.32
Rate for Payer: Fidelis Qualified Health Plan	$30,083.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$25,069.32
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25,069.32
Rate for Payer: Healthfirst Commercial	$30,903.00
Rate for Payer: Healthfirst Essential Plan	$56,405.97
Rate for Payer: Healthfirst QHP	$19,220.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$25,069.32
Rate for Payer: SOMOS Essential	$56,405.97
Rate for Payer: United Healthcare Essential Plan 1&2	$56,405.97
Rate for Payer: United Healthcare Essential Plan 3&4	$56,405.97
Rate for Payer: United Healthcare Medicaid	$25,069.32
Rate for Payer: Wellcare CHP/FHP/Medicaid	$25,069.32

APR-DRG 6604: Major hematologic/immunologic diag exc sickle cell crisis & coagul

Facility

$117,193.50

Service Code	APR-DRG 6604
Min. Negotiated Rate	$52,086.00
Max. Negotiated Rate	$117,193.50
Rate for Payer: Affinity Essential Plan 1&2	$117,193.50
Rate for Payer: Affinity Essential Plan 3&4	$117,193.50
Rate for Payer: Affinity Medicaid/CHP/HARP	$52,086.00
Rate for Payer: Amida Care Medicaid	$52,086.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$52,086.00
Rate for Payer: Fidelis Qualified Health Plan	$62,503.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$52,086.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$52,086.00
Rate for Payer: Healthfirst Commercial	$105,830.00
Rate for Payer: Healthfirst Essential Plan	$117,193.50
Rate for Payer: Healthfirst QHP	$64,828.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$52,086.00
Rate for Payer: SOMOS Essential	$117,193.50
Rate for Payer: United Healthcare Essential Plan 1&2	$117,193.50
Rate for Payer: United Healthcare Essential Plan 3&4	$117,193.50
Rate for Payer: United Healthcare Medicaid	$52,086.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$52,086.00

APR-DRG 6611: Coagulation & platelet disorders

Facility

$47,399.42

Service Code	APR-DRG 6611
Min. Negotiated Rate	$8,953.00
Max. Negotiated Rate	$47,399.42
Rate for Payer: Affinity Essential Plan 1&2	$47,399.42
Rate for Payer: Affinity Essential Plan 3&4	$47,399.42
Rate for Payer: Affinity Medicaid/CHP/HARP	$21,066.41
Rate for Payer: Amida Care Medicaid	$21,066.41
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,066.41
Rate for Payer: Fidelis Qualified Health Plan	$25,279.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,066.41
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,066.41
Rate for Payer: Healthfirst Commercial	$15,482.00
Rate for Payer: Healthfirst Essential Plan	$47,399.42
Rate for Payer: Healthfirst QHP	$8,953.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,066.41
Rate for Payer: SOMOS Essential	$47,399.42
Rate for Payer: United Healthcare Essential Plan 1&2	$47,399.42
Rate for Payer: United Healthcare Essential Plan 3&4	$47,399.42
Rate for Payer: United Healthcare Medicaid	$21,066.41
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,066.41

APR-DRG 6612: Coagulation & platelet disorders

Facility

$50,498.32

Service Code	APR-DRG 6612
Min. Negotiated Rate	$11,275.00
Max. Negotiated Rate	$50,498.32
Rate for Payer: Affinity Essential Plan 1&2	$50,498.32
Rate for Payer: Affinity Essential Plan 3&4	$50,498.32
Rate for Payer: Affinity Medicaid/CHP/HARP	$22,443.70
Rate for Payer: Amida Care Medicaid	$22,443.70
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,443.70
Rate for Payer: Fidelis Qualified Health Plan	$26,932.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,443.70
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,443.70
Rate for Payer: Healthfirst Commercial	$19,661.00
Rate for Payer: Healthfirst Essential Plan	$50,498.32
Rate for Payer: Healthfirst QHP	$11,275.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,443.70
Rate for Payer: SOMOS Essential	$50,498.32
Rate for Payer: United Healthcare Essential Plan 1&2	$50,498.32
Rate for Payer: United Healthcare Essential Plan 3&4	$50,498.32
Rate for Payer: United Healthcare Medicaid	$22,443.70
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,443.70

APR-DRG 6613: Coagulation & platelet disorders

Facility

$64,040.67

Service Code	APR-DRG 6613
Min. Negotiated Rate	$17,990.00
Max. Negotiated Rate	$64,040.67
Rate for Payer: Affinity Essential Plan 1&2	$64,040.67
Rate for Payer: Affinity Essential Plan 3&4	$64,040.67
Rate for Payer: Affinity Medicaid/CHP/HARP	$28,462.52
Rate for Payer: Amida Care Medicaid	$28,462.52
Rate for Payer: Fidelis CHP/HARP/Medicaid	$28,462.52
Rate for Payer: Fidelis Qualified Health Plan	$34,155.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$28,462.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$28,462.52
Rate for Payer: Healthfirst Commercial	$31,215.00
Rate for Payer: Healthfirst Essential Plan	$64,040.67
Rate for Payer: Healthfirst QHP	$17,990.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$28,462.52
Rate for Payer: SOMOS Essential	$64,040.67
Rate for Payer: United Healthcare Essential Plan 1&2	$64,040.67
Rate for Payer: United Healthcare Essential Plan 3&4	$64,040.67
Rate for Payer: United Healthcare Medicaid	$28,462.52
Rate for Payer: Wellcare CHP/FHP/Medicaid	$28,462.52

APR-DRG 6614: Coagulation & platelet disorders

Facility

$109,949.24

Service Code	APR-DRG 6614
Min. Negotiated Rate	$38,418.00
Max. Negotiated Rate	$109,949.24
Rate for Payer: Affinity Essential Plan 1&2	$109,949.24
Rate for Payer: Affinity Essential Plan 3&4	$109,949.24
Rate for Payer: Affinity Medicaid/CHP/HARP	$48,866.33
Rate for Payer: Amida Care Medicaid	$48,866.33
Rate for Payer: Fidelis CHP/HARP/Medicaid	$48,866.33
Rate for Payer: Fidelis Qualified Health Plan	$58,639.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$48,866.33
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$48,866.33
Rate for Payer: Healthfirst Commercial	$86,445.00
Rate for Payer: Healthfirst Essential Plan	$109,949.24
Rate for Payer: Healthfirst QHP	$38,418.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$48,866.33
Rate for Payer: SOMOS Essential	$109,949.24
Rate for Payer: United Healthcare Essential Plan 1&2	$109,949.24
Rate for Payer: United Healthcare Essential Plan 3&4	$109,949.24
Rate for Payer: United Healthcare Medicaid	$48,866.33
Rate for Payer: Wellcare CHP/FHP/Medicaid	$48,866.33

APR-DRG 6621: Sickle cell anemia crisis

Facility

$41,405.62

Service Code	APR-DRG 6621
Min. Negotiated Rate	$7,512.00
Max. Negotiated Rate	$41,405.62
Rate for Payer: Affinity Essential Plan 1&2	$41,405.62
Rate for Payer: Affinity Essential Plan 3&4	$41,405.62
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,402.50
Rate for Payer: Amida Care Medicaid	$18,402.50
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,402.50
Rate for Payer: Fidelis Qualified Health Plan	$22,083.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,402.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,402.50
Rate for Payer: Healthfirst Commercial	$12,145.00
Rate for Payer: Healthfirst Essential Plan	$41,405.62
Rate for Payer: Healthfirst QHP	$7,512.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,402.50
Rate for Payer: SOMOS Essential	$41,405.62
Rate for Payer: United Healthcare Essential Plan 1&2	$41,405.62
Rate for Payer: United Healthcare Essential Plan 3&4	$41,405.62
Rate for Payer: United Healthcare Medicaid	$18,402.50
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,402.50

APR-DRG 6622: Sickle cell anemia crisis

Facility

$46,618.54

Service Code	APR-DRG 6622
Min. Negotiated Rate	$9,690.00
Max. Negotiated Rate	$46,618.54
Rate for Payer: Affinity Essential Plan 1&2	$46,618.54
Rate for Payer: Affinity Essential Plan 3&4	$46,618.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,719.35
Rate for Payer: Amida Care Medicaid	$20,719.35
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,719.35
Rate for Payer: Fidelis Qualified Health Plan	$24,863.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,719.35
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,719.35
Rate for Payer: Healthfirst Commercial	$15,828.00
Rate for Payer: Healthfirst Essential Plan	$46,618.54
Rate for Payer: Healthfirst QHP	$9,690.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,719.35
Rate for Payer: SOMOS Essential	$46,618.54
Rate for Payer: United Healthcare Essential Plan 1&2	$46,618.54
Rate for Payer: United Healthcare Essential Plan 3&4	$46,618.54
Rate for Payer: United Healthcare Medicaid	$20,719.35
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,719.35

APR-DRG 6623: Sickle cell anemia crisis

Facility

$56,740.12

Service Code	APR-DRG 6623
Min. Negotiated Rate	$14,527.00
Max. Negotiated Rate	$56,740.12
Rate for Payer: Affinity Essential Plan 1&2	$56,740.12
Rate for Payer: Affinity Essential Plan 3&4	$56,740.12
Rate for Payer: Affinity Medicaid/CHP/HARP	$25,217.83
Rate for Payer: Amida Care Medicaid	$25,217.83
Rate for Payer: Fidelis CHP/HARP/Medicaid	$25,217.83
Rate for Payer: Fidelis Qualified Health Plan	$30,261.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$25,217.83
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25,217.83
Rate for Payer: Healthfirst Commercial	$25,448.00
Rate for Payer: Healthfirst Essential Plan	$56,740.12
Rate for Payer: Healthfirst QHP	$14,527.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$25,217.83
Rate for Payer: SOMOS Essential	$56,740.12
Rate for Payer: United Healthcare Essential Plan 1&2	$56,740.12
Rate for Payer: United Healthcare Essential Plan 3&4	$56,740.12
Rate for Payer: United Healthcare Medicaid	$25,217.83
Rate for Payer: Wellcare CHP/FHP/Medicaid	$25,217.83

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