St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

Neonate birthwt 1500-1999g w congenital/perinatal infection

Facility

$102,851.93

Service Code	APR-DRG 6132
Min. Negotiated Rate	$36,963.00
Max. Negotiated Rate	$102,851.93
Rate for Payer: Affinity Essential Plan 1&2	$102,851.93
Rate for Payer: Affinity Essential Plan 3&4	$102,851.93
Rate for Payer: Affinity Medicaid/CHP/HARP	$45,711.97
Rate for Payer: Amida Care Medicaid	$45,711.97
Rate for Payer: EmblemHealth Essential Plan 1&2	$102,851.93
Rate for Payer: EmblemHealth Essential Plan 3&4	$45,711.97
Rate for Payer: Fidelis CHP/HARP/Medicaid	$45,711.97
Rate for Payer: Fidelis Qualified Health Plan	$54,854.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$45,711.97
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$45,711.97
Rate for Payer: Healthfirst Commercial	$50,459.00
Rate for Payer: Healthfirst Essential Plan	$102,851.93
Rate for Payer: Healthfirst QHP	$36,963.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$45,711.97
Rate for Payer: SOMOS Essential	$102,851.93
Rate for Payer: United Healthcare Essential Plan 1&2	$102,851.93
Rate for Payer: United Healthcare Essential Plan 3&4	$102,851.93
Rate for Payer: United Healthcare Medicaid	$45,711.97
Rate for Payer: Wellcare CHP/FHP/Medicaid	$45,711.97

Neonate birthwt 1500-1999g w congenital/perinatal infection

Facility

$78,871.43

Service Code	APR-DRG 6131
Min. Negotiated Rate	$24,916.00
Max. Negotiated Rate	$78,871.43
Rate for Payer: Affinity Essential Plan 1&2	$78,871.43
Rate for Payer: Affinity Essential Plan 3&4	$78,871.43
Rate for Payer: Affinity Medicaid/CHP/HARP	$35,053.97
Rate for Payer: Amida Care Medicaid	$35,053.97
Rate for Payer: EmblemHealth Essential Plan 1&2	$78,871.43
Rate for Payer: EmblemHealth Essential Plan 3&4	$35,053.97
Rate for Payer: Fidelis CHP/HARP/Medicaid	$35,053.97
Rate for Payer: Fidelis Qualified Health Plan	$42,064.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$35,053.97
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$35,053.97
Rate for Payer: Healthfirst Commercial	$40,053.00
Rate for Payer: Healthfirst Essential Plan	$78,871.43
Rate for Payer: Healthfirst QHP	$24,916.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$35,053.97
Rate for Payer: SOMOS Essential	$78,871.43
Rate for Payer: United Healthcare Essential Plan 1&2	$78,871.43
Rate for Payer: United Healthcare Essential Plan 3&4	$78,871.43
Rate for Payer: United Healthcare Medicaid	$35,053.97
Rate for Payer: Wellcare CHP/FHP/Medicaid	$35,053.97

Neonate birthwt 1500-1999g w congenital/perinatal infection

Facility

$120,792.89

Service Code	APR-DRG 6133
Min. Negotiated Rate	$53,685.73
Max. Negotiated Rate	$120,792.89
Rate for Payer: Affinity Essential Plan 1&2	$120,792.89
Rate for Payer: Affinity Essential Plan 3&4	$120,792.89
Rate for Payer: Affinity Medicaid/CHP/HARP	$53,685.73
Rate for Payer: Amida Care Medicaid	$53,685.73
Rate for Payer: EmblemHealth Essential Plan 1&2	$120,792.89
Rate for Payer: EmblemHealth Essential Plan 3&4	$53,685.73
Rate for Payer: Fidelis CHP/HARP/Medicaid	$53,685.73
Rate for Payer: Fidelis Qualified Health Plan	$64,422.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$53,685.73
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$53,685.73
Rate for Payer: Healthfirst Commercial	$82,880.00
Rate for Payer: Healthfirst Essential Plan	$120,792.89
Rate for Payer: Healthfirst QHP	$56,535.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$53,685.73
Rate for Payer: SOMOS Essential	$120,792.89
Rate for Payer: United Healthcare Essential Plan 1&2	$120,792.89
Rate for Payer: United Healthcare Essential Plan 3&4	$120,792.89
Rate for Payer: United Healthcare Medicaid	$53,685.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$53,685.73

Neonate birthwt 1500-1999g w major anomaly

Facility

$76,073.26

Service Code	APR-DRG 6111
Min. Negotiated Rate	$21,815.00
Max. Negotiated Rate	$76,073.26
Rate for Payer: Affinity Essential Plan 1&2	$76,073.26
Rate for Payer: Affinity Essential Plan 3&4	$76,073.26
Rate for Payer: Affinity Medicaid/CHP/HARP	$33,810.34
Rate for Payer: Amida Care Medicaid	$33,810.34
Rate for Payer: EmblemHealth Essential Plan 1&2	$76,073.26
Rate for Payer: EmblemHealth Essential Plan 3&4	$33,810.34
Rate for Payer: Fidelis CHP/HARP/Medicaid	$33,810.34
Rate for Payer: Fidelis Qualified Health Plan	$40,572.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$33,810.34
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$33,810.34
Rate for Payer: Healthfirst Commercial	$50,024.00
Rate for Payer: Healthfirst Essential Plan	$76,073.26
Rate for Payer: Healthfirst QHP	$21,815.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$33,810.34
Rate for Payer: SOMOS Essential	$76,073.26
Rate for Payer: United Healthcare Essential Plan 1&2	$76,073.26
Rate for Payer: United Healthcare Essential Plan 3&4	$76,073.26
Rate for Payer: United Healthcare Medicaid	$33,810.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$33,810.34

Neonate birthwt 1500-1999g w major anomaly

Facility

$102,980.32

Service Code	APR-DRG 6112
Min. Negotiated Rate	$34,989.00
Max. Negotiated Rate	$102,980.32
Rate for Payer: Affinity Essential Plan 1&2	$102,980.32
Rate for Payer: Affinity Essential Plan 3&4	$102,980.32
Rate for Payer: Affinity Medicaid/CHP/HARP	$45,769.03
Rate for Payer: Amida Care Medicaid	$45,769.03
Rate for Payer: EmblemHealth Essential Plan 1&2	$102,980.32
Rate for Payer: EmblemHealth Essential Plan 3&4	$45,769.03
Rate for Payer: Fidelis CHP/HARP/Medicaid	$45,769.03
Rate for Payer: Fidelis Qualified Health Plan	$54,922.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$45,769.03
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$45,769.03
Rate for Payer: Healthfirst Commercial	$69,400.00
Rate for Payer: Healthfirst Essential Plan	$102,980.32
Rate for Payer: Healthfirst QHP	$34,989.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$45,769.03
Rate for Payer: SOMOS Essential	$102,980.32
Rate for Payer: United Healthcare Essential Plan 1&2	$102,980.32
Rate for Payer: United Healthcare Essential Plan 3&4	$102,980.32
Rate for Payer: United Healthcare Medicaid	$45,769.03
Rate for Payer: Wellcare CHP/FHP/Medicaid	$45,769.03

Neonate birthwt 1500-1999g w major anomaly

Facility

$142,216.20

Service Code	APR-DRG 6113
Min. Negotiated Rate	$47,982.00
Max. Negotiated Rate	$142,216.20
Rate for Payer: Affinity Essential Plan 1&2	$142,216.20
Rate for Payer: Affinity Essential Plan 3&4	$142,216.20
Rate for Payer: Affinity Medicaid/CHP/HARP	$63,207.20
Rate for Payer: Amida Care Medicaid	$63,207.20
Rate for Payer: EmblemHealth Essential Plan 1&2	$142,216.20
Rate for Payer: EmblemHealth Essential Plan 3&4	$63,207.20
Rate for Payer: Fidelis CHP/HARP/Medicaid	$63,207.20
Rate for Payer: Fidelis Qualified Health Plan	$75,848.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$63,207.20
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$63,207.20
Rate for Payer: Healthfirst Commercial	$95,751.00
Rate for Payer: Healthfirst Essential Plan	$142,216.20
Rate for Payer: Healthfirst QHP	$47,982.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$63,207.20
Rate for Payer: SOMOS Essential	$142,216.20
Rate for Payer: United Healthcare Essential Plan 1&2	$142,216.20
Rate for Payer: United Healthcare Essential Plan 3&4	$142,216.20
Rate for Payer: United Healthcare Medicaid	$63,207.20
Rate for Payer: Wellcare CHP/FHP/Medicaid	$63,207.20

Neonate birthwt 1500-1999g w major anomaly

Facility

$176,474.81

Service Code	APR-DRG 6114
Min. Negotiated Rate	$60,655.00
Max. Negotiated Rate	$176,474.81
Rate for Payer: Affinity Essential Plan 1&2	$176,474.81
Rate for Payer: Affinity Essential Plan 3&4	$176,474.81
Rate for Payer: Affinity Medicaid/CHP/HARP	$78,433.25
Rate for Payer: Amida Care Medicaid	$78,433.25
Rate for Payer: EmblemHealth Essential Plan 1&2	$176,474.81
Rate for Payer: EmblemHealth Essential Plan 3&4	$78,433.25
Rate for Payer: Fidelis CHP/HARP/Medicaid	$78,433.25
Rate for Payer: Fidelis Qualified Health Plan	$94,119.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$78,433.25
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$78,433.25
Rate for Payer: Healthfirst Commercial	$169,471.00
Rate for Payer: Healthfirst Essential Plan	$176,474.81
Rate for Payer: Healthfirst QHP	$60,655.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$78,433.25
Rate for Payer: SOMOS Essential	$176,474.81
Rate for Payer: United Healthcare Essential Plan 1&2	$176,474.81
Rate for Payer: United Healthcare Essential Plan 3&4	$176,474.81
Rate for Payer: United Healthcare Medicaid	$78,433.25
Rate for Payer: Wellcare CHP/FHP/Medicaid	$78,433.25

Neonate birthwt >2499g, normal newborn or neonate w other problem

Facility

$35,092.71

Service Code	APR-DRG 6401
Min. Negotiated Rate	$3,008.00
Max. Negotiated Rate	$35,092.71
Rate for Payer: Affinity Essential Plan 1&2	$35,092.71
Rate for Payer: Affinity Essential Plan 3&4	$35,092.71
Rate for Payer: Affinity Medicaid/CHP/HARP	$15,596.76
Rate for Payer: Amida Care Medicaid	$15,596.76
Rate for Payer: EmblemHealth Essential Plan 1&2	$35,092.71
Rate for Payer: EmblemHealth Essential Plan 3&4	$15,596.76
Rate for Payer: Fidelis CHP/HARP/Medicaid	$15,596.76
Rate for Payer: Fidelis Qualified Health Plan	$18,716.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$15,596.76
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$15,596.76
Rate for Payer: Healthfirst Commercial	$5,367.00
Rate for Payer: Healthfirst Essential Plan	$35,092.71
Rate for Payer: Healthfirst QHP	$3,008.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$15,596.76
Rate for Payer: SOMOS Essential	$35,092.71
Rate for Payer: United Healthcare Essential Plan 1&2	$35,092.71
Rate for Payer: United Healthcare Essential Plan 3&4	$35,092.71
Rate for Payer: United Healthcare Medicaid	$15,596.76
Rate for Payer: Wellcare CHP/FHP/Medicaid	$15,596.76

Neonate birthwt >2499g, normal newborn or neonate w other problem

Facility

$36,290.43

Service Code	APR-DRG 6402
Min. Negotiated Rate	$3,620.00
Max. Negotiated Rate	$36,290.43
Rate for Payer: Affinity Essential Plan 1&2	$36,290.43
Rate for Payer: Affinity Essential Plan 3&4	$36,290.43
Rate for Payer: Affinity Medicaid/CHP/HARP	$16,129.08
Rate for Payer: Amida Care Medicaid	$16,129.08
Rate for Payer: EmblemHealth Essential Plan 1&2	$36,290.43
Rate for Payer: EmblemHealth Essential Plan 3&4	$16,129.08
Rate for Payer: Fidelis CHP/HARP/Medicaid	$16,129.08
Rate for Payer: Fidelis Qualified Health Plan	$19,354.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$16,129.08
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16,129.08
Rate for Payer: Healthfirst Commercial	$6,450.00
Rate for Payer: Healthfirst Essential Plan	$36,290.43
Rate for Payer: Healthfirst QHP	$3,620.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$16,129.08
Rate for Payer: SOMOS Essential	$36,290.43
Rate for Payer: United Healthcare Essential Plan 1&2	$36,290.43
Rate for Payer: United Healthcare Essential Plan 3&4	$36,290.43
Rate for Payer: United Healthcare Medicaid	$16,129.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,129.08

Neonate birthwt >2499g, normal newborn or neonate w other problem

Facility

$41,526.20

Service Code	APR-DRG 6404
Min. Negotiated Rate	$6,319.00
Max. Negotiated Rate	$41,526.20
Rate for Payer: Affinity Essential Plan 1&2	$41,526.20
Rate for Payer: Affinity Essential Plan 3&4	$41,526.20
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,456.09
Rate for Payer: Amida Care Medicaid	$18,456.09
Rate for Payer: EmblemHealth Essential Plan 1&2	$41,526.20
Rate for Payer: EmblemHealth Essential Plan 3&4	$18,456.09
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,456.09
Rate for Payer: Fidelis Qualified Health Plan	$22,147.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,456.09
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,456.09
Rate for Payer: Healthfirst Commercial	$10,894.00
Rate for Payer: Healthfirst Essential Plan	$41,526.20
Rate for Payer: Healthfirst QHP	$6,319.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,456.09
Rate for Payer: SOMOS Essential	$41,526.20
Rate for Payer: United Healthcare Essential Plan 1&2	$41,526.20
Rate for Payer: United Healthcare Essential Plan 3&4	$41,526.20
Rate for Payer: United Healthcare Medicaid	$18,456.09
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,456.09

Neonate birthwt >2499g, normal newborn or neonate w other problem

Facility

$41,515.65

Service Code	APR-DRG 6403
Min. Negotiated Rate	$6,316.00
Max. Negotiated Rate	$41,515.65
Rate for Payer: Affinity Essential Plan 1&2	$41,515.65
Rate for Payer: Affinity Essential Plan 3&4	$41,515.65
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,451.40
Rate for Payer: Amida Care Medicaid	$18,451.40
Rate for Payer: EmblemHealth Essential Plan 1&2	$41,515.65
Rate for Payer: EmblemHealth Essential Plan 3&4	$18,451.40
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,451.40
Rate for Payer: Fidelis Qualified Health Plan	$22,141.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,451.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,451.40
Rate for Payer: Healthfirst Commercial	$10,885.00
Rate for Payer: Healthfirst Essential Plan	$41,515.65
Rate for Payer: Healthfirst QHP	$6,316.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,451.40
Rate for Payer: SOMOS Essential	$41,515.65
Rate for Payer: United Healthcare Essential Plan 1&2	$41,515.65
Rate for Payer: United Healthcare Essential Plan 3&4	$41,515.65
Rate for Payer: United Healthcare Medicaid	$18,451.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,451.40

Neonate birthwt >2499g w congenital/perinatal infection

Facility

$79,180.96

Service Code	APR-DRG 6364
Min. Negotiated Rate	$27,039.00
Max. Negotiated Rate	$79,180.96
Rate for Payer: Affinity Essential Plan 1&2	$79,180.96
Rate for Payer: Affinity Essential Plan 3&4	$79,180.96
Rate for Payer: Affinity Medicaid/CHP/HARP	$35,191.54
Rate for Payer: Amida Care Medicaid	$35,191.54
Rate for Payer: EmblemHealth Essential Plan 1&2	$79,180.96
Rate for Payer: EmblemHealth Essential Plan 3&4	$35,191.54
Rate for Payer: Fidelis CHP/HARP/Medicaid	$35,191.54
Rate for Payer: Fidelis Qualified Health Plan	$42,229.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$35,191.54
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$35,191.54
Rate for Payer: Healthfirst Commercial	$36,495.00
Rate for Payer: Healthfirst Essential Plan	$79,180.96
Rate for Payer: Healthfirst QHP	$27,039.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$35,191.54
Rate for Payer: SOMOS Essential	$79,180.96
Rate for Payer: United Healthcare Essential Plan 1&2	$79,180.96
Rate for Payer: United Healthcare Essential Plan 3&4	$79,180.96
Rate for Payer: United Healthcare Medicaid	$35,191.54
Rate for Payer: Wellcare CHP/FHP/Medicaid	$35,191.54

Neonate birthwt >2499g w congenital/perinatal infection

Facility

$49,382.53

Service Code	APR-DRG 6361
Min. Negotiated Rate	$9,067.00
Max. Negotiated Rate	$49,382.53
Rate for Payer: Affinity Essential Plan 1&2	$49,382.53
Rate for Payer: Affinity Essential Plan 3&4	$49,382.53
Rate for Payer: Affinity Medicaid/CHP/HARP	$21,947.79
Rate for Payer: Amida Care Medicaid	$21,947.79
Rate for Payer: EmblemHealth Essential Plan 1&2	$49,382.53
Rate for Payer: EmblemHealth Essential Plan 3&4	$21,947.79
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,947.79
Rate for Payer: Fidelis Qualified Health Plan	$26,337.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,947.79
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,947.79
Rate for Payer: Healthfirst Commercial	$14,658.00
Rate for Payer: Healthfirst Essential Plan	$49,382.53
Rate for Payer: Healthfirst QHP	$9,067.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,947.79
Rate for Payer: SOMOS Essential	$49,382.53
Rate for Payer: United Healthcare Essential Plan 1&2	$49,382.53
Rate for Payer: United Healthcare Essential Plan 3&4	$49,382.53
Rate for Payer: United Healthcare Medicaid	$21,947.79
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,947.79

Neonate birthwt >2499g w congenital/perinatal infection

Facility

$55,583.86

Service Code	APR-DRG 6362
Min. Negotiated Rate	$12,841.00
Max. Negotiated Rate	$55,583.86
Rate for Payer: Affinity Essential Plan 1&2	$55,583.86
Rate for Payer: Affinity Essential Plan 3&4	$55,583.86
Rate for Payer: Affinity Medicaid/CHP/HARP	$24,703.94
Rate for Payer: Amida Care Medicaid	$24,703.94
Rate for Payer: EmblemHealth Essential Plan 1&2	$55,583.86
Rate for Payer: EmblemHealth Essential Plan 3&4	$24,703.94
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,703.94
Rate for Payer: Fidelis Qualified Health Plan	$29,644.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,703.94
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,703.94
Rate for Payer: Healthfirst Commercial	$20,826.00
Rate for Payer: Healthfirst Essential Plan	$55,583.86
Rate for Payer: Healthfirst QHP	$12,841.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,703.94
Rate for Payer: SOMOS Essential	$55,583.86
Rate for Payer: United Healthcare Essential Plan 1&2	$55,583.86
Rate for Payer: United Healthcare Essential Plan 3&4	$55,583.86
Rate for Payer: United Healthcare Medicaid	$24,703.94
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,703.94

Neonate birthwt >2499g w congenital/perinatal infection

Facility

$68,195.84

Service Code	APR-DRG 6363
Min. Negotiated Rate	$18,758.00
Max. Negotiated Rate	$68,195.84
Rate for Payer: Affinity Essential Plan 1&2	$68,195.84
Rate for Payer: Affinity Essential Plan 3&4	$68,195.84
Rate for Payer: Affinity Medicaid/CHP/HARP	$30,309.26
Rate for Payer: Amida Care Medicaid	$30,309.26
Rate for Payer: EmblemHealth Essential Plan 1&2	$68,195.84
Rate for Payer: EmblemHealth Essential Plan 3&4	$30,309.26
Rate for Payer: Fidelis CHP/HARP/Medicaid	$30,309.26
Rate for Payer: Fidelis Qualified Health Plan	$36,371.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$30,309.26
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$30,309.26
Rate for Payer: Healthfirst Commercial	$35,196.00
Rate for Payer: Healthfirst Essential Plan	$68,195.84
Rate for Payer: Healthfirst QHP	$18,758.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$30,309.26
Rate for Payer: SOMOS Essential	$68,195.84
Rate for Payer: United Healthcare Essential Plan 1&2	$68,195.84
Rate for Payer: United Healthcare Essential Plan 3&4	$68,195.84
Rate for Payer: United Healthcare Medicaid	$30,309.26
Rate for Payer: Wellcare CHP/FHP/Medicaid	$30,309.26

Neonate birthwt >2499g w major anomaly

Facility

$74,163.26

Service Code	APR-DRG 6333
Min. Negotiated Rate	$18,583.00
Max. Negotiated Rate	$74,163.26
Rate for Payer: Affinity Essential Plan 1&2	$74,163.26
Rate for Payer: Affinity Essential Plan 3&4	$74,163.26
Rate for Payer: Affinity Medicaid/CHP/HARP	$32,961.45
Rate for Payer: Amida Care Medicaid	$32,961.45
Rate for Payer: EmblemHealth Essential Plan 1&2	$74,163.26
Rate for Payer: EmblemHealth Essential Plan 3&4	$32,961.45
Rate for Payer: Fidelis CHP/HARP/Medicaid	$32,961.45
Rate for Payer: Fidelis Qualified Health Plan	$39,553.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$32,961.45
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$32,961.45
Rate for Payer: Healthfirst Commercial	$32,884.00
Rate for Payer: Healthfirst Essential Plan	$74,163.26
Rate for Payer: Healthfirst QHP	$18,583.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$32,961.45
Rate for Payer: SOMOS Essential	$74,163.26
Rate for Payer: United Healthcare Essential Plan 1&2	$74,163.26
Rate for Payer: United Healthcare Essential Plan 3&4	$74,163.26
Rate for Payer: United Healthcare Medicaid	$32,961.45
Rate for Payer: Wellcare CHP/FHP/Medicaid	$32,961.45

Neonate birthwt >2499g w major anomaly

Facility

$36,972.81

Service Code	APR-DRG 6331
Min. Negotiated Rate	$3,840.00
Max. Negotiated Rate	$36,972.81
Rate for Payer: Affinity Essential Plan 1&2	$36,972.81
Rate for Payer: Affinity Essential Plan 3&4	$36,972.81
Rate for Payer: Affinity Medicaid/CHP/HARP	$16,432.36
Rate for Payer: Amida Care Medicaid	$16,432.36
Rate for Payer: EmblemHealth Essential Plan 1&2	$36,972.81
Rate for Payer: EmblemHealth Essential Plan 3&4	$16,432.36
Rate for Payer: Fidelis CHP/HARP/Medicaid	$16,432.36
Rate for Payer: Fidelis Qualified Health Plan	$19,718.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$16,432.36
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16,432.36
Rate for Payer: Healthfirst Commercial	$7,083.00
Rate for Payer: Healthfirst Essential Plan	$36,972.81
Rate for Payer: Healthfirst QHP	$3,840.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$16,432.36
Rate for Payer: SOMOS Essential	$36,972.81
Rate for Payer: United Healthcare Essential Plan 1&2	$36,972.81
Rate for Payer: United Healthcare Essential Plan 3&4	$36,972.81
Rate for Payer: United Healthcare Medicaid	$16,432.36
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,432.36

Neonate birthwt >2499g w major anomaly

Facility

$48,030.05

Service Code	APR-DRG 6332
Min. Negotiated Rate	$8,821.00
Max. Negotiated Rate	$48,030.05
Rate for Payer: Affinity Essential Plan 1&2	$48,030.05
Rate for Payer: Affinity Essential Plan 3&4	$48,030.05
Rate for Payer: Affinity Medicaid/CHP/HARP	$21,346.69
Rate for Payer: Amida Care Medicaid	$21,346.69
Rate for Payer: EmblemHealth Essential Plan 1&2	$48,030.05
Rate for Payer: EmblemHealth Essential Plan 3&4	$21,346.69
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,346.69
Rate for Payer: Fidelis Qualified Health Plan	$25,616.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,346.69
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,346.69
Rate for Payer: Healthfirst Commercial	$15,727.00
Rate for Payer: Healthfirst Essential Plan	$48,030.05
Rate for Payer: Healthfirst QHP	$8,821.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,346.69
Rate for Payer: SOMOS Essential	$48,030.05
Rate for Payer: United Healthcare Essential Plan 1&2	$48,030.05
Rate for Payer: United Healthcare Essential Plan 3&4	$48,030.05
Rate for Payer: United Healthcare Medicaid	$21,346.69
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,346.69

Neonate birthwt >2499g w major anomaly

Facility

$126,178.18

Service Code	APR-DRG 6334
Min. Negotiated Rate	$37,593.00
Max. Negotiated Rate	$126,178.18
Rate for Payer: Affinity Essential Plan 1&2	$126,178.18
Rate for Payer: Affinity Essential Plan 3&4	$126,178.18
Rate for Payer: Affinity Medicaid/CHP/HARP	$56,079.19
Rate for Payer: Amida Care Medicaid	$56,079.19
Rate for Payer: EmblemHealth Essential Plan 1&2	$126,178.18
Rate for Payer: EmblemHealth Essential Plan 3&4	$56,079.19
Rate for Payer: Fidelis CHP/HARP/Medicaid	$56,079.19
Rate for Payer: Fidelis Qualified Health Plan	$67,295.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$56,079.19
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$56,079.19
Rate for Payer: Healthfirst Commercial	$85,268.00
Rate for Payer: Healthfirst Essential Plan	$126,178.18
Rate for Payer: Healthfirst QHP	$37,593.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$56,079.19
Rate for Payer: SOMOS Essential	$126,178.18
Rate for Payer: United Healthcare Essential Plan 1&2	$126,178.18
Rate for Payer: United Healthcare Essential Plan 3&4	$126,178.18
Rate for Payer: United Healthcare Medicaid	$56,079.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$56,079.19

Neonate birthwt >2499g w major cardiovascular procedure

Facility

$136,231.18

Service Code	APR-DRG 6303
Min. Negotiated Rate	$49,009.00
Max. Negotiated Rate	$136,231.18
Rate for Payer: Affinity Essential Plan 1&2	$136,231.18
Rate for Payer: Affinity Essential Plan 3&4	$136,231.18
Rate for Payer: Affinity Medicaid/CHP/HARP	$60,547.19
Rate for Payer: Amida Care Medicaid	$60,547.19
Rate for Payer: EmblemHealth Essential Plan 1&2	$136,231.18
Rate for Payer: EmblemHealth Essential Plan 3&4	$60,547.19
Rate for Payer: Fidelis CHP/HARP/Medicaid	$60,547.19
Rate for Payer: Fidelis Qualified Health Plan	$72,656.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$60,547.19
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$60,547.19
Rate for Payer: Healthfirst Commercial	$103,626.00
Rate for Payer: Healthfirst Essential Plan	$136,231.18
Rate for Payer: Healthfirst QHP	$49,009.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$60,547.19
Rate for Payer: SOMOS Essential	$136,231.18
Rate for Payer: United Healthcare Essential Plan 1&2	$136,231.18
Rate for Payer: United Healthcare Essential Plan 3&4	$136,231.18
Rate for Payer: United Healthcare Medicaid	$60,547.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$60,547.19

Neonate birthwt >2499g w major cardiovascular procedure

Facility

$247,102.54

Service Code	APR-DRG 6304
Min. Negotiated Rate	$87,259.00
Max. Negotiated Rate	$247,102.54
Rate for Payer: Affinity Essential Plan 1&2	$247,102.54
Rate for Payer: Affinity Essential Plan 3&4	$247,102.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$109,823.35
Rate for Payer: Amida Care Medicaid	$109,823.35
Rate for Payer: EmblemHealth Essential Plan 1&2	$247,102.54
Rate for Payer: EmblemHealth Essential Plan 3&4	$109,823.35
Rate for Payer: Fidelis CHP/HARP/Medicaid	$109,823.35
Rate for Payer: Fidelis Qualified Health Plan	$131,788.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$109,823.35
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$109,823.35
Rate for Payer: Healthfirst Commercial	$224,416.00
Rate for Payer: Healthfirst Essential Plan	$247,102.54
Rate for Payer: Healthfirst QHP	$87,259.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$109,823.35
Rate for Payer: SOMOS Essential	$247,102.54
Rate for Payer: United Healthcare Essential Plan 1&2	$247,102.54
Rate for Payer: United Healthcare Essential Plan 3&4	$247,102.54
Rate for Payer: United Healthcare Medicaid	$109,823.35
Rate for Payer: Wellcare CHP/FHP/Medicaid	$109,823.35

Neonate birthwt >2499g w major cardiovascular procedure

Facility

$92,672.30

Service Code	APR-DRG 6301
Min. Negotiated Rate	$26,170.00
Max. Negotiated Rate	$92,672.30
Rate for Payer: Affinity Essential Plan 1&2	$92,672.30
Rate for Payer: Affinity Essential Plan 3&4	$92,672.30
Rate for Payer: Affinity Medicaid/CHP/HARP	$41,187.69
Rate for Payer: Amida Care Medicaid	$41,187.69
Rate for Payer: EmblemHealth Essential Plan 1&2	$92,672.30
Rate for Payer: EmblemHealth Essential Plan 3&4	$41,187.69
Rate for Payer: Fidelis CHP/HARP/Medicaid	$41,187.69
Rate for Payer: Fidelis Qualified Health Plan	$49,425.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$41,187.69
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$41,187.69
Rate for Payer: Healthfirst Commercial	$51,521.00
Rate for Payer: Healthfirst Essential Plan	$92,672.30
Rate for Payer: Healthfirst QHP	$26,170.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$41,187.69
Rate for Payer: SOMOS Essential	$92,672.30
Rate for Payer: United Healthcare Essential Plan 1&2	$92,672.30
Rate for Payer: United Healthcare Essential Plan 3&4	$92,672.30
Rate for Payer: United Healthcare Medicaid	$41,187.69
Rate for Payer: Wellcare CHP/FHP/Medicaid	$41,187.69

Neonate birthwt >2499g w major cardiovascular procedure

Facility

$95,097.62

Service Code	APR-DRG 6302
Min. Negotiated Rate	$29,998.00
Max. Negotiated Rate	$95,097.62
Rate for Payer: Affinity Essential Plan 1&2	$95,097.62
Rate for Payer: Affinity Essential Plan 3&4	$95,097.62
Rate for Payer: Affinity Medicaid/CHP/HARP	$42,265.61
Rate for Payer: Amida Care Medicaid	$42,265.61
Rate for Payer: EmblemHealth Essential Plan 1&2	$95,097.62
Rate for Payer: EmblemHealth Essential Plan 3&4	$42,265.61
Rate for Payer: Fidelis CHP/HARP/Medicaid	$42,265.61
Rate for Payer: Fidelis Qualified Health Plan	$50,718.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$42,265.61
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$42,265.61
Rate for Payer: Healthfirst Commercial	$57,432.00
Rate for Payer: Healthfirst Essential Plan	$95,097.62
Rate for Payer: Healthfirst QHP	$29,998.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$42,265.61
Rate for Payer: SOMOS Essential	$95,097.62
Rate for Payer: United Healthcare Essential Plan 1&2	$95,097.62
Rate for Payer: United Healthcare Essential Plan 3&4	$95,097.62
Rate for Payer: United Healthcare Medicaid	$42,265.61
Rate for Payer: Wellcare CHP/FHP/Medicaid	$42,265.61

Neonate birthwt >2499g w other major procedure

Facility

$83,618.28

Service Code	APR-DRG 6312
Min. Negotiated Rate	$27,711.00
Max. Negotiated Rate	$83,618.28
Rate for Payer: Affinity Essential Plan 1&2	$83,618.28
Rate for Payer: Affinity Essential Plan 3&4	$83,618.28
Rate for Payer: Affinity Medicaid/CHP/HARP	$37,163.68
Rate for Payer: Amida Care Medicaid	$37,163.68
Rate for Payer: EmblemHealth Essential Plan 1&2	$83,618.28
Rate for Payer: EmblemHealth Essential Plan 3&4	$37,163.68
Rate for Payer: Fidelis CHP/HARP/Medicaid	$37,163.68
Rate for Payer: Fidelis Qualified Health Plan	$44,596.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$37,163.68
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$37,163.68
Rate for Payer: Healthfirst Commercial	$59,069.00
Rate for Payer: Healthfirst Essential Plan	$83,618.28
Rate for Payer: Healthfirst QHP	$27,711.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$37,163.68
Rate for Payer: SOMOS Essential	$83,618.28
Rate for Payer: United Healthcare Essential Plan 1&2	$83,618.28
Rate for Payer: United Healthcare Essential Plan 3&4	$83,618.28
Rate for Payer: United Healthcare Medicaid	$37,163.68
Rate for Payer: Wellcare CHP/FHP/Medicaid	$37,163.68

Neonate birthwt >2499g w other major procedure

Facility

$216,920.70

Service Code	APR-DRG 6314
Min. Negotiated Rate	$96,409.20
Max. Negotiated Rate	$216,920.70
Rate for Payer: Affinity Essential Plan 1&2	$216,920.70
Rate for Payer: Affinity Essential Plan 3&4	$216,920.70
Rate for Payer: Affinity Medicaid/CHP/HARP	$96,409.20
Rate for Payer: Amida Care Medicaid	$96,409.20
Rate for Payer: EmblemHealth Essential Plan 1&2	$216,920.70
Rate for Payer: EmblemHealth Essential Plan 3&4	$96,409.20
Rate for Payer: Fidelis CHP/HARP/Medicaid	$96,409.20
Rate for Payer: Fidelis Qualified Health Plan	$115,691.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$96,409.20
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$96,409.20
Rate for Payer: Healthfirst Commercial	$176,144.00
Rate for Payer: Healthfirst Essential Plan	$216,920.70
Rate for Payer: Healthfirst QHP	$98,134.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$96,409.20
Rate for Payer: SOMOS Essential	$216,920.70
Rate for Payer: United Healthcare Essential Plan 1&2	$216,920.70
Rate for Payer: United Healthcare Essential Plan 3&4	$216,920.70
Rate for Payer: United Healthcare Medicaid	$96,409.20
Rate for Payer: Wellcare CHP/FHP/Medicaid	$96,409.20

Know your out-of-pocket cost for care.

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