St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

Neonate birthwt >2499g w other major procedure

Facility

$117,773.15

Service Code	APR-DRG 6313
Min. Negotiated Rate	$46,863.00
Max. Negotiated Rate	$117,773.15
Rate for Payer: Affinity Essential Plan 1&2	$117,773.15
Rate for Payer: Affinity Essential Plan 3&4	$117,773.15
Rate for Payer: Affinity Medicaid/CHP/HARP	$52,343.62
Rate for Payer: Amida Care Medicaid	$52,343.62
Rate for Payer: EmblemHealth Essential Plan 1&2	$117,773.15
Rate for Payer: EmblemHealth Essential Plan 3&4	$52,343.62
Rate for Payer: Fidelis CHP/HARP/Medicaid	$52,343.62
Rate for Payer: Fidelis Qualified Health Plan	$62,812.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$52,343.62
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$52,343.62
Rate for Payer: Healthfirst Commercial	$94,612.00
Rate for Payer: Healthfirst Essential Plan	$117,773.15
Rate for Payer: Healthfirst QHP	$46,863.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$52,343.62
Rate for Payer: SOMOS Essential	$117,773.15
Rate for Payer: United Healthcare Essential Plan 1&2	$117,773.15
Rate for Payer: United Healthcare Essential Plan 3&4	$117,773.15
Rate for Payer: United Healthcare Medicaid	$52,343.62
Rate for Payer: Wellcare CHP/FHP/Medicaid	$52,343.62

Neonate birthwt >2499g w other major procedure

Facility

$60,650.82

Service Code	APR-DRG 6311
Min. Negotiated Rate	$15,186.00
Max. Negotiated Rate	$60,650.82
Rate for Payer: Affinity Essential Plan 1&2	$60,650.82
Rate for Payer: Affinity Essential Plan 3&4	$60,650.82
Rate for Payer: Affinity Medicaid/CHP/HARP	$26,955.92
Rate for Payer: Amida Care Medicaid	$26,955.92
Rate for Payer: EmblemHealth Essential Plan 1&2	$60,650.82
Rate for Payer: EmblemHealth Essential Plan 3&4	$26,955.92
Rate for Payer: Fidelis CHP/HARP/Medicaid	$26,955.92
Rate for Payer: Fidelis Qualified Health Plan	$32,347.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$26,955.92
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$26,955.92
Rate for Payer: Healthfirst Commercial	$31,804.00
Rate for Payer: Healthfirst Essential Plan	$60,650.82
Rate for Payer: Healthfirst QHP	$15,186.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26,955.92
Rate for Payer: SOMOS Essential	$60,650.82
Rate for Payer: United Healthcare Essential Plan 1&2	$60,650.82
Rate for Payer: United Healthcare Essential Plan 3&4	$60,650.82
Rate for Payer: United Healthcare Medicaid	$26,955.92
Rate for Payer: Wellcare CHP/FHP/Medicaid	$26,955.92

Neonate birthwt >2499g w other significant condition

Facility

$64,794.42

Service Code	APR-DRG 6393
Min. Negotiated Rate	$16,201.00
Max. Negotiated Rate	$64,794.42
Rate for Payer: Affinity Essential Plan 1&2	$64,794.42
Rate for Payer: Affinity Essential Plan 3&4	$64,794.42
Rate for Payer: Affinity Medicaid/CHP/HARP	$28,797.52
Rate for Payer: Amida Care Medicaid	$28,797.52
Rate for Payer: EmblemHealth Essential Plan 1&2	$64,794.42
Rate for Payer: EmblemHealth Essential Plan 3&4	$28,797.52
Rate for Payer: Fidelis CHP/HARP/Medicaid	$28,797.52
Rate for Payer: Fidelis Qualified Health Plan	$34,557.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$28,797.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$28,797.52
Rate for Payer: Healthfirst Commercial	$32,160.00
Rate for Payer: Healthfirst Essential Plan	$64,794.42
Rate for Payer: Healthfirst QHP	$16,201.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$28,797.52
Rate for Payer: SOMOS Essential	$64,794.42
Rate for Payer: United Healthcare Essential Plan 1&2	$64,794.42
Rate for Payer: United Healthcare Essential Plan 3&4	$64,794.42
Rate for Payer: United Healthcare Medicaid	$28,797.52
Rate for Payer: Wellcare CHP/FHP/Medicaid	$28,797.52

Neonate birthwt >2499g w other significant condition

Facility

$41,086.53

Service Code	APR-DRG 6391
Min. Negotiated Rate	$5,526.00
Max. Negotiated Rate	$41,086.53
Rate for Payer: Affinity Essential Plan 1&2	$41,086.53
Rate for Payer: Affinity Essential Plan 3&4	$41,086.53
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,260.68
Rate for Payer: Amida Care Medicaid	$18,260.68
Rate for Payer: EmblemHealth Essential Plan 1&2	$41,086.53
Rate for Payer: EmblemHealth Essential Plan 3&4	$18,260.68
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,260.68
Rate for Payer: Fidelis Qualified Health Plan	$21,912.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,260.68
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,260.68
Rate for Payer: Healthfirst Commercial	$10,416.00
Rate for Payer: Healthfirst Essential Plan	$41,086.53
Rate for Payer: Healthfirst QHP	$5,526.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,260.68
Rate for Payer: SOMOS Essential	$41,086.53
Rate for Payer: United Healthcare Essential Plan 1&2	$41,086.53
Rate for Payer: United Healthcare Essential Plan 3&4	$41,086.53
Rate for Payer: United Healthcare Medicaid	$18,260.68
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,260.68

Neonate birthwt >2499g w other significant condition

Facility

$54,820.57

Service Code	APR-DRG 6392
Min. Negotiated Rate	$12,248.00
Max. Negotiated Rate	$54,820.57
Rate for Payer: Affinity Essential Plan 1&2	$54,820.57
Rate for Payer: Affinity Essential Plan 3&4	$54,820.57
Rate for Payer: Affinity Medicaid/CHP/HARP	$24,364.70
Rate for Payer: Amida Care Medicaid	$24,364.70
Rate for Payer: EmblemHealth Essential Plan 1&2	$54,820.57
Rate for Payer: EmblemHealth Essential Plan 3&4	$24,364.70
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,364.70
Rate for Payer: Fidelis Qualified Health Plan	$29,237.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,364.70
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,364.70
Rate for Payer: Healthfirst Commercial	$21,012.00
Rate for Payer: Healthfirst Essential Plan	$54,820.57
Rate for Payer: Healthfirst QHP	$12,248.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,364.70
Rate for Payer: SOMOS Essential	$54,820.57
Rate for Payer: United Healthcare Essential Plan 1&2	$54,820.57
Rate for Payer: United Healthcare Essential Plan 3&4	$54,820.57
Rate for Payer: United Healthcare Medicaid	$24,364.70
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,364.70

Neonate birthwt >2499g w other significant condition

Facility

$99,452.27

Service Code	APR-DRG 6394
Min. Negotiated Rate	$24,364.00
Max. Negotiated Rate	$99,452.27
Rate for Payer: Affinity Essential Plan 1&2	$99,452.27
Rate for Payer: Affinity Essential Plan 3&4	$99,452.27
Rate for Payer: Affinity Medicaid/CHP/HARP	$44,201.01
Rate for Payer: Amida Care Medicaid	$44,201.01
Rate for Payer: EmblemHealth Essential Plan 1&2	$99,452.27
Rate for Payer: EmblemHealth Essential Plan 3&4	$44,201.01
Rate for Payer: Fidelis CHP/HARP/Medicaid	$44,201.01
Rate for Payer: Fidelis Qualified Health Plan	$53,041.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$44,201.01
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$44,201.01
Rate for Payer: Healthfirst Commercial	$53,562.00
Rate for Payer: Healthfirst Essential Plan	$99,452.27
Rate for Payer: Healthfirst QHP	$24,364.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$44,201.01
Rate for Payer: SOMOS Essential	$99,452.27
Rate for Payer: United Healthcare Essential Plan 1&2	$99,452.27
Rate for Payer: United Healthcare Essential Plan 3&4	$99,452.27
Rate for Payer: United Healthcare Medicaid	$44,201.01
Rate for Payer: Wellcare CHP/FHP/Medicaid	$44,201.01

Neonate, birthwt >2499g w resp dist synd/oth maj resp cond

Facility

$46,158.75

Service Code	APR-DRG 6341
Min. Negotiated Rate	$7,869.00
Max. Negotiated Rate	$46,158.75
Rate for Payer: Affinity Essential Plan 1&2	$46,158.75
Rate for Payer: Affinity Essential Plan 3&4	$46,158.75
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,515.00
Rate for Payer: Amida Care Medicaid	$20,515.00
Rate for Payer: EmblemHealth Essential Plan 1&2	$46,158.75
Rate for Payer: EmblemHealth Essential Plan 3&4	$20,515.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,515.00
Rate for Payer: Fidelis Qualified Health Plan	$24,618.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,515.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,515.00
Rate for Payer: Healthfirst Commercial	$14,054.00
Rate for Payer: Healthfirst Essential Plan	$46,158.75
Rate for Payer: Healthfirst QHP	$7,869.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,515.00
Rate for Payer: SOMOS Essential	$46,158.75
Rate for Payer: United Healthcare Essential Plan 1&2	$46,158.75
Rate for Payer: United Healthcare Essential Plan 3&4	$46,158.75
Rate for Payer: United Healthcare Medicaid	$20,515.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,515.00

Neonate, birthwt >2499g w resp dist synd/oth maj resp cond

Facility

$71,627.15

Service Code	APR-DRG 6343
Min. Negotiated Rate	$18,584.00
Max. Negotiated Rate	$71,627.15
Rate for Payer: Affinity Essential Plan 1&2	$71,627.15
Rate for Payer: Affinity Essential Plan 3&4	$71,627.15
Rate for Payer: Affinity Medicaid/CHP/HARP	$31,834.29
Rate for Payer: Amida Care Medicaid	$31,834.29
Rate for Payer: EmblemHealth Essential Plan 1&2	$71,627.15
Rate for Payer: EmblemHealth Essential Plan 3&4	$31,834.29
Rate for Payer: Fidelis CHP/HARP/Medicaid	$31,834.29
Rate for Payer: Fidelis Qualified Health Plan	$38,201.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$31,834.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31,834.29
Rate for Payer: Healthfirst Commercial	$34,215.00
Rate for Payer: Healthfirst Essential Plan	$71,627.15
Rate for Payer: Healthfirst QHP	$18,584.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$31,834.29
Rate for Payer: SOMOS Essential	$71,627.15
Rate for Payer: United Healthcare Essential Plan 1&2	$71,627.15
Rate for Payer: United Healthcare Essential Plan 3&4	$71,627.15
Rate for Payer: United Healthcare Medicaid	$31,834.29
Rate for Payer: Wellcare CHP/FHP/Medicaid	$31,834.29

Neonate, birthwt >2499g w resp dist synd/oth maj resp cond

Facility

$102,955.70

Service Code	APR-DRG 6344
Min. Negotiated Rate	$34,196.00
Max. Negotiated Rate	$102,955.70
Rate for Payer: Affinity Essential Plan 1&2	$102,955.70
Rate for Payer: Affinity Essential Plan 3&4	$102,955.70
Rate for Payer: Affinity Medicaid/CHP/HARP	$45,758.09
Rate for Payer: Amida Care Medicaid	$45,758.09
Rate for Payer: EmblemHealth Essential Plan 1&2	$102,955.70
Rate for Payer: EmblemHealth Essential Plan 3&4	$45,758.09
Rate for Payer: Fidelis CHP/HARP/Medicaid	$45,758.09
Rate for Payer: Fidelis Qualified Health Plan	$54,909.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$45,758.09
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$45,758.09
Rate for Payer: Healthfirst Commercial	$65,432.00
Rate for Payer: Healthfirst Essential Plan	$102,955.70
Rate for Payer: Healthfirst QHP	$34,196.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$45,758.09
Rate for Payer: SOMOS Essential	$102,955.70
Rate for Payer: United Healthcare Essential Plan 1&2	$102,955.70
Rate for Payer: United Healthcare Essential Plan 3&4	$102,955.70
Rate for Payer: United Healthcare Medicaid	$45,758.09
Rate for Payer: Wellcare CHP/FHP/Medicaid	$45,758.09

Neonate, birthwt >2499g w resp dist synd/oth maj resp cond

Facility

$55,462.52

Service Code	APR-DRG 6342
Min. Negotiated Rate	$12,425.00
Max. Negotiated Rate	$55,462.52
Rate for Payer: Affinity Essential Plan 1&2	$55,462.52
Rate for Payer: Affinity Essential Plan 3&4	$55,462.52
Rate for Payer: Affinity Medicaid/CHP/HARP	$24,650.01
Rate for Payer: Amida Care Medicaid	$24,650.01
Rate for Payer: EmblemHealth Essential Plan 1&2	$55,462.52
Rate for Payer: EmblemHealth Essential Plan 3&4	$24,650.01
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,650.01
Rate for Payer: Fidelis Qualified Health Plan	$29,580.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,650.01
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,650.01
Rate for Payer: Healthfirst Commercial	$21,390.00
Rate for Payer: Healthfirst Essential Plan	$55,462.52
Rate for Payer: Healthfirst QHP	$12,425.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,650.01
Rate for Payer: SOMOS Essential	$55,462.52
Rate for Payer: United Healthcare Essential Plan 1&2	$55,462.52
Rate for Payer: United Healthcare Essential Plan 3&4	$55,462.52
Rate for Payer: United Healthcare Medicaid	$24,650.01
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,650.01

Neonate birthwt 500-749g w/o major procedure

Facility

$188,358.66

Service Code	APR-DRG 5911
Min. Negotiated Rate	$39,255.00
Max. Negotiated Rate	$188,358.66
Rate for Payer: Affinity Essential Plan 1&2	$188,358.66
Rate for Payer: Affinity Essential Plan 3&4	$188,358.66
Rate for Payer: Affinity Medicaid/CHP/HARP	$83,714.96
Rate for Payer: Amida Care Medicaid	$83,714.96
Rate for Payer: EmblemHealth Essential Plan 1&2	$188,358.66
Rate for Payer: EmblemHealth Essential Plan 3&4	$83,714.96
Rate for Payer: Fidelis CHP/HARP/Medicaid	$83,714.96
Rate for Payer: Fidelis Qualified Health Plan	$100,457.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$83,714.96
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$83,714.96
Rate for Payer: Healthfirst Commercial	$98,515.00
Rate for Payer: Healthfirst Essential Plan	$188,358.66
Rate for Payer: Healthfirst QHP	$39,255.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$83,714.96
Rate for Payer: SOMOS Essential	$188,358.66
Rate for Payer: United Healthcare Essential Plan 1&2	$188,358.66
Rate for Payer: United Healthcare Essential Plan 3&4	$188,358.66
Rate for Payer: United Healthcare Medicaid	$83,714.96
Rate for Payer: Wellcare CHP/FHP/Medicaid	$83,714.96

Neonate birthwt 500-749g w/o major procedure

Facility

$225,863.91

Service Code	APR-DRG 5912
Min. Negotiated Rate	$45,979.00
Max. Negotiated Rate	$225,863.91
Rate for Payer: Affinity Essential Plan 1&2	$225,863.91
Rate for Payer: Affinity Essential Plan 3&4	$225,863.91
Rate for Payer: Affinity Medicaid/CHP/HARP	$100,383.96
Rate for Payer: Amida Care Medicaid	$100,383.96
Rate for Payer: EmblemHealth Essential Plan 1&2	$225,863.91
Rate for Payer: EmblemHealth Essential Plan 3&4	$100,383.96
Rate for Payer: Fidelis CHP/HARP/Medicaid	$100,383.96
Rate for Payer: Fidelis Qualified Health Plan	$120,460.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$100,383.96
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$100,383.96
Rate for Payer: Healthfirst Commercial	$123,625.00
Rate for Payer: Healthfirst Essential Plan	$225,863.91
Rate for Payer: Healthfirst QHP	$45,979.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$100,383.96
Rate for Payer: SOMOS Essential	$225,863.91
Rate for Payer: United Healthcare Essential Plan 1&2	$225,863.91
Rate for Payer: United Healthcare Essential Plan 3&4	$225,863.91
Rate for Payer: United Healthcare Medicaid	$100,383.96
Rate for Payer: Wellcare CHP/FHP/Medicaid	$100,383.96

Neonate birthwt 500-749g w/o major procedure

Facility

$239,809.03

Service Code	APR-DRG 5913
Min. Negotiated Rate	$85,080.00
Max. Negotiated Rate	$239,809.03
Rate for Payer: Affinity Essential Plan 1&2	$239,809.03
Rate for Payer: Affinity Essential Plan 3&4	$239,809.03
Rate for Payer: Affinity Medicaid/CHP/HARP	$106,581.79
Rate for Payer: Amida Care Medicaid	$106,581.79
Rate for Payer: EmblemHealth Essential Plan 1&2	$239,809.03
Rate for Payer: EmblemHealth Essential Plan 3&4	$106,581.79
Rate for Payer: Fidelis CHP/HARP/Medicaid	$106,581.79
Rate for Payer: Fidelis Qualified Health Plan	$127,898.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$106,581.79
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$106,581.79
Rate for Payer: Healthfirst Commercial	$187,437.00
Rate for Payer: Healthfirst Essential Plan	$239,809.03
Rate for Payer: Healthfirst QHP	$85,080.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$106,581.79
Rate for Payer: SOMOS Essential	$239,809.03
Rate for Payer: United Healthcare Essential Plan 1&2	$239,809.03
Rate for Payer: United Healthcare Essential Plan 3&4	$239,809.03
Rate for Payer: United Healthcare Medicaid	$106,581.79
Rate for Payer: Wellcare CHP/FHP/Medicaid	$106,581.79

Neonate birthwt 500-749g w/o major procedure

Facility

$372,764.97

Service Code	APR-DRG 5914
Min. Negotiated Rate	$155,564.00
Max. Negotiated Rate	$372,764.97
Rate for Payer: Affinity Essential Plan 1&2	$372,764.97
Rate for Payer: Affinity Essential Plan 3&4	$372,764.97
Rate for Payer: Affinity Medicaid/CHP/HARP	$165,673.32
Rate for Payer: Amida Care Medicaid	$165,673.32
Rate for Payer: EmblemHealth Essential Plan 1&2	$372,764.97
Rate for Payer: EmblemHealth Essential Plan 3&4	$165,673.32
Rate for Payer: Fidelis CHP/HARP/Medicaid	$165,673.32
Rate for Payer: Fidelis Qualified Health Plan	$198,807.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$165,673.32
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$165,673.32
Rate for Payer: Healthfirst Commercial	$255,573.00
Rate for Payer: Healthfirst Essential Plan	$372,764.97
Rate for Payer: Healthfirst QHP	$155,564.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$165,673.32
Rate for Payer: SOMOS Essential	$372,764.97
Rate for Payer: United Healthcare Essential Plan 1&2	$372,764.97
Rate for Payer: United Healthcare Essential Plan 3&4	$372,764.97
Rate for Payer: United Healthcare Medicaid	$165,673.32
Rate for Payer: Wellcare CHP/FHP/Medicaid	$165,673.32

Neonate birthwt 750-999g w/o major procedure

Facility

$222,010.52

Service Code	APR-DRG 5931
Min. Negotiated Rate	$80,977.00
Max. Negotiated Rate	$222,010.52
Rate for Payer: Affinity Essential Plan 1&2	$222,010.52
Rate for Payer: Affinity Essential Plan 3&4	$222,010.52
Rate for Payer: Affinity Medicaid/CHP/HARP	$98,671.34
Rate for Payer: Amida Care Medicaid	$98,671.34
Rate for Payer: EmblemHealth Essential Plan 1&2	$222,010.52
Rate for Payer: EmblemHealth Essential Plan 3&4	$98,671.34
Rate for Payer: Fidelis CHP/HARP/Medicaid	$98,671.34
Rate for Payer: Fidelis Qualified Health Plan	$118,405.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$98,671.34
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$98,671.34
Rate for Payer: Healthfirst Commercial	$180,420.00
Rate for Payer: Healthfirst Essential Plan	$222,010.52
Rate for Payer: Healthfirst QHP	$80,977.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$98,671.34
Rate for Payer: SOMOS Essential	$222,010.52
Rate for Payer: United Healthcare Essential Plan 1&2	$222,010.52
Rate for Payer: United Healthcare Essential Plan 3&4	$222,010.52
Rate for Payer: United Healthcare Medicaid	$98,671.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$98,671.34

Neonate birthwt 750-999g w/o major procedure

Facility

$227,977.94

Service Code	APR-DRG 5932
Min. Negotiated Rate	$85,061.00
Max. Negotiated Rate	$227,977.94
Rate for Payer: Affinity Essential Plan 1&2	$227,977.94
Rate for Payer: Affinity Essential Plan 3&4	$227,977.94
Rate for Payer: Affinity Medicaid/CHP/HARP	$101,323.53
Rate for Payer: Amida Care Medicaid	$101,323.53
Rate for Payer: EmblemHealth Essential Plan 1&2	$227,977.94
Rate for Payer: EmblemHealth Essential Plan 3&4	$101,323.53
Rate for Payer: Fidelis CHP/HARP/Medicaid	$101,323.53
Rate for Payer: Fidelis Qualified Health Plan	$121,588.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$101,323.53
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$101,323.53
Rate for Payer: Healthfirst Commercial	$181,662.00
Rate for Payer: Healthfirst Essential Plan	$227,977.94
Rate for Payer: Healthfirst QHP	$85,061.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$101,323.53
Rate for Payer: SOMOS Essential	$227,977.94
Rate for Payer: United Healthcare Essential Plan 1&2	$227,977.94
Rate for Payer: United Healthcare Essential Plan 3&4	$227,977.94
Rate for Payer: United Healthcare Medicaid	$101,323.53
Rate for Payer: Wellcare CHP/FHP/Medicaid	$101,323.53

Neonate birthwt 750-999g w/o major procedure

Facility

$271,522.73

Service Code	APR-DRG 5933
Min. Negotiated Rate	$108,018.00
Max. Negotiated Rate	$271,522.73
Rate for Payer: Affinity Essential Plan 1&2	$271,522.73
Rate for Payer: Affinity Essential Plan 3&4	$271,522.73
Rate for Payer: Affinity Medicaid/CHP/HARP	$120,676.77
Rate for Payer: Amida Care Medicaid	$120,676.77
Rate for Payer: EmblemHealth Essential Plan 1&2	$271,522.73
Rate for Payer: EmblemHealth Essential Plan 3&4	$120,676.77
Rate for Payer: Fidelis CHP/HARP/Medicaid	$120,676.77
Rate for Payer: Fidelis Qualified Health Plan	$144,812.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$120,676.77
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$120,676.77
Rate for Payer: Healthfirst Commercial	$195,470.00
Rate for Payer: Healthfirst Essential Plan	$271,522.73
Rate for Payer: Healthfirst QHP	$108,018.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$120,676.77
Rate for Payer: SOMOS Essential	$271,522.73
Rate for Payer: United Healthcare Essential Plan 1&2	$271,522.73
Rate for Payer: United Healthcare Essential Plan 3&4	$271,522.73
Rate for Payer: United Healthcare Medicaid	$120,676.77
Rate for Payer: Wellcare CHP/FHP/Medicaid	$120,676.77

Neonate birthwt 750-999g w/o major procedure

Facility

$338,669.91

Service Code	APR-DRG 5934
Min. Negotiated Rate	$143,221.00
Max. Negotiated Rate	$338,669.91
Rate for Payer: Affinity Essential Plan 1&2	$338,669.91
Rate for Payer: Affinity Essential Plan 3&4	$338,669.91
Rate for Payer: Affinity Medicaid/CHP/HARP	$150,519.96
Rate for Payer: Amida Care Medicaid	$150,519.96
Rate for Payer: EmblemHealth Essential Plan 1&2	$338,669.91
Rate for Payer: EmblemHealth Essential Plan 3&4	$150,519.96
Rate for Payer: Fidelis CHP/HARP/Medicaid	$150,519.96
Rate for Payer: Fidelis Qualified Health Plan	$180,623.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$150,519.96
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$150,519.96
Rate for Payer: Healthfirst Commercial	$242,008.00
Rate for Payer: Healthfirst Essential Plan	$338,669.91
Rate for Payer: Healthfirst QHP	$143,221.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$150,519.96
Rate for Payer: SOMOS Essential	$338,669.91
Rate for Payer: United Healthcare Essential Plan 1&2	$338,669.91
Rate for Payer: United Healthcare Essential Plan 3&4	$338,669.91
Rate for Payer: United Healthcare Medicaid	$150,519.96
Rate for Payer: Wellcare CHP/FHP/Medicaid	$150,519.96

Neonate bwt 1000-1249g w resp dist synd/oth maj resp or maj anom

Facility

$228,329.68

Service Code	APR-DRG 6023
Min. Negotiated Rate	$93,493.00
Max. Negotiated Rate	$228,329.68
Rate for Payer: Affinity Essential Plan 1&2	$228,329.68
Rate for Payer: Affinity Essential Plan 3&4	$228,329.68
Rate for Payer: Affinity Medicaid/CHP/HARP	$101,479.86
Rate for Payer: Amida Care Medicaid	$101,479.86
Rate for Payer: EmblemHealth Essential Plan 1&2	$228,329.68
Rate for Payer: EmblemHealth Essential Plan 3&4	$101,479.86
Rate for Payer: Fidelis CHP/HARP/Medicaid	$101,479.86
Rate for Payer: Fidelis Qualified Health Plan	$121,775.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$101,479.86
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$101,479.86
Rate for Payer: Healthfirst Commercial	$173,995.00
Rate for Payer: Healthfirst Essential Plan	$228,329.68
Rate for Payer: Healthfirst QHP	$93,493.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$101,479.86
Rate for Payer: SOMOS Essential	$228,329.68
Rate for Payer: United Healthcare Essential Plan 1&2	$228,329.68
Rate for Payer: United Healthcare Essential Plan 3&4	$228,329.68
Rate for Payer: United Healthcare Medicaid	$101,479.86
Rate for Payer: Wellcare CHP/FHP/Medicaid	$101,479.86

Neonate bwt 1000-1249g w resp dist synd/oth maj resp or maj anom

Facility

$297,967.23

Service Code	APR-DRG 6024
Min. Negotiated Rate	$113,640.00
Max. Negotiated Rate	$297,967.23
Rate for Payer: Affinity Essential Plan 1&2	$297,967.23
Rate for Payer: Affinity Essential Plan 3&4	$297,967.23
Rate for Payer: Affinity Medicaid/CHP/HARP	$132,429.88
Rate for Payer: Amida Care Medicaid	$132,429.88
Rate for Payer: EmblemHealth Essential Plan 1&2	$297,967.23
Rate for Payer: EmblemHealth Essential Plan 3&4	$132,429.88
Rate for Payer: Fidelis CHP/HARP/Medicaid	$132,429.88
Rate for Payer: Fidelis Qualified Health Plan	$158,915.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$132,429.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$132,429.88
Rate for Payer: Healthfirst Commercial	$202,779.00
Rate for Payer: Healthfirst Essential Plan	$297,967.23
Rate for Payer: Healthfirst QHP	$113,640.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$132,429.88
Rate for Payer: SOMOS Essential	$297,967.23
Rate for Payer: United Healthcare Essential Plan 1&2	$297,967.23
Rate for Payer: United Healthcare Essential Plan 3&4	$297,967.23
Rate for Payer: United Healthcare Medicaid	$132,429.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$132,429.88

Neonate bwt 1000-1249g w resp dist synd/oth maj resp or maj anom

Facility

$198,816.17

Service Code	APR-DRG 6022
Min. Negotiated Rate	$71,360.00
Max. Negotiated Rate	$198,816.17
Rate for Payer: Affinity Essential Plan 1&2	$198,816.17
Rate for Payer: Affinity Essential Plan 3&4	$198,816.17
Rate for Payer: Affinity Medicaid/CHP/HARP	$88,362.74
Rate for Payer: Amida Care Medicaid	$88,362.74
Rate for Payer: EmblemHealth Essential Plan 1&2	$198,816.17
Rate for Payer: EmblemHealth Essential Plan 3&4	$88,362.74
Rate for Payer: Fidelis CHP/HARP/Medicaid	$88,362.74
Rate for Payer: Fidelis Qualified Health Plan	$106,035.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$88,362.74
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$88,362.74
Rate for Payer: Healthfirst Commercial	$137,679.00
Rate for Payer: Healthfirst Essential Plan	$198,816.17
Rate for Payer: Healthfirst QHP	$71,360.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$88,362.74
Rate for Payer: SOMOS Essential	$198,816.17
Rate for Payer: United Healthcare Essential Plan 1&2	$198,816.17
Rate for Payer: United Healthcare Essential Plan 3&4	$198,816.17
Rate for Payer: United Healthcare Medicaid	$88,362.74
Rate for Payer: Wellcare CHP/FHP/Medicaid	$88,362.74

Neonate bwt 1000-1249g w resp dist synd/oth maj resp or maj anom

Facility

$146,206.78

Service Code	APR-DRG 6021
Min. Negotiated Rate	$49,534.00
Max. Negotiated Rate	$146,206.78
Rate for Payer: Affinity Essential Plan 1&2	$146,206.78
Rate for Payer: Affinity Essential Plan 3&4	$146,206.78
Rate for Payer: Affinity Medicaid/CHP/HARP	$64,980.79
Rate for Payer: Amida Care Medicaid	$64,980.79
Rate for Payer: EmblemHealth Essential Plan 1&2	$146,206.78
Rate for Payer: EmblemHealth Essential Plan 3&4	$64,980.79
Rate for Payer: Fidelis CHP/HARP/Medicaid	$64,980.79
Rate for Payer: Fidelis Qualified Health Plan	$77,976.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$64,980.79
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$64,980.79
Rate for Payer: Healthfirst Commercial	$135,347.00
Rate for Payer: Healthfirst Essential Plan	$146,206.78
Rate for Payer: Healthfirst QHP	$49,534.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$64,980.79
Rate for Payer: SOMOS Essential	$146,206.78
Rate for Payer: United Healthcare Essential Plan 1&2	$146,206.78
Rate for Payer: United Healthcare Essential Plan 3&4	$146,206.78
Rate for Payer: United Healthcare Medicaid	$64,980.79
Rate for Payer: Wellcare CHP/FHP/Medicaid	$64,980.79

Neonate bwt 1250-1499g w or w/o other significant condition

Facility

$158,336.86

Service Code	APR-DRG 6084
Min. Negotiated Rate	$70,371.94
Max. Negotiated Rate	$158,336.86
Rate for Payer: Affinity Essential Plan 1&2	$158,336.86
Rate for Payer: Affinity Essential Plan 3&4	$158,336.86
Rate for Payer: Affinity Medicaid/CHP/HARP	$70,371.94
Rate for Payer: Amida Care Medicaid	$70,371.94
Rate for Payer: EmblemHealth Essential Plan 1&2	$158,336.86
Rate for Payer: EmblemHealth Essential Plan 3&4	$70,371.94
Rate for Payer: Fidelis CHP/HARP/Medicaid	$70,371.94
Rate for Payer: Fidelis Qualified Health Plan	$84,446.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$70,371.94
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$70,371.94
Rate for Payer: Healthfirst Commercial	$121,433.00
Rate for Payer: Healthfirst Essential Plan	$158,336.86
Rate for Payer: Healthfirst QHP	$90,920.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$70,371.94
Rate for Payer: SOMOS Essential	$158,336.86
Rate for Payer: United Healthcare Essential Plan 1&2	$158,336.86
Rate for Payer: United Healthcare Essential Plan 3&4	$158,336.86
Rate for Payer: United Healthcare Medicaid	$70,371.94
Rate for Payer: Wellcare CHP/FHP/Medicaid	$70,371.94

Neonate bwt 1250-1499g w or w/o other significant condition

Facility

$152,026.47

Service Code	APR-DRG 6083
Min. Negotiated Rate	$67,567.32
Max. Negotiated Rate	$152,026.47
Rate for Payer: Affinity Essential Plan 1&2	$152,026.47
Rate for Payer: Affinity Essential Plan 3&4	$152,026.47
Rate for Payer: Affinity Medicaid/CHP/HARP	$67,567.32
Rate for Payer: Amida Care Medicaid	$67,567.32
Rate for Payer: EmblemHealth Essential Plan 1&2	$152,026.47
Rate for Payer: EmblemHealth Essential Plan 3&4	$67,567.32
Rate for Payer: Fidelis CHP/HARP/Medicaid	$67,567.32
Rate for Payer: Fidelis Qualified Health Plan	$81,080.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$67,567.32
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$67,567.32
Rate for Payer: Healthfirst Commercial	$112,810.00
Rate for Payer: Healthfirst Essential Plan	$152,026.47
Rate for Payer: Healthfirst QHP	$69,310.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$67,567.32
Rate for Payer: SOMOS Essential	$152,026.47
Rate for Payer: United Healthcare Essential Plan 1&2	$152,026.47
Rate for Payer: United Healthcare Essential Plan 3&4	$152,026.47
Rate for Payer: United Healthcare Medicaid	$67,567.32
Rate for Payer: Wellcare CHP/FHP/Medicaid	$67,567.32

Neonate bwt 1250-1499g w or w/o other significant condition

Facility

$106,664.90

Service Code	APR-DRG 6081
Min. Negotiated Rate	$33,433.00
Max. Negotiated Rate	$106,664.90
Rate for Payer: Affinity Essential Plan 1&2	$106,664.90
Rate for Payer: Affinity Essential Plan 3&4	$106,664.90
Rate for Payer: Affinity Medicaid/CHP/HARP	$47,406.62
Rate for Payer: Amida Care Medicaid	$47,406.62
Rate for Payer: EmblemHealth Essential Plan 1&2	$106,664.90
Rate for Payer: EmblemHealth Essential Plan 3&4	$47,406.62
Rate for Payer: Fidelis CHP/HARP/Medicaid	$47,406.62
Rate for Payer: Fidelis Qualified Health Plan	$56,887.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$47,406.62
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$47,406.62
Rate for Payer: Healthfirst Commercial	$69,870.00
Rate for Payer: Healthfirst Essential Plan	$106,664.90
Rate for Payer: Healthfirst QHP	$33,433.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$47,406.62
Rate for Payer: SOMOS Essential	$106,664.90
Rate for Payer: United Healthcare Essential Plan 1&2	$106,664.90
Rate for Payer: United Healthcare Essential Plan 3&4	$106,664.90
Rate for Payer: United Healthcare Medicaid	$47,406.62
Rate for Payer: Wellcare CHP/FHP/Medicaid	$47,406.62

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