St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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

Facility

$132,018.98

Service Code	APR-DRG 6082
Min. Negotiated Rate	$48,612.00
Max. Negotiated Rate	$132,018.98
Rate for Payer: Affinity Essential Plan 1&2	$132,018.98
Rate for Payer: Affinity Essential Plan 3&4	$132,018.98
Rate for Payer: Affinity Medicaid/CHP/HARP	$58,675.10
Rate for Payer: Amida Care Medicaid	$58,675.10
Rate for Payer: EmblemHealth Essential Plan 1&2	$132,018.98
Rate for Payer: EmblemHealth Essential Plan 3&4	$58,675.10
Rate for Payer: Fidelis CHP/HARP/Medicaid	$58,675.10
Rate for Payer: Fidelis Qualified Health Plan	$70,410.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$58,675.10
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$58,675.10
Rate for Payer: Healthfirst Commercial	$92,493.00
Rate for Payer: Healthfirst Essential Plan	$132,018.98
Rate for Payer: Healthfirst QHP	$48,612.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$58,675.10
Rate for Payer: SOMOS Essential	$132,018.98
Rate for Payer: United Healthcare Essential Plan 1&2	$132,018.98
Rate for Payer: United Healthcare Essential Plan 3&4	$132,018.98
Rate for Payer: United Healthcare Medicaid	$58,675.10
Rate for Payer: Wellcare CHP/FHP/Medicaid	$58,675.10

Neonate bwt 1250-1499g w resp dist synd/oth maj resp or maj anom

Facility

$163,542.76

Service Code	APR-DRG 6072
Min. Negotiated Rate	$57,229.00
Max. Negotiated Rate	$163,542.76
Rate for Payer: Affinity Essential Plan 1&2	$163,542.76
Rate for Payer: Affinity Essential Plan 3&4	$163,542.76
Rate for Payer: Affinity Medicaid/CHP/HARP	$72,685.67
Rate for Payer: Amida Care Medicaid	$72,685.67
Rate for Payer: EmblemHealth Essential Plan 1&2	$163,542.76
Rate for Payer: EmblemHealth Essential Plan 3&4	$72,685.67
Rate for Payer: Fidelis CHP/HARP/Medicaid	$72,685.67
Rate for Payer: Fidelis Qualified Health Plan	$87,222.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$72,685.67
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$72,685.67
Rate for Payer: Healthfirst Commercial	$108,927.00
Rate for Payer: Healthfirst Essential Plan	$163,542.76
Rate for Payer: Healthfirst QHP	$57,229.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$72,685.67
Rate for Payer: SOMOS Essential	$163,542.76
Rate for Payer: United Healthcare Essential Plan 1&2	$163,542.76
Rate for Payer: United Healthcare Essential Plan 3&4	$163,542.76
Rate for Payer: United Healthcare Medicaid	$72,685.67
Rate for Payer: Wellcare CHP/FHP/Medicaid	$72,685.67

Neonate bwt 1250-1499g w resp dist synd/oth maj resp or maj anom

Facility

$249,144.43

Service Code	APR-DRG 6074
Min. Negotiated Rate	$89,136.00
Max. Negotiated Rate	$249,144.43
Rate for Payer: Affinity Essential Plan 1&2	$249,144.43
Rate for Payer: Affinity Essential Plan 3&4	$249,144.43
Rate for Payer: Affinity Medicaid/CHP/HARP	$110,730.86
Rate for Payer: Amida Care Medicaid	$110,730.86
Rate for Payer: EmblemHealth Essential Plan 1&2	$249,144.43
Rate for Payer: EmblemHealth Essential Plan 3&4	$110,730.86
Rate for Payer: Fidelis CHP/HARP/Medicaid	$110,730.86
Rate for Payer: Fidelis Qualified Health Plan	$132,877.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$110,730.86
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$110,730.86
Rate for Payer: Healthfirst Commercial	$189,814.00
Rate for Payer: Healthfirst Essential Plan	$249,144.43
Rate for Payer: Healthfirst QHP	$89,136.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$110,730.86
Rate for Payer: SOMOS Essential	$249,144.43
Rate for Payer: United Healthcare Essential Plan 1&2	$249,144.43
Rate for Payer: United Healthcare Essential Plan 3&4	$249,144.43
Rate for Payer: United Healthcare Medicaid	$110,730.86
Rate for Payer: Wellcare CHP/FHP/Medicaid	$110,730.86

Neonate bwt 1250-1499g w resp dist synd/oth maj resp or maj anom

Facility

$192,926.11

Service Code	APR-DRG 6073
Min. Negotiated Rate	$71,158.00
Max. Negotiated Rate	$192,926.11
Rate for Payer: Affinity Essential Plan 1&2	$192,926.11
Rate for Payer: Affinity Essential Plan 3&4	$192,926.11
Rate for Payer: Affinity Medicaid/CHP/HARP	$85,744.94
Rate for Payer: Amida Care Medicaid	$85,744.94
Rate for Payer: EmblemHealth Essential Plan 1&2	$192,926.11
Rate for Payer: EmblemHealth Essential Plan 3&4	$85,744.94
Rate for Payer: Fidelis CHP/HARP/Medicaid	$85,744.94
Rate for Payer: Fidelis Qualified Health Plan	$102,893.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$85,744.94
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$85,744.94
Rate for Payer: Healthfirst Commercial	$134,278.00
Rate for Payer: Healthfirst Essential Plan	$192,926.11
Rate for Payer: Healthfirst QHP	$71,158.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$85,744.94
Rate for Payer: SOMOS Essential	$192,926.11
Rate for Payer: United Healthcare Essential Plan 1&2	$192,926.11
Rate for Payer: United Healthcare Essential Plan 3&4	$192,926.11
Rate for Payer: United Healthcare Medicaid	$85,744.94
Rate for Payer: Wellcare CHP/FHP/Medicaid	$85,744.94

Neonate bwt 1250-1499g w resp dist synd/oth maj resp or maj anom

Facility

$138,266.05

Service Code	APR-DRG 6071
Min. Negotiated Rate	$41,939.00
Max. Negotiated Rate	$138,266.05
Rate for Payer: Affinity Essential Plan 1&2	$138,266.05
Rate for Payer: Affinity Essential Plan 3&4	$138,266.05
Rate for Payer: Affinity Medicaid/CHP/HARP	$61,451.58
Rate for Payer: Amida Care Medicaid	$61,451.58
Rate for Payer: EmblemHealth Essential Plan 1&2	$138,266.05
Rate for Payer: EmblemHealth Essential Plan 3&4	$61,451.58
Rate for Payer: Fidelis CHP/HARP/Medicaid	$61,451.58
Rate for Payer: Fidelis Qualified Health Plan	$73,741.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$61,451.58
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$61,451.58
Rate for Payer: Healthfirst Commercial	$92,938.00
Rate for Payer: Healthfirst Essential Plan	$138,266.05
Rate for Payer: Healthfirst QHP	$41,939.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$61,451.58
Rate for Payer: SOMOS Essential	$138,266.05
Rate for Payer: United Healthcare Essential Plan 1&2	$138,266.05
Rate for Payer: United Healthcare Essential Plan 3&4	$138,266.05
Rate for Payer: United Healthcare Medicaid	$61,451.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$61,451.58

Neonate bwt 1500-1999g w or w/o other significant condition

Facility

$90,025.40

Service Code	APR-DRG 6142
Min. Negotiated Rate	$28,894.00
Max. Negotiated Rate	$90,025.40
Rate for Payer: Affinity Essential Plan 1&2	$90,025.40
Rate for Payer: Affinity Essential Plan 3&4	$90,025.40
Rate for Payer: Affinity Medicaid/CHP/HARP	$40,011.29
Rate for Payer: Amida Care Medicaid	$40,011.29
Rate for Payer: EmblemHealth Essential Plan 1&2	$90,025.40
Rate for Payer: EmblemHealth Essential Plan 3&4	$40,011.29
Rate for Payer: Fidelis CHP/HARP/Medicaid	$40,011.29
Rate for Payer: Fidelis Qualified Health Plan	$48,013.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$40,011.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$40,011.29
Rate for Payer: Healthfirst Commercial	$54,832.00
Rate for Payer: Healthfirst Essential Plan	$90,025.40
Rate for Payer: Healthfirst QHP	$28,894.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$40,011.29
Rate for Payer: SOMOS Essential	$90,025.40
Rate for Payer: United Healthcare Essential Plan 1&2	$90,025.40
Rate for Payer: United Healthcare Essential Plan 3&4	$90,025.40
Rate for Payer: United Healthcare Medicaid	$40,011.29
Rate for Payer: Wellcare CHP/FHP/Medicaid	$40,011.29

Neonate bwt 1500-1999g w or w/o other significant condition

Facility

$67,096.62

Service Code	APR-DRG 6141
Min. Negotiated Rate	$16,928.00
Max. Negotiated Rate	$67,096.62
Rate for Payer: Affinity Essential Plan 1&2	$67,096.62
Rate for Payer: Affinity Essential Plan 3&4	$67,096.62
Rate for Payer: Affinity Medicaid/CHP/HARP	$29,820.72
Rate for Payer: Amida Care Medicaid	$29,820.72
Rate for Payer: EmblemHealth Essential Plan 1&2	$67,096.62
Rate for Payer: EmblemHealth Essential Plan 3&4	$29,820.72
Rate for Payer: Fidelis CHP/HARP/Medicaid	$29,820.72
Rate for Payer: Fidelis Qualified Health Plan	$35,784.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$29,820.72
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29,820.72
Rate for Payer: Healthfirst Commercial	$32,234.00
Rate for Payer: Healthfirst Essential Plan	$67,096.62
Rate for Payer: Healthfirst QHP	$16,928.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$29,820.72
Rate for Payer: SOMOS Essential	$67,096.62
Rate for Payer: United Healthcare Essential Plan 1&2	$67,096.62
Rate for Payer: United Healthcare Essential Plan 3&4	$67,096.62
Rate for Payer: United Healthcare Medicaid	$29,820.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$29,820.72

Neonate bwt 1500-1999g w or w/o other significant condition

Facility

$120,588.88

Service Code	APR-DRG 6143
Min. Negotiated Rate	$41,067.00
Max. Negotiated Rate	$120,588.88
Rate for Payer: Affinity Essential Plan 1&2	$120,588.88
Rate for Payer: Affinity Essential Plan 3&4	$120,588.88
Rate for Payer: Affinity Medicaid/CHP/HARP	$53,595.06
Rate for Payer: Amida Care Medicaid	$53,595.06
Rate for Payer: EmblemHealth Essential Plan 1&2	$120,588.88
Rate for Payer: EmblemHealth Essential Plan 3&4	$53,595.06
Rate for Payer: Fidelis CHP/HARP/Medicaid	$53,595.06
Rate for Payer: Fidelis Qualified Health Plan	$64,314.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$53,595.06
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$53,595.06
Rate for Payer: Healthfirst Commercial	$85,240.00
Rate for Payer: Healthfirst Essential Plan	$120,588.88
Rate for Payer: Healthfirst QHP	$41,067.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$53,595.06
Rate for Payer: SOMOS Essential	$120,588.88
Rate for Payer: United Healthcare Essential Plan 1&2	$120,588.88
Rate for Payer: United Healthcare Essential Plan 3&4	$120,588.88
Rate for Payer: United Healthcare Medicaid	$53,595.06
Rate for Payer: Wellcare CHP/FHP/Medicaid	$53,595.06

Neonate bwt 1500-1999g w or w/o other significant condition

Facility

$120,588.88

Service Code	APR-DRG 6144
Min. Negotiated Rate	$42,555.00
Max. Negotiated Rate	$120,588.88
Rate for Payer: Affinity Essential Plan 1&2	$120,588.88
Rate for Payer: Affinity Essential Plan 3&4	$120,588.88
Rate for Payer: Affinity Medicaid/CHP/HARP	$53,595.06
Rate for Payer: Amida Care Medicaid	$53,595.06
Rate for Payer: EmblemHealth Essential Plan 1&2	$120,588.88
Rate for Payer: EmblemHealth Essential Plan 3&4	$53,595.06
Rate for Payer: Fidelis CHP/HARP/Medicaid	$53,595.06
Rate for Payer: Fidelis Qualified Health Plan	$64,314.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$53,595.06
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$53,595.06
Rate for Payer: Healthfirst Commercial	$88,525.00
Rate for Payer: Healthfirst Essential Plan	$120,588.88
Rate for Payer: Healthfirst QHP	$42,555.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$53,595.06
Rate for Payer: SOMOS Essential	$120,588.88
Rate for Payer: United Healthcare Essential Plan 1&2	$120,588.88
Rate for Payer: United Healthcare Essential Plan 3&4	$120,588.88
Rate for Payer: United Healthcare Medicaid	$53,595.06
Rate for Payer: Wellcare CHP/FHP/Medicaid	$53,595.06

Neonate bwt 1500-1999g w resp dist synd/oth maj resp cond

Facility

$181,045.80

Service Code	APR-DRG 6124
Min. Negotiated Rate	$65,956.00
Max. Negotiated Rate	$181,045.80
Rate for Payer: Affinity Essential Plan 1&2	$181,045.80
Rate for Payer: Affinity Essential Plan 3&4	$181,045.80
Rate for Payer: Affinity Medicaid/CHP/HARP	$80,464.80
Rate for Payer: Amida Care Medicaid	$80,464.80
Rate for Payer: EmblemHealth Essential Plan 1&2	$181,045.80
Rate for Payer: EmblemHealth Essential Plan 3&4	$80,464.80
Rate for Payer: Fidelis CHP/HARP/Medicaid	$80,464.80
Rate for Payer: Fidelis Qualified Health Plan	$96,557.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$80,464.80
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$80,464.80
Rate for Payer: Healthfirst Commercial	$130,927.00
Rate for Payer: Healthfirst Essential Plan	$181,045.80
Rate for Payer: Healthfirst QHP	$65,956.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$80,464.80
Rate for Payer: SOMOS Essential	$181,045.80
Rate for Payer: United Healthcare Essential Plan 1&2	$181,045.80
Rate for Payer: United Healthcare Essential Plan 3&4	$181,045.80
Rate for Payer: United Healthcare Medicaid	$80,464.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$80,464.80

Neonate bwt 1500-1999g w resp dist synd/oth maj resp cond

Facility

$143,573.94

Service Code	APR-DRG 6123
Min. Negotiated Rate	$51,727.00
Max. Negotiated Rate	$143,573.94
Rate for Payer: Affinity Essential Plan 1&2	$143,573.94
Rate for Payer: Affinity Essential Plan 3&4	$143,573.94
Rate for Payer: Affinity Medicaid/CHP/HARP	$63,810.64
Rate for Payer: Amida Care Medicaid	$63,810.64
Rate for Payer: EmblemHealth Essential Plan 1&2	$143,573.94
Rate for Payer: EmblemHealth Essential Plan 3&4	$63,810.64
Rate for Payer: Fidelis CHP/HARP/Medicaid	$63,810.64
Rate for Payer: Fidelis Qualified Health Plan	$76,572.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$63,810.64
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$63,810.64
Rate for Payer: Healthfirst Commercial	$93,403.00
Rate for Payer: Healthfirst Essential Plan	$143,573.94
Rate for Payer: Healthfirst QHP	$51,727.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$63,810.64
Rate for Payer: SOMOS Essential	$143,573.94
Rate for Payer: United Healthcare Essential Plan 1&2	$143,573.94
Rate for Payer: United Healthcare Essential Plan 3&4	$143,573.94
Rate for Payer: United Healthcare Medicaid	$63,810.64
Rate for Payer: Wellcare CHP/FHP/Medicaid	$63,810.64

Neonate bwt 1500-1999g w resp dist synd/oth maj resp cond

Facility

$112,041.38

Service Code	APR-DRG 6122
Min. Negotiated Rate	$37,359.00
Max. Negotiated Rate	$112,041.38
Rate for Payer: Affinity Essential Plan 1&2	$112,041.38
Rate for Payer: Affinity Essential Plan 3&4	$112,041.38
Rate for Payer: Affinity Medicaid/CHP/HARP	$49,796.17
Rate for Payer: Amida Care Medicaid	$49,796.17
Rate for Payer: EmblemHealth Essential Plan 1&2	$112,041.38
Rate for Payer: EmblemHealth Essential Plan 3&4	$49,796.17
Rate for Payer: Fidelis CHP/HARP/Medicaid	$49,796.17
Rate for Payer: Fidelis Qualified Health Plan	$59,755.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$49,796.17
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$49,796.17
Rate for Payer: Healthfirst Commercial	$64,973.00
Rate for Payer: Healthfirst Essential Plan	$112,041.38
Rate for Payer: Healthfirst QHP	$37,359.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$49,796.17
Rate for Payer: SOMOS Essential	$112,041.38
Rate for Payer: United Healthcare Essential Plan 1&2	$112,041.38
Rate for Payer: United Healthcare Essential Plan 3&4	$112,041.38
Rate for Payer: United Healthcare Medicaid	$49,796.17
Rate for Payer: Wellcare CHP/FHP/Medicaid	$49,796.17

Neonate bwt 1500-1999g w resp dist synd/oth maj resp cond

Facility

$93,892.88

Service Code	APR-DRG 6121
Min. Negotiated Rate	$28,520.00
Max. Negotiated Rate	$93,892.88
Rate for Payer: Affinity Essential Plan 1&2	$93,892.88
Rate for Payer: Affinity Essential Plan 3&4	$93,892.88
Rate for Payer: Affinity Medicaid/CHP/HARP	$41,730.17
Rate for Payer: Amida Care Medicaid	$41,730.17
Rate for Payer: EmblemHealth Essential Plan 1&2	$93,892.88
Rate for Payer: EmblemHealth Essential Plan 3&4	$41,730.17
Rate for Payer: Fidelis CHP/HARP/Medicaid	$41,730.17
Rate for Payer: Fidelis Qualified Health Plan	$50,076.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$41,730.17
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$41,730.17
Rate for Payer: Healthfirst Commercial	$54,035.00
Rate for Payer: Healthfirst Essential Plan	$93,892.88
Rate for Payer: Healthfirst QHP	$28,520.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$41,730.17
Rate for Payer: SOMOS Essential	$93,892.88
Rate for Payer: United Healthcare Essential Plan 1&2	$93,892.88
Rate for Payer: United Healthcare Essential Plan 3&4	$93,892.88
Rate for Payer: United Healthcare Medicaid	$41,730.17
Rate for Payer: Wellcare CHP/FHP/Medicaid	$41,730.17

Neonate bwt 1500-2499g w major procedure

Facility

$95,245.36

Service Code	APR-DRG 6092
Min. Negotiated Rate	$35,856.00
Max. Negotiated Rate	$95,245.36
Rate for Payer: Affinity Essential Plan 1&2	$95,245.36
Rate for Payer: Affinity Essential Plan 3&4	$95,245.36
Rate for Payer: Affinity Medicaid/CHP/HARP	$42,331.27
Rate for Payer: Amida Care Medicaid	$42,331.27
Rate for Payer: EmblemHealth Essential Plan 1&2	$95,245.36
Rate for Payer: EmblemHealth Essential Plan 3&4	$42,331.27
Rate for Payer: Fidelis CHP/HARP/Medicaid	$42,331.27
Rate for Payer: Fidelis Qualified Health Plan	$50,797.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$42,331.27
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$42,331.27
Rate for Payer: Healthfirst Commercial	$67,528.00
Rate for Payer: Healthfirst Essential Plan	$95,245.36
Rate for Payer: Healthfirst QHP	$35,856.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$42,331.27
Rate for Payer: SOMOS Essential	$95,245.36
Rate for Payer: United Healthcare Essential Plan 1&2	$95,245.36
Rate for Payer: United Healthcare Essential Plan 3&4	$95,245.36
Rate for Payer: United Healthcare Medicaid	$42,331.27
Rate for Payer: Wellcare CHP/FHP/Medicaid	$42,331.27

Neonate bwt 1500-2499g w major procedure

Facility

$160,107.91

Service Code	APR-DRG 6093
Min. Negotiated Rate	$62,030.00
Max. Negotiated Rate	$160,107.91
Rate for Payer: Affinity Essential Plan 1&2	$160,107.91
Rate for Payer: Affinity Essential Plan 3&4	$160,107.91
Rate for Payer: Affinity Medicaid/CHP/HARP	$71,159.07
Rate for Payer: Amida Care Medicaid	$71,159.07
Rate for Payer: EmblemHealth Essential Plan 1&2	$160,107.91
Rate for Payer: EmblemHealth Essential Plan 3&4	$71,159.07
Rate for Payer: Fidelis CHP/HARP/Medicaid	$71,159.07
Rate for Payer: Fidelis Qualified Health Plan	$85,390.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$71,159.07
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$71,159.07
Rate for Payer: Healthfirst Commercial	$120,451.00
Rate for Payer: Healthfirst Essential Plan	$160,107.91
Rate for Payer: Healthfirst QHP	$62,030.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$71,159.07
Rate for Payer: SOMOS Essential	$160,107.91
Rate for Payer: United Healthcare Essential Plan 1&2	$160,107.91
Rate for Payer: United Healthcare Essential Plan 3&4	$160,107.91
Rate for Payer: United Healthcare Medicaid	$71,159.07
Rate for Payer: Wellcare CHP/FHP/Medicaid	$71,159.07

Neonate bwt 1500-2499g w major procedure

Facility

$94,763.45

Service Code	APR-DRG 6091
Min. Negotiated Rate	$35,120.00
Max. Negotiated Rate	$94,763.45
Rate for Payer: Affinity Essential Plan 1&2	$94,763.45
Rate for Payer: Affinity Essential Plan 3&4	$94,763.45
Rate for Payer: Affinity Medicaid/CHP/HARP	$42,117.09
Rate for Payer: Amida Care Medicaid	$42,117.09
Rate for Payer: EmblemHealth Essential Plan 1&2	$94,763.45
Rate for Payer: EmblemHealth Essential Plan 3&4	$42,117.09
Rate for Payer: Fidelis CHP/HARP/Medicaid	$42,117.09
Rate for Payer: Fidelis Qualified Health Plan	$50,540.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$42,117.09
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$42,117.09
Rate for Payer: Healthfirst Commercial	$65,904.00
Rate for Payer: Healthfirst Essential Plan	$94,763.45
Rate for Payer: Healthfirst QHP	$35,120.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$42,117.09
Rate for Payer: SOMOS Essential	$94,763.45
Rate for Payer: United Healthcare Essential Plan 1&2	$94,763.45
Rate for Payer: United Healthcare Essential Plan 3&4	$94,763.45
Rate for Payer: United Healthcare Medicaid	$42,117.09
Rate for Payer: Wellcare CHP/FHP/Medicaid	$42,117.09

Neonate bwt 1500-2499g w major procedure

Facility

$312,786.43

Service Code	APR-DRG 6094
Min. Negotiated Rate	$119,970.00
Max. Negotiated Rate	$312,786.43
Rate for Payer: Affinity Essential Plan 1&2	$312,786.43
Rate for Payer: Affinity Essential Plan 3&4	$312,786.43
Rate for Payer: Affinity Medicaid/CHP/HARP	$139,016.19
Rate for Payer: Amida Care Medicaid	$139,016.19
Rate for Payer: EmblemHealth Essential Plan 1&2	$312,786.43
Rate for Payer: EmblemHealth Essential Plan 3&4	$139,016.19
Rate for Payer: Fidelis CHP/HARP/Medicaid	$139,016.19
Rate for Payer: Fidelis Qualified Health Plan	$166,819.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$139,016.19
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$139,016.19
Rate for Payer: Healthfirst Commercial	$302,348.00
Rate for Payer: Healthfirst Essential Plan	$312,786.43
Rate for Payer: Healthfirst QHP	$119,970.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$139,016.19
Rate for Payer: SOMOS Essential	$312,786.43
Rate for Payer: United Healthcare Essential Plan 1&2	$312,786.43
Rate for Payer: United Healthcare Essential Plan 3&4	$312,786.43
Rate for Payer: United Healthcare Medicaid	$139,016.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$139,016.19

Neonate bwt <1500g w major procedure

Facility

$371,533.84

Service Code	APR-DRG 5882
Min. Negotiated Rate	$160,731.00
Max. Negotiated Rate	$371,533.84
Rate for Payer: Affinity Essential Plan 1&2	$371,533.84
Rate for Payer: Affinity Essential Plan 3&4	$371,533.84
Rate for Payer: Affinity Medicaid/CHP/HARP	$165,126.15
Rate for Payer: Amida Care Medicaid	$165,126.15
Rate for Payer: EmblemHealth Essential Plan 1&2	$371,533.84
Rate for Payer: EmblemHealth Essential Plan 3&4	$165,126.15
Rate for Payer: Fidelis CHP/HARP/Medicaid	$165,126.15
Rate for Payer: Fidelis Qualified Health Plan	$198,151.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$165,126.15
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$165,126.15
Rate for Payer: Healthfirst Commercial	$324,052.00
Rate for Payer: Healthfirst Essential Plan	$371,533.84
Rate for Payer: Healthfirst QHP	$160,731.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$165,126.15
Rate for Payer: SOMOS Essential	$371,533.84
Rate for Payer: United Healthcare Essential Plan 1&2	$371,533.84
Rate for Payer: United Healthcare Essential Plan 3&4	$371,533.84
Rate for Payer: United Healthcare Medicaid	$165,126.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$165,126.15

Neonate bwt <1500g w major procedure

Facility

$475,822.22

Service Code	APR-DRG 5883
Min. Negotiated Rate	$163,085.00
Max. Negotiated Rate	$475,822.22
Rate for Payer: Affinity Essential Plan 1&2	$475,822.22
Rate for Payer: Affinity Essential Plan 3&4	$475,822.22
Rate for Payer: Affinity Medicaid/CHP/HARP	$211,476.54
Rate for Payer: Amida Care Medicaid	$211,476.54
Rate for Payer: EmblemHealth Essential Plan 1&2	$475,822.22
Rate for Payer: EmblemHealth Essential Plan 3&4	$211,476.54
Rate for Payer: Fidelis CHP/HARP/Medicaid	$211,476.54
Rate for Payer: Fidelis Qualified Health Plan	$253,771.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$211,476.54
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$211,476.54
Rate for Payer: Healthfirst Commercial	$332,949.00
Rate for Payer: Healthfirst Essential Plan	$475,822.22
Rate for Payer: Healthfirst QHP	$163,085.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$211,476.54
Rate for Payer: SOMOS Essential	$475,822.22
Rate for Payer: United Healthcare Essential Plan 1&2	$475,822.22
Rate for Payer: United Healthcare Essential Plan 3&4	$475,822.22
Rate for Payer: United Healthcare Medicaid	$211,476.54
Rate for Payer: Wellcare CHP/FHP/Medicaid	$211,476.54

Neonate bwt <1500g w major procedure

Facility

$371,533.84

Service Code	APR-DRG 5881
Min. Negotiated Rate	$160,731.00
Max. Negotiated Rate	$371,533.84
Rate for Payer: Affinity Essential Plan 1&2	$371,533.84
Rate for Payer: Affinity Essential Plan 3&4	$371,533.84
Rate for Payer: Affinity Medicaid/CHP/HARP	$165,126.15
Rate for Payer: Amida Care Medicaid	$165,126.15
Rate for Payer: EmblemHealth Essential Plan 1&2	$371,533.84
Rate for Payer: EmblemHealth Essential Plan 3&4	$165,126.15
Rate for Payer: Fidelis CHP/HARP/Medicaid	$165,126.15
Rate for Payer: Fidelis Qualified Health Plan	$198,151.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$165,126.15
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$165,126.15
Rate for Payer: Healthfirst Commercial	$324,052.00
Rate for Payer: Healthfirst Essential Plan	$371,533.84
Rate for Payer: Healthfirst QHP	$160,731.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$165,126.15
Rate for Payer: SOMOS Essential	$371,533.84
Rate for Payer: United Healthcare Essential Plan 1&2	$371,533.84
Rate for Payer: United Healthcare Essential Plan 3&4	$371,533.84
Rate for Payer: United Healthcare Medicaid	$165,126.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$165,126.15

Neonate bwt <1500g w major procedure

Facility

$475,822.22

Service Code	APR-DRG 5884
Min. Negotiated Rate	$207,179.00
Max. Negotiated Rate	$475,822.22
Rate for Payer: Affinity Essential Plan 1&2	$475,822.22
Rate for Payer: Affinity Essential Plan 3&4	$475,822.22
Rate for Payer: Affinity Medicaid/CHP/HARP	$211,476.54
Rate for Payer: Amida Care Medicaid	$211,476.54
Rate for Payer: EmblemHealth Essential Plan 1&2	$475,822.22
Rate for Payer: EmblemHealth Essential Plan 3&4	$211,476.54
Rate for Payer: Fidelis CHP/HARP/Medicaid	$211,476.54
Rate for Payer: Fidelis Qualified Health Plan	$253,771.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$211,476.54
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$211,476.54
Rate for Payer: Healthfirst Commercial	$446,163.00
Rate for Payer: Healthfirst Essential Plan	$475,822.22
Rate for Payer: Healthfirst QHP	$207,179.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$211,476.54
Rate for Payer: SOMOS Essential	$475,822.22
Rate for Payer: United Healthcare Essential Plan 1&2	$475,822.22
Rate for Payer: United Healthcare Essential Plan 3&4	$475,822.22
Rate for Payer: United Healthcare Medicaid	$211,476.54
Rate for Payer: Wellcare CHP/FHP/Medicaid	$211,476.54

Neonate bwt 2000-2499g, normal newborn or neonate w other problem

Facility

$55,546.94

Service Code	APR-DRG 6263
Min. Negotiated Rate	$12,130.00
Max. Negotiated Rate	$55,546.94
Rate for Payer: Affinity Essential Plan 1&2	$55,546.94
Rate for Payer: Affinity Essential Plan 3&4	$55,546.94
Rate for Payer: Affinity Medicaid/CHP/HARP	$24,687.53
Rate for Payer: Amida Care Medicaid	$24,687.53
Rate for Payer: EmblemHealth Essential Plan 1&2	$55,546.94
Rate for Payer: EmblemHealth Essential Plan 3&4	$24,687.53
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,687.53
Rate for Payer: Fidelis Qualified Health Plan	$29,625.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,687.53
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,687.53
Rate for Payer: Healthfirst Commercial	$21,918.00
Rate for Payer: Healthfirst Essential Plan	$55,546.94
Rate for Payer: Healthfirst QHP	$12,130.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,687.53
Rate for Payer: SOMOS Essential	$55,546.94
Rate for Payer: United Healthcare Essential Plan 1&2	$55,546.94
Rate for Payer: United Healthcare Essential Plan 3&4	$55,546.94
Rate for Payer: United Healthcare Medicaid	$24,687.53
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,687.53

Neonate bwt 2000-2499g, normal newborn or neonate w other problem

Facility

$39,343.61

Service Code	APR-DRG 6262
Min. Negotiated Rate	$5,721.00
Max. Negotiated Rate	$39,343.61
Rate for Payer: Affinity Essential Plan 1&2	$39,343.61
Rate for Payer: Affinity Essential Plan 3&4	$39,343.61
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,486.05
Rate for Payer: Amida Care Medicaid	$17,486.05
Rate for Payer: EmblemHealth Essential Plan 1&2	$39,343.61
Rate for Payer: EmblemHealth Essential Plan 3&4	$17,486.05
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,486.05
Rate for Payer: Fidelis Qualified Health Plan	$20,983.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,486.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,486.05
Rate for Payer: Healthfirst Commercial	$9,768.00
Rate for Payer: Healthfirst Essential Plan	$39,343.61
Rate for Payer: Healthfirst QHP	$5,721.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,486.05
Rate for Payer: SOMOS Essential	$39,343.61
Rate for Payer: United Healthcare Essential Plan 1&2	$39,343.61
Rate for Payer: United Healthcare Essential Plan 3&4	$39,343.61
Rate for Payer: United Healthcare Medicaid	$17,486.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,486.05

Neonate bwt 2000-2499g, normal newborn or neonate w other problem

Facility

$35,680.14

Service Code	APR-DRG 6261
Min. Negotiated Rate	$3,253.00
Max. Negotiated Rate	$35,680.14
Rate for Payer: Affinity Essential Plan 1&2	$35,680.14
Rate for Payer: Affinity Essential Plan 3&4	$35,680.14
Rate for Payer: Affinity Medicaid/CHP/HARP	$15,857.84
Rate for Payer: Amida Care Medicaid	$15,857.84
Rate for Payer: EmblemHealth Essential Plan 1&2	$35,680.14
Rate for Payer: EmblemHealth Essential Plan 3&4	$15,857.84
Rate for Payer: Fidelis CHP/HARP/Medicaid	$15,857.84
Rate for Payer: Fidelis Qualified Health Plan	$19,029.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$15,857.84
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$15,857.84
Rate for Payer: Healthfirst Commercial	$5,811.00
Rate for Payer: Healthfirst Essential Plan	$35,680.14
Rate for Payer: Healthfirst QHP	$3,253.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$15,857.84
Rate for Payer: SOMOS Essential	$35,680.14
Rate for Payer: United Healthcare Essential Plan 1&2	$35,680.14
Rate for Payer: United Healthcare Essential Plan 3&4	$35,680.14
Rate for Payer: United Healthcare Medicaid	$15,857.84
Rate for Payer: Wellcare CHP/FHP/Medicaid	$15,857.84

Neonate bwt 2000-2499g, normal newborn or neonate w other problem

Facility

$55,573.31

Service Code	APR-DRG 6264
Min. Negotiated Rate	$12,130.00
Max. Negotiated Rate	$55,573.31
Rate for Payer: Affinity Essential Plan 1&2	$55,573.31
Rate for Payer: Affinity Essential Plan 3&4	$55,573.31
Rate for Payer: Affinity Medicaid/CHP/HARP	$24,699.25
Rate for Payer: Amida Care Medicaid	$24,699.25
Rate for Payer: EmblemHealth Essential Plan 1&2	$55,573.31
Rate for Payer: EmblemHealth Essential Plan 3&4	$24,699.25
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,699.25
Rate for Payer: Fidelis Qualified Health Plan	$29,639.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,699.25
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,699.25
Rate for Payer: Healthfirst Commercial	$21,961.00
Rate for Payer: Healthfirst Essential Plan	$55,573.31
Rate for Payer: Healthfirst QHP	$12,130.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,699.25
Rate for Payer: SOMOS Essential	$55,573.31
Rate for Payer: United Healthcare Essential Plan 1&2	$55,573.31
Rate for Payer: United Healthcare Essential Plan 3&4	$55,573.31
Rate for Payer: United Healthcare Medicaid	$24,699.25
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,699.25

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