St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

Neonate bwt 2000-2499g w congenital/perinatal infection

Facility

$86,979.24

Service Code	APR-DRG 6234
Min. Negotiated Rate	$34,525.00
Max. Negotiated Rate	$86,979.24
Rate for Payer: Affinity Essential Plan 1&2	$86,979.24
Rate for Payer: Affinity Essential Plan 3&4	$86,979.24
Rate for Payer: Affinity Medicaid/CHP/HARP	$38,657.44
Rate for Payer: Amida Care Medicaid	$38,657.44
Rate for Payer: EmblemHealth Essential Plan 1&2	$86,979.24
Rate for Payer: EmblemHealth Essential Plan 3&4	$38,657.44
Rate for Payer: Fidelis CHP/HARP/Medicaid	$38,657.44
Rate for Payer: Fidelis Qualified Health Plan	$46,388.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$38,657.44
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$38,657.44
Rate for Payer: Healthfirst Commercial	$71,248.00
Rate for Payer: Healthfirst Essential Plan	$86,979.24
Rate for Payer: Healthfirst QHP	$34,525.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$38,657.44
Rate for Payer: SOMOS Essential	$86,979.24
Rate for Payer: United Healthcare Essential Plan 1&2	$86,979.24
Rate for Payer: United Healthcare Essential Plan 3&4	$86,979.24
Rate for Payer: United Healthcare Medicaid	$38,657.44
Rate for Payer: Wellcare CHP/FHP/Medicaid	$38,657.44

Neonate bwt 2000-2499g w congenital/perinatal infection

Facility

$57,604.66

Service Code	APR-DRG 6231
Min. Negotiated Rate	$14,116.00
Max. Negotiated Rate	$57,604.66
Rate for Payer: Affinity Essential Plan 1&2	$57,604.66
Rate for Payer: Affinity Essential Plan 3&4	$57,604.66
Rate for Payer: Affinity Medicaid/CHP/HARP	$25,602.07
Rate for Payer: Amida Care Medicaid	$25,602.07
Rate for Payer: EmblemHealth Essential Plan 1&2	$57,604.66
Rate for Payer: EmblemHealth Essential Plan 3&4	$25,602.07
Rate for Payer: Fidelis CHP/HARP/Medicaid	$25,602.07
Rate for Payer: Fidelis Qualified Health Plan	$30,722.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$25,602.07
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25,602.07
Rate for Payer: Healthfirst Commercial	$21,643.00
Rate for Payer: Healthfirst Essential Plan	$57,604.66
Rate for Payer: Healthfirst QHP	$14,116.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$25,602.07
Rate for Payer: SOMOS Essential	$57,604.66
Rate for Payer: United Healthcare Essential Plan 1&2	$57,604.66
Rate for Payer: United Healthcare Essential Plan 3&4	$57,604.66
Rate for Payer: United Healthcare Medicaid	$25,602.07
Rate for Payer: Wellcare CHP/FHP/Medicaid	$25,602.07

Neonate bwt 2000-2499g w congenital/perinatal infection

Facility

$69,973.92

Service Code	APR-DRG 6232
Min. Negotiated Rate	$21,757.00
Max. Negotiated Rate	$69,973.92
Rate for Payer: Affinity Essential Plan 1&2	$69,973.92
Rate for Payer: Affinity Essential Plan 3&4	$69,973.92
Rate for Payer: Affinity Medicaid/CHP/HARP	$31,099.52
Rate for Payer: Amida Care Medicaid	$31,099.52
Rate for Payer: EmblemHealth Essential Plan 1&2	$69,973.92
Rate for Payer: EmblemHealth Essential Plan 3&4	$31,099.52
Rate for Payer: Fidelis CHP/HARP/Medicaid	$31,099.52
Rate for Payer: Fidelis Qualified Health Plan	$37,319.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$31,099.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31,099.52
Rate for Payer: Healthfirst Commercial	$32,861.00
Rate for Payer: Healthfirst Essential Plan	$69,973.92
Rate for Payer: Healthfirst QHP	$21,757.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$31,099.52
Rate for Payer: SOMOS Essential	$69,973.92
Rate for Payer: United Healthcare Essential Plan 1&2	$69,973.92
Rate for Payer: United Healthcare Essential Plan 3&4	$69,973.92
Rate for Payer: United Healthcare Medicaid	$31,099.52
Rate for Payer: Wellcare CHP/FHP/Medicaid	$31,099.52

Neonate bwt 2000-2499g w congenital/perinatal infection

Facility

$86,979.24

Service Code	APR-DRG 6233
Min. Negotiated Rate	$34,398.00
Max. Negotiated Rate	$86,979.24
Rate for Payer: Affinity Essential Plan 1&2	$86,979.24
Rate for Payer: Affinity Essential Plan 3&4	$86,979.24
Rate for Payer: Affinity Medicaid/CHP/HARP	$38,657.44
Rate for Payer: Amida Care Medicaid	$38,657.44
Rate for Payer: EmblemHealth Essential Plan 1&2	$86,979.24
Rate for Payer: EmblemHealth Essential Plan 3&4	$38,657.44
Rate for Payer: Fidelis CHP/HARP/Medicaid	$38,657.44
Rate for Payer: Fidelis Qualified Health Plan	$46,388.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$38,657.44
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$38,657.44
Rate for Payer: Healthfirst Commercial	$65,844.00
Rate for Payer: Healthfirst Essential Plan	$86,979.24
Rate for Payer: Healthfirst QHP	$34,398.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$38,657.44
Rate for Payer: SOMOS Essential	$86,979.24
Rate for Payer: United Healthcare Essential Plan 1&2	$86,979.24
Rate for Payer: United Healthcare Essential Plan 3&4	$86,979.24
Rate for Payer: United Healthcare Medicaid	$38,657.44
Rate for Payer: Wellcare CHP/FHP/Medicaid	$38,657.44

Neonate bwt 2000-2499g w major anomaly

Facility

$101,984.87

Service Code	APR-DRG 6213
Min. Negotiated Rate	$31,111.00
Max. Negotiated Rate	$101,984.87
Rate for Payer: Affinity Essential Plan 1&2	$101,984.87
Rate for Payer: Affinity Essential Plan 3&4	$101,984.87
Rate for Payer: Affinity Medicaid/CHP/HARP	$45,326.61
Rate for Payer: Amida Care Medicaid	$45,326.61
Rate for Payer: EmblemHealth Essential Plan 1&2	$101,984.87
Rate for Payer: EmblemHealth Essential Plan 3&4	$45,326.61
Rate for Payer: Fidelis CHP/HARP/Medicaid	$45,326.61
Rate for Payer: Fidelis Qualified Health Plan	$54,391.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$45,326.61
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$45,326.61
Rate for Payer: Healthfirst Commercial	$56,920.00
Rate for Payer: Healthfirst Essential Plan	$101,984.87
Rate for Payer: Healthfirst QHP	$31,111.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$45,326.61
Rate for Payer: SOMOS Essential	$101,984.87
Rate for Payer: United Healthcare Essential Plan 1&2	$101,984.87
Rate for Payer: United Healthcare Essential Plan 3&4	$101,984.87
Rate for Payer: United Healthcare Medicaid	$45,326.61
Rate for Payer: Wellcare CHP/FHP/Medicaid	$45,326.61

Neonate bwt 2000-2499g w major anomaly

Facility

$151,472.48

Service Code	APR-DRG 6214
Min. Negotiated Rate	$63,011.00
Max. Negotiated Rate	$151,472.48
Rate for Payer: Affinity Essential Plan 1&2	$151,472.48
Rate for Payer: Affinity Essential Plan 3&4	$151,472.48
Rate for Payer: Affinity Medicaid/CHP/HARP	$67,321.10
Rate for Payer: Amida Care Medicaid	$67,321.10
Rate for Payer: EmblemHealth Essential Plan 1&2	$151,472.48
Rate for Payer: EmblemHealth Essential Plan 3&4	$67,321.10
Rate for Payer: Fidelis CHP/HARP/Medicaid	$67,321.10
Rate for Payer: Fidelis Qualified Health Plan	$80,785.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$67,321.10
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$67,321.10
Rate for Payer: Healthfirst Commercial	$101,107.00
Rate for Payer: Healthfirst Essential Plan	$151,472.48
Rate for Payer: Healthfirst QHP	$63,011.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$67,321.10
Rate for Payer: SOMOS Essential	$151,472.48
Rate for Payer: United Healthcare Essential Plan 1&2	$151,472.48
Rate for Payer: United Healthcare Essential Plan 3&4	$151,472.48
Rate for Payer: United Healthcare Medicaid	$67,321.10
Rate for Payer: Wellcare CHP/FHP/Medicaid	$67,321.10

Neonate bwt 2000-2499g w major anomaly

Facility

$68,844.82

Service Code	APR-DRG 6212
Min. Negotiated Rate	$18,554.00
Max. Negotiated Rate	$68,844.82
Rate for Payer: Affinity Essential Plan 1&2	$68,844.82
Rate for Payer: Affinity Essential Plan 3&4	$68,844.82
Rate for Payer: Affinity Medicaid/CHP/HARP	$30,597.70
Rate for Payer: Amida Care Medicaid	$30,597.70
Rate for Payer: EmblemHealth Essential Plan 1&2	$68,844.82
Rate for Payer: EmblemHealth Essential Plan 3&4	$30,597.70
Rate for Payer: Fidelis CHP/HARP/Medicaid	$30,597.70
Rate for Payer: Fidelis Qualified Health Plan	$36,717.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$30,597.70
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$30,597.70
Rate for Payer: Healthfirst Commercial	$36,830.00
Rate for Payer: Healthfirst Essential Plan	$68,844.82
Rate for Payer: Healthfirst QHP	$18,554.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$30,597.70
Rate for Payer: SOMOS Essential	$68,844.82
Rate for Payer: United Healthcare Essential Plan 1&2	$68,844.82
Rate for Payer: United Healthcare Essential Plan 3&4	$68,844.82
Rate for Payer: United Healthcare Medicaid	$30,597.70
Rate for Payer: Wellcare CHP/FHP/Medicaid	$30,597.70

Neonate bwt 2000-2499g w major anomaly

Facility

$47,980.80

Service Code	APR-DRG 6211
Min. Negotiated Rate	$9,622.00
Max. Negotiated Rate	$47,980.80
Rate for Payer: Affinity Essential Plan 1&2	$47,980.80
Rate for Payer: Affinity Essential Plan 3&4	$47,980.80
Rate for Payer: Affinity Medicaid/CHP/HARP	$21,324.80
Rate for Payer: Amida Care Medicaid	$21,324.80
Rate for Payer: EmblemHealth Essential Plan 1&2	$47,980.80
Rate for Payer: EmblemHealth Essential Plan 3&4	$21,324.80
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,324.80
Rate for Payer: Fidelis Qualified Health Plan	$25,589.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,324.80
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,324.80
Rate for Payer: Healthfirst Commercial	$18,243.00
Rate for Payer: Healthfirst Essential Plan	$47,980.80
Rate for Payer: Healthfirst QHP	$9,622.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,324.80
Rate for Payer: SOMOS Essential	$47,980.80
Rate for Payer: United Healthcare Essential Plan 1&2	$47,980.80
Rate for Payer: United Healthcare Essential Plan 3&4	$47,980.80
Rate for Payer: United Healthcare Medicaid	$21,324.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,324.80

Neonate bwt 2000-2499g w other significant condition

Facility

$89,955.04

Service Code	APR-DRG 6254
Min. Negotiated Rate	$32,372.00
Max. Negotiated Rate	$89,955.04
Rate for Payer: Affinity Essential Plan 1&2	$89,955.04
Rate for Payer: Affinity Essential Plan 3&4	$89,955.04
Rate for Payer: Affinity Medicaid/CHP/HARP	$39,980.02
Rate for Payer: Amida Care Medicaid	$39,980.02
Rate for Payer: EmblemHealth Essential Plan 1&2	$89,955.04
Rate for Payer: EmblemHealth Essential Plan 3&4	$39,980.02
Rate for Payer: Fidelis CHP/HARP/Medicaid	$39,980.02
Rate for Payer: Fidelis Qualified Health Plan	$47,976.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$39,980.02
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$39,980.02
Rate for Payer: Healthfirst Commercial	$63,153.00
Rate for Payer: Healthfirst Essential Plan	$89,955.04
Rate for Payer: Healthfirst QHP	$32,372.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$39,980.02
Rate for Payer: SOMOS Essential	$89,955.04
Rate for Payer: United Healthcare Essential Plan 1&2	$89,955.04
Rate for Payer: United Healthcare Essential Plan 3&4	$89,955.04
Rate for Payer: United Healthcare Medicaid	$39,980.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$39,980.02

Neonate bwt 2000-2499g w other significant condition

Facility

$77,520.71

Service Code	APR-DRG 6252
Min. Negotiated Rate	$26,920.00
Max. Negotiated Rate	$77,520.71
Rate for Payer: Affinity Essential Plan 1&2	$77,520.71
Rate for Payer: Affinity Essential Plan 3&4	$77,520.71
Rate for Payer: Affinity Medicaid/CHP/HARP	$34,453.65
Rate for Payer: Amida Care Medicaid	$34,453.65
Rate for Payer: EmblemHealth Essential Plan 1&2	$77,520.71
Rate for Payer: EmblemHealth Essential Plan 3&4	$34,453.65
Rate for Payer: Fidelis CHP/HARP/Medicaid	$34,453.65
Rate for Payer: Fidelis Qualified Health Plan	$41,344.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$34,453.65
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$34,453.65
Rate for Payer: Healthfirst Commercial	$45,555.00
Rate for Payer: Healthfirst Essential Plan	$77,520.71
Rate for Payer: Healthfirst QHP	$26,920.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$34,453.65
Rate for Payer: SOMOS Essential	$77,520.71
Rate for Payer: United Healthcare Essential Plan 1&2	$77,520.71
Rate for Payer: United Healthcare Essential Plan 3&4	$77,520.71
Rate for Payer: United Healthcare Medicaid	$34,453.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$34,453.65

Neonate bwt 2000-2499g w other significant condition

Facility

$89,955.04

Service Code	APR-DRG 6253
Min. Negotiated Rate	$30,548.00
Max. Negotiated Rate	$89,955.04
Rate for Payer: Affinity Essential Plan 1&2	$89,955.04
Rate for Payer: Affinity Essential Plan 3&4	$89,955.04
Rate for Payer: Affinity Medicaid/CHP/HARP	$39,980.02
Rate for Payer: Amida Care Medicaid	$39,980.02
Rate for Payer: EmblemHealth Essential Plan 1&2	$89,955.04
Rate for Payer: EmblemHealth Essential Plan 3&4	$39,980.02
Rate for Payer: Fidelis CHP/HARP/Medicaid	$39,980.02
Rate for Payer: Fidelis Qualified Health Plan	$47,976.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$39,980.02
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$39,980.02
Rate for Payer: Healthfirst Commercial	$62,656.00
Rate for Payer: Healthfirst Essential Plan	$89,955.04
Rate for Payer: Healthfirst QHP	$30,548.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$39,980.02
Rate for Payer: SOMOS Essential	$89,955.04
Rate for Payer: United Healthcare Essential Plan 1&2	$89,955.04
Rate for Payer: United Healthcare Essential Plan 3&4	$89,955.04
Rate for Payer: United Healthcare Medicaid	$39,980.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$39,980.02

Neonate bwt 2000-2499g w other significant condition

Facility

$60,153.10

Service Code	APR-DRG 6251
Min. Negotiated Rate	$16,482.00
Max. Negotiated Rate	$60,153.10
Rate for Payer: Affinity Essential Plan 1&2	$60,153.10
Rate for Payer: Affinity Essential Plan 3&4	$60,153.10
Rate for Payer: Affinity Medicaid/CHP/HARP	$26,734.71
Rate for Payer: Amida Care Medicaid	$26,734.71
Rate for Payer: EmblemHealth Essential Plan 1&2	$60,153.10
Rate for Payer: EmblemHealth Essential Plan 3&4	$26,734.71
Rate for Payer: Fidelis CHP/HARP/Medicaid	$26,734.71
Rate for Payer: Fidelis Qualified Health Plan	$32,081.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$26,734.71
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$26,734.71
Rate for Payer: Healthfirst Commercial	$29,368.00
Rate for Payer: Healthfirst Essential Plan	$60,153.10
Rate for Payer: Healthfirst QHP	$16,482.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26,734.71
Rate for Payer: SOMOS Essential	$60,153.10
Rate for Payer: United Healthcare Essential Plan 1&2	$60,153.10
Rate for Payer: United Healthcare Essential Plan 3&4	$60,153.10
Rate for Payer: United Healthcare Medicaid	$26,734.71
Rate for Payer: Wellcare CHP/FHP/Medicaid	$26,734.71

Neonate bwt 2000-2499g w resp dist synd/oth maj resp cond

Facility

$122,926.25

Service Code	APR-DRG 6224
Min. Negotiated Rate	$43,148.00
Max. Negotiated Rate	$122,926.25
Rate for Payer: Affinity Essential Plan 1&2	$122,926.25
Rate for Payer: Affinity Essential Plan 3&4	$122,926.25
Rate for Payer: Affinity Medicaid/CHP/HARP	$54,633.89
Rate for Payer: Amida Care Medicaid	$54,633.89
Rate for Payer: EmblemHealth Essential Plan 1&2	$122,926.25
Rate for Payer: EmblemHealth Essential Plan 3&4	$54,633.89
Rate for Payer: Fidelis CHP/HARP/Medicaid	$54,633.89
Rate for Payer: Fidelis Qualified Health Plan	$65,560.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$54,633.89
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$54,633.89
Rate for Payer: Healthfirst Commercial	$84,939.00
Rate for Payer: Healthfirst Essential Plan	$122,926.25
Rate for Payer: Healthfirst QHP	$43,148.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$54,633.89
Rate for Payer: SOMOS Essential	$122,926.25
Rate for Payer: United Healthcare Essential Plan 1&2	$122,926.25
Rate for Payer: United Healthcare Essential Plan 3&4	$122,926.25
Rate for Payer: United Healthcare Medicaid	$54,633.89
Rate for Payer: Wellcare CHP/FHP/Medicaid	$54,633.89

Neonate bwt 2000-2499g w resp dist synd/oth maj resp cond

Facility

$78,278.74

Service Code	APR-DRG 6222
Min. Negotiated Rate	$21,426.00
Max. Negotiated Rate	$78,278.74
Rate for Payer: Affinity Essential Plan 1&2	$78,278.74
Rate for Payer: Affinity Essential Plan 3&4	$78,278.74
Rate for Payer: Affinity Medicaid/CHP/HARP	$34,790.55
Rate for Payer: Amida Care Medicaid	$34,790.55
Rate for Payer: EmblemHealth Essential Plan 1&2	$78,278.74
Rate for Payer: EmblemHealth Essential Plan 3&4	$34,790.55
Rate for Payer: Fidelis CHP/HARP/Medicaid	$34,790.55
Rate for Payer: Fidelis Qualified Health Plan	$41,748.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$34,790.55
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$34,790.55
Rate for Payer: Healthfirst Commercial	$38,014.00
Rate for Payer: Healthfirst Essential Plan	$78,278.74
Rate for Payer: Healthfirst QHP	$21,426.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$34,790.55
Rate for Payer: SOMOS Essential	$78,278.74
Rate for Payer: United Healthcare Essential Plan 1&2	$78,278.74
Rate for Payer: United Healthcare Essential Plan 3&4	$78,278.74
Rate for Payer: United Healthcare Medicaid	$34,790.55
Rate for Payer: Wellcare CHP/FHP/Medicaid	$34,790.55

Neonate bwt 2000-2499g w resp dist synd/oth maj resp cond

Facility

$95,433.55

Service Code	APR-DRG 6223
Min. Negotiated Rate	$31,405.00
Max. Negotiated Rate	$95,433.55
Rate for Payer: Affinity Essential Plan 1&2	$95,433.55
Rate for Payer: Affinity Essential Plan 3&4	$95,433.55
Rate for Payer: Affinity Medicaid/CHP/HARP	$42,414.91
Rate for Payer: Amida Care Medicaid	$42,414.91
Rate for Payer: EmblemHealth Essential Plan 1&2	$95,433.55
Rate for Payer: EmblemHealth Essential Plan 3&4	$42,414.91
Rate for Payer: Fidelis CHP/HARP/Medicaid	$42,414.91
Rate for Payer: Fidelis Qualified Health Plan	$50,897.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$42,414.91
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$42,414.91
Rate for Payer: Healthfirst Commercial	$53,068.00
Rate for Payer: Healthfirst Essential Plan	$95,433.55
Rate for Payer: Healthfirst QHP	$31,405.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$42,414.91
Rate for Payer: SOMOS Essential	$95,433.55
Rate for Payer: United Healthcare Essential Plan 1&2	$95,433.55
Rate for Payer: United Healthcare Essential Plan 3&4	$95,433.55
Rate for Payer: United Healthcare Medicaid	$42,414.91
Rate for Payer: Wellcare CHP/FHP/Medicaid	$42,414.91

Neonate bwt 2000-2499g w resp dist synd/oth maj resp cond

Facility

$66,088.87

Service Code	APR-DRG 6221
Min. Negotiated Rate	$16,202.00
Max. Negotiated Rate	$66,088.87
Rate for Payer: Affinity Essential Plan 1&2	$66,088.87
Rate for Payer: Affinity Essential Plan 3&4	$66,088.87
Rate for Payer: Affinity Medicaid/CHP/HARP	$29,372.83
Rate for Payer: Amida Care Medicaid	$29,372.83
Rate for Payer: EmblemHealth Essential Plan 1&2	$66,088.87
Rate for Payer: EmblemHealth Essential Plan 3&4	$29,372.83
Rate for Payer: Fidelis CHP/HARP/Medicaid	$29,372.83
Rate for Payer: Fidelis Qualified Health Plan	$35,247.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$29,372.83
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29,372.83
Rate for Payer: Healthfirst Commercial	$28,080.00
Rate for Payer: Healthfirst Essential Plan	$66,088.87
Rate for Payer: Healthfirst QHP	$16,202.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$29,372.83
Rate for Payer: SOMOS Essential	$66,088.87
Rate for Payer: United Healthcare Essential Plan 1&2	$66,088.87
Rate for Payer: United Healthcare Essential Plan 3&4	$66,088.87
Rate for Payer: United Healthcare Medicaid	$29,372.83
Rate for Payer: Wellcare CHP/FHP/Medicaid	$29,372.83

Neonate bwt <500g or GA <24 weeks

Facility

$245,509.11

Service Code	APR-DRG 5892
Min. Negotiated Rate	$82,660.00
Max. Negotiated Rate	$245,509.11
Rate for Payer: Affinity Essential Plan 1&2	$245,509.11
Rate for Payer: Affinity Essential Plan 3&4	$245,509.11
Rate for Payer: Affinity Medicaid/CHP/HARP	$109,115.16
Rate for Payer: Amida Care Medicaid	$109,115.16
Rate for Payer: EmblemHealth Essential Plan 1&2	$245,509.11
Rate for Payer: EmblemHealth Essential Plan 3&4	$109,115.16
Rate for Payer: Fidelis CHP/HARP/Medicaid	$109,115.16
Rate for Payer: Fidelis Qualified Health Plan	$130,938.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$109,115.16
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$109,115.16
Rate for Payer: Healthfirst Commercial	$158,643.00
Rate for Payer: Healthfirst Essential Plan	$245,509.11
Rate for Payer: Healthfirst QHP	$82,660.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$109,115.16
Rate for Payer: SOMOS Essential	$245,509.11
Rate for Payer: United Healthcare Essential Plan 1&2	$245,509.11
Rate for Payer: United Healthcare Essential Plan 3&4	$245,509.11
Rate for Payer: United Healthcare Medicaid	$109,115.16
Rate for Payer: Wellcare CHP/FHP/Medicaid	$109,115.16

Neonate bwt <500g or GA <24 weeks

Facility

$109,399.75

Service Code	APR-DRG 5893
Min. Negotiated Rate	$25,253.00
Max. Negotiated Rate	$109,399.75
Rate for Payer: Affinity Essential Plan 1&2	$109,399.75
Rate for Payer: Affinity Essential Plan 3&4	$109,399.75
Rate for Payer: Affinity Medicaid/CHP/HARP	$48,622.11
Rate for Payer: Amida Care Medicaid	$48,622.11
Rate for Payer: EmblemHealth Essential Plan 1&2	$109,399.75
Rate for Payer: EmblemHealth Essential Plan 3&4	$48,622.11
Rate for Payer: Fidelis CHP/HARP/Medicaid	$48,622.11
Rate for Payer: Fidelis Qualified Health Plan	$58,346.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$48,622.11
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$48,622.11
Rate for Payer: Healthfirst Commercial	$86,730.00
Rate for Payer: Healthfirst Essential Plan	$109,399.75
Rate for Payer: Healthfirst QHP	$25,253.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$48,622.11
Rate for Payer: SOMOS Essential	$109,399.75
Rate for Payer: United Healthcare Essential Plan 1&2	$109,399.75
Rate for Payer: United Healthcare Essential Plan 3&4	$109,399.75
Rate for Payer: United Healthcare Medicaid	$48,622.11
Rate for Payer: Wellcare CHP/FHP/Medicaid	$48,622.11

Neonate bwt <500g or GA <24 weeks

Facility

$34,012.85

Service Code	APR-DRG 5894
Min. Negotiated Rate	$2,472.00
Max. Negotiated Rate	$34,012.85
Rate for Payer: Affinity Essential Plan 1&2	$34,012.85
Rate for Payer: Affinity Essential Plan 3&4	$34,012.85
Rate for Payer: Affinity Medicaid/CHP/HARP	$15,116.82
Rate for Payer: Amida Care Medicaid	$15,116.82
Rate for Payer: EmblemHealth Essential Plan 1&2	$34,012.85
Rate for Payer: EmblemHealth Essential Plan 3&4	$15,116.82
Rate for Payer: Fidelis CHP/HARP/Medicaid	$15,116.82
Rate for Payer: Fidelis Qualified Health Plan	$18,140.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$15,116.82
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$15,116.82
Rate for Payer: Healthfirst Commercial	$4,821.00
Rate for Payer: Healthfirst Essential Plan	$34,012.85
Rate for Payer: Healthfirst QHP	$2,472.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$15,116.82
Rate for Payer: SOMOS Essential	$34,012.85
Rate for Payer: United Healthcare Essential Plan 1&2	$34,012.85
Rate for Payer: United Healthcare Essential Plan 3&4	$34,012.85
Rate for Payer: United Healthcare Medicaid	$15,116.82
Rate for Payer: Wellcare CHP/FHP/Medicaid	$15,116.82

Neonate bwt <500g or GA <24 weeks

Facility

$245,509.11

Service Code	APR-DRG 5891
Min. Negotiated Rate	$82,660.00
Max. Negotiated Rate	$245,509.11
Rate for Payer: Affinity Essential Plan 1&2	$245,509.11
Rate for Payer: Affinity Essential Plan 3&4	$245,509.11
Rate for Payer: Affinity Medicaid/CHP/HARP	$109,115.16
Rate for Payer: Amida Care Medicaid	$109,115.16
Rate for Payer: EmblemHealth Essential Plan 1&2	$245,509.11
Rate for Payer: EmblemHealth Essential Plan 3&4	$109,115.16
Rate for Payer: Fidelis CHP/HARP/Medicaid	$109,115.16
Rate for Payer: Fidelis Qualified Health Plan	$130,938.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$109,115.16
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$109,115.16
Rate for Payer: Healthfirst Commercial	$158,643.00
Rate for Payer: Healthfirst Essential Plan	$245,509.11
Rate for Payer: Healthfirst QHP	$82,660.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$109,115.16
Rate for Payer: SOMOS Essential	$245,509.11
Rate for Payer: United Healthcare Essential Plan 1&2	$245,509.11
Rate for Payer: United Healthcare Essential Plan 3&4	$245,509.11
Rate for Payer: United Healthcare Medicaid	$109,115.16
Rate for Payer: Wellcare CHP/FHP/Medicaid	$109,115.16

Neonate, transferred < 5 days old, born here

Facility

$40,715.44

Service Code	APR-DRG 5814
Min. Negotiated Rate	$5,093.00
Max. Negotiated Rate	$40,715.44
Rate for Payer: Affinity Essential Plan 1&2	$40,715.44
Rate for Payer: Affinity Essential Plan 3&4	$40,715.44
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,095.75
Rate for Payer: Amida Care Medicaid	$18,095.75
Rate for Payer: EmblemHealth Essential Plan 1&2	$40,715.44
Rate for Payer: EmblemHealth Essential Plan 3&4	$18,095.75
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,095.75
Rate for Payer: Fidelis Qualified Health Plan	$21,714.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,095.75
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,095.75
Rate for Payer: Healthfirst Commercial	$9,907.00
Rate for Payer: Healthfirst Essential Plan	$40,715.44
Rate for Payer: Healthfirst QHP	$5,093.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,095.75
Rate for Payer: SOMOS Essential	$40,715.44
Rate for Payer: United Healthcare Essential Plan 1&2	$40,715.44
Rate for Payer: United Healthcare Essential Plan 3&4	$40,715.44
Rate for Payer: United Healthcare Medicaid	$18,095.75
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,095.75

Neonate, transferred < 5 days old, born here

Facility

$34,417.35

Service Code	APR-DRG 5811
Min. Negotiated Rate	$2,866.00
Max. Negotiated Rate	$34,417.35
Rate for Payer: Affinity Essential Plan 1&2	$34,417.35
Rate for Payer: Affinity Essential Plan 3&4	$34,417.35
Rate for Payer: Affinity Medicaid/CHP/HARP	$15,296.60
Rate for Payer: Amida Care Medicaid	$15,296.60
Rate for Payer: EmblemHealth Essential Plan 1&2	$34,417.35
Rate for Payer: EmblemHealth Essential Plan 3&4	$15,296.60
Rate for Payer: Fidelis CHP/HARP/Medicaid	$15,296.60
Rate for Payer: Fidelis Qualified Health Plan	$18,355.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$15,296.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$15,296.60
Rate for Payer: Healthfirst Commercial	$4,987.00
Rate for Payer: Healthfirst Essential Plan	$34,417.35
Rate for Payer: Healthfirst QHP	$2,866.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$15,296.60
Rate for Payer: SOMOS Essential	$34,417.35
Rate for Payer: United Healthcare Essential Plan 1&2	$34,417.35
Rate for Payer: United Healthcare Essential Plan 3&4	$34,417.35
Rate for Payer: United Healthcare Medicaid	$15,296.60
Rate for Payer: Wellcare CHP/FHP/Medicaid	$15,296.60

Neonate, transferred < 5 days old, born here

Facility

$36,835.63

Service Code	APR-DRG 5813
Min. Negotiated Rate	$3,631.00
Max. Negotiated Rate	$36,835.63
Rate for Payer: Affinity Essential Plan 1&2	$36,835.63
Rate for Payer: Affinity Essential Plan 3&4	$36,835.63
Rate for Payer: Affinity Medicaid/CHP/HARP	$16,371.39
Rate for Payer: Amida Care Medicaid	$16,371.39
Rate for Payer: EmblemHealth Essential Plan 1&2	$36,835.63
Rate for Payer: EmblemHealth Essential Plan 3&4	$16,371.39
Rate for Payer: Fidelis CHP/HARP/Medicaid	$16,371.39
Rate for Payer: Fidelis Qualified Health Plan	$19,645.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$16,371.39
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16,371.39
Rate for Payer: Healthfirst Commercial	$6,453.00
Rate for Payer: Healthfirst Essential Plan	$36,835.63
Rate for Payer: Healthfirst QHP	$3,631.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$16,371.39
Rate for Payer: SOMOS Essential	$36,835.63
Rate for Payer: United Healthcare Essential Plan 1&2	$36,835.63
Rate for Payer: United Healthcare Essential Plan 3&4	$36,835.63
Rate for Payer: United Healthcare Medicaid	$16,371.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,371.39

Neonate, transferred < 5 days old, born here

Facility

$35,284.41

Service Code	APR-DRG 5812
Min. Negotiated Rate	$3,160.00
Max. Negotiated Rate	$35,284.41
Rate for Payer: Affinity Essential Plan 1&2	$35,284.41
Rate for Payer: Affinity Essential Plan 3&4	$35,284.41
Rate for Payer: Affinity Medicaid/CHP/HARP	$15,681.96
Rate for Payer: Amida Care Medicaid	$15,681.96
Rate for Payer: EmblemHealth Essential Plan 1&2	$35,284.41
Rate for Payer: EmblemHealth Essential Plan 3&4	$15,681.96
Rate for Payer: Fidelis CHP/HARP/Medicaid	$15,681.96
Rate for Payer: Fidelis Qualified Health Plan	$18,818.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$15,681.96
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$15,681.96
Rate for Payer: Healthfirst Commercial	$5,524.00
Rate for Payer: Healthfirst Essential Plan	$35,284.41
Rate for Payer: Healthfirst QHP	$3,160.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$15,681.96
Rate for Payer: SOMOS Essential	$35,284.41
Rate for Payer: United Healthcare Essential Plan 1&2	$35,284.41
Rate for Payer: United Healthcare Essential Plan 3&4	$35,284.41
Rate for Payer: United Healthcare Medicaid	$15,681.96
Rate for Payer: Wellcare CHP/FHP/Medicaid	$15,681.96

Neonate, transferred <5 days old, not born here

Facility

$38,805.43

Service Code	APR-DRG 5802
Min. Negotiated Rate	$5,684.00
Max. Negotiated Rate	$38,805.43
Rate for Payer: Affinity Essential Plan 1&2	$38,805.43
Rate for Payer: Affinity Essential Plan 3&4	$38,805.43
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,246.86
Rate for Payer: Amida Care Medicaid	$17,246.86
Rate for Payer: EmblemHealth Essential Plan 1&2	$38,805.43
Rate for Payer: EmblemHealth Essential Plan 3&4	$17,246.86
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,246.86
Rate for Payer: Fidelis Qualified Health Plan	$20,696.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,246.86
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,246.86
Rate for Payer: Healthfirst Commercial	$9,260.00
Rate for Payer: Healthfirst Essential Plan	$38,805.43
Rate for Payer: Healthfirst QHP	$5,684.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,246.86
Rate for Payer: SOMOS Essential	$38,805.43
Rate for Payer: United Healthcare Essential Plan 1&2	$38,805.43
Rate for Payer: United Healthcare Essential Plan 3&4	$38,805.43
Rate for Payer: United Healthcare Medicaid	$17,246.86
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,246.86

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