St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

APR-DRG 1374: Major respiratory infections & inflammations

Facility

$75,583.33

Service Code	APR-DRG 1374
Min. Negotiated Rate	$25,551.00
Max. Negotiated Rate	$75,583.33
Rate for Payer: Affinity Essential Plan 1&2	$75,583.33
Rate for Payer: Affinity Essential Plan 3&4	$75,583.33
Rate for Payer: Affinity Medicaid/CHP/HARP	$33,592.59
Rate for Payer: Amida Care Medicaid	$33,592.59
Rate for Payer: Fidelis CHP/HARP/Medicaid	$33,592.59
Rate for Payer: Fidelis Qualified Health Plan	$40,311.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$33,592.59
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$33,592.59
Rate for Payer: Healthfirst Commercial	$41,251.00
Rate for Payer: Healthfirst Essential Plan	$75,583.33
Rate for Payer: Healthfirst QHP	$25,551.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$33,592.59
Rate for Payer: SOMOS Essential	$75,583.33
Rate for Payer: United Healthcare Essential Plan 1&2	$75,583.33
Rate for Payer: United Healthcare Essential Plan 3&4	$75,583.33
Rate for Payer: United Healthcare Medicaid	$33,592.59
Rate for Payer: Wellcare CHP/FHP/Medicaid	$33,592.59

APR-DRG 1381: Bronchiolitis & RSV pneumonia

Facility

$38,220.52

Service Code	APR-DRG 1381
Min. Negotiated Rate	$5,529.00
Max. Negotiated Rate	$38,220.52
Rate for Payer: Affinity Essential Plan 1&2	$38,220.52
Rate for Payer: Affinity Essential Plan 3&4	$38,220.52
Rate for Payer: Affinity Medicaid/CHP/HARP	$16,986.90
Rate for Payer: Amida Care Medicaid	$16,986.90
Rate for Payer: Fidelis CHP/HARP/Medicaid	$16,986.90
Rate for Payer: Fidelis Qualified Health Plan	$20,384.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$16,986.90
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16,986.90
Rate for Payer: Healthfirst Commercial	$9,884.00
Rate for Payer: Healthfirst Essential Plan	$38,220.52
Rate for Payer: Healthfirst QHP	$5,529.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$16,986.90
Rate for Payer: SOMOS Essential	$38,220.52
Rate for Payer: United Healthcare Essential Plan 1&2	$38,220.52
Rate for Payer: United Healthcare Essential Plan 3&4	$38,220.52
Rate for Payer: United Healthcare Medicaid	$16,986.90
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,986.90

APR-DRG 1382: Bronchiolitis & RSV pneumonia

Facility

$40,728.49

Service Code	APR-DRG 1382
Min. Negotiated Rate	$7,071.00
Max. Negotiated Rate	$40,728.49
Rate for Payer: Affinity Essential Plan 1&2	$40,728.49
Rate for Payer: Affinity Essential Plan 3&4	$40,728.49
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,101.55
Rate for Payer: Amida Care Medicaid	$18,101.55
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,101.55
Rate for Payer: Fidelis Qualified Health Plan	$21,721.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,101.55
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,101.55
Rate for Payer: Healthfirst Commercial	$12,208.00
Rate for Payer: Healthfirst Essential Plan	$40,728.49
Rate for Payer: Healthfirst QHP	$7,071.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,101.55
Rate for Payer: SOMOS Essential	$40,728.49
Rate for Payer: United Healthcare Essential Plan 1&2	$40,728.49
Rate for Payer: United Healthcare Essential Plan 3&4	$40,728.49
Rate for Payer: United Healthcare Medicaid	$18,101.55
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,101.55

APR-DRG 1383: Bronchiolitis & RSV pneumonia

Facility

$53,646.48

Service Code	APR-DRG 1383
Min. Negotiated Rate	$12,771.00
Max. Negotiated Rate	$53,646.48
Rate for Payer: Affinity Essential Plan 1&2	$53,646.48
Rate for Payer: Affinity Essential Plan 3&4	$53,646.48
Rate for Payer: Affinity Medicaid/CHP/HARP	$23,842.88
Rate for Payer: Amida Care Medicaid	$23,842.88
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,842.88
Rate for Payer: Fidelis Qualified Health Plan	$28,611.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,842.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,842.88
Rate for Payer: Healthfirst Commercial	$21,746.00
Rate for Payer: Healthfirst Essential Plan	$53,646.48
Rate for Payer: Healthfirst QHP	$12,771.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,842.88
Rate for Payer: SOMOS Essential	$53,646.48
Rate for Payer: United Healthcare Essential Plan 1&2	$53,646.48
Rate for Payer: United Healthcare Essential Plan 3&4	$53,646.48
Rate for Payer: United Healthcare Medicaid	$23,842.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,842.88

APR-DRG 1384: Bronchiolitis & RSV pneumonia

Facility

$82,822.32

Service Code	APR-DRG 1384
Min. Negotiated Rate	$20,388.00
Max. Negotiated Rate	$82,822.32
Rate for Payer: Affinity Essential Plan 1&2	$82,822.32
Rate for Payer: Affinity Essential Plan 3&4	$82,822.32
Rate for Payer: Affinity Medicaid/CHP/HARP	$36,809.92
Rate for Payer: Amida Care Medicaid	$36,809.92
Rate for Payer: Fidelis CHP/HARP/Medicaid	$36,809.92
Rate for Payer: Fidelis Qualified Health Plan	$44,171.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$36,809.92
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$36,809.92
Rate for Payer: Healthfirst Commercial	$40,970.00
Rate for Payer: Healthfirst Essential Plan	$82,822.32
Rate for Payer: Healthfirst QHP	$20,388.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$36,809.92
Rate for Payer: SOMOS Essential	$82,822.32
Rate for Payer: United Healthcare Essential Plan 1&2	$82,822.32
Rate for Payer: United Healthcare Essential Plan 3&4	$82,822.32
Rate for Payer: United Healthcare Medicaid	$36,809.92
Rate for Payer: Wellcare CHP/FHP/Medicaid	$36,809.92

APR-DRG 1391: Other pneumonia

Facility

$38,677.79

Service Code	APR-DRG 1391
Min. Negotiated Rate	$5,862.00
Max. Negotiated Rate	$38,677.79
Rate for Payer: Affinity Essential Plan 1&2	$38,677.79
Rate for Payer: Affinity Essential Plan 3&4	$38,677.79
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,190.13
Rate for Payer: Amida Care Medicaid	$17,190.13
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,190.13
Rate for Payer: Fidelis Qualified Health Plan	$20,628.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,190.13
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,190.13
Rate for Payer: Healthfirst Commercial	$10,257.00
Rate for Payer: Healthfirst Essential Plan	$38,677.79
Rate for Payer: Healthfirst QHP	$5,862.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,190.13
Rate for Payer: SOMOS Essential	$38,677.79
Rate for Payer: United Healthcare Essential Plan 1&2	$38,677.79
Rate for Payer: United Healthcare Essential Plan 3&4	$38,677.79
Rate for Payer: United Healthcare Medicaid	$17,190.13
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,190.13

APR-DRG 1392: Other pneumonia

Facility

$41,572.69

Service Code	APR-DRG 1392
Min. Negotiated Rate	$7,758.00
Max. Negotiated Rate	$41,572.69
Rate for Payer: Affinity Essential Plan 1&2	$41,572.69
Rate for Payer: Affinity Essential Plan 3&4	$41,572.69
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,476.75
Rate for Payer: Amida Care Medicaid	$18,476.75
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,476.75
Rate for Payer: Fidelis Qualified Health Plan	$22,172.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,476.75
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,476.75
Rate for Payer: Healthfirst Commercial	$13,214.00
Rate for Payer: Healthfirst Essential Plan	$41,572.69
Rate for Payer: Healthfirst QHP	$7,758.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,476.75
Rate for Payer: SOMOS Essential	$41,572.69
Rate for Payer: United Healthcare Essential Plan 1&2	$41,572.69
Rate for Payer: United Healthcare Essential Plan 3&4	$41,572.69
Rate for Payer: United Healthcare Medicaid	$18,476.75
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,476.75

APR-DRG 1393: Other pneumonia

Facility

$49,659.41

Service Code	APR-DRG 1393
Min. Negotiated Rate	$11,682.00
Max. Negotiated Rate	$49,659.41
Rate for Payer: Affinity Essential Plan 1&2	$49,659.41
Rate for Payer: Affinity Essential Plan 3&4	$49,659.41
Rate for Payer: Affinity Medicaid/CHP/HARP	$22,070.85
Rate for Payer: Amida Care Medicaid	$22,070.85
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,070.85
Rate for Payer: Fidelis Qualified Health Plan	$26,485.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,070.85
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,070.85
Rate for Payer: Healthfirst Commercial	$20,518.00
Rate for Payer: Healthfirst Essential Plan	$49,659.41
Rate for Payer: Healthfirst QHP	$11,682.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,070.85
Rate for Payer: SOMOS Essential	$49,659.41
Rate for Payer: United Healthcare Essential Plan 1&2	$49,659.41
Rate for Payer: United Healthcare Essential Plan 3&4	$49,659.41
Rate for Payer: United Healthcare Medicaid	$22,070.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,070.85

APR-DRG 1394: Other pneumonia

Facility

$67,804.40

Service Code	APR-DRG 1394
Min. Negotiated Rate	$20,130.00
Max. Negotiated Rate	$67,804.40
Rate for Payer: Affinity Essential Plan 1&2	$67,804.40
Rate for Payer: Affinity Essential Plan 3&4	$67,804.40
Rate for Payer: Affinity Medicaid/CHP/HARP	$30,135.29
Rate for Payer: Amida Care Medicaid	$30,135.29
Rate for Payer: Fidelis CHP/HARP/Medicaid	$30,135.29
Rate for Payer: Fidelis Qualified Health Plan	$36,162.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$30,135.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$30,135.29
Rate for Payer: Healthfirst Commercial	$36,199.00
Rate for Payer: Healthfirst Essential Plan	$67,804.40
Rate for Payer: Healthfirst QHP	$20,130.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$30,135.29
Rate for Payer: SOMOS Essential	$67,804.40
Rate for Payer: United Healthcare Essential Plan 1&2	$67,804.40
Rate for Payer: United Healthcare Essential Plan 3&4	$67,804.40
Rate for Payer: United Healthcare Medicaid	$30,135.29
Rate for Payer: Wellcare CHP/FHP/Medicaid	$30,135.29

APR-DRG 1401: Chronic obstructive pulmonary disease

Facility

$39,757.68

Service Code	APR-DRG 1401
Min. Negotiated Rate	$6,814.00
Max. Negotiated Rate	$39,757.68
Rate for Payer: Affinity Essential Plan 1&2	$39,757.68
Rate for Payer: Affinity Essential Plan 3&4	$39,757.68
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,670.08
Rate for Payer: Amida Care Medicaid	$17,670.08
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,670.08
Rate for Payer: Fidelis Qualified Health Plan	$21,204.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,670.08
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,670.08
Rate for Payer: Healthfirst Commercial	$11,301.00
Rate for Payer: Healthfirst Essential Plan	$39,757.68
Rate for Payer: Healthfirst QHP	$6,814.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,670.08
Rate for Payer: SOMOS Essential	$39,757.68
Rate for Payer: United Healthcare Essential Plan 1&2	$39,757.68
Rate for Payer: United Healthcare Essential Plan 3&4	$39,757.68
Rate for Payer: United Healthcare Medicaid	$17,670.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,670.08

APR-DRG 1402: Chronic obstructive pulmonary disease

Facility

$42,341.26

Service Code	APR-DRG 1402
Min. Negotiated Rate	$8,324.00
Max. Negotiated Rate	$42,341.26
Rate for Payer: Affinity Essential Plan 1&2	$42,341.26
Rate for Payer: Affinity Essential Plan 3&4	$42,341.26
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,818.34
Rate for Payer: Amida Care Medicaid	$18,818.34
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,818.34
Rate for Payer: Fidelis Qualified Health Plan	$22,582.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,818.34
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,818.34
Rate for Payer: Healthfirst Commercial	$13,738.00
Rate for Payer: Healthfirst Essential Plan	$42,341.26
Rate for Payer: Healthfirst QHP	$8,324.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,818.34
Rate for Payer: SOMOS Essential	$42,341.26
Rate for Payer: United Healthcare Essential Plan 1&2	$42,341.26
Rate for Payer: United Healthcare Essential Plan 3&4	$42,341.26
Rate for Payer: United Healthcare Medicaid	$18,818.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,818.34

APR-DRG 1403: Chronic obstructive pulmonary disease

Facility

$47,446.90

Service Code	APR-DRG 1403
Min. Negotiated Rate	$11,045.00
Max. Negotiated Rate	$47,446.90
Rate for Payer: Affinity Essential Plan 1&2	$47,446.90
Rate for Payer: Affinity Essential Plan 3&4	$47,446.90
Rate for Payer: Affinity Medicaid/CHP/HARP	$21,087.51
Rate for Payer: Amida Care Medicaid	$21,087.51
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,087.51
Rate for Payer: Fidelis Qualified Health Plan	$25,305.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,087.51
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,087.51
Rate for Payer: Healthfirst Commercial	$18,891.00
Rate for Payer: Healthfirst Essential Plan	$47,446.90
Rate for Payer: Healthfirst QHP	$11,045.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,087.51
Rate for Payer: SOMOS Essential	$47,446.90
Rate for Payer: United Healthcare Essential Plan 1&2	$47,446.90
Rate for Payer: United Healthcare Essential Plan 3&4	$47,446.90
Rate for Payer: United Healthcare Medicaid	$21,087.51
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,087.51

APR-DRG 1404: Chronic obstructive pulmonary disease

Facility

$64,297.46

Service Code	APR-DRG 1404
Min. Negotiated Rate	$20,067.00
Max. Negotiated Rate	$64,297.46
Rate for Payer: Affinity Essential Plan 1&2	$64,297.46
Rate for Payer: Affinity Essential Plan 3&4	$64,297.46
Rate for Payer: Affinity Medicaid/CHP/HARP	$28,576.65
Rate for Payer: Amida Care Medicaid	$28,576.65
Rate for Payer: Fidelis CHP/HARP/Medicaid	$28,576.65
Rate for Payer: Fidelis Qualified Health Plan	$34,291.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$28,576.65
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$28,576.65
Rate for Payer: Healthfirst Commercial	$35,384.00
Rate for Payer: Healthfirst Essential Plan	$64,297.46
Rate for Payer: Healthfirst QHP	$20,067.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$28,576.65
Rate for Payer: SOMOS Essential	$64,297.46
Rate for Payer: United Healthcare Essential Plan 1&2	$64,297.46
Rate for Payer: United Healthcare Essential Plan 3&4	$64,297.46
Rate for Payer: United Healthcare Medicaid	$28,576.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$28,576.65

APR-DRG 1411: Asthma

Facility

$37,972.55

Service Code	APR-DRG 1411
Min. Negotiated Rate	$5,381.00
Max. Negotiated Rate	$37,972.55
Rate for Payer: Affinity Essential Plan 1&2	$37,972.55
Rate for Payer: Affinity Essential Plan 3&4	$37,972.55
Rate for Payer: Affinity Medicaid/CHP/HARP	$16,876.69
Rate for Payer: Amida Care Medicaid	$16,876.69
Rate for Payer: Fidelis CHP/HARP/Medicaid	$16,876.69
Rate for Payer: Fidelis Qualified Health Plan	$20,252.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$16,876.69
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16,876.69
Rate for Payer: Healthfirst Commercial	$9,251.00
Rate for Payer: Healthfirst Essential Plan	$37,972.55
Rate for Payer: Healthfirst QHP	$5,381.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$16,876.69
Rate for Payer: SOMOS Essential	$37,972.55
Rate for Payer: United Healthcare Essential Plan 1&2	$37,972.55
Rate for Payer: United Healthcare Essential Plan 3&4	$37,972.55
Rate for Payer: United Healthcare Medicaid	$16,876.69
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,876.69

APR-DRG 1412: Asthma

Facility

$40,499.86

Service Code	APR-DRG 1412
Min. Negotiated Rate	$6,513.00
Max. Negotiated Rate	$40,499.86
Rate for Payer: Affinity Essential Plan 1&2	$40,499.86
Rate for Payer: Affinity Essential Plan 3&4	$40,499.86
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,999.94
Rate for Payer: Amida Care Medicaid	$17,999.94
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,999.94
Rate for Payer: Fidelis Qualified Health Plan	$21,599.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,999.94
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,999.94
Rate for Payer: Healthfirst Commercial	$11,421.00
Rate for Payer: Healthfirst Essential Plan	$40,499.86
Rate for Payer: Healthfirst QHP	$6,513.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,999.94
Rate for Payer: SOMOS Essential	$40,499.86
Rate for Payer: United Healthcare Essential Plan 1&2	$40,499.86
Rate for Payer: United Healthcare Essential Plan 3&4	$40,499.86
Rate for Payer: United Healthcare Medicaid	$17,999.94
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,999.94

APR-DRG 1413: Asthma

Facility

$46,134.88

Service Code	APR-DRG 1413
Min. Negotiated Rate	$8,994.00
Max. Negotiated Rate	$46,134.88
Rate for Payer: Affinity Essential Plan 1&2	$46,134.88
Rate for Payer: Affinity Essential Plan 3&4	$46,134.88
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,504.39
Rate for Payer: Amida Care Medicaid	$20,504.39
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,504.39
Rate for Payer: Fidelis Qualified Health Plan	$24,605.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,504.39
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,504.39
Rate for Payer: Healthfirst Commercial	$15,622.00
Rate for Payer: Healthfirst Essential Plan	$46,134.88
Rate for Payer: Healthfirst QHP	$8,994.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,504.39
Rate for Payer: SOMOS Essential	$46,134.88
Rate for Payer: United Healthcare Essential Plan 1&2	$46,134.88
Rate for Payer: United Healthcare Essential Plan 3&4	$46,134.88
Rate for Payer: United Healthcare Medicaid	$20,504.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,504.39

APR-DRG 1414: Asthma

Facility

$58,695.84

Service Code	APR-DRG 1414
Min. Negotiated Rate	$14,682.00
Max. Negotiated Rate	$58,695.84
Rate for Payer: Affinity Essential Plan 1&2	$58,695.84
Rate for Payer: Affinity Essential Plan 3&4	$58,695.84
Rate for Payer: Affinity Medicaid/CHP/HARP	$26,087.04
Rate for Payer: Amida Care Medicaid	$26,087.04
Rate for Payer: Fidelis CHP/HARP/Medicaid	$26,087.04
Rate for Payer: Fidelis Qualified Health Plan	$31,304.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$26,087.04
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$26,087.04
Rate for Payer: Healthfirst Commercial	$26,275.00
Rate for Payer: Healthfirst Essential Plan	$58,695.84
Rate for Payer: Healthfirst QHP	$14,682.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26,087.04
Rate for Payer: SOMOS Essential	$58,695.84
Rate for Payer: United Healthcare Essential Plan 1&2	$58,695.84
Rate for Payer: United Healthcare Essential Plan 3&4	$58,695.84
Rate for Payer: United Healthcare Medicaid	$26,087.04
Rate for Payer: Wellcare CHP/FHP/Medicaid	$26,087.04

APR-DRG 1421: Interstitial & alveolar lung diseases

Facility

$41,375.72

Service Code	APR-DRG 1421
Min. Negotiated Rate	$8,077.00
Max. Negotiated Rate	$41,375.72
Rate for Payer: Affinity Essential Plan 1&2	$41,375.72
Rate for Payer: Affinity Essential Plan 3&4	$41,375.72
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,389.21
Rate for Payer: Amida Care Medicaid	$18,389.21
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,389.21
Rate for Payer: Fidelis Qualified Health Plan	$22,067.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,389.21
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,389.21
Rate for Payer: Healthfirst Commercial	$12,083.00
Rate for Payer: Healthfirst Essential Plan	$41,375.72
Rate for Payer: Healthfirst QHP	$8,077.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,389.21
Rate for Payer: SOMOS Essential	$41,375.72
Rate for Payer: United Healthcare Essential Plan 1&2	$41,375.72
Rate for Payer: United Healthcare Essential Plan 3&4	$41,375.72
Rate for Payer: United Healthcare Medicaid	$18,389.21
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,389.21

APR-DRG 1422: Interstitial & alveolar lung diseases

Facility

$44,752.50

Service Code	APR-DRG 1422
Min. Negotiated Rate	$9,568.00
Max. Negotiated Rate	$44,752.50
Rate for Payer: Affinity Essential Plan 1&2	$44,752.50
Rate for Payer: Affinity Essential Plan 3&4	$44,752.50
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,890.00
Rate for Payer: Amida Care Medicaid	$19,890.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,890.00
Rate for Payer: Fidelis Qualified Health Plan	$23,868.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,890.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,890.00
Rate for Payer: Healthfirst Commercial	$15,112.00
Rate for Payer: Healthfirst Essential Plan	$44,752.50
Rate for Payer: Healthfirst QHP	$9,568.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,890.00
Rate for Payer: SOMOS Essential	$44,752.50
Rate for Payer: United Healthcare Essential Plan 1&2	$44,752.50
Rate for Payer: United Healthcare Essential Plan 3&4	$44,752.50
Rate for Payer: United Healthcare Medicaid	$19,890.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,890.00

APR-DRG 1423: Interstitial & alveolar lung diseases

Facility

$53,048.52

Service Code	APR-DRG 1423
Min. Negotiated Rate	$13,631.00
Max. Negotiated Rate	$53,048.52
Rate for Payer: Affinity Essential Plan 1&2	$53,048.52
Rate for Payer: Affinity Essential Plan 3&4	$53,048.52
Rate for Payer: Affinity Medicaid/CHP/HARP	$23,577.12
Rate for Payer: Amida Care Medicaid	$23,577.12
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,577.12
Rate for Payer: Fidelis Qualified Health Plan	$28,292.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,577.12
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,577.12
Rate for Payer: Healthfirst Commercial	$23,243.00
Rate for Payer: Healthfirst Essential Plan	$53,048.52
Rate for Payer: Healthfirst QHP	$13,631.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,577.12
Rate for Payer: SOMOS Essential	$53,048.52
Rate for Payer: United Healthcare Essential Plan 1&2	$53,048.52
Rate for Payer: United Healthcare Essential Plan 3&4	$53,048.52
Rate for Payer: United Healthcare Medicaid	$23,577.12
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,577.12

APR-DRG 1424: Interstitial & alveolar lung diseases

Facility

$78,564.40

Service Code	APR-DRG 1424
Min. Negotiated Rate	$23,284.00
Max. Negotiated Rate	$78,564.40
Rate for Payer: Affinity Essential Plan 1&2	$78,564.40
Rate for Payer: Affinity Essential Plan 3&4	$78,564.40
Rate for Payer: Affinity Medicaid/CHP/HARP	$34,917.51
Rate for Payer: Amida Care Medicaid	$34,917.51
Rate for Payer: Fidelis CHP/HARP/Medicaid	$34,917.51
Rate for Payer: Fidelis Qualified Health Plan	$41,901.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$34,917.51
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$34,917.51
Rate for Payer: Healthfirst Commercial	$45,248.00
Rate for Payer: Healthfirst Essential Plan	$78,564.40
Rate for Payer: Healthfirst QHP	$23,284.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$34,917.51
Rate for Payer: SOMOS Essential	$78,564.40
Rate for Payer: United Healthcare Essential Plan 1&2	$78,564.40
Rate for Payer: United Healthcare Essential Plan 3&4	$78,564.40
Rate for Payer: United Healthcare Medicaid	$34,917.51
Rate for Payer: Wellcare CHP/FHP/Medicaid	$34,917.51

APR-DRG 1431: Other respiratory diagnoses except signs, symptoms & minor diagnoses

Facility

$38,983.82

Service Code	APR-DRG 1431
Min. Negotiated Rate	$6,249.00
Max. Negotiated Rate	$38,983.82
Rate for Payer: Affinity Essential Plan 1&2	$38,983.82
Rate for Payer: Affinity Essential Plan 3&4	$38,983.82
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,326.14
Rate for Payer: Amida Care Medicaid	$17,326.14
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,326.14
Rate for Payer: Fidelis Qualified Health Plan	$20,791.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,326.14
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,326.14
Rate for Payer: Healthfirst Commercial	$10,352.00
Rate for Payer: Healthfirst Essential Plan	$38,983.82
Rate for Payer: Healthfirst QHP	$6,249.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,326.14
Rate for Payer: SOMOS Essential	$38,983.82
Rate for Payer: United Healthcare Essential Plan 1&2	$38,983.82
Rate for Payer: United Healthcare Essential Plan 3&4	$38,983.82
Rate for Payer: United Healthcare Medicaid	$17,326.14
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,326.14

APR-DRG 1432: Other respiratory diagnoses except signs, symptoms & minor diagnoses

Facility

$42,992.01

Service Code	APR-DRG 1432
Min. Negotiated Rate	$8,399.00
Max. Negotiated Rate	$42,992.01
Rate for Payer: Affinity Essential Plan 1&2	$42,992.01
Rate for Payer: Affinity Essential Plan 3&4	$42,992.01
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,107.56
Rate for Payer: Amida Care Medicaid	$19,107.56
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,107.56
Rate for Payer: Fidelis Qualified Health Plan	$22,929.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,107.56
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,107.56
Rate for Payer: Healthfirst Commercial	$14,728.00
Rate for Payer: Healthfirst Essential Plan	$42,992.01
Rate for Payer: Healthfirst QHP	$8,399.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,107.56
Rate for Payer: SOMOS Essential	$42,992.01
Rate for Payer: United Healthcare Essential Plan 1&2	$42,992.01
Rate for Payer: United Healthcare Essential Plan 3&4	$42,992.01
Rate for Payer: United Healthcare Medicaid	$19,107.56
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,107.56

APR-DRG 1433: Other respiratory diagnoses except signs, symptoms & minor diagnoses

Facility

$52,204.32

Service Code	APR-DRG 1433
Min. Negotiated Rate	$12,791.00
Max. Negotiated Rate	$52,204.32
Rate for Payer: Affinity Essential Plan 1&2	$52,204.32
Rate for Payer: Affinity Essential Plan 3&4	$52,204.32
Rate for Payer: Affinity Medicaid/CHP/HARP	$23,201.92
Rate for Payer: Amida Care Medicaid	$23,201.92
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,201.92
Rate for Payer: Fidelis Qualified Health Plan	$27,842.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,201.92
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,201.92
Rate for Payer: Healthfirst Commercial	$22,055.00
Rate for Payer: Healthfirst Essential Plan	$52,204.32
Rate for Payer: Healthfirst QHP	$12,791.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,201.92
Rate for Payer: SOMOS Essential	$52,204.32
Rate for Payer: United Healthcare Essential Plan 1&2	$52,204.32
Rate for Payer: United Healthcare Essential Plan 3&4	$52,204.32
Rate for Payer: United Healthcare Medicaid	$23,201.92
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,201.92

APR-DRG 1434: Other respiratory diagnoses except signs, symptoms & minor diagnoses

Facility

$65,832.84

Service Code	APR-DRG 1434
Min. Negotiated Rate	$18,391.00
Max. Negotiated Rate	$65,832.84
Rate for Payer: Affinity Essential Plan 1&2	$65,832.84
Rate for Payer: Affinity Essential Plan 3&4	$65,832.84
Rate for Payer: Affinity Medicaid/CHP/HARP	$29,259.04
Rate for Payer: Amida Care Medicaid	$29,259.04
Rate for Payer: Fidelis CHP/HARP/Medicaid	$29,259.04
Rate for Payer: Fidelis Qualified Health Plan	$35,110.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$29,259.04
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29,259.04
Rate for Payer: Healthfirst Commercial	$33,983.00
Rate for Payer: Healthfirst Essential Plan	$65,832.84
Rate for Payer: Healthfirst QHP	$18,391.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$29,259.04
Rate for Payer: SOMOS Essential	$65,832.84
Rate for Payer: United Healthcare Essential Plan 1&2	$65,832.84
Rate for Payer: United Healthcare Essential Plan 3&4	$65,832.84
Rate for Payer: United Healthcare Medicaid	$29,259.04
Rate for Payer: Wellcare CHP/FHP/Medicaid	$29,259.04

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