St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

APR-DRG 1662: Coronary bypass w/o AMI or complex PDX

Facility

$87,006.40

Service Code	APR-DRG 1662
Min. Negotiated Rate	$33,191.00
Max. Negotiated Rate	$87,006.40
Rate for Payer: Affinity Essential Plan 1&2	$87,006.40
Rate for Payer: Affinity Essential Plan 3&4	$87,006.40
Rate for Payer: Affinity Medicaid/CHP/HARP	$38,669.51
Rate for Payer: Amida Care Medicaid	$38,669.51
Rate for Payer: Fidelis CHP/HARP/Medicaid	$38,669.51
Rate for Payer: Fidelis Qualified Health Plan	$46,403.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$38,669.51
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$38,669.51
Rate for Payer: Healthfirst Commercial	$55,156.00
Rate for Payer: Healthfirst Essential Plan	$87,006.40
Rate for Payer: Healthfirst QHP	$33,191.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$38,669.51
Rate for Payer: SOMOS Essential	$87,006.40
Rate for Payer: United Healthcare Essential Plan 1&2	$87,006.40
Rate for Payer: United Healthcare Essential Plan 3&4	$87,006.40
Rate for Payer: United Healthcare Medicaid	$38,669.51
Rate for Payer: Wellcare CHP/FHP/Medicaid	$38,669.51

APR-DRG 1663: Coronary bypass w/o AMI or complex PDX

Facility

$100,270.84

Service Code	APR-DRG 1663
Min. Negotiated Rate	$41,785.00
Max. Negotiated Rate	$100,270.84
Rate for Payer: Affinity Essential Plan 1&2	$100,270.84
Rate for Payer: Affinity Essential Plan 3&4	$100,270.84
Rate for Payer: Affinity Medicaid/CHP/HARP	$44,564.82
Rate for Payer: Amida Care Medicaid	$44,564.82
Rate for Payer: Fidelis CHP/HARP/Medicaid	$44,564.82
Rate for Payer: Fidelis Qualified Health Plan	$53,477.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$44,564.82
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$44,564.82
Rate for Payer: Healthfirst Commercial	$75,699.00
Rate for Payer: Healthfirst Essential Plan	$100,270.84
Rate for Payer: Healthfirst QHP	$41,785.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$44,564.82
Rate for Payer: SOMOS Essential	$100,270.84
Rate for Payer: United Healthcare Essential Plan 1&2	$100,270.84
Rate for Payer: United Healthcare Essential Plan 3&4	$100,270.84
Rate for Payer: United Healthcare Medicaid	$44,564.82
Rate for Payer: Wellcare CHP/FHP/Medicaid	$44,564.82

APR-DRG 1664: Coronary bypass w/o AMI or complex PDX

Facility

$157,774.00

Service Code	APR-DRG 1664
Min. Negotiated Rate	$61,881.83
Max. Negotiated Rate	$157,774.00
Rate for Payer: Affinity Essential Plan 1&2	$139,234.12
Rate for Payer: Affinity Essential Plan 3&4	$139,234.12
Rate for Payer: Affinity Medicaid/CHP/HARP	$61,881.83
Rate for Payer: Amida Care Medicaid	$61,881.83
Rate for Payer: Fidelis CHP/HARP/Medicaid	$61,881.83
Rate for Payer: Fidelis Qualified Health Plan	$74,258.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$61,881.83
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$61,881.83
Rate for Payer: Healthfirst Commercial	$157,774.00
Rate for Payer: Healthfirst Essential Plan	$139,234.12
Rate for Payer: Healthfirst QHP	$71,480.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$61,881.83
Rate for Payer: SOMOS Essential	$139,234.12
Rate for Payer: United Healthcare Essential Plan 1&2	$139,234.12
Rate for Payer: United Healthcare Essential Plan 3&4	$139,234.12
Rate for Payer: United Healthcare Medicaid	$61,881.83
Rate for Payer: Wellcare CHP/FHP/Medicaid	$61,881.83

APR-DRG 1671: Other cardiothoracic & thoracic vascular procedures

Facility

$72,305.03

Service Code	APR-DRG 1671
Min. Negotiated Rate	$25,501.00
Max. Negotiated Rate	$72,305.03
Rate for Payer: Affinity Essential Plan 1&2	$72,305.03
Rate for Payer: Affinity Essential Plan 3&4	$72,305.03
Rate for Payer: Affinity Medicaid/CHP/HARP	$32,135.57
Rate for Payer: Amida Care Medicaid	$32,135.57
Rate for Payer: Fidelis CHP/HARP/Medicaid	$32,135.57
Rate for Payer: Fidelis Qualified Health Plan	$38,562.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$32,135.57
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$32,135.57
Rate for Payer: Healthfirst Commercial	$38,757.00
Rate for Payer: Healthfirst Essential Plan	$72,305.03
Rate for Payer: Healthfirst QHP	$25,501.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$32,135.57
Rate for Payer: SOMOS Essential	$72,305.03
Rate for Payer: United Healthcare Essential Plan 1&2	$72,305.03
Rate for Payer: United Healthcare Essential Plan 3&4	$72,305.03
Rate for Payer: United Healthcare Medicaid	$32,135.57
Rate for Payer: Wellcare CHP/FHP/Medicaid	$32,135.57

APR-DRG 1672: Other cardiothoracic & thoracic vascular procedures

Facility

$79,586.24

Service Code	APR-DRG 1672
Min. Negotiated Rate	$31,563.00
Max. Negotiated Rate	$79,586.24
Rate for Payer: Affinity Essential Plan 1&2	$79,586.24
Rate for Payer: Affinity Essential Plan 3&4	$79,586.24
Rate for Payer: Affinity Medicaid/CHP/HARP	$35,371.66
Rate for Payer: Amida Care Medicaid	$35,371.66
Rate for Payer: Fidelis CHP/HARP/Medicaid	$35,371.66
Rate for Payer: Fidelis Qualified Health Plan	$42,445.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$35,371.66
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$35,371.66
Rate for Payer: Healthfirst Commercial	$50,132.00
Rate for Payer: Healthfirst Essential Plan	$79,586.24
Rate for Payer: Healthfirst QHP	$31,563.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$35,371.66
Rate for Payer: SOMOS Essential	$79,586.24
Rate for Payer: United Healthcare Essential Plan 1&2	$79,586.24
Rate for Payer: United Healthcare Essential Plan 3&4	$79,586.24
Rate for Payer: United Healthcare Medicaid	$35,371.66
Rate for Payer: Wellcare CHP/FHP/Medicaid	$35,371.66

APR-DRG 1673: Other cardiothoracic & thoracic vascular procedures

Facility

$94,386.08

Service Code	APR-DRG 1673
Min. Negotiated Rate	$40,259.00
Max. Negotiated Rate	$94,386.08
Rate for Payer: Affinity Essential Plan 1&2	$94,386.08
Rate for Payer: Affinity Essential Plan 3&4	$94,386.08
Rate for Payer: Affinity Medicaid/CHP/HARP	$41,949.37
Rate for Payer: Amida Care Medicaid	$41,949.37
Rate for Payer: Fidelis CHP/HARP/Medicaid	$41,949.37
Rate for Payer: Fidelis Qualified Health Plan	$50,339.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$41,949.37
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$41,949.37
Rate for Payer: Healthfirst Commercial	$61,936.00
Rate for Payer: Healthfirst Essential Plan	$94,386.08
Rate for Payer: Healthfirst QHP	$40,259.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$41,949.37
Rate for Payer: SOMOS Essential	$94,386.08
Rate for Payer: United Healthcare Essential Plan 1&2	$94,386.08
Rate for Payer: United Healthcare Essential Plan 3&4	$94,386.08
Rate for Payer: United Healthcare Medicaid	$41,949.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$41,949.37

APR-DRG 1674: Other cardiothoracic & thoracic vascular procedures

Facility

$146,269.10

Service Code	APR-DRG 1674
Min. Negotiated Rate	$65,008.49
Max. Negotiated Rate	$146,269.10
Rate for Payer: Affinity Essential Plan 1&2	$146,269.10
Rate for Payer: Affinity Essential Plan 3&4	$146,269.10
Rate for Payer: Affinity Medicaid/CHP/HARP	$65,008.49
Rate for Payer: Amida Care Medicaid	$65,008.49
Rate for Payer: Fidelis CHP/HARP/Medicaid	$65,008.49
Rate for Payer: Fidelis Qualified Health Plan	$78,010.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$65,008.49
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$65,008.49
Rate for Payer: Healthfirst Commercial	$119,803.00
Rate for Payer: Healthfirst Essential Plan	$146,269.10
Rate for Payer: Healthfirst QHP	$69,036.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$65,008.49
Rate for Payer: SOMOS Essential	$146,269.10
Rate for Payer: United Healthcare Essential Plan 1&2	$146,269.10
Rate for Payer: United Healthcare Essential Plan 3&4	$146,269.10
Rate for Payer: United Healthcare Medicaid	$65,008.49
Rate for Payer: Wellcare CHP/FHP/Medicaid	$65,008.49

APR-DRG 1691: Major abdominal vascular procedures

Facility

$61,006.84

Service Code	APR-DRG 1691
Min. Negotiated Rate	$19,847.00
Max. Negotiated Rate	$61,006.84
Rate for Payer: Affinity Essential Plan 1&2	$61,006.84
Rate for Payer: Affinity Essential Plan 3&4	$61,006.84
Rate for Payer: Affinity Medicaid/CHP/HARP	$27,114.15
Rate for Payer: Amida Care Medicaid	$27,114.15
Rate for Payer: Fidelis CHP/HARP/Medicaid	$27,114.15
Rate for Payer: Fidelis Qualified Health Plan	$32,536.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$27,114.15
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$27,114.15
Rate for Payer: Healthfirst Commercial	$33,533.00
Rate for Payer: Healthfirst Essential Plan	$61,006.84
Rate for Payer: Healthfirst QHP	$19,847.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$27,114.15
Rate for Payer: SOMOS Essential	$61,006.84
Rate for Payer: United Healthcare Essential Plan 1&2	$61,006.84
Rate for Payer: United Healthcare Essential Plan 3&4	$61,006.84
Rate for Payer: United Healthcare Medicaid	$27,114.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$27,114.15

APR-DRG 1692: Major abdominal vascular procedures

Facility

$69,890.26

Service Code	APR-DRG 1692
Min. Negotiated Rate	$26,132.00
Max. Negotiated Rate	$69,890.26
Rate for Payer: Affinity Essential Plan 1&2	$69,890.26
Rate for Payer: Affinity Essential Plan 3&4	$69,890.26
Rate for Payer: Affinity Medicaid/CHP/HARP	$31,062.34
Rate for Payer: Amida Care Medicaid	$31,062.34
Rate for Payer: Fidelis CHP/HARP/Medicaid	$31,062.34
Rate for Payer: Fidelis Qualified Health Plan	$37,274.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$31,062.34
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31,062.34
Rate for Payer: Healthfirst Commercial	$44,838.00
Rate for Payer: Healthfirst Essential Plan	$69,890.26
Rate for Payer: Healthfirst QHP	$26,132.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$31,062.34
Rate for Payer: SOMOS Essential	$69,890.26
Rate for Payer: United Healthcare Essential Plan 1&2	$69,890.26
Rate for Payer: United Healthcare Essential Plan 3&4	$69,890.26
Rate for Payer: United Healthcare Medicaid	$31,062.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$31,062.34

APR-DRG 1693: Major abdominal vascular procedures

Facility

$94,987.58

Service Code	APR-DRG 1693
Min. Negotiated Rate	$42,216.70
Max. Negotiated Rate	$94,987.58
Rate for Payer: Affinity Essential Plan 1&2	$94,987.58
Rate for Payer: Affinity Essential Plan 3&4	$94,987.58
Rate for Payer: Affinity Medicaid/CHP/HARP	$42,216.70
Rate for Payer: Amida Care Medicaid	$42,216.70
Rate for Payer: Fidelis CHP/HARP/Medicaid	$42,216.70
Rate for Payer: Fidelis Qualified Health Plan	$50,660.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$42,216.70
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$42,216.70
Rate for Payer: Healthfirst Commercial	$71,633.00
Rate for Payer: Healthfirst Essential Plan	$94,987.58
Rate for Payer: Healthfirst QHP	$42,527.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$42,216.70
Rate for Payer: SOMOS Essential	$94,987.58
Rate for Payer: United Healthcare Essential Plan 1&2	$94,987.58
Rate for Payer: United Healthcare Essential Plan 3&4	$94,987.58
Rate for Payer: United Healthcare Medicaid	$42,216.70
Rate for Payer: Wellcare CHP/FHP/Medicaid	$42,216.70

APR-DRG 1694: Major abdominal vascular procedures

Facility

$155,972.12

Service Code	APR-DRG 1694
Min. Negotiated Rate	$69,320.94
Max. Negotiated Rate	$155,972.12
Rate for Payer: Affinity Essential Plan 1&2	$155,972.12
Rate for Payer: Affinity Essential Plan 3&4	$155,972.12
Rate for Payer: Affinity Medicaid/CHP/HARP	$69,320.94
Rate for Payer: Amida Care Medicaid	$69,320.94
Rate for Payer: Fidelis CHP/HARP/Medicaid	$69,320.94
Rate for Payer: Fidelis Qualified Health Plan	$83,185.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$69,320.94
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$69,320.94
Rate for Payer: Healthfirst Commercial	$129,968.00
Rate for Payer: Healthfirst Essential Plan	$155,972.12
Rate for Payer: Healthfirst QHP	$81,947.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$69,320.94
Rate for Payer: SOMOS Essential	$155,972.12
Rate for Payer: United Healthcare Essential Plan 1&2	$155,972.12
Rate for Payer: United Healthcare Essential Plan 3&4	$155,972.12
Rate for Payer: United Healthcare Medicaid	$69,320.94
Rate for Payer: Wellcare CHP/FHP/Medicaid	$69,320.94

APR-DRG 1701: Permanent cardiac pacemaker implant w AMI, heart failure or shock

Facility

$77,227.76

Service Code	APR-DRG 1701
Min. Negotiated Rate	$32,533.00
Max. Negotiated Rate	$77,227.76
Rate for Payer: Affinity Essential Plan 1&2	$77,227.76
Rate for Payer: Affinity Essential Plan 3&4	$77,227.76
Rate for Payer: Affinity Medicaid/CHP/HARP	$34,323.45
Rate for Payer: Amida Care Medicaid	$34,323.45
Rate for Payer: Fidelis CHP/HARP/Medicaid	$34,323.45
Rate for Payer: Fidelis Qualified Health Plan	$41,188.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$34,323.45
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$34,323.45
Rate for Payer: Healthfirst Commercial	$55,952.00
Rate for Payer: Healthfirst Essential Plan	$77,227.76
Rate for Payer: Healthfirst QHP	$32,533.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$34,323.45
Rate for Payer: SOMOS Essential	$77,227.76
Rate for Payer: United Healthcare Essential Plan 1&2	$77,227.76
Rate for Payer: United Healthcare Essential Plan 3&4	$77,227.76
Rate for Payer: United Healthcare Medicaid	$34,323.45
Rate for Payer: Wellcare CHP/FHP/Medicaid	$34,323.45

APR-DRG 1702: Permanent cardiac pacemaker implant w AMI, heart failure or shock

Facility

$77,751.86

Service Code	APR-DRG 1702
Min. Negotiated Rate	$32,533.00
Max. Negotiated Rate	$77,751.86
Rate for Payer: Affinity Essential Plan 1&2	$77,751.86
Rate for Payer: Affinity Essential Plan 3&4	$77,751.86
Rate for Payer: Affinity Medicaid/CHP/HARP	$34,556.38
Rate for Payer: Amida Care Medicaid	$34,556.38
Rate for Payer: Fidelis CHP/HARP/Medicaid	$34,556.38
Rate for Payer: Fidelis Qualified Health Plan	$41,467.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$34,556.38
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$34,556.38
Rate for Payer: Healthfirst Commercial	$55,952.00
Rate for Payer: Healthfirst Essential Plan	$77,751.86
Rate for Payer: Healthfirst QHP	$32,533.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$34,556.38
Rate for Payer: SOMOS Essential	$77,751.86
Rate for Payer: United Healthcare Essential Plan 1&2	$77,751.86
Rate for Payer: United Healthcare Essential Plan 3&4	$77,751.86
Rate for Payer: United Healthcare Medicaid	$34,556.38
Rate for Payer: Wellcare CHP/FHP/Medicaid	$34,556.38

APR-DRG 1703: Permanent cardiac pacemaker implant w AMI, heart failure or shock

Facility

$93,010.75

Service Code	APR-DRG 1703
Min. Negotiated Rate	$41,338.11
Max. Negotiated Rate	$93,010.75
Rate for Payer: Affinity Essential Plan 1&2	$93,010.75
Rate for Payer: Affinity Essential Plan 3&4	$93,010.75
Rate for Payer: Affinity Medicaid/CHP/HARP	$41,338.11
Rate for Payer: Amida Care Medicaid	$41,338.11
Rate for Payer: Fidelis CHP/HARP/Medicaid	$41,338.11
Rate for Payer: Fidelis Qualified Health Plan	$49,605.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$41,338.11
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$41,338.11
Rate for Payer: Healthfirst Commercial	$65,542.00
Rate for Payer: Healthfirst Essential Plan	$93,010.75
Rate for Payer: Healthfirst QHP	$42,271.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$41,338.11
Rate for Payer: SOMOS Essential	$93,010.75
Rate for Payer: United Healthcare Essential Plan 1&2	$93,010.75
Rate for Payer: United Healthcare Essential Plan 3&4	$93,010.75
Rate for Payer: United Healthcare Medicaid	$41,338.11
Rate for Payer: Wellcare CHP/FHP/Medicaid	$41,338.11

APR-DRG 1704: Permanent cardiac pacemaker implant w AMI, heart failure or shock

Facility

$114,282.79

Service Code	APR-DRG 1704
Min. Negotiated Rate	$44,870.00
Max. Negotiated Rate	$114,282.79
Rate for Payer: Affinity Essential Plan 1&2	$114,282.79
Rate for Payer: Affinity Essential Plan 3&4	$114,282.79
Rate for Payer: Affinity Medicaid/CHP/HARP	$50,792.35
Rate for Payer: Amida Care Medicaid	$50,792.35
Rate for Payer: Fidelis CHP/HARP/Medicaid	$50,792.35
Rate for Payer: Fidelis Qualified Health Plan	$60,950.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$50,792.35
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$50,792.35
Rate for Payer: Healthfirst Commercial	$110,030.00
Rate for Payer: Healthfirst Essential Plan	$114,282.79
Rate for Payer: Healthfirst QHP	$44,870.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$50,792.35
Rate for Payer: SOMOS Essential	$114,282.79
Rate for Payer: United Healthcare Essential Plan 1&2	$114,282.79
Rate for Payer: United Healthcare Essential Plan 3&4	$114,282.79
Rate for Payer: United Healthcare Medicaid	$50,792.35
Rate for Payer: Wellcare CHP/FHP/Medicaid	$50,792.35

APR-DRG 1711: Perm cardiac pacemaker implant w/o AMI, heart failure or shock

Facility

$60,241.79

Service Code	APR-DRG 1711
Min. Negotiated Rate	$22,406.00
Max. Negotiated Rate	$60,241.79
Rate for Payer: Affinity Essential Plan 1&2	$60,241.79
Rate for Payer: Affinity Essential Plan 3&4	$60,241.79
Rate for Payer: Affinity Medicaid/CHP/HARP	$26,774.13
Rate for Payer: Amida Care Medicaid	$26,774.13
Rate for Payer: Fidelis CHP/HARP/Medicaid	$26,774.13
Rate for Payer: Fidelis Qualified Health Plan	$32,128.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$26,774.13
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$26,774.13
Rate for Payer: Healthfirst Commercial	$34,616.00
Rate for Payer: Healthfirst Essential Plan	$60,241.79
Rate for Payer: Healthfirst QHP	$22,406.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26,774.13
Rate for Payer: SOMOS Essential	$60,241.79
Rate for Payer: United Healthcare Essential Plan 1&2	$60,241.79
Rate for Payer: United Healthcare Essential Plan 3&4	$60,241.79
Rate for Payer: United Healthcare Medicaid	$26,774.13
Rate for Payer: Wellcare CHP/FHP/Medicaid	$26,774.13

APR-DRG 1712: Perm cardiac pacemaker implant w/o AMI, heart failure or shock

Facility

$67,350.64

Service Code	APR-DRG 1712
Min. Negotiated Rate	$26,055.00
Max. Negotiated Rate	$67,350.64
Rate for Payer: Affinity Essential Plan 1&2	$67,350.64
Rate for Payer: Affinity Essential Plan 3&4	$67,350.64
Rate for Payer: Affinity Medicaid/CHP/HARP	$29,933.62
Rate for Payer: Amida Care Medicaid	$29,933.62
Rate for Payer: Fidelis CHP/HARP/Medicaid	$29,933.62
Rate for Payer: Fidelis Qualified Health Plan	$35,920.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$29,933.62
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29,933.62
Rate for Payer: Healthfirst Commercial	$41,563.00
Rate for Payer: Healthfirst Essential Plan	$67,350.64
Rate for Payer: Healthfirst QHP	$26,055.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$29,933.62
Rate for Payer: SOMOS Essential	$67,350.64
Rate for Payer: United Healthcare Essential Plan 1&2	$67,350.64
Rate for Payer: United Healthcare Essential Plan 3&4	$67,350.64
Rate for Payer: United Healthcare Medicaid	$29,933.62
Rate for Payer: Wellcare CHP/FHP/Medicaid	$29,933.62

APR-DRG 1713: Perm cardiac pacemaker implant w/o AMI, heart failure or shock

Facility

$82,192.70

Service Code	APR-DRG 1713
Min. Negotiated Rate	$33,372.00
Max. Negotiated Rate	$82,192.70
Rate for Payer: Affinity Essential Plan 1&2	$82,192.70
Rate for Payer: Affinity Essential Plan 3&4	$82,192.70
Rate for Payer: Affinity Medicaid/CHP/HARP	$36,530.09
Rate for Payer: Amida Care Medicaid	$36,530.09
Rate for Payer: Fidelis CHP/HARP/Medicaid	$36,530.09
Rate for Payer: Fidelis Qualified Health Plan	$43,836.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$36,530.09
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$36,530.09
Rate for Payer: Healthfirst Commercial	$58,526.00
Rate for Payer: Healthfirst Essential Plan	$82,192.70
Rate for Payer: Healthfirst QHP	$33,372.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$36,530.09
Rate for Payer: SOMOS Essential	$82,192.70
Rate for Payer: United Healthcare Essential Plan 1&2	$82,192.70
Rate for Payer: United Healthcare Essential Plan 3&4	$82,192.70
Rate for Payer: United Healthcare Medicaid	$36,530.09
Rate for Payer: Wellcare CHP/FHP/Medicaid	$36,530.09

APR-DRG 1714: Perm cardiac pacemaker implant w/o AMI, heart failure or shock

Facility

$134,531.24

Service Code	APR-DRG 1714
Min. Negotiated Rate	$58,033.00
Max. Negotiated Rate	$134,531.24
Rate for Payer: Affinity Essential Plan 1&2	$134,531.24
Rate for Payer: Affinity Essential Plan 3&4	$134,531.24
Rate for Payer: Affinity Medicaid/CHP/HARP	$59,791.66
Rate for Payer: Amida Care Medicaid	$59,791.66
Rate for Payer: Fidelis CHP/HARP/Medicaid	$59,791.66
Rate for Payer: Fidelis Qualified Health Plan	$71,749.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$59,791.66
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$59,791.66
Rate for Payer: Healthfirst Commercial	$103,751.00
Rate for Payer: Healthfirst Essential Plan	$134,531.24
Rate for Payer: Healthfirst QHP	$58,033.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$59,791.66
Rate for Payer: SOMOS Essential	$134,531.24
Rate for Payer: United Healthcare Essential Plan 1&2	$134,531.24
Rate for Payer: United Healthcare Essential Plan 3&4	$134,531.24
Rate for Payer: United Healthcare Medicaid	$59,791.66
Rate for Payer: Wellcare CHP/FHP/Medicaid	$59,791.66

APR-DRG 1741: Percutaneous coronary intervention w AMI

Facility

$60,685.00

Service Code	APR-DRG 1741
Min. Negotiated Rate	$22,001.00
Max. Negotiated Rate	$60,685.00
Rate for Payer: Affinity Essential Plan 1&2	$60,685.00
Rate for Payer: Affinity Essential Plan 3&4	$60,685.00
Rate for Payer: Affinity Medicaid/CHP/HARP	$26,971.11
Rate for Payer: Amida Care Medicaid	$26,971.11
Rate for Payer: Fidelis CHP/HARP/Medicaid	$26,971.11
Rate for Payer: Fidelis Qualified Health Plan	$32,365.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$26,971.11
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$26,971.11
Rate for Payer: Healthfirst Commercial	$36,598.00
Rate for Payer: Healthfirst Essential Plan	$60,685.00
Rate for Payer: Healthfirst QHP	$22,001.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26,971.11
Rate for Payer: SOMOS Essential	$60,685.00
Rate for Payer: United Healthcare Essential Plan 1&2	$60,685.00
Rate for Payer: United Healthcare Essential Plan 3&4	$60,685.00
Rate for Payer: United Healthcare Medicaid	$26,971.11
Rate for Payer: Wellcare CHP/FHP/Medicaid	$26,971.11

APR-DRG 1742: Percutaneous coronary intervention w AMI

Facility

$63,803.25

Service Code	APR-DRG 1742
Min. Negotiated Rate	$23,432.00
Max. Negotiated Rate	$63,803.25
Rate for Payer: Affinity Essential Plan 1&2	$63,803.25
Rate for Payer: Affinity Essential Plan 3&4	$63,803.25
Rate for Payer: Affinity Medicaid/CHP/HARP	$28,357.00
Rate for Payer: Amida Care Medicaid	$28,357.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$28,357.00
Rate for Payer: Fidelis Qualified Health Plan	$34,028.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$28,357.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$28,357.00
Rate for Payer: Healthfirst Commercial	$40,354.00
Rate for Payer: Healthfirst Essential Plan	$63,803.25
Rate for Payer: Healthfirst QHP	$23,432.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$28,357.00
Rate for Payer: SOMOS Essential	$63,803.25
Rate for Payer: United Healthcare Essential Plan 1&2	$63,803.25
Rate for Payer: United Healthcare Essential Plan 3&4	$63,803.25
Rate for Payer: United Healthcare Medicaid	$28,357.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$28,357.00

APR-DRG 1743: Percutaneous coronary intervention w AMI

Facility

$73,724.33

Service Code	APR-DRG 1743
Min. Negotiated Rate	$28,582.00
Max. Negotiated Rate	$73,724.33
Rate for Payer: Affinity Essential Plan 1&2	$73,724.33
Rate for Payer: Affinity Essential Plan 3&4	$73,724.33
Rate for Payer: Affinity Medicaid/CHP/HARP	$32,766.37
Rate for Payer: Amida Care Medicaid	$32,766.37
Rate for Payer: Fidelis CHP/HARP/Medicaid	$32,766.37
Rate for Payer: Fidelis Qualified Health Plan	$39,319.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$32,766.37
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$32,766.37
Rate for Payer: Healthfirst Commercial	$51,661.00
Rate for Payer: Healthfirst Essential Plan	$73,724.33
Rate for Payer: Healthfirst QHP	$28,582.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$32,766.37
Rate for Payer: SOMOS Essential	$73,724.33
Rate for Payer: United Healthcare Essential Plan 1&2	$73,724.33
Rate for Payer: United Healthcare Essential Plan 3&4	$73,724.33
Rate for Payer: United Healthcare Medicaid	$32,766.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$32,766.37

APR-DRG 1744: Percutaneous coronary intervention w AMI

Facility

$96,982.00

Service Code	APR-DRG 1744
Min. Negotiated Rate	$41,468.00
Max. Negotiated Rate	$96,982.00
Rate for Payer: Affinity Essential Plan 1&2	$96,982.00
Rate for Payer: Affinity Essential Plan 3&4	$96,982.00
Rate for Payer: Affinity Medicaid/CHP/HARP	$43,103.11
Rate for Payer: Amida Care Medicaid	$43,103.11
Rate for Payer: Fidelis CHP/HARP/Medicaid	$43,103.11
Rate for Payer: Fidelis Qualified Health Plan	$51,723.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$43,103.11
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$43,103.11
Rate for Payer: Healthfirst Commercial	$71,773.00
Rate for Payer: Healthfirst Essential Plan	$96,982.00
Rate for Payer: Healthfirst QHP	$41,468.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$43,103.11
Rate for Payer: SOMOS Essential	$96,982.00
Rate for Payer: United Healthcare Essential Plan 1&2	$96,982.00
Rate for Payer: United Healthcare Essential Plan 3&4	$96,982.00
Rate for Payer: United Healthcare Medicaid	$43,103.11
Rate for Payer: Wellcare CHP/FHP/Medicaid	$43,103.11

APR-DRG 1751: Percutaneous coronary intervention w/o AMI

Facility

$55,591.67

Service Code	APR-DRG 1751
Min. Negotiated Rate	$15,095.00
Max. Negotiated Rate	$55,591.67
Rate for Payer: Affinity Essential Plan 1&2	$55,591.67
Rate for Payer: Affinity Essential Plan 3&4	$55,591.67
Rate for Payer: Affinity Medicaid/CHP/HARP	$24,707.41
Rate for Payer: Amida Care Medicaid	$24,707.41
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,707.41
Rate for Payer: Fidelis Qualified Health Plan	$29,648.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,707.41
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,707.41
Rate for Payer: Healthfirst Commercial	$25,181.00
Rate for Payer: Healthfirst Essential Plan	$55,591.67
Rate for Payer: Healthfirst QHP	$15,095.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,707.41
Rate for Payer: SOMOS Essential	$55,591.67
Rate for Payer: United Healthcare Essential Plan 1&2	$55,591.67
Rate for Payer: United Healthcare Essential Plan 3&4	$55,591.67
Rate for Payer: United Healthcare Medicaid	$24,707.41
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,707.41

APR-DRG 1752: Percutaneous coronary intervention w/o AMI

Facility

$59,086.28

Service Code	APR-DRG 1752
Min. Negotiated Rate	$16,066.00
Max. Negotiated Rate	$59,086.28
Rate for Payer: Affinity Essential Plan 1&2	$59,086.28
Rate for Payer: Affinity Essential Plan 3&4	$59,086.28
Rate for Payer: Affinity Medicaid/CHP/HARP	$26,260.57
Rate for Payer: Amida Care Medicaid	$26,260.57
Rate for Payer: Fidelis CHP/HARP/Medicaid	$26,260.57
Rate for Payer: Fidelis Qualified Health Plan	$31,512.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$26,260.57
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$26,260.57
Rate for Payer: Healthfirst Commercial	$27,953.00
Rate for Payer: Healthfirst Essential Plan	$59,086.28
Rate for Payer: Healthfirst QHP	$16,066.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26,260.57
Rate for Payer: SOMOS Essential	$59,086.28
Rate for Payer: United Healthcare Essential Plan 1&2	$59,086.28
Rate for Payer: United Healthcare Essential Plan 3&4	$59,086.28
Rate for Payer: United Healthcare Medicaid	$26,260.57
Rate for Payer: Wellcare CHP/FHP/Medicaid	$26,260.57

Know your out-of-pocket cost for care.

All Charges