St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

APR-DRG 1753: Percutaneous coronary intervention w/o AMI

Facility

$72,176.65

Service Code	APR-DRG 1753
Min. Negotiated Rate	$20,589.00
Max. Negotiated Rate	$72,176.65
Rate for Payer: Affinity Essential Plan 1&2	$72,176.65
Rate for Payer: Affinity Essential Plan 3&4	$72,176.65
Rate for Payer: Affinity Medicaid/CHP/HARP	$32,078.51
Rate for Payer: Amida Care Medicaid	$32,078.51
Rate for Payer: Fidelis CHP/HARP/Medicaid	$32,078.51
Rate for Payer: Fidelis Qualified Health Plan	$38,494.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$32,078.51
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$32,078.51
Rate for Payer: Healthfirst Commercial	$41,224.00
Rate for Payer: Healthfirst Essential Plan	$72,176.65
Rate for Payer: Healthfirst QHP	$20,589.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$32,078.51
Rate for Payer: SOMOS Essential	$72,176.65
Rate for Payer: United Healthcare Essential Plan 1&2	$72,176.65
Rate for Payer: United Healthcare Essential Plan 3&4	$72,176.65
Rate for Payer: United Healthcare Medicaid	$32,078.51
Rate for Payer: Wellcare CHP/FHP/Medicaid	$32,078.51

APR-DRG 1754: Percutaneous coronary intervention w/o AMI

Facility

$116,009.86

Service Code	APR-DRG 1754
Min. Negotiated Rate	$36,547.00
Max. Negotiated Rate	$116,009.86
Rate for Payer: Affinity Essential Plan 1&2	$116,009.86
Rate for Payer: Affinity Essential Plan 3&4	$116,009.86
Rate for Payer: Affinity Medicaid/CHP/HARP	$51,559.94
Rate for Payer: Amida Care Medicaid	$51,559.94
Rate for Payer: Fidelis CHP/HARP/Medicaid	$51,559.94
Rate for Payer: Fidelis Qualified Health Plan	$61,871.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$51,559.94
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$51,559.94
Rate for Payer: Healthfirst Commercial	$62,724.00
Rate for Payer: Healthfirst Essential Plan	$116,009.86
Rate for Payer: Healthfirst QHP	$36,547.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$51,559.94
Rate for Payer: SOMOS Essential	$116,009.86
Rate for Payer: United Healthcare Essential Plan 1&2	$116,009.86
Rate for Payer: United Healthcare Essential Plan 3&4	$116,009.86
Rate for Payer: United Healthcare Medicaid	$51,559.94
Rate for Payer: Wellcare CHP/FHP/Medicaid	$51,559.94

APR-DRG 1761: Cardiac pacemaker & defibrillator device replacement

Facility

$54,844.20

Service Code	APR-DRG 1761
Min. Negotiated Rate	$17,073.00
Max. Negotiated Rate	$54,844.20
Rate for Payer: Affinity Essential Plan 1&2	$54,844.20
Rate for Payer: Affinity Essential Plan 3&4	$54,844.20
Rate for Payer: Affinity Medicaid/CHP/HARP	$24,375.20
Rate for Payer: Amida Care Medicaid	$24,375.20
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,375.20
Rate for Payer: Fidelis Qualified Health Plan	$29,250.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,375.20
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,375.20
Rate for Payer: Healthfirst Commercial	$26,405.00
Rate for Payer: Healthfirst Essential Plan	$54,844.20
Rate for Payer: Healthfirst QHP	$17,073.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,375.20
Rate for Payer: SOMOS Essential	$54,844.20
Rate for Payer: United Healthcare Essential Plan 1&2	$54,844.20
Rate for Payer: United Healthcare Essential Plan 3&4	$54,844.20
Rate for Payer: United Healthcare Medicaid	$24,375.20
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,375.20

APR-DRG 1762: Cardiac pacemaker & defibrillator device replacement

Facility

$76,081.05

Service Code	APR-DRG 1762
Min. Negotiated Rate	$33,813.80
Max. Negotiated Rate	$76,081.05
Rate for Payer: Affinity Essential Plan 1&2	$76,081.05
Rate for Payer: Affinity Essential Plan 3&4	$76,081.05
Rate for Payer: Affinity Medicaid/CHP/HARP	$33,813.80
Rate for Payer: Amida Care Medicaid	$33,813.80
Rate for Payer: Fidelis CHP/HARP/Medicaid	$33,813.80
Rate for Payer: Fidelis Qualified Health Plan	$40,576.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$33,813.80
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$33,813.80
Rate for Payer: Healthfirst Commercial	$47,587.00
Rate for Payer: Healthfirst Essential Plan	$76,081.05
Rate for Payer: Healthfirst QHP	$43,368.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$33,813.80
Rate for Payer: SOMOS Essential	$76,081.05
Rate for Payer: United Healthcare Essential Plan 1&2	$76,081.05
Rate for Payer: United Healthcare Essential Plan 3&4	$76,081.05
Rate for Payer: United Healthcare Medicaid	$33,813.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$33,813.80

APR-DRG 1763: Cardiac pacemaker & defibrillator device replacement

Facility

$88,817.90

Service Code	APR-DRG 1763
Min. Negotiated Rate	$39,474.62
Max. Negotiated Rate	$88,817.90
Rate for Payer: Affinity Essential Plan 1&2	$88,817.90
Rate for Payer: Affinity Essential Plan 3&4	$88,817.90
Rate for Payer: Affinity Medicaid/CHP/HARP	$39,474.62
Rate for Payer: Amida Care Medicaid	$39,474.62
Rate for Payer: Fidelis CHP/HARP/Medicaid	$39,474.62
Rate for Payer: Fidelis Qualified Health Plan	$47,369.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$39,474.62
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$39,474.62
Rate for Payer: Healthfirst Commercial	$52,768.00
Rate for Payer: Healthfirst Essential Plan	$88,817.90
Rate for Payer: Healthfirst QHP	$42,968.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$39,474.62
Rate for Payer: SOMOS Essential	$88,817.90
Rate for Payer: United Healthcare Essential Plan 1&2	$88,817.90
Rate for Payer: United Healthcare Essential Plan 3&4	$88,817.90
Rate for Payer: United Healthcare Medicaid	$39,474.62
Rate for Payer: Wellcare CHP/FHP/Medicaid	$39,474.62

APR-DRG 1764: Cardiac pacemaker & defibrillator device replacement

Facility

$92,097.97

Service Code	APR-DRG 1764
Min. Negotiated Rate	$40,932.43
Max. Negotiated Rate	$92,097.97
Rate for Payer: Affinity Essential Plan 1&2	$92,097.97
Rate for Payer: Affinity Essential Plan 3&4	$92,097.97
Rate for Payer: Affinity Medicaid/CHP/HARP	$40,932.43
Rate for Payer: Amida Care Medicaid	$40,932.43
Rate for Payer: Fidelis CHP/HARP/Medicaid	$40,932.43
Rate for Payer: Fidelis Qualified Health Plan	$49,118.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$40,932.43
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$40,932.43
Rate for Payer: Healthfirst Commercial	$54,844.00
Rate for Payer: Healthfirst Essential Plan	$92,097.97
Rate for Payer: Healthfirst QHP	$42,968.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$40,932.43
Rate for Payer: SOMOS Essential	$92,097.97
Rate for Payer: United Healthcare Essential Plan 1&2	$92,097.97
Rate for Payer: United Healthcare Essential Plan 3&4	$92,097.97
Rate for Payer: United Healthcare Medicaid	$40,932.43
Rate for Payer: Wellcare CHP/FHP/Medicaid	$40,932.43

APR-DRG 1771: Cardiac pacemaker & defibrillator revision except device replacement

Facility

$54,163.55

Service Code	APR-DRG 1771
Min. Negotiated Rate	$14,541.00
Max. Negotiated Rate	$54,163.55
Rate for Payer: Affinity Essential Plan 1&2	$54,163.55
Rate for Payer: Affinity Essential Plan 3&4	$54,163.55
Rate for Payer: Affinity Medicaid/CHP/HARP	$24,072.69
Rate for Payer: Amida Care Medicaid	$24,072.69
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,072.69
Rate for Payer: Fidelis Qualified Health Plan	$28,887.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,072.69
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,072.69
Rate for Payer: Healthfirst Commercial	$26,973.00
Rate for Payer: Healthfirst Essential Plan	$54,163.55
Rate for Payer: Healthfirst QHP	$14,541.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,072.69
Rate for Payer: SOMOS Essential	$54,163.55
Rate for Payer: United Healthcare Essential Plan 1&2	$54,163.55
Rate for Payer: United Healthcare Essential Plan 3&4	$54,163.55
Rate for Payer: United Healthcare Medicaid	$24,072.69
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,072.69

APR-DRG 1772: Cardiac pacemaker & defibrillator revision except device replacement

Facility

$60,371.93

Service Code	APR-DRG 1772
Min. Negotiated Rate	$20,523.00
Max. Negotiated Rate	$60,371.93
Rate for Payer: Affinity Essential Plan 1&2	$60,371.93
Rate for Payer: Affinity Essential Plan 3&4	$60,371.93
Rate for Payer: Affinity Medicaid/CHP/HARP	$26,831.97
Rate for Payer: Amida Care Medicaid	$26,831.97
Rate for Payer: Fidelis CHP/HARP/Medicaid	$26,831.97
Rate for Payer: Fidelis Qualified Health Plan	$32,198.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$26,831.97
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$26,831.97
Rate for Payer: Healthfirst Commercial	$34,323.00
Rate for Payer: Healthfirst Essential Plan	$60,371.93
Rate for Payer: Healthfirst QHP	$20,523.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26,831.97
Rate for Payer: SOMOS Essential	$60,371.93
Rate for Payer: United Healthcare Essential Plan 1&2	$60,371.93
Rate for Payer: United Healthcare Essential Plan 3&4	$60,371.93
Rate for Payer: United Healthcare Medicaid	$26,831.97
Rate for Payer: Wellcare CHP/FHP/Medicaid	$26,831.97

APR-DRG 1773: Cardiac pacemaker & defibrillator revision except device replacement

Facility

$76,788.07

Service Code	APR-DRG 1773
Min. Negotiated Rate	$27,716.00
Max. Negotiated Rate	$76,788.07
Rate for Payer: Affinity Essential Plan 1&2	$76,788.07
Rate for Payer: Affinity Essential Plan 3&4	$76,788.07
Rate for Payer: Affinity Medicaid/CHP/HARP	$34,128.03
Rate for Payer: Amida Care Medicaid	$34,128.03
Rate for Payer: Fidelis CHP/HARP/Medicaid	$34,128.03
Rate for Payer: Fidelis Qualified Health Plan	$40,953.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$34,128.03
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$34,128.03
Rate for Payer: Healthfirst Commercial	$50,471.00
Rate for Payer: Healthfirst Essential Plan	$76,788.07
Rate for Payer: Healthfirst QHP	$27,716.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$34,128.03
Rate for Payer: SOMOS Essential	$76,788.07
Rate for Payer: United Healthcare Essential Plan 1&2	$76,788.07
Rate for Payer: United Healthcare Essential Plan 3&4	$76,788.07
Rate for Payer: United Healthcare Medicaid	$34,128.03
Rate for Payer: Wellcare CHP/FHP/Medicaid	$34,128.03

APR-DRG 1774: Cardiac pacemaker & defibrillator revision except device replacement

Facility

$141,052.66

Service Code	APR-DRG 1774
Min. Negotiated Rate	$62,000.00
Max. Negotiated Rate	$141,052.66
Rate for Payer: Affinity Essential Plan 1&2	$141,052.66
Rate for Payer: Affinity Essential Plan 3&4	$141,052.66
Rate for Payer: Affinity Medicaid/CHP/HARP	$62,690.07
Rate for Payer: Amida Care Medicaid	$62,690.07
Rate for Payer: Fidelis CHP/HARP/Medicaid	$62,690.07
Rate for Payer: Fidelis Qualified Health Plan	$75,228.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$62,690.07
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$62,690.07
Rate for Payer: Healthfirst Commercial	$125,515.00
Rate for Payer: Healthfirst Essential Plan	$141,052.66
Rate for Payer: Healthfirst QHP	$62,000.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$62,690.07
Rate for Payer: SOMOS Essential	$141,052.66
Rate for Payer: United Healthcare Essential Plan 1&2	$141,052.66
Rate for Payer: United Healthcare Essential Plan 3&4	$141,052.66
Rate for Payer: United Healthcare Medicaid	$62,690.07
Rate for Payer: Wellcare CHP/FHP/Medicaid	$62,690.07

APR-DRG 1801: Other circulatory system procedures

Facility

$49,675.23

Service Code	APR-DRG 1801
Min. Negotiated Rate	$13,536.00
Max. Negotiated Rate	$49,675.23
Rate for Payer: Affinity Essential Plan 1&2	$49,675.23
Rate for Payer: Affinity Essential Plan 3&4	$49,675.23
Rate for Payer: Affinity Medicaid/CHP/HARP	$22,077.88
Rate for Payer: Amida Care Medicaid	$22,077.88
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,077.88
Rate for Payer: Fidelis Qualified Health Plan	$26,493.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,077.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,077.88
Rate for Payer: Healthfirst Commercial	$23,162.00
Rate for Payer: Healthfirst Essential Plan	$49,675.23
Rate for Payer: Healthfirst QHP	$13,536.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,077.88
Rate for Payer: SOMOS Essential	$49,675.23
Rate for Payer: United Healthcare Essential Plan 1&2	$49,675.23
Rate for Payer: United Healthcare Essential Plan 3&4	$49,675.23
Rate for Payer: United Healthcare Medicaid	$22,077.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,077.88

APR-DRG 1802: Other circulatory system procedures

Facility

$58,595.60

Service Code	APR-DRG 1802
Min. Negotiated Rate	$19,402.00
Max. Negotiated Rate	$58,595.60
Rate for Payer: Affinity Essential Plan 1&2	$58,595.60
Rate for Payer: Affinity Essential Plan 3&4	$58,595.60
Rate for Payer: Affinity Medicaid/CHP/HARP	$26,042.49
Rate for Payer: Amida Care Medicaid	$26,042.49
Rate for Payer: Fidelis CHP/HARP/Medicaid	$26,042.49
Rate for Payer: Fidelis Qualified Health Plan	$31,250.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$26,042.49
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$26,042.49
Rate for Payer: Healthfirst Commercial	$32,071.00
Rate for Payer: Healthfirst Essential Plan	$58,595.60
Rate for Payer: Healthfirst QHP	$19,402.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26,042.49
Rate for Payer: SOMOS Essential	$58,595.60
Rate for Payer: United Healthcare Essential Plan 1&2	$58,595.60
Rate for Payer: United Healthcare Essential Plan 3&4	$58,595.60
Rate for Payer: United Healthcare Medicaid	$26,042.49
Rate for Payer: Wellcare CHP/FHP/Medicaid	$26,042.49

APR-DRG 1803: Other circulatory system procedures

Facility

$72,195.98

Service Code	APR-DRG 1803
Min. Negotiated Rate	$29,867.00
Max. Negotiated Rate	$72,195.98
Rate for Payer: Affinity Essential Plan 1&2	$72,195.98
Rate for Payer: Affinity Essential Plan 3&4	$72,195.98
Rate for Payer: Affinity Medicaid/CHP/HARP	$32,087.10
Rate for Payer: Amida Care Medicaid	$32,087.10
Rate for Payer: Fidelis CHP/HARP/Medicaid	$32,087.10
Rate for Payer: Fidelis Qualified Health Plan	$38,504.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$32,087.10
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$32,087.10
Rate for Payer: Healthfirst Commercial	$51,273.00
Rate for Payer: Healthfirst Essential Plan	$72,195.98
Rate for Payer: Healthfirst QHP	$29,867.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$32,087.10
Rate for Payer: SOMOS Essential	$72,195.98
Rate for Payer: United Healthcare Essential Plan 1&2	$72,195.98
Rate for Payer: United Healthcare Essential Plan 3&4	$72,195.98
Rate for Payer: United Healthcare Medicaid	$32,087.10
Rate for Payer: Wellcare CHP/FHP/Medicaid	$32,087.10

APR-DRG 1804: Other circulatory system procedures

Facility

$114,398.86

Service Code	APR-DRG 1804
Min. Negotiated Rate	$50,843.94
Max. Negotiated Rate	$114,398.86
Rate for Payer: Affinity Essential Plan 1&2	$114,398.86
Rate for Payer: Affinity Essential Plan 3&4	$114,398.86
Rate for Payer: Affinity Medicaid/CHP/HARP	$50,843.94
Rate for Payer: Amida Care Medicaid	$50,843.94
Rate for Payer: Fidelis CHP/HARP/Medicaid	$50,843.94
Rate for Payer: Fidelis Qualified Health Plan	$61,012.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$50,843.94
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$50,843.94
Rate for Payer: Healthfirst Commercial	$93,996.00
Rate for Payer: Healthfirst Essential Plan	$114,398.86
Rate for Payer: Healthfirst QHP	$56,430.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$50,843.94
Rate for Payer: SOMOS Essential	$114,398.86
Rate for Payer: United Healthcare Essential Plan 1&2	$114,398.86
Rate for Payer: United Healthcare Essential Plan 3&4	$114,398.86
Rate for Payer: United Healthcare Medicaid	$50,843.94
Rate for Payer: Wellcare CHP/FHP/Medicaid	$50,843.94

APR-DRG 1811: Lower extremity arterial procedures #

Facility

$54,881.12

Service Code	APR-DRG 1811
Min. Negotiated Rate	$24,391.61
Max. Negotiated Rate	$54,881.12
Rate for Payer: Affinity Essential Plan 1&2	$54,881.12
Rate for Payer: Affinity Essential Plan 3&4	$54,881.12
Rate for Payer: Affinity Medicaid/CHP/HARP	$24,391.61
Rate for Payer: Amida Care Medicaid	$24,391.61
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,391.61
Rate for Payer: Fidelis Qualified Health Plan	$29,269.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,391.61
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,391.61
Rate for Payer: Healthfirst Essential Plan	$54,881.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,391.61
Rate for Payer: SOMOS Essential	$54,881.12
Rate for Payer: United Healthcare Essential Plan 1&2	$54,881.12
Rate for Payer: United Healthcare Essential Plan 3&4	$54,881.12
Rate for Payer: United Healthcare Medicaid	$24,391.61
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,391.61

APR-DRG 1812: Lower extremity arterial procedures #

Facility

$69,702.08

Service Code	APR-DRG 1812
Min. Negotiated Rate	$30,978.70
Max. Negotiated Rate	$69,702.08
Rate for Payer: Affinity Essential Plan 1&2	$69,702.08
Rate for Payer: Affinity Essential Plan 3&4	$69,702.08
Rate for Payer: Affinity Medicaid/CHP/HARP	$30,978.70
Rate for Payer: Amida Care Medicaid	$30,978.70
Rate for Payer: Fidelis CHP/HARP/Medicaid	$30,978.70
Rate for Payer: Fidelis Qualified Health Plan	$37,174.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$30,978.70
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$30,978.70
Rate for Payer: Healthfirst Essential Plan	$69,702.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$30,978.70
Rate for Payer: SOMOS Essential	$69,702.08
Rate for Payer: United Healthcare Essential Plan 1&2	$69,702.08
Rate for Payer: United Healthcare Essential Plan 3&4	$69,702.08
Rate for Payer: United Healthcare Medicaid	$30,978.70
Rate for Payer: Wellcare CHP/FHP/Medicaid	$30,978.70

APR-DRG 1813: Lower extremity arterial procedures #

Facility

$101,581.11

Service Code	APR-DRG 1813
Min. Negotiated Rate	$45,147.16
Max. Negotiated Rate	$101,581.11
Rate for Payer: Affinity Essential Plan 1&2	$101,581.11
Rate for Payer: Affinity Essential Plan 3&4	$101,581.11
Rate for Payer: Affinity Medicaid/CHP/HARP	$45,147.16
Rate for Payer: Amida Care Medicaid	$45,147.16
Rate for Payer: Fidelis CHP/HARP/Medicaid	$45,147.16
Rate for Payer: Fidelis Qualified Health Plan	$54,176.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$45,147.16
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$45,147.16
Rate for Payer: Healthfirst Essential Plan	$101,581.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$45,147.16
Rate for Payer: SOMOS Essential	$101,581.11
Rate for Payer: United Healthcare Essential Plan 1&2	$101,581.11
Rate for Payer: United Healthcare Essential Plan 3&4	$101,581.11
Rate for Payer: United Healthcare Medicaid	$45,147.16
Rate for Payer: Wellcare CHP/FHP/Medicaid	$45,147.16

APR-DRG 1814: Lower extremity arterial procedures #

Facility

$146,010.56

Service Code	APR-DRG 1814
Min. Negotiated Rate	$64,893.58
Max. Negotiated Rate	$146,010.56
Rate for Payer: Affinity Essential Plan 1&2	$146,010.56
Rate for Payer: Affinity Essential Plan 3&4	$146,010.56
Rate for Payer: Affinity Medicaid/CHP/HARP	$64,893.58
Rate for Payer: Amida Care Medicaid	$64,893.58
Rate for Payer: Fidelis CHP/HARP/Medicaid	$64,893.58
Rate for Payer: Fidelis Qualified Health Plan	$77,872.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$64,893.58
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$64,893.58
Rate for Payer: Healthfirst Essential Plan	$146,010.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$64,893.58
Rate for Payer: SOMOS Essential	$146,010.56
Rate for Payer: United Healthcare Essential Plan 1&2	$146,010.56
Rate for Payer: United Healthcare Essential Plan 3&4	$146,010.56
Rate for Payer: United Healthcare Medicaid	$64,893.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$64,893.58

APR-DRG 1821: Other peripheral vascular procedures #

Facility

$56,031.34

Service Code	APR-DRG 1821
Min. Negotiated Rate	$24,902.82
Max. Negotiated Rate	$56,031.34
Rate for Payer: Affinity Essential Plan 1&2	$56,031.34
Rate for Payer: Affinity Essential Plan 3&4	$56,031.34
Rate for Payer: Affinity Medicaid/CHP/HARP	$24,902.82
Rate for Payer: Amida Care Medicaid	$24,902.82
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,902.82
Rate for Payer: Fidelis Qualified Health Plan	$29,883.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,902.82
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,902.82
Rate for Payer: Healthfirst Essential Plan	$56,031.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,902.82
Rate for Payer: SOMOS Essential	$56,031.34
Rate for Payer: United Healthcare Essential Plan 1&2	$56,031.34
Rate for Payer: United Healthcare Essential Plan 3&4	$56,031.34
Rate for Payer: United Healthcare Medicaid	$24,902.82
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,902.82

APR-DRG 1822: Other peripheral vascular procedures #

Facility

$66,893.36

Service Code	APR-DRG 1822
Min. Negotiated Rate	$29,730.38
Max. Negotiated Rate	$66,893.36
Rate for Payer: Affinity Essential Plan 1&2	$66,893.36
Rate for Payer: Affinity Essential Plan 3&4	$66,893.36
Rate for Payer: Affinity Medicaid/CHP/HARP	$29,730.38
Rate for Payer: Amida Care Medicaid	$29,730.38
Rate for Payer: Fidelis CHP/HARP/Medicaid	$29,730.38
Rate for Payer: Fidelis Qualified Health Plan	$35,676.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$29,730.38
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29,730.38
Rate for Payer: Healthfirst Essential Plan	$66,893.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$29,730.38
Rate for Payer: SOMOS Essential	$66,893.36
Rate for Payer: United Healthcare Essential Plan 1&2	$66,893.36
Rate for Payer: United Healthcare Essential Plan 3&4	$66,893.36
Rate for Payer: United Healthcare Medicaid	$29,730.38
Rate for Payer: Wellcare CHP/FHP/Medicaid	$29,730.38

APR-DRG 1823: Other peripheral vascular procedures #

Facility

$86,345.10

Service Code	APR-DRG 1823
Min. Negotiated Rate	$38,375.60
Max. Negotiated Rate	$86,345.10
Rate for Payer: Affinity Essential Plan 1&2	$86,345.10
Rate for Payer: Affinity Essential Plan 3&4	$86,345.10
Rate for Payer: Affinity Medicaid/CHP/HARP	$38,375.60
Rate for Payer: Amida Care Medicaid	$38,375.60
Rate for Payer: Fidelis CHP/HARP/Medicaid	$38,375.60
Rate for Payer: Fidelis Qualified Health Plan	$46,050.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$38,375.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$38,375.60
Rate for Payer: Healthfirst Essential Plan	$86,345.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$38,375.60
Rate for Payer: SOMOS Essential	$86,345.10
Rate for Payer: United Healthcare Essential Plan 1&2	$86,345.10
Rate for Payer: United Healthcare Essential Plan 3&4	$86,345.10
Rate for Payer: United Healthcare Medicaid	$38,375.60
Rate for Payer: Wellcare CHP/FHP/Medicaid	$38,375.60

APR-DRG 1824: Other peripheral vascular procedures #

Facility

$139,951.69

Service Code	APR-DRG 1824
Min. Negotiated Rate	$62,200.75
Max. Negotiated Rate	$139,951.69
Rate for Payer: Affinity Essential Plan 1&2	$139,951.69
Rate for Payer: Affinity Essential Plan 3&4	$139,951.69
Rate for Payer: Affinity Medicaid/CHP/HARP	$62,200.75
Rate for Payer: Amida Care Medicaid	$62,200.75
Rate for Payer: Fidelis CHP/HARP/Medicaid	$62,200.75
Rate for Payer: Fidelis Qualified Health Plan	$74,640.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$62,200.75
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$62,200.75
Rate for Payer: Healthfirst Essential Plan	$139,951.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$62,200.75
Rate for Payer: SOMOS Essential	$139,951.69
Rate for Payer: United Healthcare Essential Plan 1&2	$139,951.69
Rate for Payer: United Healthcare Essential Plan 3&4	$139,951.69
Rate for Payer: United Healthcare Medicaid	$62,200.75
Rate for Payer: Wellcare CHP/FHP/Medicaid	$62,200.75

APR-DRG 1901: Acute myocardial infarction

Facility

$42,582.22

Service Code	APR-DRG 1901
Min. Negotiated Rate	$8,833.00
Max. Negotiated Rate	$42,582.22
Rate for Payer: Affinity Essential Plan 1&2	$42,582.22
Rate for Payer: Affinity Essential Plan 3&4	$42,582.22
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,925.43
Rate for Payer: Amida Care Medicaid	$18,925.43
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,925.43
Rate for Payer: Fidelis Qualified Health Plan	$22,710.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,925.43
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,925.43
Rate for Payer: Healthfirst Commercial	$14,788.00
Rate for Payer: Healthfirst Essential Plan	$42,582.22
Rate for Payer: Healthfirst QHP	$8,833.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,925.43
Rate for Payer: SOMOS Essential	$42,582.22
Rate for Payer: United Healthcare Essential Plan 1&2	$42,582.22
Rate for Payer: United Healthcare Essential Plan 3&4	$42,582.22
Rate for Payer: United Healthcare Medicaid	$18,925.43
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,925.43

APR-DRG 1902: Acute myocardial infarction

Facility

$46,497.20

Service Code	APR-DRG 1902
Min. Negotiated Rate	$10,375.00
Max. Negotiated Rate	$46,497.20
Rate for Payer: Affinity Essential Plan 1&2	$46,497.20
Rate for Payer: Affinity Essential Plan 3&4	$46,497.20
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,665.42
Rate for Payer: Amida Care Medicaid	$20,665.42
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,665.42
Rate for Payer: Fidelis Qualified Health Plan	$24,798.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,665.42
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,665.42
Rate for Payer: Healthfirst Commercial	$18,561.00
Rate for Payer: Healthfirst Essential Plan	$46,497.20
Rate for Payer: Healthfirst QHP	$10,375.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,665.42
Rate for Payer: SOMOS Essential	$46,497.20
Rate for Payer: United Healthcare Essential Plan 1&2	$46,497.20
Rate for Payer: United Healthcare Essential Plan 3&4	$46,497.20
Rate for Payer: United Healthcare Medicaid	$20,665.42
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,665.42

APR-DRG 1903: Acute myocardial infarction

Facility

$55,159.02

Service Code	APR-DRG 1903
Min. Negotiated Rate	$14,364.00
Max. Negotiated Rate	$55,159.02
Rate for Payer: Affinity Essential Plan 1&2	$55,159.02
Rate for Payer: Affinity Essential Plan 3&4	$55,159.02
Rate for Payer: Affinity Medicaid/CHP/HARP	$24,515.12
Rate for Payer: Amida Care Medicaid	$24,515.12
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,515.12
Rate for Payer: Fidelis Qualified Health Plan	$29,418.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,515.12
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,515.12
Rate for Payer: Healthfirst Commercial	$26,129.00
Rate for Payer: Healthfirst Essential Plan	$55,159.02
Rate for Payer: Healthfirst QHP	$14,364.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,515.12
Rate for Payer: SOMOS Essential	$55,159.02
Rate for Payer: United Healthcare Essential Plan 1&2	$55,159.02
Rate for Payer: United Healthcare Essential Plan 3&4	$55,159.02
Rate for Payer: United Healthcare Medicaid	$24,515.12
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,515.12

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