St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

Extensive 3rd degree burns w skin graft

Facility

$301,254.00

Service Code	APR-DRG 8411
Min. Negotiated Rate	$56,180.03
Max. Negotiated Rate	$301,254.00
Rate for Payer: Affinity Essential Plan 1&2	$126,405.07
Rate for Payer: Affinity Essential Plan 3&4	$126,405.07
Rate for Payer: Affinity Medicaid/CHP/HARP	$56,180.03
Rate for Payer: Amida Care Medicaid	$56,180.03
Rate for Payer: EmblemHealth Essential Plan 1&2	$126,405.07
Rate for Payer: EmblemHealth Essential Plan 3&4	$56,180.03
Rate for Payer: Fidelis CHP/HARP/Medicaid	$56,180.03
Rate for Payer: Fidelis Qualified Health Plan	$67,416.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$56,180.03
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$56,180.03
Rate for Payer: Healthfirst Commercial	$165,466.00
Rate for Payer: Healthfirst Essential Plan	$126,405.07
Rate for Payer: Healthfirst QHP	$301,254.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$56,180.03
Rate for Payer: SOMOS Essential	$126,405.07
Rate for Payer: United Healthcare Essential Plan 1&2	$126,405.07
Rate for Payer: United Healthcare Essential Plan 3&4	$126,405.07
Rate for Payer: United Healthcare Medicaid	$56,180.03
Rate for Payer: Wellcare CHP/FHP/Medicaid	$56,180.03

Extensive 3rd degree burns w skin graft

Facility

$301,254.00

Service Code	APR-DRG 8412
Min. Negotiated Rate	$69,586.36
Max. Negotiated Rate	$301,254.00
Rate for Payer: Affinity Essential Plan 1&2	$156,569.31
Rate for Payer: Affinity Essential Plan 3&4	$156,569.31
Rate for Payer: Affinity Medicaid/CHP/HARP	$69,586.36
Rate for Payer: Amida Care Medicaid	$69,586.36
Rate for Payer: EmblemHealth Essential Plan 1&2	$156,569.31
Rate for Payer: EmblemHealth Essential Plan 3&4	$69,586.36
Rate for Payer: Fidelis CHP/HARP/Medicaid	$69,586.36
Rate for Payer: Fidelis Qualified Health Plan	$83,503.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$69,586.36
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$69,586.36
Rate for Payer: Healthfirst Commercial	$165,466.00
Rate for Payer: Healthfirst Essential Plan	$156,569.31
Rate for Payer: Healthfirst QHP	$301,254.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$69,586.36
Rate for Payer: SOMOS Essential	$156,569.31
Rate for Payer: United Healthcare Essential Plan 1&2	$156,569.31
Rate for Payer: United Healthcare Essential Plan 3&4	$156,569.31
Rate for Payer: United Healthcare Medicaid	$69,586.36
Rate for Payer: Wellcare CHP/FHP/Medicaid	$69,586.36

Extensive 3rd degree burns w skin graft

Facility

$301,805.00

Service Code	APR-DRG 8413
Min. Negotiated Rate	$128,688.05
Max. Negotiated Rate	$301,805.00
Rate for Payer: Affinity Essential Plan 1&2	$289,548.11
Rate for Payer: Affinity Essential Plan 3&4	$289,548.11
Rate for Payer: Affinity Medicaid/CHP/HARP	$128,688.05
Rate for Payer: Amida Care Medicaid	$128,688.05
Rate for Payer: EmblemHealth Essential Plan 1&2	$289,548.11
Rate for Payer: EmblemHealth Essential Plan 3&4	$128,688.05
Rate for Payer: Fidelis CHP/HARP/Medicaid	$128,688.05
Rate for Payer: Fidelis Qualified Health Plan	$154,425.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$128,688.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$128,688.05
Rate for Payer: Healthfirst Commercial	$166,826.00
Rate for Payer: Healthfirst Essential Plan	$289,548.11
Rate for Payer: Healthfirst QHP	$301,805.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$128,688.05
Rate for Payer: SOMOS Essential	$289,548.11
Rate for Payer: United Healthcare Essential Plan 1&2	$289,548.11
Rate for Payer: United Healthcare Essential Plan 3&4	$289,548.11
Rate for Payer: United Healthcare Medicaid	$128,688.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$128,688.05

Extensive 3rd degree burns w skin graft

Facility

$474,024.00

Service Code	APR-DRG 8414
Min. Negotiated Rate	$160,701.14
Max. Negotiated Rate	$474,024.00
Rate for Payer: Affinity Essential Plan 1&2	$361,577.57
Rate for Payer: Affinity Essential Plan 3&4	$361,577.57
Rate for Payer: Affinity Medicaid/CHP/HARP	$160,701.14
Rate for Payer: Amida Care Medicaid	$160,701.14
Rate for Payer: EmblemHealth Essential Plan 1&2	$361,577.57
Rate for Payer: EmblemHealth Essential Plan 3&4	$160,701.14
Rate for Payer: Fidelis CHP/HARP/Medicaid	$160,701.14
Rate for Payer: Fidelis Qualified Health Plan	$192,841.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$160,701.14
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$160,701.14
Rate for Payer: Healthfirst Commercial	$474,024.00
Rate for Payer: Healthfirst Essential Plan	$361,577.57
Rate for Payer: Healthfirst QHP	$301,805.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$160,701.14
Rate for Payer: SOMOS Essential	$361,577.57
Rate for Payer: United Healthcare Essential Plan 1&2	$361,577.57
Rate for Payer: United Healthcare Essential Plan 3&4	$361,577.57
Rate for Payer: United Healthcare Medicaid	$160,701.14
Rate for Payer: Wellcare CHP/FHP/Medicaid	$160,701.14

Extensive 3rd degree or full thickness burns w/o skin graft

Facility

$66,688.58

Service Code	APR-DRG 8432
Min. Negotiated Rate	$15,308.00
Max. Negotiated Rate	$66,688.58
Rate for Payer: Affinity Essential Plan 1&2	$66,688.58
Rate for Payer: Affinity Essential Plan 3&4	$66,688.58
Rate for Payer: Affinity Medicaid/CHP/HARP	$29,639.37
Rate for Payer: Amida Care Medicaid	$29,639.37
Rate for Payer: EmblemHealth Essential Plan 1&2	$66,688.58
Rate for Payer: EmblemHealth Essential Plan 3&4	$29,639.37
Rate for Payer: Fidelis CHP/HARP/Medicaid	$29,639.37
Rate for Payer: Fidelis Qualified Health Plan	$35,567.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$29,639.37
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29,639.37
Rate for Payer: Healthfirst Commercial	$21,275.00
Rate for Payer: Healthfirst Essential Plan	$66,688.58
Rate for Payer: Healthfirst QHP	$15,308.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$29,639.37
Rate for Payer: SOMOS Essential	$66,688.58
Rate for Payer: United Healthcare Essential Plan 1&2	$66,688.58
Rate for Payer: United Healthcare Essential Plan 3&4	$66,688.58
Rate for Payer: United Healthcare Medicaid	$29,639.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$29,639.37

Extensive 3rd degree or full thickness burns w/o skin graft

Facility

$66,688.58

Service Code	APR-DRG 8433
Min. Negotiated Rate	$19,507.00
Max. Negotiated Rate	$66,688.58
Rate for Payer: Affinity Essential Plan 1&2	$66,688.58
Rate for Payer: Affinity Essential Plan 3&4	$66,688.58
Rate for Payer: Affinity Medicaid/CHP/HARP	$29,639.37
Rate for Payer: Amida Care Medicaid	$29,639.37
Rate for Payer: EmblemHealth Essential Plan 1&2	$66,688.58
Rate for Payer: EmblemHealth Essential Plan 3&4	$29,639.37
Rate for Payer: Fidelis CHP/HARP/Medicaid	$29,639.37
Rate for Payer: Fidelis Qualified Health Plan	$35,567.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$29,639.37
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29,639.37
Rate for Payer: Healthfirst Commercial	$30,817.00
Rate for Payer: Healthfirst Essential Plan	$66,688.58
Rate for Payer: Healthfirst QHP	$19,507.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$29,639.37
Rate for Payer: SOMOS Essential	$66,688.58
Rate for Payer: United Healthcare Essential Plan 1&2	$66,688.58
Rate for Payer: United Healthcare Essential Plan 3&4	$66,688.58
Rate for Payer: United Healthcare Medicaid	$29,639.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$29,639.37

Extensive 3rd degree or full thickness burns w/o skin graft

Facility

$66,688.58

Service Code	APR-DRG 8434
Min. Negotiated Rate	$29,639.37
Max. Negotiated Rate	$66,688.58
Rate for Payer: Affinity Essential Plan 1&2	$66,688.58
Rate for Payer: Affinity Essential Plan 3&4	$66,688.58
Rate for Payer: Affinity Medicaid/CHP/HARP	$29,639.37
Rate for Payer: Amida Care Medicaid	$29,639.37
Rate for Payer: EmblemHealth Essential Plan 1&2	$66,688.58
Rate for Payer: EmblemHealth Essential Plan 3&4	$29,639.37
Rate for Payer: Fidelis CHP/HARP/Medicaid	$29,639.37
Rate for Payer: Fidelis Qualified Health Plan	$35,567.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$29,639.37
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29,639.37
Rate for Payer: Healthfirst Commercial	$47,891.00
Rate for Payer: Healthfirst Essential Plan	$66,688.58
Rate for Payer: Healthfirst QHP	$32,630.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$29,639.37
Rate for Payer: SOMOS Essential	$66,688.58
Rate for Payer: United Healthcare Essential Plan 1&2	$66,688.58
Rate for Payer: United Healthcare Essential Plan 3&4	$66,688.58
Rate for Payer: United Healthcare Medicaid	$29,639.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$29,639.37

Extensive 3rd degree or full thickness burns w/o skin graft

Facility

$66,688.58

Service Code	APR-DRG 8431
Min. Negotiated Rate	$9,103.00
Max. Negotiated Rate	$66,688.58
Rate for Payer: Affinity Essential Plan 1&2	$66,688.58
Rate for Payer: Affinity Essential Plan 3&4	$66,688.58
Rate for Payer: Affinity Medicaid/CHP/HARP	$29,639.37
Rate for Payer: Amida Care Medicaid	$29,639.37
Rate for Payer: EmblemHealth Essential Plan 1&2	$66,688.58
Rate for Payer: EmblemHealth Essential Plan 3&4	$29,639.37
Rate for Payer: Fidelis CHP/HARP/Medicaid	$29,639.37
Rate for Payer: Fidelis Qualified Health Plan	$35,567.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$29,639.37
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29,639.37
Rate for Payer: Healthfirst Commercial	$15,424.00
Rate for Payer: Healthfirst Essential Plan	$66,688.58
Rate for Payer: Healthfirst QHP	$9,103.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$29,639.37
Rate for Payer: SOMOS Essential	$66,688.58
Rate for Payer: United Healthcare Essential Plan 1&2	$66,688.58
Rate for Payer: United Healthcare Essential Plan 3&4	$66,688.58
Rate for Payer: United Healthcare Medicaid	$29,639.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$29,639.37

EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS W/O SKIN GRAFT

Facility

$287.19

Service Code	EAPG 00860
Min. Negotiated Rate	$208.29
Max. Negotiated Rate	$287.19
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$208.29
Rate for Payer: Healthfirst Commercial	$287.19

Extensive abdominal/thoracic procedures for mult significant trauma

Facility

$146,164.57

Service Code	APR-DRG 9114
Min. Negotiated Rate	$64,962.03
Max. Negotiated Rate	$146,164.57
Rate for Payer: Affinity Essential Plan 1&2	$146,164.57
Rate for Payer: Affinity Essential Plan 3&4	$146,164.57
Rate for Payer: Affinity Medicaid/CHP/HARP	$64,962.03
Rate for Payer: Amida Care Medicaid	$64,962.03
Rate for Payer: EmblemHealth Essential Plan 1&2	$146,164.57
Rate for Payer: EmblemHealth Essential Plan 3&4	$64,962.03
Rate for Payer: Fidelis CHP/HARP/Medicaid	$64,962.03
Rate for Payer: Fidelis Qualified Health Plan	$77,954.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$64,962.03
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$64,962.03
Rate for Payer: Healthfirst Commercial	$116,804.00
Rate for Payer: Healthfirst Essential Plan	$146,164.57
Rate for Payer: Healthfirst QHP	$73,824.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$64,962.03
Rate for Payer: SOMOS Essential	$146,164.57
Rate for Payer: United Healthcare Essential Plan 1&2	$146,164.57
Rate for Payer: United Healthcare Essential Plan 3&4	$146,164.57
Rate for Payer: United Healthcare Medicaid	$64,962.03
Rate for Payer: Wellcare CHP/FHP/Medicaid	$64,962.03

Extensive abdominal/thoracic procedures for mult significant trauma

Facility

$64,929.85

Service Code	APR-DRG 9111
Min. Negotiated Rate	$24,668.00
Max. Negotiated Rate	$64,929.85
Rate for Payer: Affinity Essential Plan 1&2	$64,929.85
Rate for Payer: Affinity Essential Plan 3&4	$64,929.85
Rate for Payer: Affinity Medicaid/CHP/HARP	$28,857.71
Rate for Payer: Amida Care Medicaid	$28,857.71
Rate for Payer: EmblemHealth Essential Plan 1&2	$64,929.85
Rate for Payer: EmblemHealth Essential Plan 3&4	$28,857.71
Rate for Payer: Fidelis CHP/HARP/Medicaid	$28,857.71
Rate for Payer: Fidelis Qualified Health Plan	$34,629.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$28,857.71
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$28,857.71
Rate for Payer: Healthfirst Commercial	$38,449.00
Rate for Payer: Healthfirst Essential Plan	$64,929.85
Rate for Payer: Healthfirst QHP	$24,668.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$28,857.71
Rate for Payer: SOMOS Essential	$64,929.85
Rate for Payer: United Healthcare Essential Plan 1&2	$64,929.85
Rate for Payer: United Healthcare Essential Plan 3&4	$64,929.85
Rate for Payer: United Healthcare Medicaid	$28,857.71
Rate for Payer: Wellcare CHP/FHP/Medicaid	$28,857.71

Extensive abdominal/thoracic procedures for mult significant trauma

Facility

$77,095.10

Service Code	APR-DRG 9113
Min. Negotiated Rate	$29,206.00
Max. Negotiated Rate	$77,095.10
Rate for Payer: Affinity Essential Plan 1&2	$77,095.10
Rate for Payer: Affinity Essential Plan 3&4	$77,095.10
Rate for Payer: Affinity Medicaid/CHP/HARP	$34,264.49
Rate for Payer: Amida Care Medicaid	$34,264.49
Rate for Payer: EmblemHealth Essential Plan 1&2	$77,095.10
Rate for Payer: EmblemHealth Essential Plan 3&4	$34,264.49
Rate for Payer: Fidelis CHP/HARP/Medicaid	$34,264.49
Rate for Payer: Fidelis Qualified Health Plan	$41,117.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$34,264.49
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$34,264.49
Rate for Payer: Healthfirst Commercial	$47,801.00
Rate for Payer: Healthfirst Essential Plan	$77,095.10
Rate for Payer: Healthfirst QHP	$29,206.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$34,264.49
Rate for Payer: SOMOS Essential	$77,095.10
Rate for Payer: United Healthcare Essential Plan 1&2	$77,095.10
Rate for Payer: United Healthcare Essential Plan 3&4	$77,095.10
Rate for Payer: United Healthcare Medicaid	$34,264.49
Rate for Payer: Wellcare CHP/FHP/Medicaid	$34,264.49

Extensive abdominal/thoracic procedures for mult significant trauma

Facility

$64,929.85

Service Code	APR-DRG 9112
Min. Negotiated Rate	$24,722.00
Max. Negotiated Rate	$64,929.85
Rate for Payer: Affinity Essential Plan 1&2	$64,929.85
Rate for Payer: Affinity Essential Plan 3&4	$64,929.85
Rate for Payer: Affinity Medicaid/CHP/HARP	$28,857.71
Rate for Payer: Amida Care Medicaid	$28,857.71
Rate for Payer: EmblemHealth Essential Plan 1&2	$64,929.85
Rate for Payer: EmblemHealth Essential Plan 3&4	$28,857.71
Rate for Payer: Fidelis CHP/HARP/Medicaid	$28,857.71
Rate for Payer: Fidelis Qualified Health Plan	$34,629.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$28,857.71
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$28,857.71
Rate for Payer: Healthfirst Commercial	$38,896.00
Rate for Payer: Healthfirst Essential Plan	$64,929.85
Rate for Payer: Healthfirst QHP	$24,722.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$28,857.71
Rate for Payer: SOMOS Essential	$64,929.85
Rate for Payer: United Healthcare Essential Plan 1&2	$64,929.85
Rate for Payer: United Healthcare Essential Plan 3&4	$64,929.85
Rate for Payer: United Healthcare Medicaid	$28,857.71
Rate for Payer: Wellcare CHP/FHP/Medicaid	$28,857.71

Extensive procedure unrelated to principal diagnosis

Facility

$55,977.82

Service Code	APR-DRG 9501
Min. Negotiated Rate	$15,024.00
Max. Negotiated Rate	$55,977.82
Rate for Payer: Affinity Essential Plan 1&2	$55,977.82
Rate for Payer: Affinity Essential Plan 3&4	$55,977.82
Rate for Payer: Affinity Medicaid/CHP/HARP	$24,879.03
Rate for Payer: Amida Care Medicaid	$24,879.03
Rate for Payer: EmblemHealth Essential Plan 1&2	$55,977.82
Rate for Payer: EmblemHealth Essential Plan 3&4	$24,879.03
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,879.03
Rate for Payer: Fidelis Qualified Health Plan	$29,854.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,879.03
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,879.03
Rate for Payer: Healthfirst Commercial	$23,902.00
Rate for Payer: Healthfirst Essential Plan	$55,977.82
Rate for Payer: Healthfirst QHP	$15,024.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,879.03
Rate for Payer: SOMOS Essential	$55,977.82
Rate for Payer: United Healthcare Essential Plan 1&2	$55,977.82
Rate for Payer: United Healthcare Essential Plan 3&4	$55,977.82
Rate for Payer: United Healthcare Medicaid	$24,879.03
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,879.03

Extensive procedure unrelated to principal diagnosis

Facility

$69,988.01

Service Code	APR-DRG 9502
Min. Negotiated Rate	$26,677.00
Max. Negotiated Rate	$69,988.01
Rate for Payer: Affinity Essential Plan 1&2	$69,988.01
Rate for Payer: Affinity Essential Plan 3&4	$69,988.01
Rate for Payer: Affinity Medicaid/CHP/HARP	$31,105.78
Rate for Payer: Amida Care Medicaid	$31,105.78
Rate for Payer: EmblemHealth Essential Plan 1&2	$69,988.01
Rate for Payer: EmblemHealth Essential Plan 3&4	$31,105.78
Rate for Payer: Fidelis CHP/HARP/Medicaid	$31,105.78
Rate for Payer: Fidelis Qualified Health Plan	$37,326.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$31,105.78
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31,105.78
Rate for Payer: Healthfirst Commercial	$42,267.00
Rate for Payer: Healthfirst Essential Plan	$69,988.01
Rate for Payer: Healthfirst QHP	$26,677.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$31,105.78
Rate for Payer: SOMOS Essential	$69,988.01
Rate for Payer: United Healthcare Essential Plan 1&2	$69,988.01
Rate for Payer: United Healthcare Essential Plan 3&4	$69,988.01
Rate for Payer: United Healthcare Medicaid	$31,105.78
Rate for Payer: Wellcare CHP/FHP/Medicaid	$31,105.78

Extensive procedure unrelated to principal diagnosis

Facility

$102,268.04

Service Code	APR-DRG 9503
Min. Negotiated Rate	$45,114.00
Max. Negotiated Rate	$102,268.04
Rate for Payer: Affinity Essential Plan 1&2	$102,268.04
Rate for Payer: Affinity Essential Plan 3&4	$102,268.04
Rate for Payer: Affinity Medicaid/CHP/HARP	$45,452.46
Rate for Payer: Amida Care Medicaid	$45,452.46
Rate for Payer: EmblemHealth Essential Plan 1&2	$102,268.04
Rate for Payer: EmblemHealth Essential Plan 3&4	$45,452.46
Rate for Payer: Fidelis CHP/HARP/Medicaid	$45,452.46
Rate for Payer: Fidelis Qualified Health Plan	$54,542.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$45,452.46
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$45,452.46
Rate for Payer: Healthfirst Commercial	$72,203.00
Rate for Payer: Healthfirst Essential Plan	$102,268.04
Rate for Payer: Healthfirst QHP	$45,114.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$45,452.46
Rate for Payer: SOMOS Essential	$102,268.04
Rate for Payer: United Healthcare Essential Plan 1&2	$102,268.04
Rate for Payer: United Healthcare Essential Plan 3&4	$102,268.04
Rate for Payer: United Healthcare Medicaid	$45,452.46
Rate for Payer: Wellcare CHP/FHP/Medicaid	$45,452.46

Extensive procedure unrelated to principal diagnosis

Facility

$174,726.61

Service Code	APR-DRG 9504
Min. Negotiated Rate	$77,656.27
Max. Negotiated Rate	$174,726.61
Rate for Payer: Affinity Essential Plan 1&2	$174,726.61
Rate for Payer: Affinity Essential Plan 3&4	$174,726.61
Rate for Payer: Affinity Medicaid/CHP/HARP	$77,656.27
Rate for Payer: Amida Care Medicaid	$77,656.27
Rate for Payer: EmblemHealth Essential Plan 1&2	$174,726.61
Rate for Payer: EmblemHealth Essential Plan 3&4	$77,656.27
Rate for Payer: Fidelis CHP/HARP/Medicaid	$77,656.27
Rate for Payer: Fidelis Qualified Health Plan	$93,187.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$77,656.27
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$77,656.27
Rate for Payer: Healthfirst Commercial	$143,729.00
Rate for Payer: Healthfirst Essential Plan	$174,726.61
Rate for Payer: Healthfirst QHP	$91,510.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$77,656.27
Rate for Payer: SOMOS Essential	$174,726.61
Rate for Payer: United Healthcare Essential Plan 1&2	$174,726.61
Rate for Payer: United Healthcare Essential Plan 3&4	$174,726.61
Rate for Payer: United Healthcare Medicaid	$77,656.27
Rate for Payer: Wellcare CHP/FHP/Medicaid	$77,656.27

Extracranial vascular procedures

Facility

$58,427.75

Service Code	APR-DRG 0241
Min. Negotiated Rate	$15,222.00
Max. Negotiated Rate	$58,427.75
Rate for Payer: Affinity Essential Plan 1&2	$58,427.75
Rate for Payer: Affinity Essential Plan 3&4	$58,427.75
Rate for Payer: Affinity Medicaid/CHP/HARP	$25,967.89
Rate for Payer: Amida Care Medicaid	$25,967.89
Rate for Payer: EmblemHealth Essential Plan 1&2	$58,427.75
Rate for Payer: EmblemHealth Essential Plan 3&4	$25,967.89
Rate for Payer: Fidelis CHP/HARP/Medicaid	$25,967.89
Rate for Payer: Fidelis Qualified Health Plan	$31,161.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$25,967.89
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25,967.89
Rate for Payer: Healthfirst Commercial	$24,418.00
Rate for Payer: Healthfirst Essential Plan	$58,427.75
Rate for Payer: Healthfirst QHP	$15,222.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$25,967.89
Rate for Payer: SOMOS Essential	$58,427.75
Rate for Payer: United Healthcare Essential Plan 1&2	$58,427.75
Rate for Payer: United Healthcare Essential Plan 3&4	$58,427.75
Rate for Payer: United Healthcare Medicaid	$25,967.89
Rate for Payer: Wellcare CHP/FHP/Medicaid	$25,967.89

Extracranial vascular procedures

Facility

$151,498.85

Service Code	APR-DRG 0244
Min. Negotiated Rate	$67,332.82
Max. Negotiated Rate	$151,498.85
Rate for Payer: Affinity Essential Plan 1&2	$151,498.85
Rate for Payer: Affinity Essential Plan 3&4	$151,498.85
Rate for Payer: Affinity Medicaid/CHP/HARP	$67,332.82
Rate for Payer: Amida Care Medicaid	$67,332.82
Rate for Payer: EmblemHealth Essential Plan 1&2	$151,498.85
Rate for Payer: EmblemHealth Essential Plan 3&4	$67,332.82
Rate for Payer: Fidelis CHP/HARP/Medicaid	$67,332.82
Rate for Payer: Fidelis Qualified Health Plan	$80,799.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$67,332.82
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$67,332.82
Rate for Payer: Healthfirst Commercial	$122,908.00
Rate for Payer: Healthfirst Essential Plan	$151,498.85
Rate for Payer: Healthfirst QHP	$75,011.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$67,332.82
Rate for Payer: SOMOS Essential	$151,498.85
Rate for Payer: United Healthcare Essential Plan 1&2	$151,498.85
Rate for Payer: United Healthcare Essential Plan 3&4	$151,498.85
Rate for Payer: United Healthcare Medicaid	$67,332.82
Rate for Payer: Wellcare CHP/FHP/Medicaid	$67,332.82

Extracranial vascular procedures

Facility

$96,919.67

Service Code	APR-DRG 0243
Min. Negotiated Rate	$40,103.00
Max. Negotiated Rate	$96,919.67
Rate for Payer: Affinity Essential Plan 1&2	$96,919.67
Rate for Payer: Affinity Essential Plan 3&4	$96,919.67
Rate for Payer: Affinity Medicaid/CHP/HARP	$43,075.41
Rate for Payer: Amida Care Medicaid	$43,075.41
Rate for Payer: EmblemHealth Essential Plan 1&2	$96,919.67
Rate for Payer: EmblemHealth Essential Plan 3&4	$43,075.41
Rate for Payer: Fidelis CHP/HARP/Medicaid	$43,075.41
Rate for Payer: Fidelis Qualified Health Plan	$51,690.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$43,075.41
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$43,075.41
Rate for Payer: Healthfirst Commercial	$68,705.00
Rate for Payer: Healthfirst Essential Plan	$96,919.67
Rate for Payer: Healthfirst QHP	$40,103.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$43,075.41
Rate for Payer: SOMOS Essential	$96,919.67
Rate for Payer: United Healthcare Essential Plan 1&2	$96,919.67
Rate for Payer: United Healthcare Essential Plan 3&4	$96,919.67
Rate for Payer: United Healthcare Medicaid	$43,075.41
Rate for Payer: Wellcare CHP/FHP/Medicaid	$43,075.41

Extracranial vascular procedures

Facility

$69,486.75

Service Code	APR-DRG 0242
Min. Negotiated Rate	$19,762.00
Max. Negotiated Rate	$69,486.75
Rate for Payer: Affinity Essential Plan 1&2	$69,486.75
Rate for Payer: Affinity Essential Plan 3&4	$69,486.75
Rate for Payer: Affinity Medicaid/CHP/HARP	$30,883.00
Rate for Payer: Amida Care Medicaid	$30,883.00
Rate for Payer: EmblemHealth Essential Plan 1&2	$69,486.75
Rate for Payer: EmblemHealth Essential Plan 3&4	$30,883.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$30,883.00
Rate for Payer: Fidelis Qualified Health Plan	$37,059.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$30,883.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$30,883.00
Rate for Payer: Healthfirst Commercial	$35,015.00
Rate for Payer: Healthfirst Essential Plan	$69,486.75
Rate for Payer: Healthfirst QHP	$19,762.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$30,883.00
Rate for Payer: SOMOS Essential	$69,486.75
Rate for Payer: United Healthcare Essential Plan 1&2	$69,486.75
Rate for Payer: United Healthcare Essential Plan 3&4	$69,486.75
Rate for Payer: United Healthcare Medicaid	$30,883.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$30,883.00

Eye disorders except major infections

Facility

$50,063.15

Service Code	APR-DRG 0823
Min. Negotiated Rate	$10,435.00
Max. Negotiated Rate	$50,063.15
Rate for Payer: Affinity Essential Plan 1&2	$50,063.15
Rate for Payer: Affinity Essential Plan 3&4	$50,063.15
Rate for Payer: Affinity Medicaid/CHP/HARP	$22,250.29
Rate for Payer: Amida Care Medicaid	$22,250.29
Rate for Payer: EmblemHealth Essential Plan 1&2	$50,063.15
Rate for Payer: EmblemHealth Essential Plan 3&4	$22,250.29
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,250.29
Rate for Payer: Fidelis Qualified Health Plan	$26,700.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,250.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,250.29
Rate for Payer: Healthfirst Commercial	$17,568.00
Rate for Payer: Healthfirst Essential Plan	$50,063.15
Rate for Payer: Healthfirst QHP	$10,435.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,250.29
Rate for Payer: SOMOS Essential	$50,063.15
Rate for Payer: United Healthcare Essential Plan 1&2	$50,063.15
Rate for Payer: United Healthcare Essential Plan 3&4	$50,063.15
Rate for Payer: United Healthcare Medicaid	$22,250.29
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,250.29

Eye disorders except major infections

Facility

$42,454.82

Service Code	APR-DRG 0822
Min. Negotiated Rate	$6,730.00
Max. Negotiated Rate	$42,454.82
Rate for Payer: Affinity Essential Plan 1&2	$42,454.82
Rate for Payer: Affinity Essential Plan 3&4	$42,454.82
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,868.81
Rate for Payer: Amida Care Medicaid	$18,868.81
Rate for Payer: EmblemHealth Essential Plan 1&2	$42,454.82
Rate for Payer: EmblemHealth Essential Plan 3&4	$18,868.81
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,868.81
Rate for Payer: Fidelis Qualified Health Plan	$22,642.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,868.81
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,868.81
Rate for Payer: Healthfirst Commercial	$11,189.00
Rate for Payer: Healthfirst Essential Plan	$42,454.82
Rate for Payer: Healthfirst QHP	$6,730.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,868.81
Rate for Payer: SOMOS Essential	$42,454.82
Rate for Payer: United Healthcare Essential Plan 1&2	$42,454.82
Rate for Payer: United Healthcare Essential Plan 3&4	$42,454.82
Rate for Payer: United Healthcare Medicaid	$18,868.81
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,868.81

Eye disorders except major infections

Facility

$40,625.73

Service Code	APR-DRG 0821
Min. Negotiated Rate	$5,849.00
Max. Negotiated Rate	$40,625.73
Rate for Payer: Affinity Essential Plan 1&2	$40,625.73
Rate for Payer: Affinity Essential Plan 3&4	$40,625.73
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,055.88
Rate for Payer: Amida Care Medicaid	$18,055.88
Rate for Payer: EmblemHealth Essential Plan 1&2	$40,625.73
Rate for Payer: EmblemHealth Essential Plan 3&4	$18,055.88
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,055.88
Rate for Payer: Fidelis Qualified Health Plan	$21,667.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,055.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,055.88
Rate for Payer: Healthfirst Commercial	$10,072.00
Rate for Payer: Healthfirst Essential Plan	$40,625.73
Rate for Payer: Healthfirst QHP	$5,849.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,055.88
Rate for Payer: SOMOS Essential	$40,625.73
Rate for Payer: United Healthcare Essential Plan 1&2	$40,625.73
Rate for Payer: United Healthcare Essential Plan 3&4	$40,625.73
Rate for Payer: United Healthcare Medicaid	$18,055.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,055.88

Eye disorders except major infections

Facility

$50,569.67

Service Code	APR-DRG 0824
Min. Negotiated Rate	$10,858.00
Max. Negotiated Rate	$50,569.67
Rate for Payer: Affinity Essential Plan 1&2	$50,569.67
Rate for Payer: Affinity Essential Plan 3&4	$50,569.67
Rate for Payer: Affinity Medicaid/CHP/HARP	$22,475.41
Rate for Payer: Amida Care Medicaid	$22,475.41
Rate for Payer: EmblemHealth Essential Plan 1&2	$50,569.67
Rate for Payer: EmblemHealth Essential Plan 3&4	$22,475.41
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,475.41
Rate for Payer: Fidelis Qualified Health Plan	$26,970.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,475.41
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,475.41
Rate for Payer: Healthfirst Commercial	$19,450.00
Rate for Payer: Healthfirst Essential Plan	$50,569.67
Rate for Payer: Healthfirst QHP	$10,858.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,475.41
Rate for Payer: SOMOS Essential	$50,569.67
Rate for Payer: United Healthcare Essential Plan 1&2	$50,569.67
Rate for Payer: United Healthcare Essential Plan 3&4	$50,569.67
Rate for Payer: United Healthcare Medicaid	$22,475.41
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,475.41

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