St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

APR-DRG 0931: Sinus & mastoid procedures

Facility

$45,419.08

Service Code	APR-DRG 0931
Min. Negotiated Rate	$8,780.00
Max. Negotiated Rate	$45,419.08
Rate for Payer: Affinity Essential Plan 1&2	$45,419.08
Rate for Payer: Affinity Essential Plan 3&4	$45,419.08
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,186.26
Rate for Payer: Amida Care Medicaid	$20,186.26
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,186.26
Rate for Payer: Fidelis Qualified Health Plan	$24,223.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,186.26
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,186.26
Rate for Payer: Healthfirst Commercial	$14,831.00
Rate for Payer: Healthfirst Essential Plan	$45,419.08
Rate for Payer: Healthfirst QHP	$8,780.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,186.26
Rate for Payer: SOMOS Essential	$45,419.08
Rate for Payer: United Healthcare Essential Plan 1&2	$45,419.08
Rate for Payer: United Healthcare Essential Plan 3&4	$45,419.08
Rate for Payer: United Healthcare Medicaid	$20,186.26
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,186.26

APR-DRG 0932: Sinus & mastoid procedures

Facility

$51,342.52

Service Code	APR-DRG 0932
Min. Negotiated Rate	$11,493.00
Max. Negotiated Rate	$51,342.52
Rate for Payer: Affinity Essential Plan 1&2	$51,342.52
Rate for Payer: Affinity Essential Plan 3&4	$51,342.52
Rate for Payer: Affinity Medicaid/CHP/HARP	$22,818.90
Rate for Payer: Amida Care Medicaid	$22,818.90
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,818.90
Rate for Payer: Fidelis Qualified Health Plan	$27,382.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,818.90
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,818.90
Rate for Payer: Healthfirst Commercial	$20,353.00
Rate for Payer: Healthfirst Essential Plan	$51,342.52
Rate for Payer: Healthfirst QHP	$11,493.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,818.90
Rate for Payer: SOMOS Essential	$51,342.52
Rate for Payer: United Healthcare Essential Plan 1&2	$51,342.52
Rate for Payer: United Healthcare Essential Plan 3&4	$51,342.52
Rate for Payer: United Healthcare Medicaid	$22,818.90
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,818.90

APR-DRG 0933: Sinus & mastoid procedures

Facility

$71,291.99

Service Code	APR-DRG 0933
Min. Negotiated Rate	$21,120.00
Max. Negotiated Rate	$71,291.99
Rate for Payer: Affinity Essential Plan 1&2	$71,291.99
Rate for Payer: Affinity Essential Plan 3&4	$71,291.99
Rate for Payer: Affinity Medicaid/CHP/HARP	$31,685.33
Rate for Payer: Amida Care Medicaid	$31,685.33
Rate for Payer: Fidelis CHP/HARP/Medicaid	$31,685.33
Rate for Payer: Fidelis Qualified Health Plan	$38,022.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$31,685.33
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31,685.33
Rate for Payer: Healthfirst Commercial	$37,309.00
Rate for Payer: Healthfirst Essential Plan	$71,291.99
Rate for Payer: Healthfirst QHP	$21,120.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$31,685.33
Rate for Payer: SOMOS Essential	$71,291.99
Rate for Payer: United Healthcare Essential Plan 1&2	$71,291.99
Rate for Payer: United Healthcare Essential Plan 3&4	$71,291.99
Rate for Payer: United Healthcare Medicaid	$31,685.33
Rate for Payer: Wellcare CHP/FHP/Medicaid	$31,685.33

APR-DRG 0934: Sinus & mastoid procedures

Facility

$78,553.84

Service Code	APR-DRG 0934
Min. Negotiated Rate	$23,420.00
Max. Negotiated Rate	$78,553.84
Rate for Payer: Affinity Essential Plan 1&2	$78,553.84
Rate for Payer: Affinity Essential Plan 3&4	$78,553.84
Rate for Payer: Affinity Medicaid/CHP/HARP	$34,912.82
Rate for Payer: Amida Care Medicaid	$34,912.82
Rate for Payer: Fidelis CHP/HARP/Medicaid	$34,912.82
Rate for Payer: Fidelis Qualified Health Plan	$41,895.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$34,912.82
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$34,912.82
Rate for Payer: Healthfirst Commercial	$38,420.00
Rate for Payer: Healthfirst Essential Plan	$78,553.84
Rate for Payer: Healthfirst QHP	$23,420.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$34,912.82
Rate for Payer: SOMOS Essential	$78,553.84
Rate for Payer: United Healthcare Essential Plan 1&2	$78,553.84
Rate for Payer: United Healthcare Essential Plan 3&4	$78,553.84
Rate for Payer: United Healthcare Medicaid	$34,912.82
Rate for Payer: Wellcare CHP/FHP/Medicaid	$34,912.82

APR-DRG 0951: Cleft lip & palate repair

Facility

$42,251.58

Service Code	APR-DRG 0951
Min. Negotiated Rate	$7,478.00
Max. Negotiated Rate	$42,251.58
Rate for Payer: Affinity Essential Plan 1&2	$42,251.58
Rate for Payer: Affinity Essential Plan 3&4	$42,251.58
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,778.48
Rate for Payer: Amida Care Medicaid	$18,778.48
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,778.48
Rate for Payer: Fidelis Qualified Health Plan	$22,534.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,778.48
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,778.48
Rate for Payer: Healthfirst Commercial	$13,087.00
Rate for Payer: Healthfirst Essential Plan	$42,251.58
Rate for Payer: Healthfirst QHP	$7,478.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,778.48
Rate for Payer: SOMOS Essential	$42,251.58
Rate for Payer: United Healthcare Essential Plan 1&2	$42,251.58
Rate for Payer: United Healthcare Essential Plan 3&4	$42,251.58
Rate for Payer: United Healthcare Medicaid	$18,778.48
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,778.48

APR-DRG 0952: Cleft lip & palate repair

Facility

$45,594.94

Service Code	APR-DRG 0952
Min. Negotiated Rate	$9,006.00
Max. Negotiated Rate	$45,594.94
Rate for Payer: Affinity Essential Plan 1&2	$45,594.94
Rate for Payer: Affinity Essential Plan 3&4	$45,594.94
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,264.42
Rate for Payer: Amida Care Medicaid	$20,264.42
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,264.42
Rate for Payer: Fidelis Qualified Health Plan	$24,317.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,264.42
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,264.42
Rate for Payer: Healthfirst Commercial	$15,429.00
Rate for Payer: Healthfirst Essential Plan	$45,594.94
Rate for Payer: Healthfirst QHP	$9,006.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,264.42
Rate for Payer: SOMOS Essential	$45,594.94
Rate for Payer: United Healthcare Essential Plan 1&2	$45,594.94
Rate for Payer: United Healthcare Essential Plan 3&4	$45,594.94
Rate for Payer: United Healthcare Medicaid	$20,264.42
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,264.42

APR-DRG 0953: Cleft lip & palate repair

Facility

$54,026.37

Service Code	APR-DRG 0953
Min. Negotiated Rate	$13,121.00
Max. Negotiated Rate	$54,026.37
Rate for Payer: Affinity Essential Plan 1&2	$54,026.37
Rate for Payer: Affinity Essential Plan 3&4	$54,026.37
Rate for Payer: Affinity Medicaid/CHP/HARP	$24,011.72
Rate for Payer: Amida Care Medicaid	$24,011.72
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,011.72
Rate for Payer: Fidelis Qualified Health Plan	$28,814.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,011.72
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,011.72
Rate for Payer: Healthfirst Commercial	$22,406.00
Rate for Payer: Healthfirst Essential Plan	$54,026.37
Rate for Payer: Healthfirst QHP	$13,121.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,011.72
Rate for Payer: SOMOS Essential	$54,026.37
Rate for Payer: United Healthcare Essential Plan 1&2	$54,026.37
Rate for Payer: United Healthcare Essential Plan 3&4	$54,026.37
Rate for Payer: United Healthcare Medicaid	$24,011.72
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,011.72

APR-DRG 0954: Cleft lip & palate repair

Facility

$74,376.83

Service Code	APR-DRG 0954
Min. Negotiated Rate	$14,438.00
Max. Negotiated Rate	$74,376.83
Rate for Payer: Affinity Essential Plan 1&2	$74,376.83
Rate for Payer: Affinity Essential Plan 3&4	$74,376.83
Rate for Payer: Affinity Medicaid/CHP/HARP	$33,056.37
Rate for Payer: Amida Care Medicaid	$33,056.37
Rate for Payer: Fidelis CHP/HARP/Medicaid	$33,056.37
Rate for Payer: Fidelis Qualified Health Plan	$39,667.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$33,056.37
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$33,056.37
Rate for Payer: Healthfirst Commercial	$26,447.00
Rate for Payer: Healthfirst Essential Plan	$74,376.83
Rate for Payer: Healthfirst QHP	$14,438.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$33,056.37
Rate for Payer: SOMOS Essential	$74,376.83
Rate for Payer: United Healthcare Essential Plan 1&2	$74,376.83
Rate for Payer: United Healthcare Essential Plan 3&4	$74,376.83
Rate for Payer: United Healthcare Medicaid	$33,056.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$33,056.37

APR-DRG 0971: Tonsil & adenoid procedures

Facility

$38,158.96

Service Code	APR-DRG 0971
Min. Negotiated Rate	$5,472.00
Max. Negotiated Rate	$38,158.96
Rate for Payer: Affinity Essential Plan 1&2	$38,158.96
Rate for Payer: Affinity Essential Plan 3&4	$38,158.96
Rate for Payer: Affinity Medicaid/CHP/HARP	$16,959.54
Rate for Payer: Amida Care Medicaid	$16,959.54
Rate for Payer: Fidelis CHP/HARP/Medicaid	$16,959.54
Rate for Payer: Fidelis Qualified Health Plan	$20,351.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$16,959.54
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16,959.54
Rate for Payer: Healthfirst Commercial	$9,684.00
Rate for Payer: Healthfirst Essential Plan	$38,158.96
Rate for Payer: Healthfirst QHP	$5,472.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$16,959.54
Rate for Payer: SOMOS Essential	$38,158.96
Rate for Payer: United Healthcare Essential Plan 1&2	$38,158.96
Rate for Payer: United Healthcare Essential Plan 3&4	$38,158.96
Rate for Payer: United Healthcare Medicaid	$16,959.54
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,959.54

APR-DRG 0972: Tonsil & adenoid procedures

Facility

$41,789.02

Service Code	APR-DRG 0972
Min. Negotiated Rate	$7,669.00
Max. Negotiated Rate	$41,789.02
Rate for Payer: Affinity Essential Plan 1&2	$41,789.02
Rate for Payer: Affinity Essential Plan 3&4	$41,789.02
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,572.90
Rate for Payer: Amida Care Medicaid	$18,572.90
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,572.90
Rate for Payer: Fidelis Qualified Health Plan	$22,287.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,572.90
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,572.90
Rate for Payer: Healthfirst Commercial	$13,001.00
Rate for Payer: Healthfirst Essential Plan	$41,789.02
Rate for Payer: Healthfirst QHP	$7,669.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,572.90
Rate for Payer: SOMOS Essential	$41,789.02
Rate for Payer: United Healthcare Essential Plan 1&2	$41,789.02
Rate for Payer: United Healthcare Essential Plan 3&4	$41,789.02
Rate for Payer: United Healthcare Medicaid	$18,572.90
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,572.90

APR-DRG 0973: Tonsil & adenoid procedures

Facility

$55,656.74

Service Code	APR-DRG 0973
Min. Negotiated Rate	$14,506.00
Max. Negotiated Rate	$55,656.74
Rate for Payer: Affinity Essential Plan 1&2	$55,656.74
Rate for Payer: Affinity Essential Plan 3&4	$55,656.74
Rate for Payer: Affinity Medicaid/CHP/HARP	$24,736.33
Rate for Payer: Amida Care Medicaid	$24,736.33
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,736.33
Rate for Payer: Fidelis Qualified Health Plan	$29,683.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,736.33
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,736.33
Rate for Payer: Healthfirst Commercial	$26,419.00
Rate for Payer: Healthfirst Essential Plan	$55,656.74
Rate for Payer: Healthfirst QHP	$14,506.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,736.33
Rate for Payer: SOMOS Essential	$55,656.74
Rate for Payer: United Healthcare Essential Plan 1&2	$55,656.74
Rate for Payer: United Healthcare Essential Plan 3&4	$55,656.74
Rate for Payer: United Healthcare Medicaid	$24,736.33
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,736.33

APR-DRG 0974: Tonsil & adenoid procedures

Facility

$99,539.21

Service Code	APR-DRG 0974
Min. Negotiated Rate	$16,890.00
Max. Negotiated Rate	$99,539.21
Rate for Payer: Affinity Essential Plan 1&2	$99,539.21
Rate for Payer: Affinity Essential Plan 3&4	$99,539.21
Rate for Payer: Affinity Medicaid/CHP/HARP	$44,239.65
Rate for Payer: Amida Care Medicaid	$44,239.65
Rate for Payer: Fidelis CHP/HARP/Medicaid	$44,239.65
Rate for Payer: Fidelis Qualified Health Plan	$53,087.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$44,239.65
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$44,239.65
Rate for Payer: Healthfirst Commercial	$31,354.00
Rate for Payer: Healthfirst Essential Plan	$99,539.21
Rate for Payer: Healthfirst QHP	$16,890.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$44,239.65
Rate for Payer: SOMOS Essential	$99,539.21
Rate for Payer: United Healthcare Essential Plan 1&2	$99,539.21
Rate for Payer: United Healthcare Essential Plan 3&4	$99,539.21
Rate for Payer: United Healthcare Medicaid	$44,239.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$44,239.65

APR-DRG 0981: Other ear, nose, mouth & throat procedures

Facility

$41,685.26

Service Code	APR-DRG 0981
Min. Negotiated Rate	$7,790.00
Max. Negotiated Rate	$41,685.26
Rate for Payer: Affinity Essential Plan 1&2	$41,685.26
Rate for Payer: Affinity Essential Plan 3&4	$41,685.26
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,526.78
Rate for Payer: Amida Care Medicaid	$18,526.78
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,526.78
Rate for Payer: Fidelis Qualified Health Plan	$22,232.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,526.78
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,526.78
Rate for Payer: Healthfirst Commercial	$13,061.00
Rate for Payer: Healthfirst Essential Plan	$41,685.26
Rate for Payer: Healthfirst QHP	$7,790.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,526.78
Rate for Payer: SOMOS Essential	$41,685.26
Rate for Payer: United Healthcare Essential Plan 1&2	$41,685.26
Rate for Payer: United Healthcare Essential Plan 3&4	$41,685.26
Rate for Payer: United Healthcare Medicaid	$18,526.78
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,526.78

APR-DRG 0982: Other ear, nose, mouth & throat procedures

Facility

$46,796.18

Service Code	APR-DRG 0982
Min. Negotiated Rate	$10,153.00
Max. Negotiated Rate	$46,796.18
Rate for Payer: Affinity Essential Plan 1&2	$46,796.18
Rate for Payer: Affinity Essential Plan 3&4	$46,796.18
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,798.30
Rate for Payer: Amida Care Medicaid	$20,798.30
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,798.30
Rate for Payer: Fidelis Qualified Health Plan	$24,957.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,798.30
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,798.30
Rate for Payer: Healthfirst Commercial	$17,532.00
Rate for Payer: Healthfirst Essential Plan	$46,796.18
Rate for Payer: Healthfirst QHP	$10,153.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,798.30
Rate for Payer: SOMOS Essential	$46,796.18
Rate for Payer: United Healthcare Essential Plan 1&2	$46,796.18
Rate for Payer: United Healthcare Essential Plan 3&4	$46,796.18
Rate for Payer: United Healthcare Medicaid	$20,798.30
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,798.30

APR-DRG 0983: Other ear, nose, mouth & throat procedures

Facility

$62,413.83

Service Code	APR-DRG 0983
Min. Negotiated Rate	$20,168.00
Max. Negotiated Rate	$62,413.83
Rate for Payer: Affinity Essential Plan 1&2	$62,413.83
Rate for Payer: Affinity Essential Plan 3&4	$62,413.83
Rate for Payer: Affinity Medicaid/CHP/HARP	$27,739.48
Rate for Payer: Amida Care Medicaid	$27,739.48
Rate for Payer: Fidelis CHP/HARP/Medicaid	$27,739.48
Rate for Payer: Fidelis Qualified Health Plan	$33,287.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$27,739.48
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$27,739.48
Rate for Payer: Healthfirst Commercial	$33,679.00
Rate for Payer: Healthfirst Essential Plan	$62,413.83
Rate for Payer: Healthfirst QHP	$20,168.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$27,739.48
Rate for Payer: SOMOS Essential	$62,413.83
Rate for Payer: United Healthcare Essential Plan 1&2	$62,413.83
Rate for Payer: United Healthcare Essential Plan 3&4	$62,413.83
Rate for Payer: United Healthcare Medicaid	$27,739.48
Rate for Payer: Wellcare CHP/FHP/Medicaid	$27,739.48

APR-DRG 0984: Other ear, nose, mouth & throat procedures

Facility

$102,833.35

Service Code	APR-DRG 0984
Min. Negotiated Rate	$44,320.00
Max. Negotiated Rate	$102,833.35
Rate for Payer: Affinity Essential Plan 1&2	$102,833.35
Rate for Payer: Affinity Essential Plan 3&4	$102,833.35
Rate for Payer: Affinity Medicaid/CHP/HARP	$45,703.71
Rate for Payer: Amida Care Medicaid	$45,703.71
Rate for Payer: Fidelis CHP/HARP/Medicaid	$45,703.71
Rate for Payer: Fidelis Qualified Health Plan	$54,844.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$45,703.71
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$45,703.71
Rate for Payer: Healthfirst Commercial	$84,102.00
Rate for Payer: Healthfirst Essential Plan	$102,833.35
Rate for Payer: Healthfirst QHP	$44,320.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$45,703.71
Rate for Payer: SOMOS Essential	$102,833.35
Rate for Payer: United Healthcare Essential Plan 1&2	$102,833.35
Rate for Payer: United Healthcare Essential Plan 3&4	$102,833.35
Rate for Payer: United Healthcare Medicaid	$45,703.71
Rate for Payer: Wellcare CHP/FHP/Medicaid	$45,703.71

APR-DRG 1101: Ear, nose, mouth, throat, cranial/facial malignancies

Facility

$42,256.84

Service Code	APR-DRG 1101
Min. Negotiated Rate	$6,768.00
Max. Negotiated Rate	$42,256.84
Rate for Payer: Affinity Essential Plan 1&2	$42,256.84
Rate for Payer: Affinity Essential Plan 3&4	$42,256.84
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,780.82
Rate for Payer: Amida Care Medicaid	$18,780.82
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,780.82
Rate for Payer: Fidelis Qualified Health Plan	$22,536.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,780.82
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,780.82
Rate for Payer: Healthfirst Commercial	$13,306.00
Rate for Payer: Healthfirst Essential Plan	$42,256.84
Rate for Payer: Healthfirst QHP	$6,768.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,780.82
Rate for Payer: SOMOS Essential	$42,256.84
Rate for Payer: United Healthcare Essential Plan 1&2	$42,256.84
Rate for Payer: United Healthcare Essential Plan 3&4	$42,256.84
Rate for Payer: United Healthcare Medicaid	$18,780.82
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,780.82

APR-DRG 1102: Ear, nose, mouth, throat, cranial/facial malignancies

Facility

$45,515.81

Service Code	APR-DRG 1102
Min. Negotiated Rate	$9,645.00
Max. Negotiated Rate	$45,515.81
Rate for Payer: Affinity Essential Plan 1&2	$45,515.81
Rate for Payer: Affinity Essential Plan 3&4	$45,515.81
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,229.25
Rate for Payer: Amida Care Medicaid	$20,229.25
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,229.25
Rate for Payer: Fidelis Qualified Health Plan	$24,275.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,229.25
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,229.25
Rate for Payer: Healthfirst Commercial	$18,019.00
Rate for Payer: Healthfirst Essential Plan	$45,515.81
Rate for Payer: Healthfirst QHP	$9,645.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,229.25
Rate for Payer: SOMOS Essential	$45,515.81
Rate for Payer: United Healthcare Essential Plan 1&2	$45,515.81
Rate for Payer: United Healthcare Essential Plan 3&4	$45,515.81
Rate for Payer: United Healthcare Medicaid	$20,229.25
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,229.25

APR-DRG 1103: Ear, nose, mouth, throat, cranial/facial malignancies

Facility

$60,834.49

Service Code	APR-DRG 1103
Min. Negotiated Rate	$15,600.00
Max. Negotiated Rate	$60,834.49
Rate for Payer: Affinity Essential Plan 1&2	$60,834.49
Rate for Payer: Affinity Essential Plan 3&4	$60,834.49
Rate for Payer: Affinity Medicaid/CHP/HARP	$27,037.55
Rate for Payer: Amida Care Medicaid	$27,037.55
Rate for Payer: Fidelis CHP/HARP/Medicaid	$27,037.55
Rate for Payer: Fidelis Qualified Health Plan	$32,445.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$27,037.55
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$27,037.55
Rate for Payer: Healthfirst Commercial	$24,880.00
Rate for Payer: Healthfirst Essential Plan	$60,834.49
Rate for Payer: Healthfirst QHP	$15,600.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$27,037.55
Rate for Payer: SOMOS Essential	$60,834.49
Rate for Payer: United Healthcare Essential Plan 1&2	$60,834.49
Rate for Payer: United Healthcare Essential Plan 3&4	$60,834.49
Rate for Payer: United Healthcare Medicaid	$27,037.55
Rate for Payer: Wellcare CHP/FHP/Medicaid	$27,037.55

APR-DRG 1104: Ear, nose, mouth, throat, cranial/facial malignancies

Facility

$93,445.16

Service Code	APR-DRG 1104
Min. Negotiated Rate	$32,763.00
Max. Negotiated Rate	$93,445.16
Rate for Payer: Affinity Essential Plan 1&2	$93,445.16
Rate for Payer: Affinity Essential Plan 3&4	$93,445.16
Rate for Payer: Affinity Medicaid/CHP/HARP	$41,531.18
Rate for Payer: Amida Care Medicaid	$41,531.18
Rate for Payer: Fidelis CHP/HARP/Medicaid	$41,531.18
Rate for Payer: Fidelis Qualified Health Plan	$49,837.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$41,531.18
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$41,531.18
Rate for Payer: Healthfirst Commercial	$54,791.00
Rate for Payer: Healthfirst Essential Plan	$93,445.16
Rate for Payer: Healthfirst QHP	$32,763.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$41,531.18
Rate for Payer: SOMOS Essential	$93,445.16
Rate for Payer: United Healthcare Essential Plan 1&2	$93,445.16
Rate for Payer: United Healthcare Essential Plan 3&4	$93,445.16
Rate for Payer: United Healthcare Medicaid	$41,531.18
Rate for Payer: Wellcare CHP/FHP/Medicaid	$41,531.18

APR-DRG 1111: Vertigo & other labyrinth disorders

Facility

$37,342.91

Service Code	APR-DRG 1111
Min. Negotiated Rate	$5,294.00
Max. Negotiated Rate	$37,342.91
Rate for Payer: Affinity Essential Plan 1&2	$37,342.91
Rate for Payer: Affinity Essential Plan 3&4	$37,342.91
Rate for Payer: Affinity Medicaid/CHP/HARP	$16,596.85
Rate for Payer: Amida Care Medicaid	$16,596.85
Rate for Payer: Fidelis CHP/HARP/Medicaid	$16,596.85
Rate for Payer: Fidelis Qualified Health Plan	$19,916.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$16,596.85
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16,596.85
Rate for Payer: Healthfirst Commercial	$8,967.00
Rate for Payer: Healthfirst Essential Plan	$37,342.91
Rate for Payer: Healthfirst QHP	$5,294.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$16,596.85
Rate for Payer: SOMOS Essential	$37,342.91
Rate for Payer: United Healthcare Essential Plan 1&2	$37,342.91
Rate for Payer: United Healthcare Essential Plan 3&4	$37,342.91
Rate for Payer: United Healthcare Medicaid	$16,596.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,596.85

APR-DRG 1112: Vertigo & other labyrinth disorders

Facility

$39,170.25

Service Code	APR-DRG 1112
Min. Negotiated Rate	$6,283.00
Max. Negotiated Rate	$39,170.25
Rate for Payer: Affinity Essential Plan 1&2	$39,170.25
Rate for Payer: Affinity Essential Plan 3&4	$39,170.25
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,409.00
Rate for Payer: Amida Care Medicaid	$17,409.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,409.00
Rate for Payer: Fidelis Qualified Health Plan	$20,890.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,409.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,409.00
Rate for Payer: Healthfirst Commercial	$10,525.00
Rate for Payer: Healthfirst Essential Plan	$39,170.25
Rate for Payer: Healthfirst QHP	$6,283.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,409.00
Rate for Payer: SOMOS Essential	$39,170.25
Rate for Payer: United Healthcare Essential Plan 1&2	$39,170.25
Rate for Payer: United Healthcare Essential Plan 3&4	$39,170.25
Rate for Payer: United Healthcare Medicaid	$17,409.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,409.00

APR-DRG 1113: Vertigo & other labyrinth disorders

Facility

$43,055.32

Service Code	APR-DRG 1113
Min. Negotiated Rate	$7,483.00
Max. Negotiated Rate	$43,055.32
Rate for Payer: Affinity Essential Plan 1&2	$43,055.32
Rate for Payer: Affinity Essential Plan 3&4	$43,055.32
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,135.70
Rate for Payer: Amida Care Medicaid	$19,135.70
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,135.70
Rate for Payer: Fidelis Qualified Health Plan	$22,962.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,135.70
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,135.70
Rate for Payer: Healthfirst Commercial	$14,043.00
Rate for Payer: Healthfirst Essential Plan	$43,055.32
Rate for Payer: Healthfirst QHP	$7,483.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,135.70
Rate for Payer: SOMOS Essential	$43,055.32
Rate for Payer: United Healthcare Essential Plan 1&2	$43,055.32
Rate for Payer: United Healthcare Essential Plan 3&4	$43,055.32
Rate for Payer: United Healthcare Medicaid	$19,135.70
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,135.70

APR-DRG 1114: Vertigo & other labyrinth disorders

Facility

$43,299.79

Service Code	APR-DRG 1114
Min. Negotiated Rate	$7,793.00
Max. Negotiated Rate	$43,299.79
Rate for Payer: Affinity Essential Plan 1&2	$43,299.79
Rate for Payer: Affinity Essential Plan 3&4	$43,299.79
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,244.35
Rate for Payer: Amida Care Medicaid	$19,244.35
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,244.35
Rate for Payer: Fidelis Qualified Health Plan	$23,093.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,244.35
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,244.35
Rate for Payer: Healthfirst Commercial	$14,126.00
Rate for Payer: Healthfirst Essential Plan	$43,299.79
Rate for Payer: Healthfirst QHP	$7,793.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,244.35
Rate for Payer: SOMOS Essential	$43,299.79
Rate for Payer: United Healthcare Essential Plan 1&2	$43,299.79
Rate for Payer: United Healthcare Essential Plan 3&4	$43,299.79
Rate for Payer: United Healthcare Medicaid	$19,244.35
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,244.35

APR-DRG 1131: Infections of upper respiratory tract

Facility

$36,468.81

Service Code	APR-DRG 1131
Min. Negotiated Rate	$4,662.00
Max. Negotiated Rate	$36,468.81
Rate for Payer: Affinity Essential Plan 1&2	$36,468.81
Rate for Payer: Affinity Essential Plan 3&4	$36,468.81
Rate for Payer: Affinity Medicaid/CHP/HARP	$16,208.36
Rate for Payer: Amida Care Medicaid	$16,208.36
Rate for Payer: Fidelis CHP/HARP/Medicaid	$16,208.36
Rate for Payer: Fidelis Qualified Health Plan	$19,450.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$16,208.36
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16,208.36
Rate for Payer: Healthfirst Commercial	$8,277.00
Rate for Payer: Healthfirst Essential Plan	$36,468.81
Rate for Payer: Healthfirst QHP	$4,662.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$16,208.36
Rate for Payer: SOMOS Essential	$36,468.81
Rate for Payer: United Healthcare Essential Plan 1&2	$36,468.81
Rate for Payer: United Healthcare Essential Plan 3&4	$36,468.81
Rate for Payer: United Healthcare Medicaid	$16,208.36
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,208.36

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