St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

APR-DRG 3162: Hand & wrist procedures

Facility

$50,406.88

Service Code	APR-DRG 3162
Min. Negotiated Rate	$11,299.00
Max. Negotiated Rate	$50,406.88
Rate for Payer: Affinity Essential Plan 1&2	$50,406.88
Rate for Payer: Affinity Essential Plan 3&4	$50,406.88
Rate for Payer: Affinity Medicaid/CHP/HARP	$22,403.06
Rate for Payer: Amida Care Medicaid	$22,403.06
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,403.06
Rate for Payer: Fidelis Qualified Health Plan	$26,883.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,403.06
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,403.06
Rate for Payer: Healthfirst Commercial	$20,998.00
Rate for Payer: Healthfirst Essential Plan	$50,406.88
Rate for Payer: Healthfirst QHP	$11,299.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,403.06
Rate for Payer: SOMOS Essential	$50,406.88
Rate for Payer: United Healthcare Essential Plan 1&2	$50,406.88
Rate for Payer: United Healthcare Essential Plan 3&4	$50,406.88
Rate for Payer: United Healthcare Medicaid	$22,403.06
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,403.06

APR-DRG 3163: Hand & wrist procedures

Facility

$67,158.94

Service Code	APR-DRG 3163
Min. Negotiated Rate	$20,327.00
Max. Negotiated Rate	$67,158.94
Rate for Payer: Affinity Essential Plan 1&2	$67,158.94
Rate for Payer: Affinity Essential Plan 3&4	$67,158.94
Rate for Payer: Affinity Medicaid/CHP/HARP	$29,848.42
Rate for Payer: Amida Care Medicaid	$29,848.42
Rate for Payer: Fidelis CHP/HARP/Medicaid	$29,848.42
Rate for Payer: Fidelis Qualified Health Plan	$35,818.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$29,848.42
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29,848.42
Rate for Payer: Healthfirst Commercial	$36,156.00
Rate for Payer: Healthfirst Essential Plan	$67,158.94
Rate for Payer: Healthfirst QHP	$20,327.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$29,848.42
Rate for Payer: SOMOS Essential	$67,158.94
Rate for Payer: United Healthcare Essential Plan 1&2	$67,158.94
Rate for Payer: United Healthcare Essential Plan 3&4	$67,158.94
Rate for Payer: United Healthcare Medicaid	$29,848.42
Rate for Payer: Wellcare CHP/FHP/Medicaid	$29,848.42

APR-DRG 3164: Hand & wrist procedures

Facility

$71,631.43

Service Code	APR-DRG 3164
Min. Negotiated Rate	$20,488.00
Max. Negotiated Rate	$71,631.43
Rate for Payer: Affinity Essential Plan 1&2	$71,631.43
Rate for Payer: Affinity Essential Plan 3&4	$71,631.43
Rate for Payer: Affinity Medicaid/CHP/HARP	$31,836.19
Rate for Payer: Amida Care Medicaid	$31,836.19
Rate for Payer: Fidelis CHP/HARP/Medicaid	$31,836.19
Rate for Payer: Fidelis Qualified Health Plan	$38,203.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$31,836.19
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31,836.19
Rate for Payer: Healthfirst Commercial	$36,562.00
Rate for Payer: Healthfirst Essential Plan	$71,631.43
Rate for Payer: Healthfirst QHP	$20,488.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$31,836.19
Rate for Payer: SOMOS Essential	$71,631.43
Rate for Payer: United Healthcare Essential Plan 1&2	$71,631.43
Rate for Payer: United Healthcare Essential Plan 3&4	$71,631.43
Rate for Payer: United Healthcare Medicaid	$31,836.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$31,836.19

APR-DRG 3171: Tendon, muscle & other soft tissue procedures

Facility

$45,468.32

Service Code	APR-DRG 3171
Min. Negotiated Rate	$10,079.00
Max. Negotiated Rate	$45,468.32
Rate for Payer: Affinity Essential Plan 1&2	$45,468.32
Rate for Payer: Affinity Essential Plan 3&4	$45,468.32
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,208.14
Rate for Payer: Amida Care Medicaid	$20,208.14
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,208.14
Rate for Payer: Fidelis Qualified Health Plan	$24,249.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,208.14
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,208.14
Rate for Payer: Healthfirst Commercial	$17,202.00
Rate for Payer: Healthfirst Essential Plan	$45,468.32
Rate for Payer: Healthfirst QHP	$10,079.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,208.14
Rate for Payer: SOMOS Essential	$45,468.32
Rate for Payer: United Healthcare Essential Plan 1&2	$45,468.32
Rate for Payer: United Healthcare Essential Plan 3&4	$45,468.32
Rate for Payer: United Healthcare Medicaid	$20,208.14
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,208.14

APR-DRG 3172: Tendon, muscle & other soft tissue procedures

Facility

$54,879.37

Service Code	APR-DRG 3172
Min. Negotiated Rate	$16,179.00
Max. Negotiated Rate	$54,879.37
Rate for Payer: Affinity Essential Plan 1&2	$54,879.37
Rate for Payer: Affinity Essential Plan 3&4	$54,879.37
Rate for Payer: Affinity Medicaid/CHP/HARP	$24,390.83
Rate for Payer: Amida Care Medicaid	$24,390.83
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,390.83
Rate for Payer: Fidelis Qualified Health Plan	$29,269.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,390.83
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,390.83
Rate for Payer: Healthfirst Commercial	$27,090.00
Rate for Payer: Healthfirst Essential Plan	$54,879.37
Rate for Payer: Healthfirst QHP	$16,179.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,390.83
Rate for Payer: SOMOS Essential	$54,879.37
Rate for Payer: United Healthcare Essential Plan 1&2	$54,879.37
Rate for Payer: United Healthcare Essential Plan 3&4	$54,879.37
Rate for Payer: United Healthcare Medicaid	$24,390.83
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,390.83

APR-DRG 3173: Tendon, muscle & other soft tissue procedures

Facility

$75,507.70

Service Code	APR-DRG 3173
Min. Negotiated Rate	$26,951.00
Max. Negotiated Rate	$75,507.70
Rate for Payer: Affinity Essential Plan 1&2	$75,507.70
Rate for Payer: Affinity Essential Plan 3&4	$75,507.70
Rate for Payer: Affinity Medicaid/CHP/HARP	$33,558.98
Rate for Payer: Amida Care Medicaid	$33,558.98
Rate for Payer: Fidelis CHP/HARP/Medicaid	$33,558.98
Rate for Payer: Fidelis Qualified Health Plan	$40,270.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$33,558.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$33,558.98
Rate for Payer: Healthfirst Commercial	$46,551.00
Rate for Payer: Healthfirst Essential Plan	$75,507.70
Rate for Payer: Healthfirst QHP	$26,951.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$33,558.98
Rate for Payer: SOMOS Essential	$75,507.70
Rate for Payer: United Healthcare Essential Plan 1&2	$75,507.70
Rate for Payer: United Healthcare Essential Plan 3&4	$75,507.70
Rate for Payer: United Healthcare Medicaid	$33,558.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$33,558.98

APR-DRG 3174: Tendon, muscle & other soft tissue procedures

Facility

$140,760.70

Service Code	APR-DRG 3174
Min. Negotiated Rate	$62,560.31
Max. Negotiated Rate	$140,760.70
Rate for Payer: Affinity Essential Plan 1&2	$140,760.70
Rate for Payer: Affinity Essential Plan 3&4	$140,760.70
Rate for Payer: Affinity Medicaid/CHP/HARP	$62,560.31
Rate for Payer: Amida Care Medicaid	$62,560.31
Rate for Payer: Fidelis CHP/HARP/Medicaid	$62,560.31
Rate for Payer: Fidelis Qualified Health Plan	$75,072.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$62,560.31
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$62,560.31
Rate for Payer: Healthfirst Commercial	$121,158.00
Rate for Payer: Healthfirst Essential Plan	$140,760.70
Rate for Payer: Healthfirst QHP	$66,772.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$62,560.31
Rate for Payer: SOMOS Essential	$140,760.70
Rate for Payer: United Healthcare Essential Plan 1&2	$140,760.70
Rate for Payer: United Healthcare Essential Plan 3&4	$140,760.70
Rate for Payer: United Healthcare Medicaid	$62,560.31
Rate for Payer: Wellcare CHP/FHP/Medicaid	$62,560.31

APR-DRG 3201: Other musculoskeletal system & connective tissue procedures

Facility

$47,677.30

Service Code	APR-DRG 3201
Min. Negotiated Rate	$10,743.00
Max. Negotiated Rate	$47,677.30
Rate for Payer: Affinity Essential Plan 1&2	$47,677.30
Rate for Payer: Affinity Essential Plan 3&4	$47,677.30
Rate for Payer: Affinity Medicaid/CHP/HARP	$21,189.91
Rate for Payer: Amida Care Medicaid	$21,189.91
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,189.91
Rate for Payer: Fidelis Qualified Health Plan	$25,427.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,189.91
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,189.91
Rate for Payer: Healthfirst Commercial	$18,516.00
Rate for Payer: Healthfirst Essential Plan	$47,677.30
Rate for Payer: Healthfirst QHP	$10,743.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,189.91
Rate for Payer: SOMOS Essential	$47,677.30
Rate for Payer: United Healthcare Essential Plan 1&2	$47,677.30
Rate for Payer: United Healthcare Essential Plan 3&4	$47,677.30
Rate for Payer: United Healthcare Medicaid	$21,189.91
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,189.91

APR-DRG 3202: Other musculoskeletal system & connective tissue procedures

Facility

$58,271.98

Service Code	APR-DRG 3202
Min. Negotiated Rate	$17,953.00
Max. Negotiated Rate	$58,271.98
Rate for Payer: Affinity Essential Plan 1&2	$58,271.98
Rate for Payer: Affinity Essential Plan 3&4	$58,271.98
Rate for Payer: Affinity Medicaid/CHP/HARP	$25,898.66
Rate for Payer: Amida Care Medicaid	$25,898.66
Rate for Payer: Fidelis CHP/HARP/Medicaid	$25,898.66
Rate for Payer: Fidelis Qualified Health Plan	$31,078.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$25,898.66
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25,898.66
Rate for Payer: Healthfirst Commercial	$30,130.00
Rate for Payer: Healthfirst Essential Plan	$58,271.98
Rate for Payer: Healthfirst QHP	$17,953.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$25,898.66
Rate for Payer: SOMOS Essential	$58,271.98
Rate for Payer: United Healthcare Essential Plan 1&2	$58,271.98
Rate for Payer: United Healthcare Essential Plan 3&4	$58,271.98
Rate for Payer: United Healthcare Medicaid	$25,898.66
Rate for Payer: Wellcare CHP/FHP/Medicaid	$25,898.66

APR-DRG 3203: Other musculoskeletal system & connective tissue procedures

Facility

$73,873.82

Service Code	APR-DRG 3203
Min. Negotiated Rate	$27,682.00
Max. Negotiated Rate	$73,873.82
Rate for Payer: Affinity Essential Plan 1&2	$73,873.82
Rate for Payer: Affinity Essential Plan 3&4	$73,873.82
Rate for Payer: Affinity Medicaid/CHP/HARP	$32,832.81
Rate for Payer: Amida Care Medicaid	$32,832.81
Rate for Payer: Fidelis CHP/HARP/Medicaid	$32,832.81
Rate for Payer: Fidelis Qualified Health Plan	$39,399.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$32,832.81
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$32,832.81
Rate for Payer: Healthfirst Commercial	$47,919.00
Rate for Payer: Healthfirst Essential Plan	$73,873.82
Rate for Payer: Healthfirst QHP	$27,682.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$32,832.81
Rate for Payer: SOMOS Essential	$73,873.82
Rate for Payer: United Healthcare Essential Plan 1&2	$73,873.82
Rate for Payer: United Healthcare Essential Plan 3&4	$73,873.82
Rate for Payer: United Healthcare Medicaid	$32,832.81
Rate for Payer: Wellcare CHP/FHP/Medicaid	$32,832.81

APR-DRG 3204: Other musculoskeletal system & connective tissue procedures

Facility

$117,643.75

Service Code	APR-DRG 3204
Min. Negotiated Rate	$52,286.11
Max. Negotiated Rate	$117,643.75
Rate for Payer: Affinity Essential Plan 1&2	$117,643.75
Rate for Payer: Affinity Essential Plan 3&4	$117,643.75
Rate for Payer: Affinity Medicaid/CHP/HARP	$52,286.11
Rate for Payer: Amida Care Medicaid	$52,286.11
Rate for Payer: Fidelis CHP/HARP/Medicaid	$52,286.11
Rate for Payer: Fidelis Qualified Health Plan	$62,743.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$52,286.11
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$52,286.11
Rate for Payer: Healthfirst Commercial	$107,294.00
Rate for Payer: Healthfirst Essential Plan	$117,643.75
Rate for Payer: Healthfirst QHP	$71,428.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$52,286.11
Rate for Payer: SOMOS Essential	$117,643.75
Rate for Payer: United Healthcare Essential Plan 1&2	$117,643.75
Rate for Payer: United Healthcare Essential Plan 3&4	$117,643.75
Rate for Payer: United Healthcare Medicaid	$52,286.11
Rate for Payer: Wellcare CHP/FHP/Medicaid	$52,286.11

APR-DRG 3211: Cervical spinal fusion & other back/neck proc exc disc excis/decomp

Facility

$58,340.59

Service Code	APR-DRG 3211
Min. Negotiated Rate	$19,121.00
Max. Negotiated Rate	$58,340.59
Rate for Payer: Affinity Essential Plan 1&2	$58,340.59
Rate for Payer: Affinity Essential Plan 3&4	$58,340.59
Rate for Payer: Affinity Medicaid/CHP/HARP	$25,929.15
Rate for Payer: Amida Care Medicaid	$25,929.15
Rate for Payer: Fidelis CHP/HARP/Medicaid	$25,929.15
Rate for Payer: Fidelis Qualified Health Plan	$31,114.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$25,929.15
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25,929.15
Rate for Payer: Healthfirst Commercial	$31,053.00
Rate for Payer: Healthfirst Essential Plan	$58,340.59
Rate for Payer: Healthfirst QHP	$19,121.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$25,929.15
Rate for Payer: SOMOS Essential	$58,340.59
Rate for Payer: United Healthcare Essential Plan 1&2	$58,340.59
Rate for Payer: United Healthcare Essential Plan 3&4	$58,340.59
Rate for Payer: United Healthcare Medicaid	$25,929.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$25,929.15

APR-DRG 3212: Cervical spinal fusion & other back/neck proc exc disc excis/decomp

Facility

$67,405.16

Service Code	APR-DRG 3212
Min. Negotiated Rate	$24,410.00
Max. Negotiated Rate	$67,405.16
Rate for Payer: Affinity Essential Plan 1&2	$67,405.16
Rate for Payer: Affinity Essential Plan 3&4	$67,405.16
Rate for Payer: Affinity Medicaid/CHP/HARP	$29,957.85
Rate for Payer: Amida Care Medicaid	$29,957.85
Rate for Payer: Fidelis CHP/HARP/Medicaid	$29,957.85
Rate for Payer: Fidelis Qualified Health Plan	$35,949.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$29,957.85
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29,957.85
Rate for Payer: Healthfirst Commercial	$41,505.00
Rate for Payer: Healthfirst Essential Plan	$67,405.16
Rate for Payer: Healthfirst QHP	$24,410.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$29,957.85
Rate for Payer: SOMOS Essential	$67,405.16
Rate for Payer: United Healthcare Essential Plan 1&2	$67,405.16
Rate for Payer: United Healthcare Essential Plan 3&4	$67,405.16
Rate for Payer: United Healthcare Medicaid	$29,957.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$29,957.85

APR-DRG 3213: Cervical spinal fusion & other back/neck proc exc disc excis/decomp

Facility

$94,762.46

Service Code	APR-DRG 3213
Min. Negotiated Rate	$42,116.65
Max. Negotiated Rate	$94,762.46
Rate for Payer: Affinity Essential Plan 1&2	$94,762.46
Rate for Payer: Affinity Essential Plan 3&4	$94,762.46
Rate for Payer: Affinity Medicaid/CHP/HARP	$42,116.65
Rate for Payer: Amida Care Medicaid	$42,116.65
Rate for Payer: Fidelis CHP/HARP/Medicaid	$42,116.65
Rate for Payer: Fidelis Qualified Health Plan	$50,539.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$42,116.65
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$42,116.65
Rate for Payer: Healthfirst Commercial	$71,586.00
Rate for Payer: Healthfirst Essential Plan	$94,762.46
Rate for Payer: Healthfirst QHP	$45,114.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$42,116.65
Rate for Payer: SOMOS Essential	$94,762.46
Rate for Payer: United Healthcare Essential Plan 1&2	$94,762.46
Rate for Payer: United Healthcare Essential Plan 3&4	$94,762.46
Rate for Payer: United Healthcare Medicaid	$42,116.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$42,116.65

APR-DRG 3214: Cervical spinal fusion & other back/neck proc exc disc excis/decomp

Facility

$153,884.48

Service Code	APR-DRG 3214
Min. Negotiated Rate	$68,393.10
Max. Negotiated Rate	$153,884.48
Rate for Payer: Affinity Essential Plan 1&2	$153,884.48
Rate for Payer: Affinity Essential Plan 3&4	$153,884.48
Rate for Payer: Affinity Medicaid/CHP/HARP	$68,393.10
Rate for Payer: Amida Care Medicaid	$68,393.10
Rate for Payer: Fidelis CHP/HARP/Medicaid	$68,393.10
Rate for Payer: Fidelis Qualified Health Plan	$82,071.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$68,393.10
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$68,393.10
Rate for Payer: Healthfirst Commercial	$140,740.00
Rate for Payer: Healthfirst Essential Plan	$153,884.48
Rate for Payer: Healthfirst QHP	$85,302.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$68,393.10
Rate for Payer: SOMOS Essential	$153,884.48
Rate for Payer: United Healthcare Essential Plan 1&2	$153,884.48
Rate for Payer: United Healthcare Essential Plan 3&4	$153,884.48
Rate for Payer: United Healthcare Medicaid	$68,393.10
Rate for Payer: Wellcare CHP/FHP/Medicaid	$68,393.10

APR-DRG 3221: Shoulder & elbow joint replacement #

Facility

$57,436.58

Service Code	APR-DRG 3221
Min. Negotiated Rate	$25,527.37
Max. Negotiated Rate	$57,436.58
Rate for Payer: Affinity Essential Plan 1&2	$57,436.58
Rate for Payer: Affinity Essential Plan 3&4	$57,436.58
Rate for Payer: Affinity Medicaid/CHP/HARP	$25,527.37
Rate for Payer: Amida Care Medicaid	$25,527.37
Rate for Payer: Fidelis CHP/HARP/Medicaid	$25,527.37
Rate for Payer: Fidelis Qualified Health Plan	$30,632.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$25,527.37
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25,527.37
Rate for Payer: Healthfirst Essential Plan	$57,436.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$25,527.37
Rate for Payer: SOMOS Essential	$57,436.58
Rate for Payer: United Healthcare Essential Plan 1&2	$57,436.58
Rate for Payer: United Healthcare Essential Plan 3&4	$57,436.58
Rate for Payer: United Healthcare Medicaid	$25,527.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$25,527.37

APR-DRG 3222: Shoulder & elbow joint replacement #

Facility

$60,343.78

Service Code	APR-DRG 3222
Min. Negotiated Rate	$26,819.46
Max. Negotiated Rate	$60,343.78
Rate for Payer: Affinity Essential Plan 1&2	$60,343.78
Rate for Payer: Affinity Essential Plan 3&4	$60,343.78
Rate for Payer: Affinity Medicaid/CHP/HARP	$26,819.46
Rate for Payer: Amida Care Medicaid	$26,819.46
Rate for Payer: Fidelis CHP/HARP/Medicaid	$26,819.46
Rate for Payer: Fidelis Qualified Health Plan	$32,183.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$26,819.46
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$26,819.46
Rate for Payer: Healthfirst Essential Plan	$60,343.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26,819.46
Rate for Payer: SOMOS Essential	$60,343.78
Rate for Payer: United Healthcare Essential Plan 1&2	$60,343.78
Rate for Payer: United Healthcare Essential Plan 3&4	$60,343.78
Rate for Payer: United Healthcare Medicaid	$26,819.46
Rate for Payer: Wellcare CHP/FHP/Medicaid	$26,819.46

APR-DRG 3223: Shoulder & elbow joint replacement #

Facility

$81,061.83

Service Code	APR-DRG 3223
Min. Negotiated Rate	$36,027.48
Max. Negotiated Rate	$81,061.83
Rate for Payer: Affinity Essential Plan 1&2	$81,061.83
Rate for Payer: Affinity Essential Plan 3&4	$81,061.83
Rate for Payer: Affinity Medicaid/CHP/HARP	$36,027.48
Rate for Payer: Amida Care Medicaid	$36,027.48
Rate for Payer: Fidelis CHP/HARP/Medicaid	$36,027.48
Rate for Payer: Fidelis Qualified Health Plan	$43,232.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$36,027.48
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$36,027.48
Rate for Payer: Healthfirst Essential Plan	$81,061.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$36,027.48
Rate for Payer: SOMOS Essential	$81,061.83
Rate for Payer: United Healthcare Essential Plan 1&2	$81,061.83
Rate for Payer: United Healthcare Essential Plan 3&4	$81,061.83
Rate for Payer: United Healthcare Medicaid	$36,027.48
Rate for Payer: Wellcare CHP/FHP/Medicaid	$36,027.48

APR-DRG 3224: Shoulder & elbow joint replacement #

Facility

$89,764.11

Service Code	APR-DRG 3224
Min. Negotiated Rate	$39,895.16
Max. Negotiated Rate	$89,764.11
Rate for Payer: Affinity Essential Plan 1&2	$89,764.11
Rate for Payer: Affinity Essential Plan 3&4	$89,764.11
Rate for Payer: Affinity Medicaid/CHP/HARP	$39,895.16
Rate for Payer: Amida Care Medicaid	$39,895.16
Rate for Payer: Fidelis CHP/HARP/Medicaid	$39,895.16
Rate for Payer: Fidelis Qualified Health Plan	$47,874.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$39,895.16
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$39,895.16
Rate for Payer: Healthfirst Essential Plan	$89,764.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$39,895.16
Rate for Payer: SOMOS Essential	$89,764.11
Rate for Payer: United Healthcare Essential Plan 1&2	$89,764.11
Rate for Payer: United Healthcare Essential Plan 3&4	$89,764.11
Rate for Payer: United Healthcare Medicaid	$39,895.16
Rate for Payer: Wellcare CHP/FHP/Medicaid	$39,895.16

APR-DRG 3401: Fracture of femur

Facility

$38,941.60

Service Code	APR-DRG 3401
Min. Negotiated Rate	$7,074.00
Max. Negotiated Rate	$38,941.60
Rate for Payer: Affinity Essential Plan 1&2	$38,941.60
Rate for Payer: Affinity Essential Plan 3&4	$38,941.60
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,307.38
Rate for Payer: Amida Care Medicaid	$17,307.38
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,307.38
Rate for Payer: Fidelis Qualified Health Plan	$20,768.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,307.38
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,307.38
Rate for Payer: Healthfirst Commercial	$11,587.00
Rate for Payer: Healthfirst Essential Plan	$38,941.60
Rate for Payer: Healthfirst QHP	$7,074.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,307.38
Rate for Payer: SOMOS Essential	$38,941.60
Rate for Payer: United Healthcare Essential Plan 1&2	$38,941.60
Rate for Payer: United Healthcare Essential Plan 3&4	$38,941.60
Rate for Payer: United Healthcare Medicaid	$17,307.38
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,307.38

APR-DRG 3402: Fracture of femur

Facility

$42,096.80

Service Code	APR-DRG 3402
Min. Negotiated Rate	$8,238.00
Max. Negotiated Rate	$42,096.80
Rate for Payer: Affinity Essential Plan 1&2	$42,096.80
Rate for Payer: Affinity Essential Plan 3&4	$42,096.80
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,709.69
Rate for Payer: Amida Care Medicaid	$18,709.69
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,709.69
Rate for Payer: Fidelis Qualified Health Plan	$22,451.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,709.69
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,709.69
Rate for Payer: Healthfirst Commercial	$13,300.00
Rate for Payer: Healthfirst Essential Plan	$42,096.80
Rate for Payer: Healthfirst QHP	$8,238.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,709.69
Rate for Payer: SOMOS Essential	$42,096.80
Rate for Payer: United Healthcare Essential Plan 1&2	$42,096.80
Rate for Payer: United Healthcare Essential Plan 3&4	$42,096.80
Rate for Payer: United Healthcare Medicaid	$18,709.69
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,709.69

APR-DRG 3403: Fracture of femur

Facility

$59,603.36

Service Code	APR-DRG 3403
Min. Negotiated Rate	$13,069.00
Max. Negotiated Rate	$59,603.36
Rate for Payer: Affinity Essential Plan 1&2	$59,603.36
Rate for Payer: Affinity Essential Plan 3&4	$59,603.36
Rate for Payer: Affinity Medicaid/CHP/HARP	$26,490.38
Rate for Payer: Amida Care Medicaid	$26,490.38
Rate for Payer: Fidelis CHP/HARP/Medicaid	$26,490.38
Rate for Payer: Fidelis Qualified Health Plan	$31,788.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$26,490.38
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$26,490.38
Rate for Payer: Healthfirst Commercial	$19,303.00
Rate for Payer: Healthfirst Essential Plan	$59,603.36
Rate for Payer: Healthfirst QHP	$13,069.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26,490.38
Rate for Payer: SOMOS Essential	$59,603.36
Rate for Payer: United Healthcare Essential Plan 1&2	$59,603.36
Rate for Payer: United Healthcare Essential Plan 3&4	$59,603.36
Rate for Payer: United Healthcare Medicaid	$26,490.38
Rate for Payer: Wellcare CHP/FHP/Medicaid	$26,490.38

APR-DRG 3404: Fracture of femur

Facility

$70,412.62

Service Code	APR-DRG 3404
Min. Negotiated Rate	$25,036.00
Max. Negotiated Rate	$70,412.62
Rate for Payer: Affinity Essential Plan 1&2	$70,412.62
Rate for Payer: Affinity Essential Plan 3&4	$70,412.62
Rate for Payer: Affinity Medicaid/CHP/HARP	$31,294.50
Rate for Payer: Amida Care Medicaid	$31,294.50
Rate for Payer: Fidelis CHP/HARP/Medicaid	$31,294.50
Rate for Payer: Fidelis Qualified Health Plan	$37,553.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$31,294.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31,294.50
Rate for Payer: Healthfirst Commercial	$38,321.00
Rate for Payer: Healthfirst Essential Plan	$70,412.62
Rate for Payer: Healthfirst QHP	$25,036.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$31,294.50
Rate for Payer: SOMOS Essential	$70,412.62
Rate for Payer: United Healthcare Essential Plan 1&2	$70,412.62
Rate for Payer: United Healthcare Essential Plan 3&4	$70,412.62
Rate for Payer: United Healthcare Medicaid	$31,294.50
Rate for Payer: Wellcare CHP/FHP/Medicaid	$31,294.50

APR-DRG 3411: Fracture of pelvis or dislocation of hip

Facility

$39,711.94

Service Code	APR-DRG 3411
Min. Negotiated Rate	$6,475.00
Max. Negotiated Rate	$39,711.94
Rate for Payer: Affinity Essential Plan 1&2	$39,711.94
Rate for Payer: Affinity Essential Plan 3&4	$39,711.94
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,649.75
Rate for Payer: Amida Care Medicaid	$17,649.75
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,649.75
Rate for Payer: Fidelis Qualified Health Plan	$21,179.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,649.75
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,649.75
Rate for Payer: Healthfirst Commercial	$11,025.00
Rate for Payer: Healthfirst Essential Plan	$39,711.94
Rate for Payer: Healthfirst QHP	$6,475.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,649.75
Rate for Payer: SOMOS Essential	$39,711.94
Rate for Payer: United Healthcare Essential Plan 1&2	$39,711.94
Rate for Payer: United Healthcare Essential Plan 3&4	$39,711.94
Rate for Payer: United Healthcare Medicaid	$17,649.75
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,649.75

APR-DRG 3412: Fracture of pelvis or dislocation of hip

Facility

$42,197.04

Service Code	APR-DRG 3412
Min. Negotiated Rate	$8,423.00
Max. Negotiated Rate	$42,197.04
Rate for Payer: Affinity Essential Plan 1&2	$42,197.04
Rate for Payer: Affinity Essential Plan 3&4	$42,197.04
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,754.24
Rate for Payer: Amida Care Medicaid	$18,754.24
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,754.24
Rate for Payer: Fidelis Qualified Health Plan	$22,505.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,754.24
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,754.24
Rate for Payer: Healthfirst Commercial	$13,501.00
Rate for Payer: Healthfirst Essential Plan	$42,197.04
Rate for Payer: Healthfirst QHP	$8,423.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,754.24
Rate for Payer: SOMOS Essential	$42,197.04
Rate for Payer: United Healthcare Essential Plan 1&2	$42,197.04
Rate for Payer: United Healthcare Essential Plan 3&4	$42,197.04
Rate for Payer: United Healthcare Medicaid	$18,754.24
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,754.24

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