St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

APR-DRG 4233: Inborn errors of metabolism

Facility

$57,779.55

Service Code	APR-DRG 4233
Min. Negotiated Rate	$15,363.00
Max. Negotiated Rate	$57,779.55
Rate for Payer: Affinity Essential Plan 1&2	$57,779.55
Rate for Payer: Affinity Essential Plan 3&4	$57,779.55
Rate for Payer: Affinity Medicaid/CHP/HARP	$25,679.80
Rate for Payer: Amida Care Medicaid	$25,679.80
Rate for Payer: Fidelis CHP/HARP/Medicaid	$25,679.80
Rate for Payer: Fidelis Qualified Health Plan	$30,815.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$25,679.80
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25,679.80
Rate for Payer: Healthfirst Commercial	$27,115.00
Rate for Payer: Healthfirst Essential Plan	$57,779.55
Rate for Payer: Healthfirst QHP	$15,363.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$25,679.80
Rate for Payer: SOMOS Essential	$57,779.55
Rate for Payer: United Healthcare Essential Plan 1&2	$57,779.55
Rate for Payer: United Healthcare Essential Plan 3&4	$57,779.55
Rate for Payer: United Healthcare Medicaid	$25,679.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$25,679.80

APR-DRG 4234: Inborn errors of metabolism

Facility

$125,289.02

Service Code	APR-DRG 4234
Min. Negotiated Rate	$35,549.00
Max. Negotiated Rate	$125,289.02
Rate for Payer: Affinity Essential Plan 1&2	$125,289.02
Rate for Payer: Affinity Essential Plan 3&4	$125,289.02
Rate for Payer: Affinity Medicaid/CHP/HARP	$55,684.01
Rate for Payer: Amida Care Medicaid	$55,684.01
Rate for Payer: Fidelis CHP/HARP/Medicaid	$55,684.01
Rate for Payer: Fidelis Qualified Health Plan	$66,820.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$55,684.01
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$55,684.01
Rate for Payer: Healthfirst Commercial	$77,092.00
Rate for Payer: Healthfirst Essential Plan	$125,289.02
Rate for Payer: Healthfirst QHP	$35,549.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$55,684.01
Rate for Payer: SOMOS Essential	$125,289.02
Rate for Payer: United Healthcare Essential Plan 1&2	$125,289.02
Rate for Payer: United Healthcare Essential Plan 3&4	$125,289.02
Rate for Payer: United Healthcare Medicaid	$55,684.01
Rate for Payer: Wellcare CHP/FHP/Medicaid	$55,684.01

APR-DRG 4241: Other endocrine disorders

Facility

$38,417.51

Service Code	APR-DRG 4241
Min. Negotiated Rate	$5,801.00
Max. Negotiated Rate	$38,417.51
Rate for Payer: Affinity Essential Plan 1&2	$38,417.51
Rate for Payer: Affinity Essential Plan 3&4	$38,417.51
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,074.45
Rate for Payer: Amida Care Medicaid	$17,074.45
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,074.45
Rate for Payer: Fidelis Qualified Health Plan	$20,489.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,074.45
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,074.45
Rate for Payer: Healthfirst Commercial	$10,109.00
Rate for Payer: Healthfirst Essential Plan	$38,417.51
Rate for Payer: Healthfirst QHP	$5,801.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,074.45
Rate for Payer: SOMOS Essential	$38,417.51
Rate for Payer: United Healthcare Essential Plan 1&2	$38,417.51
Rate for Payer: United Healthcare Essential Plan 3&4	$38,417.51
Rate for Payer: United Healthcare Medicaid	$17,074.45
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,074.45

APR-DRG 4242: Other endocrine disorders

Facility

$42,999.03

Service Code	APR-DRG 4242
Min. Negotiated Rate	$8,144.00
Max. Negotiated Rate	$42,999.03
Rate for Payer: Affinity Essential Plan 1&2	$42,999.03
Rate for Payer: Affinity Essential Plan 3&4	$42,999.03
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,110.68
Rate for Payer: Amida Care Medicaid	$19,110.68
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,110.68
Rate for Payer: Fidelis Qualified Health Plan	$22,932.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,110.68
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,110.68
Rate for Payer: Healthfirst Commercial	$14,308.00
Rate for Payer: Healthfirst Essential Plan	$42,999.03
Rate for Payer: Healthfirst QHP	$8,144.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,110.68
Rate for Payer: SOMOS Essential	$42,999.03
Rate for Payer: United Healthcare Essential Plan 1&2	$42,999.03
Rate for Payer: United Healthcare Essential Plan 3&4	$42,999.03
Rate for Payer: United Healthcare Medicaid	$19,110.68
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,110.68

APR-DRG 4243: Other endocrine disorders

Facility

$50,489.55

Service Code	APR-DRG 4243
Min. Negotiated Rate	$12,192.00
Max. Negotiated Rate	$50,489.55
Rate for Payer: Affinity Essential Plan 1&2	$50,489.55
Rate for Payer: Affinity Essential Plan 3&4	$50,489.55
Rate for Payer: Affinity Medicaid/CHP/HARP	$22,439.80
Rate for Payer: Amida Care Medicaid	$22,439.80
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,439.80
Rate for Payer: Fidelis Qualified Health Plan	$26,927.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,439.80
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,439.80
Rate for Payer: Healthfirst Commercial	$22,664.00
Rate for Payer: Healthfirst Essential Plan	$50,489.55
Rate for Payer: Healthfirst QHP	$12,192.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,439.80
Rate for Payer: SOMOS Essential	$50,489.55
Rate for Payer: United Healthcare Essential Plan 1&2	$50,489.55
Rate for Payer: United Healthcare Essential Plan 3&4	$50,489.55
Rate for Payer: United Healthcare Medicaid	$22,439.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,439.80

APR-DRG 4244: Other endocrine disorders

Facility

$78,590.79

Service Code	APR-DRG 4244
Min. Negotiated Rate	$26,490.00
Max. Negotiated Rate	$78,590.79
Rate for Payer: Affinity Essential Plan 1&2	$78,590.79
Rate for Payer: Affinity Essential Plan 3&4	$78,590.79
Rate for Payer: Affinity Medicaid/CHP/HARP	$34,929.24
Rate for Payer: Amida Care Medicaid	$34,929.24
Rate for Payer: Fidelis CHP/HARP/Medicaid	$34,929.24
Rate for Payer: Fidelis Qualified Health Plan	$41,915.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$34,929.24
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$34,929.24
Rate for Payer: Healthfirst Commercial	$44,433.00
Rate for Payer: Healthfirst Essential Plan	$78,590.79
Rate for Payer: Healthfirst QHP	$26,490.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$34,929.24
Rate for Payer: SOMOS Essential	$78,590.79
Rate for Payer: United Healthcare Essential Plan 1&2	$78,590.79
Rate for Payer: United Healthcare Essential Plan 3&4	$78,590.79
Rate for Payer: United Healthcare Medicaid	$34,929.24
Rate for Payer: Wellcare CHP/FHP/Medicaid	$34,929.24

APR-DRG 4251: Electrolyte disorders except hypovolemia related

Facility

$37,219.79

Service Code	APR-DRG 4251
Min. Negotiated Rate	$5,231.00
Max. Negotiated Rate	$37,219.79
Rate for Payer: Affinity Essential Plan 1&2	$37,219.79
Rate for Payer: Affinity Essential Plan 3&4	$37,219.79
Rate for Payer: Affinity Medicaid/CHP/HARP	$16,542.13
Rate for Payer: Amida Care Medicaid	$16,542.13
Rate for Payer: Fidelis CHP/HARP/Medicaid	$16,542.13
Rate for Payer: Fidelis Qualified Health Plan	$19,850.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$16,542.13
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16,542.13
Rate for Payer: Healthfirst Commercial	$9,119.00
Rate for Payer: Healthfirst Essential Plan	$37,219.79
Rate for Payer: Healthfirst QHP	$5,231.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$16,542.13
Rate for Payer: SOMOS Essential	$37,219.79
Rate for Payer: United Healthcare Essential Plan 1&2	$37,219.79
Rate for Payer: United Healthcare Essential Plan 3&4	$37,219.79
Rate for Payer: United Healthcare Medicaid	$16,542.13
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,542.13

APR-DRG 4252: Electrolyte disorders except hypovolemia related

Facility

$40,209.66

Service Code	APR-DRG 4252
Min. Negotiated Rate	$6,776.00
Max. Negotiated Rate	$40,209.66
Rate for Payer: Affinity Essential Plan 1&2	$40,209.66
Rate for Payer: Affinity Essential Plan 3&4	$40,209.66
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,870.96
Rate for Payer: Amida Care Medicaid	$17,870.96
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,870.96
Rate for Payer: Fidelis Qualified Health Plan	$21,445.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,870.96
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,870.96
Rate for Payer: Healthfirst Commercial	$11,746.00
Rate for Payer: Healthfirst Essential Plan	$40,209.66
Rate for Payer: Healthfirst QHP	$6,776.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,870.96
Rate for Payer: SOMOS Essential	$40,209.66
Rate for Payer: United Healthcare Essential Plan 1&2	$40,209.66
Rate for Payer: United Healthcare Essential Plan 3&4	$40,209.66
Rate for Payer: United Healthcare Medicaid	$17,870.96
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,870.96

APR-DRG 4253: Electrolyte disorders except hypovolemia related

Facility

$47,202.44

Service Code	APR-DRG 4253
Min. Negotiated Rate	$9,743.00
Max. Negotiated Rate	$47,202.44
Rate for Payer: Affinity Essential Plan 1&2	$47,202.44
Rate for Payer: Affinity Essential Plan 3&4	$47,202.44
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,978.86
Rate for Payer: Amida Care Medicaid	$20,978.86
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,978.86
Rate for Payer: Fidelis Qualified Health Plan	$25,174.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,978.86
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,978.86
Rate for Payer: Healthfirst Commercial	$18,182.00
Rate for Payer: Healthfirst Essential Plan	$47,202.44
Rate for Payer: Healthfirst QHP	$9,743.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,978.86
Rate for Payer: SOMOS Essential	$47,202.44
Rate for Payer: United Healthcare Essential Plan 1&2	$47,202.44
Rate for Payer: United Healthcare Essential Plan 3&4	$47,202.44
Rate for Payer: United Healthcare Medicaid	$20,978.86
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,978.86

APR-DRG 4254: Electrolyte disorders except hypovolemia related

Facility

$73,453.50

Service Code	APR-DRG 4254
Min. Negotiated Rate	$20,800.00
Max. Negotiated Rate	$73,453.50
Rate for Payer: Affinity Essential Plan 1&2	$73,453.50
Rate for Payer: Affinity Essential Plan 3&4	$73,453.50
Rate for Payer: Affinity Medicaid/CHP/HARP	$32,646.00
Rate for Payer: Amida Care Medicaid	$32,646.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$32,646.00
Rate for Payer: Fidelis Qualified Health Plan	$39,175.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$32,646.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$32,646.00
Rate for Payer: Healthfirst Commercial	$42,893.00
Rate for Payer: Healthfirst Essential Plan	$73,453.50
Rate for Payer: Healthfirst QHP	$20,800.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$32,646.00
Rate for Payer: SOMOS Essential	$73,453.50
Rate for Payer: United Healthcare Essential Plan 1&2	$73,453.50
Rate for Payer: United Healthcare Essential Plan 3&4	$73,453.50
Rate for Payer: United Healthcare Medicaid	$32,646.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$32,646.00

APR-DRG 4401: Kidney transplant

Facility

$164,943.00

Service Code	APR-DRG 4401
Min. Negotiated Rate	$42,143.22
Max. Negotiated Rate	$164,943.00
Rate for Payer: Affinity Essential Plan 1&2	$94,822.24
Rate for Payer: Affinity Essential Plan 3&4	$94,822.24
Rate for Payer: Affinity Medicaid/CHP/HARP	$42,143.22
Rate for Payer: Amida Care Medicaid	$42,143.22
Rate for Payer: Fidelis CHP/HARP/Medicaid	$42,143.22
Rate for Payer: Fidelis Qualified Health Plan	$50,571.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$42,143.22
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$42,143.22
Rate for Payer: Healthfirst Commercial	$164,943.00
Rate for Payer: Healthfirst Essential Plan	$94,822.24
Rate for Payer: Healthfirst QHP	$74,003.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$42,143.22
Rate for Payer: SOMOS Essential	$94,822.24
Rate for Payer: United Healthcare Essential Plan 1&2	$94,822.24
Rate for Payer: United Healthcare Essential Plan 3&4	$94,822.24
Rate for Payer: United Healthcare Medicaid	$42,143.22
Rate for Payer: Wellcare CHP/FHP/Medicaid	$42,143.22

APR-DRG 4402: Kidney transplant

Facility

$168,510.00

Service Code	APR-DRG 4402
Min. Negotiated Rate	$49,486.19
Max. Negotiated Rate	$168,510.00
Rate for Payer: Affinity Essential Plan 1&2	$111,343.93
Rate for Payer: Affinity Essential Plan 3&4	$111,343.93
Rate for Payer: Affinity Medicaid/CHP/HARP	$49,486.19
Rate for Payer: Amida Care Medicaid	$49,486.19
Rate for Payer: Fidelis CHP/HARP/Medicaid	$49,486.19
Rate for Payer: Fidelis Qualified Health Plan	$59,383.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$49,486.19
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$49,486.19
Rate for Payer: Healthfirst Commercial	$168,510.00
Rate for Payer: Healthfirst Essential Plan	$111,343.93
Rate for Payer: Healthfirst QHP	$81,081.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$49,486.19
Rate for Payer: SOMOS Essential	$111,343.93
Rate for Payer: United Healthcare Essential Plan 1&2	$111,343.93
Rate for Payer: United Healthcare Essential Plan 3&4	$111,343.93
Rate for Payer: United Healthcare Medicaid	$49,486.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$49,486.19

APR-DRG 4403: Kidney transplant

Facility

$194,434.00

Service Code	APR-DRG 4403
Min. Negotiated Rate	$57,513.89
Max. Negotiated Rate	$194,434.00
Rate for Payer: Affinity Essential Plan 1&2	$129,406.25
Rate for Payer: Affinity Essential Plan 3&4	$129,406.25
Rate for Payer: Affinity Medicaid/CHP/HARP	$57,513.89
Rate for Payer: Amida Care Medicaid	$57,513.89
Rate for Payer: Fidelis CHP/HARP/Medicaid	$57,513.89
Rate for Payer: Fidelis Qualified Health Plan	$69,016.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$57,513.89
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$57,513.89
Rate for Payer: Healthfirst Commercial	$194,434.00
Rate for Payer: Healthfirst Essential Plan	$129,406.25
Rate for Payer: Healthfirst QHP	$92,736.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$57,513.89
Rate for Payer: SOMOS Essential	$129,406.25
Rate for Payer: United Healthcare Essential Plan 1&2	$129,406.25
Rate for Payer: United Healthcare Essential Plan 3&4	$129,406.25
Rate for Payer: United Healthcare Medicaid	$57,513.89
Rate for Payer: Wellcare CHP/FHP/Medicaid	$57,513.89

APR-DRG 4404: Kidney transplant

Facility

$284,677.00

Service Code	APR-DRG 4404
Min. Negotiated Rate	$94,343.60
Max. Negotiated Rate	$284,677.00
Rate for Payer: Affinity Essential Plan 1&2	$212,273.10
Rate for Payer: Affinity Essential Plan 3&4	$212,273.10
Rate for Payer: Affinity Medicaid/CHP/HARP	$94,343.60
Rate for Payer: Amida Care Medicaid	$94,343.60
Rate for Payer: Fidelis CHP/HARP/Medicaid	$94,343.60
Rate for Payer: Fidelis Qualified Health Plan	$113,212.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$94,343.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$94,343.60
Rate for Payer: Healthfirst Commercial	$284,677.00
Rate for Payer: Healthfirst Essential Plan	$212,273.10
Rate for Payer: Healthfirst QHP	$140,549.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$94,343.60
Rate for Payer: SOMOS Essential	$212,273.10
Rate for Payer: United Healthcare Essential Plan 1&2	$212,273.10
Rate for Payer: United Healthcare Essential Plan 3&4	$212,273.10
Rate for Payer: United Healthcare Medicaid	$94,343.60
Rate for Payer: Wellcare CHP/FHP/Medicaid	$94,343.60

APR-DRG 4411: Major bladder procedures

Facility

$52,162.11

Service Code	APR-DRG 4411
Min. Negotiated Rate	$16,755.00
Max. Negotiated Rate	$52,162.11
Rate for Payer: Affinity Essential Plan 1&2	$52,162.11
Rate for Payer: Affinity Essential Plan 3&4	$52,162.11
Rate for Payer: Affinity Medicaid/CHP/HARP	$23,183.16
Rate for Payer: Amida Care Medicaid	$23,183.16
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,183.16
Rate for Payer: Fidelis Qualified Health Plan	$27,819.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,183.16
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,183.16
Rate for Payer: Healthfirst Commercial	$28,659.00
Rate for Payer: Healthfirst Essential Plan	$52,162.11
Rate for Payer: Healthfirst QHP	$16,755.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,183.16
Rate for Payer: SOMOS Essential	$52,162.11
Rate for Payer: United Healthcare Essential Plan 1&2	$52,162.11
Rate for Payer: United Healthcare Essential Plan 3&4	$52,162.11
Rate for Payer: United Healthcare Medicaid	$23,183.16
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,183.16

APR-DRG 4412: Major bladder procedures

Facility

$68,798.09

Service Code	APR-DRG 4412
Min. Negotiated Rate	$25,348.00
Max. Negotiated Rate	$68,798.09
Rate for Payer: Affinity Essential Plan 1&2	$68,798.09
Rate for Payer: Affinity Essential Plan 3&4	$68,798.09
Rate for Payer: Affinity Medicaid/CHP/HARP	$30,576.93
Rate for Payer: Amida Care Medicaid	$30,576.93
Rate for Payer: Fidelis CHP/HARP/Medicaid	$30,576.93
Rate for Payer: Fidelis Qualified Health Plan	$36,692.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$30,576.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$30,576.93
Rate for Payer: Healthfirst Commercial	$42,488.00
Rate for Payer: Healthfirst Essential Plan	$68,798.09
Rate for Payer: Healthfirst QHP	$25,348.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$30,576.93
Rate for Payer: SOMOS Essential	$68,798.09
Rate for Payer: United Healthcare Essential Plan 1&2	$68,798.09
Rate for Payer: United Healthcare Essential Plan 3&4	$68,798.09
Rate for Payer: United Healthcare Medicaid	$30,576.93
Rate for Payer: Wellcare CHP/FHP/Medicaid	$30,576.93

APR-DRG 4413: Major bladder procedures

Facility

$85,003.18

Service Code	APR-DRG 4413
Min. Negotiated Rate	$34,958.00
Max. Negotiated Rate	$85,003.18
Rate for Payer: Affinity Essential Plan 1&2	$85,003.18
Rate for Payer: Affinity Essential Plan 3&4	$85,003.18
Rate for Payer: Affinity Medicaid/CHP/HARP	$37,779.19
Rate for Payer: Amida Care Medicaid	$37,779.19
Rate for Payer: Fidelis CHP/HARP/Medicaid	$37,779.19
Rate for Payer: Fidelis Qualified Health Plan	$45,335.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$37,779.19
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$37,779.19
Rate for Payer: Healthfirst Commercial	$59,934.00
Rate for Payer: Healthfirst Essential Plan	$85,003.18
Rate for Payer: Healthfirst QHP	$34,958.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$37,779.19
Rate for Payer: SOMOS Essential	$85,003.18
Rate for Payer: United Healthcare Essential Plan 1&2	$85,003.18
Rate for Payer: United Healthcare Essential Plan 3&4	$85,003.18
Rate for Payer: United Healthcare Medicaid	$37,779.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$37,779.19

APR-DRG 4414: Major bladder procedures

Facility

$148,592.41

Service Code	APR-DRG 4414
Min. Negotiated Rate	$66,041.07
Max. Negotiated Rate	$148,592.41
Rate for Payer: Affinity Essential Plan 1&2	$148,592.41
Rate for Payer: Affinity Essential Plan 3&4	$148,592.41
Rate for Payer: Affinity Medicaid/CHP/HARP	$66,041.07
Rate for Payer: Amida Care Medicaid	$66,041.07
Rate for Payer: Fidelis CHP/HARP/Medicaid	$66,041.07
Rate for Payer: Fidelis Qualified Health Plan	$79,249.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$66,041.07
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$66,041.07
Rate for Payer: Healthfirst Commercial	$135,454.00
Rate for Payer: Healthfirst Essential Plan	$148,592.41
Rate for Payer: Healthfirst QHP	$87,340.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$66,041.07
Rate for Payer: SOMOS Essential	$148,592.41
Rate for Payer: United Healthcare Essential Plan 1&2	$148,592.41
Rate for Payer: United Healthcare Essential Plan 3&4	$148,592.41
Rate for Payer: United Healthcare Medicaid	$66,041.07
Rate for Payer: Wellcare CHP/FHP/Medicaid	$66,041.07

APR-DRG 4421: Kidney & urinary tract procedures for malignancy

Facility

$52,401.31

Service Code	APR-DRG 4421
Min. Negotiated Rate	$14,765.00
Max. Negotiated Rate	$52,401.31
Rate for Payer: Affinity Essential Plan 1&2	$52,401.31
Rate for Payer: Affinity Essential Plan 3&4	$52,401.31
Rate for Payer: Affinity Medicaid/CHP/HARP	$23,289.47
Rate for Payer: Amida Care Medicaid	$23,289.47
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,289.47
Rate for Payer: Fidelis Qualified Health Plan	$27,947.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,289.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,289.47
Rate for Payer: Healthfirst Commercial	$24,992.00
Rate for Payer: Healthfirst Essential Plan	$52,401.31
Rate for Payer: Healthfirst QHP	$14,765.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,289.47
Rate for Payer: SOMOS Essential	$52,401.31
Rate for Payer: United Healthcare Essential Plan 1&2	$52,401.31
Rate for Payer: United Healthcare Essential Plan 3&4	$52,401.31
Rate for Payer: United Healthcare Medicaid	$23,289.47
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,289.47

APR-DRG 4422: Kidney & urinary tract procedures for malignancy

Facility

$56,680.34

Service Code	APR-DRG 4422
Min. Negotiated Rate	$17,645.00
Max. Negotiated Rate	$56,680.34
Rate for Payer: Affinity Essential Plan 1&2	$56,680.34
Rate for Payer: Affinity Essential Plan 3&4	$56,680.34
Rate for Payer: Affinity Medicaid/CHP/HARP	$25,191.26
Rate for Payer: Amida Care Medicaid	$25,191.26
Rate for Payer: Fidelis CHP/HARP/Medicaid	$25,191.26
Rate for Payer: Fidelis Qualified Health Plan	$30,229.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$25,191.26
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25,191.26
Rate for Payer: Healthfirst Commercial	$29,537.00
Rate for Payer: Healthfirst Essential Plan	$56,680.34
Rate for Payer: Healthfirst QHP	$17,645.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$25,191.26
Rate for Payer: SOMOS Essential	$56,680.34
Rate for Payer: United Healthcare Essential Plan 1&2	$56,680.34
Rate for Payer: United Healthcare Essential Plan 3&4	$56,680.34
Rate for Payer: United Healthcare Medicaid	$25,191.26
Rate for Payer: Wellcare CHP/FHP/Medicaid	$25,191.26

APR-DRG 4423: Kidney & urinary tract procedures for malignancy

Facility

$79,164.14

Service Code	APR-DRG 4423
Min. Negotiated Rate	$29,318.00
Max. Negotiated Rate	$79,164.14
Rate for Payer: Affinity Essential Plan 1&2	$79,164.14
Rate for Payer: Affinity Essential Plan 3&4	$79,164.14
Rate for Payer: Affinity Medicaid/CHP/HARP	$35,184.06
Rate for Payer: Amida Care Medicaid	$35,184.06
Rate for Payer: Fidelis CHP/HARP/Medicaid	$35,184.06
Rate for Payer: Fidelis Qualified Health Plan	$42,220.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$35,184.06
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$35,184.06
Rate for Payer: Healthfirst Commercial	$51,466.00
Rate for Payer: Healthfirst Essential Plan	$79,164.14
Rate for Payer: Healthfirst QHP	$29,318.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$35,184.06
Rate for Payer: SOMOS Essential	$79,164.14
Rate for Payer: United Healthcare Essential Plan 1&2	$79,164.14
Rate for Payer: United Healthcare Essential Plan 3&4	$79,164.14
Rate for Payer: United Healthcare Medicaid	$35,184.06
Rate for Payer: Wellcare CHP/FHP/Medicaid	$35,184.06

APR-DRG 4424: Kidney & urinary tract procedures for malignancy

Facility

$141,779.02

Service Code	APR-DRG 4424
Min. Negotiated Rate	$63,012.90
Max. Negotiated Rate	$141,779.02
Rate for Payer: Affinity Essential Plan 1&2	$141,779.02
Rate for Payer: Affinity Essential Plan 3&4	$141,779.02
Rate for Payer: Affinity Medicaid/CHP/HARP	$63,012.90
Rate for Payer: Amida Care Medicaid	$63,012.90
Rate for Payer: Fidelis CHP/HARP/Medicaid	$63,012.90
Rate for Payer: Fidelis Qualified Health Plan	$75,615.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$63,012.90
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$63,012.90
Rate for Payer: Healthfirst Commercial	$113,854.00
Rate for Payer: Healthfirst Essential Plan	$141,779.02
Rate for Payer: Healthfirst QHP	$65,522.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$63,012.90
Rate for Payer: SOMOS Essential	$141,779.02
Rate for Payer: United Healthcare Essential Plan 1&2	$141,779.02
Rate for Payer: United Healthcare Essential Plan 3&4	$141,779.02
Rate for Payer: United Healthcare Medicaid	$63,012.90
Rate for Payer: Wellcare CHP/FHP/Medicaid	$63,012.90

APR-DRG 4431: Kidney & urinary tract procedures for nonmalignancy

Facility

$48,505.68

Service Code	APR-DRG 4431
Min. Negotiated Rate	$12,779.00
Max. Negotiated Rate	$48,505.68
Rate for Payer: Affinity Essential Plan 1&2	$48,505.68
Rate for Payer: Affinity Essential Plan 3&4	$48,505.68
Rate for Payer: Affinity Medicaid/CHP/HARP	$21,558.08
Rate for Payer: Amida Care Medicaid	$21,558.08
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,558.08
Rate for Payer: Fidelis Qualified Health Plan	$25,869.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,558.08
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,558.08
Rate for Payer: Healthfirst Commercial	$21,445.00
Rate for Payer: Healthfirst Essential Plan	$48,505.68
Rate for Payer: Healthfirst QHP	$12,779.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,558.08
Rate for Payer: SOMOS Essential	$48,505.68
Rate for Payer: United Healthcare Essential Plan 1&2	$48,505.68
Rate for Payer: United Healthcare Essential Plan 3&4	$48,505.68
Rate for Payer: United Healthcare Medicaid	$21,558.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,558.08

APR-DRG 4432: Kidney & urinary tract procedures for nonmalignancy

Facility

$50,605.63

Service Code	APR-DRG 4432
Min. Negotiated Rate	$14,272.00
Max. Negotiated Rate	$50,605.63
Rate for Payer: Affinity Essential Plan 1&2	$50,605.63
Rate for Payer: Affinity Essential Plan 3&4	$50,605.63
Rate for Payer: Affinity Medicaid/CHP/HARP	$22,491.39
Rate for Payer: Amida Care Medicaid	$22,491.39
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,491.39
Rate for Payer: Fidelis Qualified Health Plan	$26,989.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,491.39
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,491.39
Rate for Payer: Healthfirst Commercial	$23,240.00
Rate for Payer: Healthfirst Essential Plan	$50,605.63
Rate for Payer: Healthfirst QHP	$14,272.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,491.39
Rate for Payer: SOMOS Essential	$50,605.63
Rate for Payer: United Healthcare Essential Plan 1&2	$50,605.63
Rate for Payer: United Healthcare Essential Plan 3&4	$50,605.63
Rate for Payer: United Healthcare Medicaid	$22,491.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,491.39

APR-DRG 4433: Kidney & urinary tract procedures for nonmalignancy

Facility

$69,598.33

Service Code	APR-DRG 4433
Min. Negotiated Rate	$25,671.00
Max. Negotiated Rate	$69,598.33
Rate for Payer: Affinity Essential Plan 1&2	$69,598.33
Rate for Payer: Affinity Essential Plan 3&4	$69,598.33
Rate for Payer: Affinity Medicaid/CHP/HARP	$30,932.59
Rate for Payer: Amida Care Medicaid	$30,932.59
Rate for Payer: Fidelis CHP/HARP/Medicaid	$30,932.59
Rate for Payer: Fidelis Qualified Health Plan	$37,119.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$30,932.59
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$30,932.59
Rate for Payer: Healthfirst Commercial	$42,985.00
Rate for Payer: Healthfirst Essential Plan	$69,598.33
Rate for Payer: Healthfirst QHP	$25,671.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$30,932.59
Rate for Payer: SOMOS Essential	$69,598.33
Rate for Payer: United Healthcare Essential Plan 1&2	$69,598.33
Rate for Payer: United Healthcare Essential Plan 3&4	$69,598.33
Rate for Payer: United Healthcare Medicaid	$30,932.59
Rate for Payer: Wellcare CHP/FHP/Medicaid	$30,932.59

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