St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

APR-DRG 4434: Kidney & urinary tract procedures for nonmalignancy

Facility

$118,772.86

Service Code	APR-DRG 4434
Min. Negotiated Rate	$52,787.94
Max. Negotiated Rate	$118,772.86
Rate for Payer: Affinity Essential Plan 1&2	$118,772.86
Rate for Payer: Affinity Essential Plan 3&4	$118,772.86
Rate for Payer: Affinity Medicaid/CHP/HARP	$52,787.94
Rate for Payer: Amida Care Medicaid	$52,787.94
Rate for Payer: Fidelis CHP/HARP/Medicaid	$52,787.94
Rate for Payer: Fidelis Qualified Health Plan	$63,345.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$52,787.94
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$52,787.94
Rate for Payer: Healthfirst Commercial	$105,797.00
Rate for Payer: Healthfirst Essential Plan	$118,772.86
Rate for Payer: Healthfirst QHP	$59,011.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$52,787.94
Rate for Payer: SOMOS Essential	$118,772.86
Rate for Payer: United Healthcare Essential Plan 1&2	$118,772.86
Rate for Payer: United Healthcare Essential Plan 3&4	$118,772.86
Rate for Payer: United Healthcare Medicaid	$52,787.94
Rate for Payer: Wellcare CHP/FHP/Medicaid	$52,787.94

APR-DRG 4441: Renal dialysis access device procedure only

Facility

$46,921.05

Service Code	APR-DRG 4441
Min. Negotiated Rate	$11,671.00
Max. Negotiated Rate	$46,921.05
Rate for Payer: Affinity Essential Plan 1&2	$46,921.05
Rate for Payer: Affinity Essential Plan 3&4	$46,921.05
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,853.80
Rate for Payer: Amida Care Medicaid	$20,853.80
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,853.80
Rate for Payer: Fidelis Qualified Health Plan	$25,024.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,853.80
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,853.80
Rate for Payer: Healthfirst Commercial	$20,448.00
Rate for Payer: Healthfirst Essential Plan	$46,921.05
Rate for Payer: Healthfirst QHP	$11,671.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,853.80
Rate for Payer: SOMOS Essential	$46,921.05
Rate for Payer: United Healthcare Essential Plan 1&2	$46,921.05
Rate for Payer: United Healthcare Essential Plan 3&4	$46,921.05
Rate for Payer: United Healthcare Medicaid	$20,853.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,853.80

APR-DRG 4442: Renal dialysis access device procedure only

Facility

$60,366.67

Service Code	APR-DRG 4442
Min. Negotiated Rate	$17,664.00
Max. Negotiated Rate	$60,366.67
Rate for Payer: Affinity Essential Plan 1&2	$60,366.67
Rate for Payer: Affinity Essential Plan 3&4	$60,366.67
Rate for Payer: Affinity Medicaid/CHP/HARP	$26,829.63
Rate for Payer: Amida Care Medicaid	$26,829.63
Rate for Payer: Fidelis CHP/HARP/Medicaid	$26,829.63
Rate for Payer: Fidelis Qualified Health Plan	$32,195.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$26,829.63
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$26,829.63
Rate for Payer: Healthfirst Commercial	$30,086.00
Rate for Payer: Healthfirst Essential Plan	$60,366.67
Rate for Payer: Healthfirst QHP	$17,664.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26,829.63
Rate for Payer: SOMOS Essential	$60,366.67
Rate for Payer: United Healthcare Essential Plan 1&2	$60,366.67
Rate for Payer: United Healthcare Essential Plan 3&4	$60,366.67
Rate for Payer: United Healthcare Medicaid	$26,829.63
Rate for Payer: Wellcare CHP/FHP/Medicaid	$26,829.63

APR-DRG 4443: Renal dialysis access device procedure only

Facility

$86,496.34

Service Code	APR-DRG 4443
Min. Negotiated Rate	$33,511.00
Max. Negotiated Rate	$86,496.34
Rate for Payer: Affinity Essential Plan 1&2	$86,496.34
Rate for Payer: Affinity Essential Plan 3&4	$86,496.34
Rate for Payer: Affinity Medicaid/CHP/HARP	$38,442.82
Rate for Payer: Amida Care Medicaid	$38,442.82
Rate for Payer: Fidelis CHP/HARP/Medicaid	$38,442.82
Rate for Payer: Fidelis Qualified Health Plan	$46,131.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$38,442.82
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$38,442.82
Rate for Payer: Healthfirst Commercial	$57,702.00
Rate for Payer: Healthfirst Essential Plan	$86,496.34
Rate for Payer: Healthfirst QHP	$33,511.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$38,442.82
Rate for Payer: SOMOS Essential	$86,496.34
Rate for Payer: United Healthcare Essential Plan 1&2	$86,496.34
Rate for Payer: United Healthcare Essential Plan 3&4	$86,496.34
Rate for Payer: United Healthcare Medicaid	$38,442.82
Rate for Payer: Wellcare CHP/FHP/Medicaid	$38,442.82

APR-DRG 4444: Renal dialysis access device procedure only

Facility

$138,437.42

Service Code	APR-DRG 4444
Min. Negotiated Rate	$61,527.74
Max. Negotiated Rate	$138,437.42
Rate for Payer: Affinity Essential Plan 1&2	$138,437.42
Rate for Payer: Affinity Essential Plan 3&4	$138,437.42
Rate for Payer: Affinity Medicaid/CHP/HARP	$61,527.74
Rate for Payer: Amida Care Medicaid	$61,527.74
Rate for Payer: Fidelis CHP/HARP/Medicaid	$61,527.74
Rate for Payer: Fidelis Qualified Health Plan	$73,833.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$61,527.74
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$61,527.74
Rate for Payer: Healthfirst Commercial	$111,996.00
Rate for Payer: Healthfirst Essential Plan	$138,437.42
Rate for Payer: Healthfirst QHP	$74,800.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$61,527.74
Rate for Payer: SOMOS Essential	$138,437.42
Rate for Payer: United Healthcare Essential Plan 1&2	$138,437.42
Rate for Payer: United Healthcare Essential Plan 3&4	$138,437.42
Rate for Payer: United Healthcare Medicaid	$61,527.74
Rate for Payer: Wellcare CHP/FHP/Medicaid	$61,527.74

APR-DRG 4451: Other bladder procedures

Facility

$44,089.47

Service Code	APR-DRG 4451
Min. Negotiated Rate	$8,222.00
Max. Negotiated Rate	$44,089.47
Rate for Payer: Affinity Essential Plan 1&2	$44,089.47
Rate for Payer: Affinity Essential Plan 3&4	$44,089.47
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,595.32
Rate for Payer: Amida Care Medicaid	$19,595.32
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,595.32
Rate for Payer: Fidelis Qualified Health Plan	$23,514.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,595.32
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,595.32
Rate for Payer: Healthfirst Commercial	$14,301.00
Rate for Payer: Healthfirst Essential Plan	$44,089.47
Rate for Payer: Healthfirst QHP	$8,222.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,595.32
Rate for Payer: SOMOS Essential	$44,089.47
Rate for Payer: United Healthcare Essential Plan 1&2	$44,089.47
Rate for Payer: United Healthcare Essential Plan 3&4	$44,089.47
Rate for Payer: United Healthcare Medicaid	$19,595.32
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,595.32

APR-DRG 4452: Other bladder procedures

Facility

$51,963.37

Service Code	APR-DRG 4452
Min. Negotiated Rate	$13,123.00
Max. Negotiated Rate	$51,963.37
Rate for Payer: Affinity Essential Plan 1&2	$51,963.37
Rate for Payer: Affinity Essential Plan 3&4	$51,963.37
Rate for Payer: Affinity Medicaid/CHP/HARP	$23,094.83
Rate for Payer: Amida Care Medicaid	$23,094.83
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,094.83
Rate for Payer: Fidelis Qualified Health Plan	$27,713.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,094.83
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,094.83
Rate for Payer: Healthfirst Commercial	$22,612.00
Rate for Payer: Healthfirst Essential Plan	$51,963.37
Rate for Payer: Healthfirst QHP	$13,123.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,094.83
Rate for Payer: SOMOS Essential	$51,963.37
Rate for Payer: United Healthcare Essential Plan 1&2	$51,963.37
Rate for Payer: United Healthcare Essential Plan 3&4	$51,963.37
Rate for Payer: United Healthcare Medicaid	$23,094.83
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,094.83

APR-DRG 4453: Other bladder procedures

Facility

$62,580.92

Service Code	APR-DRG 4453
Min. Negotiated Rate	$16,655.00
Max. Negotiated Rate	$62,580.92
Rate for Payer: Affinity Essential Plan 1&2	$62,580.92
Rate for Payer: Affinity Essential Plan 3&4	$62,580.92
Rate for Payer: Affinity Medicaid/CHP/HARP	$27,813.74
Rate for Payer: Amida Care Medicaid	$27,813.74
Rate for Payer: Fidelis CHP/HARP/Medicaid	$27,813.74
Rate for Payer: Fidelis Qualified Health Plan	$33,376.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$27,813.74
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$27,813.74
Rate for Payer: Healthfirst Commercial	$33,678.00
Rate for Payer: Healthfirst Essential Plan	$62,580.92
Rate for Payer: Healthfirst QHP	$16,655.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$27,813.74
Rate for Payer: SOMOS Essential	$62,580.92
Rate for Payer: United Healthcare Essential Plan 1&2	$62,580.92
Rate for Payer: United Healthcare Essential Plan 3&4	$62,580.92
Rate for Payer: United Healthcare Medicaid	$27,813.74
Rate for Payer: Wellcare CHP/FHP/Medicaid	$27,813.74

APR-DRG 4454: Other bladder procedures

Facility

$72,725.38

Service Code	APR-DRG 4454
Min. Negotiated Rate	$21,779.00
Max. Negotiated Rate	$72,725.38
Rate for Payer: Affinity Essential Plan 1&2	$72,725.38
Rate for Payer: Affinity Essential Plan 3&4	$72,725.38
Rate for Payer: Affinity Medicaid/CHP/HARP	$32,322.39
Rate for Payer: Amida Care Medicaid	$32,322.39
Rate for Payer: Fidelis CHP/HARP/Medicaid	$32,322.39
Rate for Payer: Fidelis Qualified Health Plan	$38,786.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$32,322.39
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$32,322.39
Rate for Payer: Healthfirst Commercial	$43,972.00
Rate for Payer: Healthfirst Essential Plan	$72,725.38
Rate for Payer: Healthfirst QHP	$21,779.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$32,322.39
Rate for Payer: SOMOS Essential	$72,725.38
Rate for Payer: United Healthcare Essential Plan 1&2	$72,725.38
Rate for Payer: United Healthcare Essential Plan 3&4	$72,725.38
Rate for Payer: United Healthcare Medicaid	$32,322.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$32,322.39

APR-DRG 4461: Urethral & transurethral procedures

Facility

$41,681.74

Service Code	APR-DRG 4461
Min. Negotiated Rate	$7,519.00
Max. Negotiated Rate	$41,681.74
Rate for Payer: Affinity Essential Plan 1&2	$41,681.74
Rate for Payer: Affinity Essential Plan 3&4	$41,681.74
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,525.22
Rate for Payer: Amida Care Medicaid	$18,525.22
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,525.22
Rate for Payer: Fidelis Qualified Health Plan	$22,230.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,525.22
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,525.22
Rate for Payer: Healthfirst Commercial	$12,609.00
Rate for Payer: Healthfirst Essential Plan	$41,681.74
Rate for Payer: Healthfirst QHP	$7,519.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,525.22
Rate for Payer: SOMOS Essential	$41,681.74
Rate for Payer: United Healthcare Essential Plan 1&2	$41,681.74
Rate for Payer: United Healthcare Essential Plan 3&4	$41,681.74
Rate for Payer: United Healthcare Medicaid	$18,525.22
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,525.22

APR-DRG 4462: Urethral & transurethral procedures

Facility

$43,540.74

Service Code	APR-DRG 4462
Min. Negotiated Rate	$8,662.00
Max. Negotiated Rate	$43,540.74
Rate for Payer: Affinity Essential Plan 1&2	$43,540.74
Rate for Payer: Affinity Essential Plan 3&4	$43,540.74
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,351.44
Rate for Payer: Amida Care Medicaid	$19,351.44
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,351.44
Rate for Payer: Fidelis Qualified Health Plan	$23,221.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,351.44
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,351.44
Rate for Payer: Healthfirst Commercial	$14,893.00
Rate for Payer: Healthfirst Essential Plan	$43,540.74
Rate for Payer: Healthfirst QHP	$8,662.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,351.44
Rate for Payer: SOMOS Essential	$43,540.74
Rate for Payer: United Healthcare Essential Plan 1&2	$43,540.74
Rate for Payer: United Healthcare Essential Plan 3&4	$43,540.74
Rate for Payer: United Healthcare Medicaid	$19,351.44
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,351.44

APR-DRG 4463: Urethral & transurethral procedures

Facility

$56,161.48

Service Code	APR-DRG 4463
Min. Negotiated Rate	$15,287.00
Max. Negotiated Rate	$56,161.48
Rate for Payer: Affinity Essential Plan 1&2	$56,161.48
Rate for Payer: Affinity Essential Plan 3&4	$56,161.48
Rate for Payer: Affinity Medicaid/CHP/HARP	$24,960.66
Rate for Payer: Amida Care Medicaid	$24,960.66
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,960.66
Rate for Payer: Fidelis Qualified Health Plan	$29,952.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,960.66
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,960.66
Rate for Payer: Healthfirst Commercial	$26,632.00
Rate for Payer: Healthfirst Essential Plan	$56,161.48
Rate for Payer: Healthfirst QHP	$15,287.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,960.66
Rate for Payer: SOMOS Essential	$56,161.48
Rate for Payer: United Healthcare Essential Plan 1&2	$56,161.48
Rate for Payer: United Healthcare Essential Plan 3&4	$56,161.48
Rate for Payer: United Healthcare Medicaid	$24,960.66
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,960.66

APR-DRG 4464: Urethral & transurethral procedures

Facility

$87,486.52

Service Code	APR-DRG 4464
Min. Negotiated Rate	$27,304.00
Max. Negotiated Rate	$87,486.52
Rate for Payer: Affinity Essential Plan 1&2	$87,486.52
Rate for Payer: Affinity Essential Plan 3&4	$87,486.52
Rate for Payer: Affinity Medicaid/CHP/HARP	$38,882.90
Rate for Payer: Amida Care Medicaid	$38,882.90
Rate for Payer: Fidelis CHP/HARP/Medicaid	$38,882.90
Rate for Payer: Fidelis Qualified Health Plan	$46,659.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$38,882.90
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$38,882.90
Rate for Payer: Healthfirst Commercial	$65,055.00
Rate for Payer: Healthfirst Essential Plan	$87,486.52
Rate for Payer: Healthfirst QHP	$27,304.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$38,882.90
Rate for Payer: SOMOS Essential	$87,486.52
Rate for Payer: United Healthcare Essential Plan 1&2	$87,486.52
Rate for Payer: United Healthcare Essential Plan 3&4	$87,486.52
Rate for Payer: United Healthcare Medicaid	$38,882.90
Rate for Payer: Wellcare CHP/FHP/Medicaid	$38,882.90

APR-DRG 4471: Other kidney, urinary tract & related procedures

Facility

$50,690.05

Service Code	APR-DRG 4471
Min. Negotiated Rate	$13,171.00
Max. Negotiated Rate	$50,690.05
Rate for Payer: Affinity Essential Plan 1&2	$50,690.05
Rate for Payer: Affinity Essential Plan 3&4	$50,690.05
Rate for Payer: Affinity Medicaid/CHP/HARP	$22,528.91
Rate for Payer: Amida Care Medicaid	$22,528.91
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,528.91
Rate for Payer: Fidelis Qualified Health Plan	$27,034.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,528.91
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,528.91
Rate for Payer: Healthfirst Commercial	$21,777.00
Rate for Payer: Healthfirst Essential Plan	$50,690.05
Rate for Payer: Healthfirst QHP	$13,171.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,528.91
Rate for Payer: SOMOS Essential	$50,690.05
Rate for Payer: United Healthcare Essential Plan 1&2	$50,690.05
Rate for Payer: United Healthcare Essential Plan 3&4	$50,690.05
Rate for Payer: United Healthcare Medicaid	$22,528.91
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,528.91

APR-DRG 4472: Other kidney, urinary tract & related procedures

Facility

$52,549.02

Service Code	APR-DRG 4472
Min. Negotiated Rate	$16,343.00
Max. Negotiated Rate	$52,549.02
Rate for Payer: Affinity Essential Plan 1&2	$52,549.02
Rate for Payer: Affinity Essential Plan 3&4	$52,549.02
Rate for Payer: Affinity Medicaid/CHP/HARP	$23,355.12
Rate for Payer: Amida Care Medicaid	$23,355.12
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,355.12
Rate for Payer: Fidelis Qualified Health Plan	$28,026.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,355.12
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,355.12
Rate for Payer: Healthfirst Commercial	$26,836.00
Rate for Payer: Healthfirst Essential Plan	$52,549.02
Rate for Payer: Healthfirst QHP	$16,343.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,355.12
Rate for Payer: SOMOS Essential	$52,549.02
Rate for Payer: United Healthcare Essential Plan 1&2	$52,549.02
Rate for Payer: United Healthcare Essential Plan 3&4	$52,549.02
Rate for Payer: United Healthcare Medicaid	$23,355.12
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,355.12

APR-DRG 4473: Other kidney, urinary tract & related procedures

Facility

$81,195.48

Service Code	APR-DRG 4473
Min. Negotiated Rate	$27,966.00
Max. Negotiated Rate	$81,195.48
Rate for Payer: Affinity Essential Plan 1&2	$81,195.48
Rate for Payer: Affinity Essential Plan 3&4	$81,195.48
Rate for Payer: Affinity Medicaid/CHP/HARP	$36,086.88
Rate for Payer: Amida Care Medicaid	$36,086.88
Rate for Payer: Fidelis CHP/HARP/Medicaid	$36,086.88
Rate for Payer: Fidelis Qualified Health Plan	$43,304.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$36,086.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$36,086.88
Rate for Payer: Healthfirst Commercial	$52,989.00
Rate for Payer: Healthfirst Essential Plan	$81,195.48
Rate for Payer: Healthfirst QHP	$27,966.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$36,086.88
Rate for Payer: SOMOS Essential	$81,195.48
Rate for Payer: United Healthcare Essential Plan 1&2	$81,195.48
Rate for Payer: United Healthcare Essential Plan 3&4	$81,195.48
Rate for Payer: United Healthcare Medicaid	$36,086.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$36,086.88

APR-DRG 4474: Other kidney, urinary tract & related procedures

Facility

$163,846.01

Service Code	APR-DRG 4474
Min. Negotiated Rate	$72,820.45
Max. Negotiated Rate	$163,846.01
Rate for Payer: Affinity Essential Plan 1&2	$163,846.01
Rate for Payer: Affinity Essential Plan 3&4	$163,846.01
Rate for Payer: Affinity Medicaid/CHP/HARP	$72,820.45
Rate for Payer: Amida Care Medicaid	$72,820.45
Rate for Payer: Fidelis CHP/HARP/Medicaid	$72,820.45
Rate for Payer: Fidelis Qualified Health Plan	$87,384.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$72,820.45
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$72,820.45
Rate for Payer: Healthfirst Commercial	$123,417.00
Rate for Payer: Healthfirst Essential Plan	$163,846.01
Rate for Payer: Healthfirst QHP	$76,315.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$72,820.45
Rate for Payer: SOMOS Essential	$163,846.01
Rate for Payer: United Healthcare Essential Plan 1&2	$163,846.01
Rate for Payer: United Healthcare Essential Plan 3&4	$163,846.01
Rate for Payer: United Healthcare Medicaid	$72,820.45
Rate for Payer: Wellcare CHP/FHP/Medicaid	$72,820.45

APR-DRG 4611: Kidney & urinary tract malignancy

Facility

$37,638.38

Service Code	APR-DRG 4611
Min. Negotiated Rate	$5,588.00
Max. Negotiated Rate	$37,638.38
Rate for Payer: Affinity Essential Plan 1&2	$37,638.38
Rate for Payer: Affinity Essential Plan 3&4	$37,638.38
Rate for Payer: Affinity Medicaid/CHP/HARP	$16,728.17
Rate for Payer: Amida Care Medicaid	$16,728.17
Rate for Payer: Fidelis CHP/HARP/Medicaid	$16,728.17
Rate for Payer: Fidelis Qualified Health Plan	$20,073.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$16,728.17
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16,728.17
Rate for Payer: Healthfirst Commercial	$11,009.00
Rate for Payer: Healthfirst Essential Plan	$37,638.38
Rate for Payer: Healthfirst QHP	$5,588.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$16,728.17
Rate for Payer: SOMOS Essential	$37,638.38
Rate for Payer: United Healthcare Essential Plan 1&2	$37,638.38
Rate for Payer: United Healthcare Essential Plan 3&4	$37,638.38
Rate for Payer: United Healthcare Medicaid	$16,728.17
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,728.17

APR-DRG 4612: Kidney & urinary tract malignancy

Facility

$43,804.55

Service Code	APR-DRG 4612
Min. Negotiated Rate	$8,823.00
Max. Negotiated Rate	$43,804.55
Rate for Payer: Affinity Essential Plan 1&2	$43,804.55
Rate for Payer: Affinity Essential Plan 3&4	$43,804.55
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,468.69
Rate for Payer: Amida Care Medicaid	$19,468.69
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,468.69
Rate for Payer: Fidelis Qualified Health Plan	$23,362.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,468.69
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,468.69
Rate for Payer: Healthfirst Commercial	$15,164.00
Rate for Payer: Healthfirst Essential Plan	$43,804.55
Rate for Payer: Healthfirst QHP	$8,823.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,468.69
Rate for Payer: SOMOS Essential	$43,804.55
Rate for Payer: United Healthcare Essential Plan 1&2	$43,804.55
Rate for Payer: United Healthcare Essential Plan 3&4	$43,804.55
Rate for Payer: United Healthcare Medicaid	$19,468.69
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,468.69

APR-DRG 4613: Kidney & urinary tract malignancy

Facility

$56,075.31

Service Code	APR-DRG 4613
Min. Negotiated Rate	$14,288.00
Max. Negotiated Rate	$56,075.31
Rate for Payer: Affinity Essential Plan 1&2	$56,075.31
Rate for Payer: Affinity Essential Plan 3&4	$56,075.31
Rate for Payer: Affinity Medicaid/CHP/HARP	$24,922.36
Rate for Payer: Amida Care Medicaid	$24,922.36
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,922.36
Rate for Payer: Fidelis Qualified Health Plan	$29,906.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,922.36
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,922.36
Rate for Payer: Healthfirst Commercial	$23,888.00
Rate for Payer: Healthfirst Essential Plan	$56,075.31
Rate for Payer: Healthfirst QHP	$14,288.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,922.36
Rate for Payer: SOMOS Essential	$56,075.31
Rate for Payer: United Healthcare Essential Plan 1&2	$56,075.31
Rate for Payer: United Healthcare Essential Plan 3&4	$56,075.31
Rate for Payer: United Healthcare Medicaid	$24,922.36
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,922.36

APR-DRG 4614: Kidney & urinary tract malignancy

Facility

$70,588.48

Service Code	APR-DRG 4614
Min. Negotiated Rate	$22,064.00
Max. Negotiated Rate	$70,588.48
Rate for Payer: Affinity Essential Plan 1&2	$70,588.48
Rate for Payer: Affinity Essential Plan 3&4	$70,588.48
Rate for Payer: Affinity Medicaid/CHP/HARP	$31,372.66
Rate for Payer: Amida Care Medicaid	$31,372.66
Rate for Payer: Fidelis CHP/HARP/Medicaid	$31,372.66
Rate for Payer: Fidelis Qualified Health Plan	$37,647.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$31,372.66
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$31,372.66
Rate for Payer: Healthfirst Commercial	$50,818.00
Rate for Payer: Healthfirst Essential Plan	$70,588.48
Rate for Payer: Healthfirst QHP	$22,064.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$31,372.66
Rate for Payer: SOMOS Essential	$70,588.48
Rate for Payer: United Healthcare Essential Plan 1&2	$70,588.48
Rate for Payer: United Healthcare Essential Plan 3&4	$70,588.48
Rate for Payer: United Healthcare Medicaid	$31,372.66
Rate for Payer: Wellcare CHP/FHP/Medicaid	$31,372.66

APR-DRG 4621: Nephritis & nephrosis

Facility

$40,023.25

Service Code	APR-DRG 4621
Min. Negotiated Rate	$5,860.00
Max. Negotiated Rate	$40,023.25
Rate for Payer: Affinity Essential Plan 1&2	$40,023.25
Rate for Payer: Affinity Essential Plan 3&4	$40,023.25
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,788.11
Rate for Payer: Amida Care Medicaid	$17,788.11
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,788.11
Rate for Payer: Fidelis Qualified Health Plan	$21,345.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,788.11
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,788.11
Rate for Payer: Healthfirst Commercial	$10,413.00
Rate for Payer: Healthfirst Essential Plan	$40,023.25
Rate for Payer: Healthfirst QHP	$5,860.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,788.11
Rate for Payer: SOMOS Essential	$40,023.25
Rate for Payer: United Healthcare Essential Plan 1&2	$40,023.25
Rate for Payer: United Healthcare Essential Plan 3&4	$40,023.25
Rate for Payer: United Healthcare Medicaid	$17,788.11
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,788.11

APR-DRG 4622: Nephritis & nephrosis

Facility

$42,251.58

Service Code	APR-DRG 4622
Min. Negotiated Rate	$7,808.00
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	$12,840.00
Rate for Payer: Healthfirst Essential Plan	$42,251.58
Rate for Payer: Healthfirst QHP	$7,808.00
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 4623: Nephritis & nephrosis

Facility

$51,887.74

Service Code	APR-DRG 4623
Min. Negotiated Rate	$11,817.00
Max. Negotiated Rate	$51,887.74
Rate for Payer: Affinity Essential Plan 1&2	$51,887.74
Rate for Payer: Affinity Essential Plan 3&4	$51,887.74
Rate for Payer: Affinity Medicaid/CHP/HARP	$23,061.22
Rate for Payer: Amida Care Medicaid	$23,061.22
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,061.22
Rate for Payer: Fidelis Qualified Health Plan	$27,673.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,061.22
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,061.22
Rate for Payer: Healthfirst Commercial	$21,130.00
Rate for Payer: Healthfirst Essential Plan	$51,887.74
Rate for Payer: Healthfirst QHP	$11,817.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,061.22
Rate for Payer: SOMOS Essential	$51,887.74
Rate for Payer: United Healthcare Essential Plan 1&2	$51,887.74
Rate for Payer: United Healthcare Essential Plan 3&4	$51,887.74
Rate for Payer: United Healthcare Medicaid	$23,061.22
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,061.22

APR-DRG 4624: Nephritis & nephrosis

Facility

$100,311.30

Service Code	APR-DRG 4624
Min. Negotiated Rate	$13,048.00
Max. Negotiated Rate	$100,311.30
Rate for Payer: Affinity Essential Plan 1&2	$100,311.30
Rate for Payer: Affinity Essential Plan 3&4	$100,311.30
Rate for Payer: Affinity Medicaid/CHP/HARP	$44,582.80
Rate for Payer: Amida Care Medicaid	$44,582.80
Rate for Payer: Fidelis CHP/HARP/Medicaid	$44,582.80
Rate for Payer: Fidelis Qualified Health Plan	$53,499.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$44,582.80
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$44,582.80
Rate for Payer: Healthfirst Commercial	$23,114.00
Rate for Payer: Healthfirst Essential Plan	$100,311.30
Rate for Payer: Healthfirst QHP	$13,048.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$44,582.80
Rate for Payer: SOMOS Essential	$100,311.30
Rate for Payer: United Healthcare Essential Plan 1&2	$100,311.30
Rate for Payer: United Healthcare Essential Plan 3&4	$100,311.30
Rate for Payer: United Healthcare Medicaid	$44,582.80
Rate for Payer: Wellcare CHP/FHP/Medicaid	$44,582.80

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