|
APR-DRG 8132: Other complications of treatment
|
Facility
|
IP
|
$41,727.46
|
|
|
Service Code
|
APR-DRG 8132
|
| Min. Negotiated Rate |
$7,445.00 |
| Max. Negotiated Rate |
$41,727.46 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$41,727.46
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$41,727.46
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$18,545.54
|
| Rate for Payer: Amida Care Medicaid |
$18,545.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18,545.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22,254.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18,545.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18,545.54
|
| Rate for Payer: Healthfirst Commercial |
$13,122.00
|
| Rate for Payer: Healthfirst Essential Plan |
$41,727.46
|
| Rate for Payer: Healthfirst QHP |
$7,445.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18,545.54
|
| Rate for Payer: SOMOS Essential |
$41,727.46
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$41,727.46
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$41,727.46
|
| Rate for Payer: United Healthcare Medicaid |
$18,545.54
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18,545.54
|
|
|
APR-DRG 8133: Other complications of treatment
|
Facility
|
IP
|
$49,659.41
|
|
|
Service Code
|
APR-DRG 8133
|
| Min. Negotiated Rate |
$11,574.00 |
| Max. Negotiated Rate |
$49,659.41 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$49,659.41
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$49,659.41
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$22,070.85
|
| Rate for Payer: Amida Care Medicaid |
$22,070.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22,070.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26,485.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22,070.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22,070.85
|
| Rate for Payer: Healthfirst Commercial |
$20,395.00
|
| Rate for Payer: Healthfirst Essential Plan |
$49,659.41
|
| Rate for Payer: Healthfirst QHP |
$11,574.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22,070.85
|
| Rate for Payer: SOMOS Essential |
$49,659.41
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$49,659.41
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$49,659.41
|
| Rate for Payer: United Healthcare Medicaid |
$22,070.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$22,070.85
|
|
|
APR-DRG 8134: Other complications of treatment
|
Facility
|
IP
|
$75,609.72
|
|
|
Service Code
|
APR-DRG 8134
|
| Min. Negotiated Rate |
$23,940.00 |
| Max. Negotiated Rate |
$75,609.72 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$75,609.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$75,609.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$33,604.32
|
| Rate for Payer: Amida Care Medicaid |
$33,604.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33,604.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$40,325.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33,604.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33,604.32
|
| Rate for Payer: Healthfirst Commercial |
$44,596.00
|
| Rate for Payer: Healthfirst Essential Plan |
$75,609.72
|
| Rate for Payer: Healthfirst QHP |
$23,940.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$33,604.32
|
| Rate for Payer: SOMOS Essential |
$75,609.72
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$75,609.72
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$75,609.72
|
| Rate for Payer: United Healthcare Medicaid |
$33,604.32
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$33,604.32
|
|
|
APR-DRG 8151: Other injury, poisoning & toxic effect diagnoses
|
Facility
|
IP
|
$35,997.48
|
|
|
Service Code
|
APR-DRG 8151
|
| Min. Negotiated Rate |
$4,459.00 |
| Max. Negotiated Rate |
$35,997.48 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$35,997.48
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$35,997.48
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$15,998.88
|
| Rate for Payer: Amida Care Medicaid |
$15,998.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15,998.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19,198.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,998.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15,998.88
|
| Rate for Payer: Healthfirst Commercial |
$7,629.00
|
| Rate for Payer: Healthfirst Essential Plan |
$35,997.48
|
| Rate for Payer: Healthfirst QHP |
$4,459.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15,998.88
|
| Rate for Payer: SOMOS Essential |
$35,997.48
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$35,997.48
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$35,997.48
|
| Rate for Payer: United Healthcare Medicaid |
$15,998.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$15,998.88
|
|
|
APR-DRG 8152: Other injury, poisoning & toxic effect diagnoses
|
Facility
|
IP
|
$40,512.17
|
|
|
Service Code
|
APR-DRG 8152
|
| Min. Negotiated Rate |
$6,595.00 |
| Max. Negotiated Rate |
$40,512.17 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$40,512.17
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$40,512.17
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$18,005.41
|
| Rate for Payer: Amida Care Medicaid |
$18,005.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18,005.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21,606.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18,005.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18,005.41
|
| Rate for Payer: Healthfirst Commercial |
$10,791.00
|
| Rate for Payer: Healthfirst Essential Plan |
$40,512.17
|
| Rate for Payer: Healthfirst QHP |
$6,595.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18,005.41
|
| Rate for Payer: SOMOS Essential |
$40,512.17
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$40,512.17
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$40,512.17
|
| Rate for Payer: United Healthcare Medicaid |
$18,005.41
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18,005.41
|
|
|
APR-DRG 8153: Other injury, poisoning & toxic effect diagnoses
|
Facility
|
IP
|
$48,190.86
|
|
|
Service Code
|
APR-DRG 8153
|
| Min. Negotiated Rate |
$11,550.00 |
| Max. Negotiated Rate |
$48,190.86 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$48,190.86
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$48,190.86
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$21,418.16
|
| Rate for Payer: Amida Care Medicaid |
$21,418.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21,418.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25,701.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21,418.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21,418.16
|
| Rate for Payer: Healthfirst Commercial |
$19,420.00
|
| Rate for Payer: Healthfirst Essential Plan |
$48,190.86
|
| Rate for Payer: Healthfirst QHP |
$11,550.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21,418.16
|
| Rate for Payer: SOMOS Essential |
$48,190.86
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$48,190.86
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$48,190.86
|
| Rate for Payer: United Healthcare Medicaid |
$21,418.16
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$21,418.16
|
|
|
APR-DRG 8154: Other injury, poisoning & toxic effect diagnoses
|
Facility
|
IP
|
$77,208.41
|
|
|
Service Code
|
APR-DRG 8154
|
| Min. Negotiated Rate |
$25,346.00 |
| Max. Negotiated Rate |
$77,208.41 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$77,208.41
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$77,208.41
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$34,314.85
|
| Rate for Payer: Amida Care Medicaid |
$34,314.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34,314.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41,177.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34,314.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34,314.85
|
| Rate for Payer: Healthfirst Commercial |
$42,388.00
|
| Rate for Payer: Healthfirst Essential Plan |
$77,208.41
|
| Rate for Payer: Healthfirst QHP |
$25,346.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$34,314.85
|
| Rate for Payer: SOMOS Essential |
$77,208.41
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$77,208.41
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$77,208.41
|
| Rate for Payer: United Healthcare Medicaid |
$34,314.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$34,314.85
|
|
|
APR-DRG 8161: Toxic effects of non-medicinal substances
|
Facility
|
IP
|
$37,522.30
|
|
|
Service Code
|
APR-DRG 8161
|
| Min. Negotiated Rate |
$4,795.00 |
| Max. Negotiated Rate |
$37,522.30 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$37,522.30
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$37,522.30
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$16,676.58
|
| Rate for Payer: Amida Care Medicaid |
$16,676.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16,676.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$20,011.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16,676.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16,676.58
|
| Rate for Payer: Healthfirst Commercial |
$8,661.00
|
| Rate for Payer: Healthfirst Essential Plan |
$37,522.30
|
| Rate for Payer: Healthfirst QHP |
$4,795.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$16,676.58
|
| Rate for Payer: SOMOS Essential |
$37,522.30
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$37,522.30
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$37,522.30
|
| Rate for Payer: United Healthcare Medicaid |
$16,676.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16,676.58
|
|
|
APR-DRG 8162: Toxic effects of non-medicinal substances
|
Facility
|
IP
|
$39,604.66
|
|
|
Service Code
|
APR-DRG 8162
|
| Min. Negotiated Rate |
$5,969.00 |
| Max. Negotiated Rate |
$39,604.66 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$39,604.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$39,604.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$17,602.07
|
| Rate for Payer: Amida Care Medicaid |
$17,602.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17,602.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21,122.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17,602.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17,602.07
|
| Rate for Payer: Healthfirst Commercial |
$10,676.00
|
| Rate for Payer: Healthfirst Essential Plan |
$39,604.66
|
| Rate for Payer: Healthfirst QHP |
$5,969.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$17,602.07
|
| Rate for Payer: SOMOS Essential |
$39,604.66
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$39,604.66
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$39,604.66
|
| Rate for Payer: United Healthcare Medicaid |
$17,602.07
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17,602.07
|
|
|
APR-DRG 8163: Toxic effects of non-medicinal substances
|
Facility
|
IP
|
$45,139.43
|
|
|
Service Code
|
APR-DRG 8163
|
| Min. Negotiated Rate |
$8,947.00 |
| Max. Negotiated Rate |
$45,139.43 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$45,139.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45,139.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20,061.97
|
| Rate for Payer: Amida Care Medicaid |
$20,061.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20,061.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24,074.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20,061.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20,061.97
|
| Rate for Payer: Healthfirst Commercial |
$16,026.00
|
| Rate for Payer: Healthfirst Essential Plan |
$45,139.43
|
| Rate for Payer: Healthfirst QHP |
$8,947.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20,061.97
|
| Rate for Payer: SOMOS Essential |
$45,139.43
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$45,139.43
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$45,139.43
|
| Rate for Payer: United Healthcare Medicaid |
$20,061.97
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20,061.97
|
|
|
APR-DRG 8164: Toxic effects of non-medicinal substances
|
Facility
|
IP
|
$66,471.28
|
|
|
Service Code
|
APR-DRG 8164
|
| Min. Negotiated Rate |
$22,054.00 |
| Max. Negotiated Rate |
$66,471.28 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$66,471.28
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$66,471.28
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$29,542.79
|
| Rate for Payer: Amida Care Medicaid |
$29,542.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29,542.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35,451.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29,542.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29,542.79
|
| Rate for Payer: Healthfirst Commercial |
$38,329.00
|
| Rate for Payer: Healthfirst Essential Plan |
$66,471.28
|
| Rate for Payer: Healthfirst QHP |
$22,054.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29,542.79
|
| Rate for Payer: SOMOS Essential |
$66,471.28
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$66,471.28
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$66,471.28
|
| Rate for Payer: United Healthcare Medicaid |
$29,542.79
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$29,542.79
|
|
|
APR-DRG 8411: Extensive 3rd degree burns w skin graft
|
Facility
|
IP
|
$301,254.00
|
|
|
Service Code
|
APR-DRG 8411
|
| Min. Negotiated Rate |
$55,125.12 |
| Max. Negotiated Rate |
$301,254.00 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$124,031.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$124,031.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$55,125.12
|
| Rate for Payer: Amida Care Medicaid |
$55,125.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$55,125.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$66,150.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55,125.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$55,125.12
|
| Rate for Payer: Healthfirst Commercial |
$165,466.00
|
| Rate for Payer: Healthfirst Essential Plan |
$124,031.52
|
| Rate for Payer: Healthfirst QHP |
$301,254.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$55,125.12
|
| Rate for Payer: SOMOS Essential |
$124,031.52
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$124,031.52
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$124,031.52
|
| Rate for Payer: United Healthcare Medicaid |
$55,125.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$55,125.12
|
|
|
APR-DRG 8412: Extensive 3rd degree burns w skin graft
|
Facility
|
IP
|
$301,254.00
|
|
|
Service Code
|
APR-DRG 8412
|
| Min. Negotiated Rate |
$68,531.45 |
| Max. Negotiated Rate |
$301,254.00 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$154,195.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$154,195.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$68,531.45
|
| Rate for Payer: Amida Care Medicaid |
$68,531.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$68,531.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$82,237.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$68,531.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$68,531.45
|
| Rate for Payer: Healthfirst Commercial |
$165,466.00
|
| Rate for Payer: Healthfirst Essential Plan |
$154,195.76
|
| Rate for Payer: Healthfirst QHP |
$301,254.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$68,531.45
|
| Rate for Payer: SOMOS Essential |
$154,195.76
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$154,195.76
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$154,195.76
|
| Rate for Payer: United Healthcare Medicaid |
$68,531.45
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$68,531.45
|
|
|
APR-DRG 8413: Extensive 3rd degree burns w skin graft
|
Facility
|
IP
|
$301,805.00
|
|
|
Service Code
|
APR-DRG 8413
|
| Min. Negotiated Rate |
$127,633.14 |
| Max. Negotiated Rate |
$301,805.00 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$287,174.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$287,174.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$127,633.14
|
| Rate for Payer: Amida Care Medicaid |
$127,633.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$127,633.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$153,159.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$127,633.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$127,633.14
|
| Rate for Payer: Healthfirst Commercial |
$166,826.00
|
| Rate for Payer: Healthfirst Essential Plan |
$287,174.56
|
| Rate for Payer: Healthfirst QHP |
$301,805.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$127,633.14
|
| Rate for Payer: SOMOS Essential |
$287,174.56
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$287,174.56
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$287,174.56
|
| Rate for Payer: United Healthcare Medicaid |
$127,633.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$127,633.14
|
|
|
APR-DRG 8414: Extensive 3rd degree burns w skin graft
|
Facility
|
IP
|
$474,024.00
|
|
|
Service Code
|
APR-DRG 8414
|
| Min. Negotiated Rate |
$159,646.23 |
| Max. Negotiated Rate |
$474,024.00 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$359,204.02
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$359,204.02
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$159,646.23
|
| Rate for Payer: Amida Care Medicaid |
$159,646.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$159,646.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$191,575.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$159,646.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$159,646.23
|
| Rate for Payer: Healthfirst Commercial |
$474,024.00
|
| Rate for Payer: Healthfirst Essential Plan |
$359,204.02
|
| Rate for Payer: Healthfirst QHP |
$301,805.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$159,646.23
|
| Rate for Payer: SOMOS Essential |
$359,204.02
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$359,204.02
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$359,204.02
|
| Rate for Payer: United Healthcare Medicaid |
$159,646.23
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$159,646.23
|
|
|
APR-DRG 8421: Burns with skin graft except extensive 3rd degree burns
|
Facility
|
IP
|
$67,547.61
|
|
|
Service Code
|
APR-DRG 8421
|
| Min. Negotiated Rate |
$30,021.16 |
| Max. Negotiated Rate |
$67,547.61 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$67,547.61
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$67,547.61
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$30,021.16
|
| Rate for Payer: Amida Care Medicaid |
$30,021.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30,021.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36,025.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30,021.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30,021.16
|
| Rate for Payer: Healthfirst Commercial |
$42,567.00
|
| Rate for Payer: Healthfirst Essential Plan |
$67,547.61
|
| Rate for Payer: Healthfirst QHP |
$31,652.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$30,021.16
|
| Rate for Payer: SOMOS Essential |
$67,547.61
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$67,547.61
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$67,547.61
|
| Rate for Payer: United Healthcare Medicaid |
$30,021.16
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$30,021.16
|
|
|
APR-DRG 8422: Burns with skin graft except extensive 3rd degree burns
|
Facility
|
IP
|
$79,493.02
|
|
|
Service Code
|
APR-DRG 8422
|
| Min. Negotiated Rate |
$35,330.23 |
| Max. Negotiated Rate |
$79,493.02 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$79,493.02
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$79,493.02
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$35,330.23
|
| Rate for Payer: Amida Care Medicaid |
$35,330.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35,330.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42,396.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35,330.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35,330.23
|
| Rate for Payer: Healthfirst Commercial |
$65,412.00
|
| Rate for Payer: Healthfirst Essential Plan |
$79,493.02
|
| Rate for Payer: Healthfirst QHP |
$70,380.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35,330.23
|
| Rate for Payer: SOMOS Essential |
$79,493.02
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$79,493.02
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$79,493.02
|
| Rate for Payer: United Healthcare Medicaid |
$35,330.23
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$35,330.23
|
|
|
APR-DRG 8423: Burns with skin graft except extensive 3rd degree burns
|
Facility
|
IP
|
$113,704.00
|
|
|
Service Code
|
APR-DRG 8423
|
| Min. Negotiated Rate |
$47,282.67 |
| Max. Negotiated Rate |
$113,704.00 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$106,386.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$106,386.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$47,282.67
|
| Rate for Payer: Amida Care Medicaid |
$47,282.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47,282.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$56,739.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47,282.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47,282.67
|
| Rate for Payer: Healthfirst Commercial |
$113,704.00
|
| Rate for Payer: Healthfirst Essential Plan |
$106,386.01
|
| Rate for Payer: Healthfirst QHP |
$99,660.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47,282.67
|
| Rate for Payer: SOMOS Essential |
$106,386.01
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$106,386.01
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$106,386.01
|
| Rate for Payer: United Healthcare Medicaid |
$47,282.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$47,282.67
|
|
|
APR-DRG 8424: Burns with skin graft except extensive 3rd degree burns
|
Facility
|
IP
|
$233,529.00
|
|
|
Service Code
|
APR-DRG 8424
|
| Min. Negotiated Rate |
$80,692.60 |
| Max. Negotiated Rate |
$233,529.00 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$181,558.35
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$181,558.35
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$80,692.60
|
| Rate for Payer: Amida Care Medicaid |
$80,692.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$80,692.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$96,831.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80,692.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80,692.60
|
| Rate for Payer: Healthfirst Commercial |
$213,461.00
|
| Rate for Payer: Healthfirst Essential Plan |
$181,558.35
|
| Rate for Payer: Healthfirst QHP |
$233,529.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$80,692.60
|
| Rate for Payer: SOMOS Essential |
$181,558.35
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$181,558.35
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$181,558.35
|
| Rate for Payer: United Healthcare Medicaid |
$80,692.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$80,692.60
|
|
|
APR-DRG 8431: Extensive 3rd degree or full thickness burns w/o skin graft
|
Facility
|
IP
|
$64,315.04
|
|
|
Service Code
|
APR-DRG 8431
|
| Min. Negotiated Rate |
$9,103.00 |
| Max. Negotiated Rate |
$64,315.04 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$64,315.04
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$64,315.04
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$28,584.46
|
| Rate for Payer: Amida Care Medicaid |
$28,584.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28,584.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34,301.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28,584.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28,584.46
|
| Rate for Payer: Healthfirst Commercial |
$15,424.00
|
| Rate for Payer: Healthfirst Essential Plan |
$64,315.04
|
| Rate for Payer: Healthfirst QHP |
$9,103.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28,584.46
|
| Rate for Payer: SOMOS Essential |
$64,315.04
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$64,315.04
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$64,315.04
|
| Rate for Payer: United Healthcare Medicaid |
$28,584.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$28,584.46
|
|
|
APR-DRG 8432: Extensive 3rd degree or full thickness burns w/o skin graft
|
Facility
|
IP
|
$64,315.04
|
|
|
Service Code
|
APR-DRG 8432
|
| Min. Negotiated Rate |
$15,308.00 |
| Max. Negotiated Rate |
$64,315.04 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$64,315.04
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$64,315.04
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$28,584.46
|
| Rate for Payer: Amida Care Medicaid |
$28,584.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28,584.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34,301.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28,584.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28,584.46
|
| Rate for Payer: Healthfirst Commercial |
$21,275.00
|
| Rate for Payer: Healthfirst Essential Plan |
$64,315.04
|
| Rate for Payer: Healthfirst QHP |
$15,308.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28,584.46
|
| Rate for Payer: SOMOS Essential |
$64,315.04
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$64,315.04
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$64,315.04
|
| Rate for Payer: United Healthcare Medicaid |
$28,584.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$28,584.46
|
|
|
APR-DRG 8433: Extensive 3rd degree or full thickness burns w/o skin graft
|
Facility
|
IP
|
$64,315.04
|
|
|
Service Code
|
APR-DRG 8433
|
| Min. Negotiated Rate |
$19,507.00 |
| Max. Negotiated Rate |
$64,315.04 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$64,315.04
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$64,315.04
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$28,584.46
|
| Rate for Payer: Amida Care Medicaid |
$28,584.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28,584.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34,301.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28,584.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28,584.46
|
| Rate for Payer: Healthfirst Commercial |
$30,817.00
|
| Rate for Payer: Healthfirst Essential Plan |
$64,315.04
|
| Rate for Payer: Healthfirst QHP |
$19,507.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28,584.46
|
| Rate for Payer: SOMOS Essential |
$64,315.04
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$64,315.04
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$64,315.04
|
| Rate for Payer: United Healthcare Medicaid |
$28,584.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$28,584.46
|
|
|
APR-DRG 8434: Extensive 3rd degree or full thickness burns w/o skin graft
|
Facility
|
IP
|
$64,315.04
|
|
|
Service Code
|
APR-DRG 8434
|
| Min. Negotiated Rate |
$28,584.46 |
| Max. Negotiated Rate |
$64,315.04 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$64,315.04
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$64,315.04
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$28,584.46
|
| Rate for Payer: Amida Care Medicaid |
$28,584.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28,584.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34,301.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28,584.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28,584.46
|
| Rate for Payer: Healthfirst Commercial |
$47,891.00
|
| Rate for Payer: Healthfirst Essential Plan |
$64,315.04
|
| Rate for Payer: Healthfirst QHP |
$32,630.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28,584.46
|
| Rate for Payer: SOMOS Essential |
$64,315.04
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$64,315.04
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$64,315.04
|
| Rate for Payer: United Healthcare Medicaid |
$28,584.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$28,584.46
|
|
|
APR-DRG 8441: Partial thickness burns without skin graft
|
Facility
|
IP
|
$41,062.66
|
|
|
Service Code
|
APR-DRG 8441
|
| Min. Negotiated Rate |
$7,278.00 |
| Max. Negotiated Rate |
$41,062.66 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$41,062.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$41,062.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$18,250.07
|
| Rate for Payer: Amida Care Medicaid |
$18,250.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18,250.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21,900.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18,250.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18,250.07
|
| Rate for Payer: Healthfirst Commercial |
$13,184.00
|
| Rate for Payer: Healthfirst Essential Plan |
$41,062.66
|
| Rate for Payer: Healthfirst QHP |
$7,278.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18,250.07
|
| Rate for Payer: SOMOS Essential |
$41,062.66
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$41,062.66
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$41,062.66
|
| Rate for Payer: United Healthcare Medicaid |
$18,250.07
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18,250.07
|
|
|
APR-DRG 8442: Partial thickness burns without skin graft
|
Facility
|
IP
|
$48,349.15
|
|
|
Service Code
|
APR-DRG 8442
|
| Min. Negotiated Rate |
$21,488.51 |
| Max. Negotiated Rate |
$48,349.15 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$48,349.15
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$48,349.15
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$21,488.51
|
| Rate for Payer: Amida Care Medicaid |
$21,488.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21,488.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25,786.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21,488.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21,488.51
|
| Rate for Payer: Healthfirst Commercial |
$21,751.00
|
| Rate for Payer: Healthfirst Essential Plan |
$48,349.15
|
| Rate for Payer: Healthfirst QHP |
$27,333.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21,488.51
|
| Rate for Payer: SOMOS Essential |
$48,349.15
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$48,349.15
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$48,349.15
|
| Rate for Payer: United Healthcare Medicaid |
$21,488.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$21,488.51
|
|
