|
APR-DRG 9301: Multiple significant trauma w/o O.R. procedure
|
Facility
|
IP
|
$45,153.50
|
|
|
Service Code
|
APR-DRG 9301
|
| Min. Negotiated Rate |
$9,062.00 |
| Max. Negotiated Rate |
$45,153.50 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$45,153.50
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45,153.50
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20,068.22
|
| Rate for Payer: Amida Care Medicaid |
$20,068.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20,068.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24,081.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20,068.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20,068.22
|
| Rate for Payer: Healthfirst Commercial |
$11,950.00
|
| Rate for Payer: Healthfirst Essential Plan |
$45,153.50
|
| Rate for Payer: Healthfirst QHP |
$9,062.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20,068.22
|
| Rate for Payer: SOMOS Essential |
$45,153.50
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$45,153.50
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$45,153.50
|
| Rate for Payer: United Healthcare Medicaid |
$20,068.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20,068.22
|
|
|
APR-DRG 9302: Multiple significant trauma w/o O.R. procedure
|
Facility
|
IP
|
$45,234.40
|
|
|
Service Code
|
APR-DRG 9302
|
| Min. Negotiated Rate |
$10,690.00 |
| Max. Negotiated Rate |
$45,234.40 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$45,234.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45,234.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20,104.18
|
| Rate for Payer: Amida Care Medicaid |
$20,104.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20,104.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24,125.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20,104.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20,104.18
|
| Rate for Payer: Healthfirst Commercial |
$17,376.00
|
| Rate for Payer: Healthfirst Essential Plan |
$45,234.40
|
| Rate for Payer: Healthfirst QHP |
$10,690.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20,104.18
|
| Rate for Payer: SOMOS Essential |
$45,234.40
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$45,234.40
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$45,234.40
|
| Rate for Payer: United Healthcare Medicaid |
$20,104.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20,104.18
|
|
|
APR-DRG 9303: Multiple significant trauma w/o O.R. procedure
|
Facility
|
IP
|
$57,478.79
|
|
|
Service Code
|
APR-DRG 9303
|
| Min. Negotiated Rate |
$16,996.00 |
| Max. Negotiated Rate |
$57,478.79 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$57,478.79
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$57,478.79
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$25,546.13
|
| Rate for Payer: Amida Care Medicaid |
$25,546.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25,546.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30,655.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25,546.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25,546.13
|
| Rate for Payer: Healthfirst Commercial |
$28,553.00
|
| Rate for Payer: Healthfirst Essential Plan |
$57,478.79
|
| Rate for Payer: Healthfirst QHP |
$16,996.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25,546.13
|
| Rate for Payer: SOMOS Essential |
$57,478.79
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$57,478.79
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$57,478.79
|
| Rate for Payer: United Healthcare Medicaid |
$25,546.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$25,546.13
|
|
|
APR-DRG 9304: Multiple significant trauma w/o O.R. procedure
|
Facility
|
IP
|
$93,907.71
|
|
|
Service Code
|
APR-DRG 9304
|
| Min. Negotiated Rate |
$37,901.00 |
| Max. Negotiated Rate |
$93,907.71 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$93,907.71
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$93,907.71
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$41,736.76
|
| Rate for Payer: Amida Care Medicaid |
$41,736.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41,736.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50,084.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41,736.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41,736.76
|
| Rate for Payer: Healthfirst Commercial |
$58,473.00
|
| Rate for Payer: Healthfirst Essential Plan |
$93,907.71
|
| Rate for Payer: Healthfirst QHP |
$37,901.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$41,736.76
|
| Rate for Payer: SOMOS Essential |
$93,907.71
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$93,907.71
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$93,907.71
|
| Rate for Payer: United Healthcare Medicaid |
$41,736.76
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$41,736.76
|
|
|
APR-DRG 9501: Extensive procedure unrelated to principal diagnosis
|
Facility
|
IP
|
$53,604.27
|
|
|
Service Code
|
APR-DRG 9501
|
| Min. Negotiated Rate |
$15,024.00 |
| Max. Negotiated Rate |
$53,604.27 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$53,604.27
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$53,604.27
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$23,824.12
|
| Rate for Payer: Amida Care Medicaid |
$23,824.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23,824.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28,588.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23,824.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23,824.12
|
| Rate for Payer: Healthfirst Commercial |
$23,902.00
|
| Rate for Payer: Healthfirst Essential Plan |
$53,604.27
|
| Rate for Payer: Healthfirst QHP |
$15,024.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23,824.12
|
| Rate for Payer: SOMOS Essential |
$53,604.27
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$53,604.27
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$53,604.27
|
| Rate for Payer: United Healthcare Medicaid |
$23,824.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$23,824.12
|
|
|
APR-DRG 9502: Extensive procedure unrelated to principal diagnosis
|
Facility
|
IP
|
$67,614.46
|
|
|
Service Code
|
APR-DRG 9502
|
| Min. Negotiated Rate |
$26,677.00 |
| Max. Negotiated Rate |
$67,614.46 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$67,614.46
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$67,614.46
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$30,050.87
|
| Rate for Payer: Amida Care Medicaid |
$30,050.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30,050.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36,061.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30,050.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30,050.87
|
| Rate for Payer: Healthfirst Commercial |
$42,267.00
|
| Rate for Payer: Healthfirst Essential Plan |
$67,614.46
|
| Rate for Payer: Healthfirst QHP |
$26,677.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$30,050.87
|
| Rate for Payer: SOMOS Essential |
$67,614.46
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$67,614.46
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$67,614.46
|
| Rate for Payer: United Healthcare Medicaid |
$30,050.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$30,050.87
|
|
|
APR-DRG 9503: Extensive procedure unrelated to principal diagnosis
|
Facility
|
IP
|
$99,894.49
|
|
|
Service Code
|
APR-DRG 9503
|
| Min. Negotiated Rate |
$44,397.55 |
| Max. Negotiated Rate |
$99,894.49 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$99,894.49
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$99,894.49
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$44,397.55
|
| Rate for Payer: Amida Care Medicaid |
$44,397.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$44,397.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$53,277.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44,397.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44,397.55
|
| Rate for Payer: Healthfirst Commercial |
$72,203.00
|
| Rate for Payer: Healthfirst Essential Plan |
$99,894.49
|
| Rate for Payer: Healthfirst QHP |
$45,114.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$44,397.55
|
| Rate for Payer: SOMOS Essential |
$99,894.49
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$99,894.49
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$99,894.49
|
| Rate for Payer: United Healthcare Medicaid |
$44,397.55
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$44,397.55
|
|
|
APR-DRG 9504: Extensive procedure unrelated to principal diagnosis
|
Facility
|
IP
|
$172,353.06
|
|
|
Service Code
|
APR-DRG 9504
|
| Min. Negotiated Rate |
$76,601.36 |
| Max. Negotiated Rate |
$172,353.06 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$172,353.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$172,353.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$76,601.36
|
| Rate for Payer: Amida Care Medicaid |
$76,601.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$76,601.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$91,921.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76,601.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$76,601.36
|
| Rate for Payer: Healthfirst Commercial |
$143,729.00
|
| Rate for Payer: Healthfirst Essential Plan |
$172,353.06
|
| Rate for Payer: Healthfirst QHP |
$91,510.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$76,601.36
|
| Rate for Payer: SOMOS Essential |
$172,353.06
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$172,353.06
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$172,353.06
|
| Rate for Payer: United Healthcare Medicaid |
$76,601.36
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$76,601.36
|
|
|
APR-DRG 9511: Moderately extensive procedure unrelated to principal diagnosis
|
Facility
|
IP
|
$45,842.94
|
|
|
Service Code
|
APR-DRG 9511
|
| Min. Negotiated Rate |
$11,479.00 |
| Max. Negotiated Rate |
$45,842.94 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$45,842.94
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45,842.94
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20,374.64
|
| Rate for Payer: Amida Care Medicaid |
$20,374.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20,374.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24,449.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20,374.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20,374.64
|
| Rate for Payer: Healthfirst Commercial |
$19,268.00
|
| Rate for Payer: Healthfirst Essential Plan |
$45,842.94
|
| Rate for Payer: Healthfirst QHP |
$11,479.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20,374.64
|
| Rate for Payer: SOMOS Essential |
$45,842.94
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$45,842.94
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$45,842.94
|
| Rate for Payer: United Healthcare Medicaid |
$20,374.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20,374.64
|
|
|
APR-DRG 9512: Moderately extensive procedure unrelated to principal diagnosis
|
Facility
|
IP
|
$54,100.24
|
|
|
Service Code
|
APR-DRG 9512
|
| Min. Negotiated Rate |
$16,709.00 |
| Max. Negotiated Rate |
$54,100.24 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$54,100.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$54,100.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$24,044.55
|
| Rate for Payer: Amida Care Medicaid |
$24,044.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24,044.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28,853.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24,044.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24,044.55
|
| Rate for Payer: Healthfirst Commercial |
$28,792.00
|
| Rate for Payer: Healthfirst Essential Plan |
$54,100.24
|
| Rate for Payer: Healthfirst QHP |
$16,709.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24,044.55
|
| Rate for Payer: SOMOS Essential |
$54,100.24
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$54,100.24
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$54,100.24
|
| Rate for Payer: United Healthcare Medicaid |
$24,044.55
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$24,044.55
|
|
|
APR-DRG 9513: Moderately extensive procedure unrelated to principal diagnosis
|
Facility
|
IP
|
$77,336.80
|
|
|
Service Code
|
APR-DRG 9513
|
| Min. Negotiated Rate |
$30,600.00 |
| Max. Negotiated Rate |
$77,336.80 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$77,336.80
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$77,336.80
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$34,371.91
|
| Rate for Payer: Amida Care Medicaid |
$34,371.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34,371.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41,246.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34,371.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34,371.91
|
| Rate for Payer: Healthfirst Commercial |
$54,751.00
|
| Rate for Payer: Healthfirst Essential Plan |
$77,336.80
|
| Rate for Payer: Healthfirst QHP |
$30,600.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$34,371.91
|
| Rate for Payer: SOMOS Essential |
$77,336.80
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$77,336.80
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$77,336.80
|
| Rate for Payer: United Healthcare Medicaid |
$34,371.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$34,371.91
|
|
|
APR-DRG 9514: Moderately extensive procedure unrelated to principal diagnosis
|
Facility
|
IP
|
$140,006.20
|
|
|
Service Code
|
APR-DRG 9514
|
| Min. Negotiated Rate |
$62,224.98 |
| Max. Negotiated Rate |
$140,006.20 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$140,006.20
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$140,006.20
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$62,224.98
|
| Rate for Payer: Amida Care Medicaid |
$62,224.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$62,224.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$74,669.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$62,224.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$62,224.98
|
| Rate for Payer: Healthfirst Commercial |
$116,196.00
|
| Rate for Payer: Healthfirst Essential Plan |
$140,006.20
|
| Rate for Payer: Healthfirst QHP |
$65,667.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$62,224.98
|
| Rate for Payer: SOMOS Essential |
$140,006.20
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$140,006.20
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$140,006.20
|
| Rate for Payer: United Healthcare Medicaid |
$62,224.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$62,224.98
|
|
|
APR-DRG 9521: Nonextensive procedure unrelated to principal diagnosis
|
Facility
|
IP
|
$43,447.52
|
|
|
Service Code
|
APR-DRG 9521
|
| Min. Negotiated Rate |
$9,694.00 |
| Max. Negotiated Rate |
$43,447.52 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$43,447.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$43,447.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$19,310.01
|
| Rate for Payer: Amida Care Medicaid |
$19,310.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19,310.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23,172.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19,310.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19,310.01
|
| Rate for Payer: Healthfirst Commercial |
$15,907.00
|
| Rate for Payer: Healthfirst Essential Plan |
$43,447.52
|
| Rate for Payer: Healthfirst QHP |
$9,694.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19,310.01
|
| Rate for Payer: SOMOS Essential |
$43,447.52
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$43,447.52
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$43,447.52
|
| Rate for Payer: United Healthcare Medicaid |
$19,310.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$19,310.01
|
|
|
APR-DRG 9522: Nonextensive procedure unrelated to principal diagnosis
|
Facility
|
IP
|
$50,681.25
|
|
|
Service Code
|
APR-DRG 9522
|
| Min. Negotiated Rate |
$13,608.00 |
| Max. Negotiated Rate |
$50,681.25 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$50,681.25
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$50,681.25
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$22,525.00
|
| Rate for Payer: Amida Care Medicaid |
$22,525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22,525.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27,030.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22,525.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22,525.00
|
| Rate for Payer: Healthfirst Commercial |
$24,355.00
|
| Rate for Payer: Healthfirst Essential Plan |
$50,681.25
|
| Rate for Payer: Healthfirst QHP |
$13,608.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22,525.00
|
| Rate for Payer: SOMOS Essential |
$50,681.25
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$50,681.25
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$50,681.25
|
| Rate for Payer: United Healthcare Medicaid |
$22,525.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$22,525.00
|
|
|
APR-DRG 9523: Nonextensive procedure unrelated to principal diagnosis
|
Facility
|
IP
|
$72,625.12
|
|
|
Service Code
|
APR-DRG 9523
|
| Min. Negotiated Rate |
$27,682.00 |
| Max. Negotiated Rate |
$72,625.12 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$72,625.12
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$72,625.12
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$32,277.83
|
| Rate for Payer: Amida Care Medicaid |
$32,277.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32,277.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38,733.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32,277.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32,277.83
|
| Rate for Payer: Healthfirst Commercial |
$46,722.00
|
| Rate for Payer: Healthfirst Essential Plan |
$72,625.12
|
| Rate for Payer: Healthfirst QHP |
$27,682.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32,277.83
|
| Rate for Payer: SOMOS Essential |
$72,625.12
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$72,625.12
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$72,625.12
|
| Rate for Payer: United Healthcare Medicaid |
$32,277.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$32,277.83
|
|
|
APR-DRG 9524: Nonextensive procedure unrelated to principal diagnosis
|
Facility
|
IP
|
$133,964.91
|
|
|
Service Code
|
APR-DRG 9524
|
| Min. Negotiated Rate |
$59,539.96 |
| Max. Negotiated Rate |
$133,964.91 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$133,964.91
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$133,964.91
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$59,539.96
|
| Rate for Payer: Amida Care Medicaid |
$59,539.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$59,539.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$71,447.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59,539.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$59,539.96
|
| Rate for Payer: Healthfirst Commercial |
$104,583.00
|
| Rate for Payer: Healthfirst Essential Plan |
$133,964.91
|
| Rate for Payer: Healthfirst QHP |
$68,772.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$59,539.96
|
| Rate for Payer: SOMOS Essential |
$133,964.91
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$133,964.91
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$133,964.91
|
| Rate for Payer: United Healthcare Medicaid |
$59,539.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$59,539.96
|
|
|
APREPITANT 125 MG CAP
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
HCPCS J8501
|
| Hospital Charge Code |
41643836
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$109.00 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$109.00
|
|
|
APREPITANT 125 MG CAP
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
HCPCS J8501
|
| Hospital Charge Code |
41643836
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$141.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$119.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.57
|
| Rate for Payer: Aetna Government |
$4.57
|
| Rate for Payer: Brighton Health Commercial |
$130.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$109.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$125.35
|
| Rate for Payer: Group Health Inc Commercial |
$109.00
|
| Rate for Payer: Group Health Inc Medicare |
$76.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$109.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.71
|
| Rate for Payer: SOMOS Essential |
$3.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$141.70
|
|
|
APREPITANT 125 MG CAP
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
HCPCS J8501
|
| Hospital Charge Code |
41653836
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$109.00 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$109.00
|
|
|
APREPITANT 125 MG CAP
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
HCPCS J8501
|
| Hospital Charge Code |
41653836
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$141.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$119.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.57
|
| Rate for Payer: Aetna Government |
$4.57
|
| Rate for Payer: Brighton Health Commercial |
$130.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$109.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$125.35
|
| Rate for Payer: Group Health Inc Commercial |
$109.00
|
| Rate for Payer: Group Health Inc Medicare |
$76.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$109.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.71
|
| Rate for Payer: SOMOS Essential |
$3.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$141.70
|
|
|
APREPITANT 80 MG CAP
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
HCPCS J8501
|
| Hospital Charge Code |
41643835
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$141.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$119.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.57
|
| Rate for Payer: Aetna Government |
$4.57
|
| Rate for Payer: Brighton Health Commercial |
$130.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$109.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$125.35
|
| Rate for Payer: Group Health Inc Commercial |
$109.00
|
| Rate for Payer: Group Health Inc Medicare |
$76.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$109.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.71
|
| Rate for Payer: SOMOS Essential |
$3.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$141.70
|
|
|
APREPITANT 80 MG CAP
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
HCPCS J8501
|
| Hospital Charge Code |
41643835
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$109.00 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$109.00
|
|
|
APREPITANT 80 MG CAP
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
HCPCS J8501
|
| Hospital Charge Code |
41653835
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$109.00 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$109.00
|
|
|
APREPITANT 80 MG CAP
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
HCPCS J8501
|
| Hospital Charge Code |
41653835
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$141.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$119.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.57
|
| Rate for Payer: Aetna Government |
$4.57
|
| Rate for Payer: Brighton Health Commercial |
$130.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$109.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$125.35
|
| Rate for Payer: Group Health Inc Commercial |
$109.00
|
| Rate for Payer: Group Health Inc Medicare |
$76.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$109.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.71
|
| Rate for Payer: SOMOS Essential |
$3.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$141.70
|
|
|
APTTMX+PTMX
|
Facility
|
OP
|
$16.18
|
|
|
Service Code
|
HCPCS 85732
|
| Hospital Charge Code |
40629818
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$12.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.47
|
| Rate for Payer: Aetna Government |
$6.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.53
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.53
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.53
|
| Rate for Payer: Brighton Health Commercial |
$12.14
|
| Rate for Payer: Cash Price |
$6.47
|
| Rate for Payer: Cash Price |
$6.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.70
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.47
|
| Rate for Payer: EmblemHealth Commercial |
$6.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.76
|
| Rate for Payer: Group Health Inc Commercial |
$6.47
|
| Rate for Payer: Group Health Inc Medicare |
$6.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.47
|
| Rate for Payer: Healthfirst QHP |
$6.47
|
| Rate for Payer: Humana Medicare |
$6.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.47
|
| Rate for Payer: United Healthcare Commercial |
$8.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.18
|
| Rate for Payer: Wellcare Medicare |
$5.82
|
|
