|
Kidney & urinary tract malignancy
|
Facility
|
IP
|
$40,011.93
|
|
|
Service Code
|
APR-DRG 4611
|
| Min. Negotiated Rate |
$5,588.00 |
| Max. Negotiated Rate |
$40,011.93 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$40,011.93
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$40,011.93
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$17,783.08
|
| Rate for Payer: Amida Care Medicaid |
$17,783.08
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$40,011.93
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$17,783.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17,783.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21,339.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17,783.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17,783.08
|
| Rate for Payer: Healthfirst Commercial |
$11,009.00
|
| Rate for Payer: Healthfirst Essential Plan |
$40,011.93
|
| Rate for Payer: Healthfirst QHP |
$5,588.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$17,783.08
|
| Rate for Payer: SOMOS Essential |
$40,011.93
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$40,011.93
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$40,011.93
|
| Rate for Payer: United Healthcare Medicaid |
$17,783.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17,783.08
|
|
|
Kidney & urinary tract malignancy
|
Facility
|
IP
|
$46,178.10
|
|
|
Service Code
|
APR-DRG 4612
|
| Min. Negotiated Rate |
$8,823.00 |
| Max. Negotiated Rate |
$46,178.10 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$46,178.10
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$46,178.10
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20,523.60
|
| Rate for Payer: Amida Care Medicaid |
$20,523.60
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$46,178.10
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$20,523.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20,523.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24,628.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20,523.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20,523.60
|
| Rate for Payer: Healthfirst Commercial |
$15,164.00
|
| Rate for Payer: Healthfirst Essential Plan |
$46,178.10
|
| Rate for Payer: Healthfirst QHP |
$8,823.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20,523.60
|
| Rate for Payer: SOMOS Essential |
$46,178.10
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$46,178.10
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$46,178.10
|
| Rate for Payer: United Healthcare Medicaid |
$20,523.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20,523.60
|
|
|
Kidney & urinary tract malignancy
|
Facility
|
IP
|
$72,962.03
|
|
|
Service Code
|
APR-DRG 4614
|
| Min. Negotiated Rate |
$22,064.00 |
| Max. Negotiated Rate |
$72,962.03 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$72,962.03
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$72,962.03
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$32,427.57
|
| Rate for Payer: Amida Care Medicaid |
$32,427.57
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$72,962.03
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$32,427.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32,427.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38,913.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32,427.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32,427.57
|
| Rate for Payer: Healthfirst Commercial |
$50,818.00
|
| Rate for Payer: Healthfirst Essential Plan |
$72,962.03
|
| Rate for Payer: Healthfirst QHP |
$22,064.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32,427.57
|
| Rate for Payer: SOMOS Essential |
$72,962.03
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$72,962.03
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$72,962.03
|
| Rate for Payer: United Healthcare Medicaid |
$32,427.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$32,427.57
|
|
|
Kidney & urinary tract procedures for malignancy
|
Facility
|
IP
|
$59,053.88
|
|
|
Service Code
|
APR-DRG 4422
|
| Min. Negotiated Rate |
$17,645.00 |
| Max. Negotiated Rate |
$59,053.88 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$59,053.88
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$59,053.88
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$26,246.17
|
| Rate for Payer: Amida Care Medicaid |
$26,246.17
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$59,053.88
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$26,246.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26,246.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31,495.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26,246.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26,246.17
|
| Rate for Payer: Healthfirst Commercial |
$29,537.00
|
| Rate for Payer: Healthfirst Essential Plan |
$59,053.88
|
| Rate for Payer: Healthfirst QHP |
$17,645.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26,246.17
|
| Rate for Payer: SOMOS Essential |
$59,053.88
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$59,053.88
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$59,053.88
|
| Rate for Payer: United Healthcare Medicaid |
$26,246.17
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$26,246.17
|
|
|
Kidney & urinary tract procedures for malignancy
|
Facility
|
IP
|
$81,537.68
|
|
|
Service Code
|
APR-DRG 4423
|
| Min. Negotiated Rate |
$29,318.00 |
| Max. Negotiated Rate |
$81,537.68 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$81,537.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$81,537.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$36,238.97
|
| Rate for Payer: Amida Care Medicaid |
$36,238.97
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$81,537.68
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$36,238.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36,238.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43,486.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36,238.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36,238.97
|
| Rate for Payer: Healthfirst Commercial |
$51,466.00
|
| Rate for Payer: Healthfirst Essential Plan |
$81,537.68
|
| Rate for Payer: Healthfirst QHP |
$29,318.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36,238.97
|
| Rate for Payer: SOMOS Essential |
$81,537.68
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$81,537.68
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$81,537.68
|
| Rate for Payer: United Healthcare Medicaid |
$36,238.97
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$36,238.97
|
|
|
Kidney & urinary tract procedures for malignancy
|
Facility
|
IP
|
$144,152.57
|
|
|
Service Code
|
APR-DRG 4424
|
| Min. Negotiated Rate |
$64,067.81 |
| Max. Negotiated Rate |
$144,152.57 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$144,152.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$144,152.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$64,067.81
|
| Rate for Payer: Amida Care Medicaid |
$64,067.81
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$144,152.57
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$64,067.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$64,067.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$76,881.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64,067.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64,067.81
|
| Rate for Payer: Healthfirst Commercial |
$113,854.00
|
| Rate for Payer: Healthfirst Essential Plan |
$144,152.57
|
| Rate for Payer: Healthfirst QHP |
$65,522.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$64,067.81
|
| Rate for Payer: SOMOS Essential |
$144,152.57
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$144,152.57
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$144,152.57
|
| Rate for Payer: United Healthcare Medicaid |
$64,067.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$64,067.81
|
|
|
Kidney & urinary tract procedures for malignancy
|
Facility
|
IP
|
$54,774.86
|
|
|
Service Code
|
APR-DRG 4421
|
| Min. Negotiated Rate |
$14,765.00 |
| Max. Negotiated Rate |
$54,774.86 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$54,774.86
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$54,774.86
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$24,344.38
|
| Rate for Payer: Amida Care Medicaid |
$24,344.38
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$54,774.86
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$24,344.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24,344.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29,213.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24,344.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24,344.38
|
| Rate for Payer: Healthfirst Commercial |
$24,992.00
|
| Rate for Payer: Healthfirst Essential Plan |
$54,774.86
|
| Rate for Payer: Healthfirst QHP |
$14,765.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24,344.38
|
| Rate for Payer: SOMOS Essential |
$54,774.86
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$54,774.86
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$54,774.86
|
| Rate for Payer: United Healthcare Medicaid |
$24,344.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$24,344.38
|
|
|
Kidney & urinary tract procedures for nonmalignancy
|
Facility
|
IP
|
$52,979.18
|
|
|
Service Code
|
APR-DRG 4432
|
| Min. Negotiated Rate |
$14,272.00 |
| Max. Negotiated Rate |
$52,979.18 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$52,979.18
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$52,979.18
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$23,546.30
|
| Rate for Payer: Amida Care Medicaid |
$23,546.30
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$52,979.18
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$23,546.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23,546.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28,255.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23,546.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23,546.30
|
| Rate for Payer: Healthfirst Commercial |
$23,240.00
|
| Rate for Payer: Healthfirst Essential Plan |
$52,979.18
|
| Rate for Payer: Healthfirst QHP |
$14,272.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23,546.30
|
| Rate for Payer: SOMOS Essential |
$52,979.18
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$52,979.18
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$52,979.18
|
| Rate for Payer: United Healthcare Medicaid |
$23,546.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$23,546.30
|
|
|
Kidney & urinary tract procedures for nonmalignancy
|
Facility
|
IP
|
$121,146.41
|
|
|
Service Code
|
APR-DRG 4434
|
| Min. Negotiated Rate |
$53,842.85 |
| Max. Negotiated Rate |
$121,146.41 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$121,146.41
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$121,146.41
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$53,842.85
|
| Rate for Payer: Amida Care Medicaid |
$53,842.85
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$121,146.41
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$53,842.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$53,842.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64,611.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53,842.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$53,842.85
|
| Rate for Payer: Healthfirst Commercial |
$105,797.00
|
| Rate for Payer: Healthfirst Essential Plan |
$121,146.41
|
| Rate for Payer: Healthfirst QHP |
$59,011.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$53,842.85
|
| Rate for Payer: SOMOS Essential |
$121,146.41
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$121,146.41
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$121,146.41
|
| Rate for Payer: United Healthcare Medicaid |
$53,842.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$53,842.85
|
|
|
Kidney & urinary tract procedures for nonmalignancy
|
Facility
|
IP
|
$71,971.88
|
|
|
Service Code
|
APR-DRG 4433
|
| Min. Negotiated Rate |
$25,671.00 |
| Max. Negotiated Rate |
$71,971.88 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$71,971.88
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$71,971.88
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$31,987.50
|
| Rate for Payer: Amida Care Medicaid |
$31,987.50
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$71,971.88
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$31,987.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31,987.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38,385.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31,987.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31,987.50
|
| Rate for Payer: Healthfirst Commercial |
$42,985.00
|
| Rate for Payer: Healthfirst Essential Plan |
$71,971.88
|
| Rate for Payer: Healthfirst QHP |
$25,671.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31,987.50
|
| Rate for Payer: SOMOS Essential |
$71,971.88
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$71,971.88
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$71,971.88
|
| Rate for Payer: United Healthcare Medicaid |
$31,987.50
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$31,987.50
|
|
|
Kidney & urinary tract procedures for nonmalignancy
|
Facility
|
IP
|
$50,879.23
|
|
|
Service Code
|
APR-DRG 4431
|
| Min. Negotiated Rate |
$12,779.00 |
| Max. Negotiated Rate |
$50,879.23 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$50,879.23
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$50,879.23
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$22,612.99
|
| Rate for Payer: Amida Care Medicaid |
$22,612.99
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$50,879.23
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$22,612.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22,612.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27,135.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22,612.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22,612.99
|
| Rate for Payer: Healthfirst Commercial |
$21,445.00
|
| Rate for Payer: Healthfirst Essential Plan |
$50,879.23
|
| Rate for Payer: Healthfirst QHP |
$12,779.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22,612.99
|
| Rate for Payer: SOMOS Essential |
$50,879.23
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$50,879.23
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$50,879.23
|
| Rate for Payer: United Healthcare Medicaid |
$22,612.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$22,612.99
|
|
|
Knee joint replacement
|
Facility
|
IP
|
$63,200.99
|
|
|
Service Code
|
APR-DRG 3021
|
| Min. Negotiated Rate |
$22,164.00 |
| Max. Negotiated Rate |
$63,200.99 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$63,200.99
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$63,200.99
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$28,089.33
|
| Rate for Payer: Amida Care Medicaid |
$28,089.33
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$63,200.99
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$28,089.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28,089.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33,707.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28,089.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28,089.33
|
| Rate for Payer: Healthfirst Commercial |
$35,147.00
|
| Rate for Payer: Healthfirst Essential Plan |
$63,200.99
|
| Rate for Payer: Healthfirst QHP |
$22,164.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28,089.33
|
| Rate for Payer: SOMOS Essential |
$63,200.99
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$63,200.99
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$63,200.99
|
| Rate for Payer: United Healthcare Medicaid |
$28,089.33
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$28,089.33
|
|
|
Knee joint replacement
|
Facility
|
IP
|
$127,741.70
|
|
|
Service Code
|
APR-DRG 3024
|
| Min. Negotiated Rate |
$55,631.00 |
| Max. Negotiated Rate |
$127,741.70 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$127,741.70
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$127,741.70
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$56,774.09
|
| Rate for Payer: Amida Care Medicaid |
$56,774.09
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$127,741.70
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$56,774.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$56,774.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$68,128.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56,774.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$56,774.09
|
| Rate for Payer: Healthfirst Commercial |
$105,227.00
|
| Rate for Payer: Healthfirst Essential Plan |
$127,741.70
|
| Rate for Payer: Healthfirst QHP |
$55,631.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$56,774.09
|
| Rate for Payer: SOMOS Essential |
$127,741.70
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$127,741.70
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$127,741.70
|
| Rate for Payer: United Healthcare Medicaid |
$56,774.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$56,774.09
|
|
|
Knee joint replacement
|
Facility
|
IP
|
$79,390.26
|
|
|
Service Code
|
APR-DRG 3023
|
| Min. Negotiated Rate |
$29,855.00 |
| Max. Negotiated Rate |
$79,390.26 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$79,390.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$79,390.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$35,284.56
|
| Rate for Payer: Amida Care Medicaid |
$35,284.56
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$79,390.26
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$35,284.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35,284.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42,341.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35,284.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35,284.56
|
| Rate for Payer: Healthfirst Commercial |
$49,462.00
|
| Rate for Payer: Healthfirst Essential Plan |
$79,390.26
|
| Rate for Payer: Healthfirst QHP |
$29,855.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35,284.56
|
| Rate for Payer: SOMOS Essential |
$79,390.26
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$79,390.26
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$79,390.26
|
| Rate for Payer: United Healthcare Medicaid |
$35,284.56
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$35,284.56
|
|
|
Knee joint replacement
|
Facility
|
IP
|
$67,202.15
|
|
|
Service Code
|
APR-DRG 3022
|
| Min. Negotiated Rate |
$24,310.00 |
| Max. Negotiated Rate |
$67,202.15 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$67,202.15
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$67,202.15
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$29,867.62
|
| Rate for Payer: Amida Care Medicaid |
$29,867.62
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$67,202.15
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$29,867.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29,867.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35,841.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29,867.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29,867.62
|
| Rate for Payer: Healthfirst Commercial |
$38,821.00
|
| Rate for Payer: Healthfirst Essential Plan |
$67,202.15
|
| Rate for Payer: Healthfirst QHP |
$24,310.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29,867.62
|
| Rate for Payer: SOMOS Essential |
$67,202.15
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$67,202.15
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$67,202.15
|
| Rate for Payer: United Healthcare Medicaid |
$29,867.62
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$29,867.62
|
|
|
Knee & lower leg procedures except foot
|
Facility
|
IP
|
$53,056.55
|
|
|
Service Code
|
APR-DRG 3131
|
| Min. Negotiated Rate |
$12,495.00 |
| Max. Negotiated Rate |
$53,056.55 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$53,056.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$53,056.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$23,580.69
|
| Rate for Payer: Amida Care Medicaid |
$23,580.69
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$53,056.55
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$23,580.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23,580.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28,296.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23,580.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23,580.69
|
| Rate for Payer: Healthfirst Commercial |
$21,364.00
|
| Rate for Payer: Healthfirst Essential Plan |
$53,056.55
|
| Rate for Payer: Healthfirst QHP |
$12,495.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23,580.69
|
| Rate for Payer: SOMOS Essential |
$53,056.55
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$53,056.55
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$53,056.55
|
| Rate for Payer: United Healthcare Medicaid |
$23,580.69
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$23,580.69
|
|
|
Knee & lower leg procedures except foot
|
Facility
|
IP
|
$62,893.21
|
|
|
Service Code
|
APR-DRG 3132
|
| Min. Negotiated Rate |
$17,921.00 |
| Max. Negotiated Rate |
$62,893.21 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$62,893.21
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$62,893.21
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$27,952.54
|
| Rate for Payer: Amida Care Medicaid |
$27,952.54
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$62,893.21
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$27,952.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27,952.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33,543.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27,952.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27,952.54
|
| Rate for Payer: Healthfirst Commercial |
$31,012.00
|
| Rate for Payer: Healthfirst Essential Plan |
$62,893.21
|
| Rate for Payer: Healthfirst QHP |
$17,921.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27,952.54
|
| Rate for Payer: SOMOS Essential |
$62,893.21
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$62,893.21
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$62,893.21
|
| Rate for Payer: United Healthcare Medicaid |
$27,952.54
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$27,952.54
|
|
|
Knee & lower leg procedures except foot
|
Facility
|
IP
|
$145,830.42
|
|
|
Service Code
|
APR-DRG 3134
|
| Min. Negotiated Rate |
$64,813.52 |
| Max. Negotiated Rate |
$145,830.42 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$145,830.42
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$145,830.42
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$64,813.52
|
| Rate for Payer: Amida Care Medicaid |
$64,813.52
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$145,830.42
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$64,813.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$64,813.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77,776.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64,813.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64,813.52
|
| Rate for Payer: Healthfirst Commercial |
$124,114.00
|
| Rate for Payer: Healthfirst Essential Plan |
$145,830.42
|
| Rate for Payer: Healthfirst QHP |
$72,793.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$64,813.52
|
| Rate for Payer: SOMOS Essential |
$145,830.42
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$145,830.42
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$145,830.42
|
| Rate for Payer: United Healthcare Medicaid |
$64,813.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$64,813.52
|
|
|
Knee & lower leg procedures except foot
|
Facility
|
IP
|
$82,580.62
|
|
|
Service Code
|
APR-DRG 3133
|
| Min. Negotiated Rate |
$30,380.00 |
| Max. Negotiated Rate |
$82,580.62 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$82,580.62
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$82,580.62
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$36,702.50
|
| Rate for Payer: Amida Care Medicaid |
$36,702.50
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$82,580.62
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$36,702.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36,702.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$44,043.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36,702.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36,702.50
|
| Rate for Payer: Healthfirst Commercial |
$51,432.00
|
| Rate for Payer: Healthfirst Essential Plan |
$82,580.62
|
| Rate for Payer: Healthfirst QHP |
$30,380.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36,702.50
|
| Rate for Payer: SOMOS Essential |
$82,580.62
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$82,580.62
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$82,580.62
|
| Rate for Payer: United Healthcare Medicaid |
$36,702.50
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$36,702.50
|
|
|
LABETALOL HCL 100 MG PO TABS
|
Facility
|
OP
|
$0.55
|
|
|
Service Code
|
NDC 0904745161
|
| Hospital Charge Code |
0904745161
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.28
|
| Rate for Payer: Aetna Government |
$0.28
|
| Rate for Payer: Brighton Health Commercial |
$0.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.37
|
| Rate for Payer: EmblemHealth Commercial |
$0.28
|
| Rate for Payer: Group Health Inc Commercial |
$0.28
|
| Rate for Payer: Group Health Inc Medicare |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.36
|
|
|
LABETALOL HCL 100 MG PO TABS
|
Facility
|
OP
|
$0.67
|
|
|
Service Code
|
NDC 7037706012
|
| Hospital Charge Code |
7037706012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.34
|
| Rate for Payer: Aetna Government |
$0.34
|
| Rate for Payer: Brighton Health Commercial |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.46
|
| Rate for Payer: EmblemHealth Commercial |
$0.34
|
| Rate for Payer: Group Health Inc Commercial |
$0.34
|
| Rate for Payer: Group Health Inc Medicare |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.44
|
|
|
LABETALOL HCL 100 MG PO TABS
|
Facility
|
IP
|
$0.67
|
|
|
Service Code
|
NDC 6838279801
|
| Hospital Charge Code |
6838279801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.34
|
|
|
LABETALOL HCL 100 MG PO TABS
|
Facility
|
OP
|
$0.54
|
|
|
Service Code
|
NDC 6068743901
|
| Hospital Charge Code |
6068743901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.27
|
| Rate for Payer: Aetna Government |
$0.27
|
| Rate for Payer: Brighton Health Commercial |
$0.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.37
|
| Rate for Payer: EmblemHealth Commercial |
$0.27
|
| Rate for Payer: Group Health Inc Commercial |
$0.27
|
| Rate for Payer: Group Health Inc Medicare |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.35
|
|
|
LABETALOL HCL 100 MG PO TABS
|
Facility
|
OP
|
$0.67
|
|
|
Service Code
|
NDC 4988412205
|
| Hospital Charge Code |
4988412205
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.34
|
| Rate for Payer: Aetna Government |
$0.34
|
| Rate for Payer: Brighton Health Commercial |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.46
|
| Rate for Payer: EmblemHealth Commercial |
$0.34
|
| Rate for Payer: Group Health Inc Commercial |
$0.34
|
| Rate for Payer: Group Health Inc Medicare |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.44
|
|
|
LABETALOL HCL 100 MG PO TABS
|
Facility
|
OP
|
$0.50
|
|
|
Service Code
|
NDC 0591060501
|
| Hospital Charge Code |
0591060501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.25
|
| Rate for Payer: Aetna Government |
$0.25
|
| Rate for Payer: Brighton Health Commercial |
$0.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.34
|
| Rate for Payer: EmblemHealth Commercial |
$0.25
|
| Rate for Payer: Group Health Inc Commercial |
$0.25
|
| Rate for Payer: Group Health Inc Medicare |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.33
|
|
