|
Major chest & respiratory trauma
|
Facility
|
IP
|
$44,695.46
|
|
|
Service Code
|
APR-DRG 1352
|
| Min. Negotiated Rate |
$8,442.00 |
| Max. Negotiated Rate |
$44,695.46 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$44,695.46
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$44,695.46
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$19,864.65
|
| Rate for Payer: Amida Care Medicaid |
$19,864.65
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$44,695.46
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$19,864.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19,864.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23,837.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19,864.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19,864.65
|
| Rate for Payer: Healthfirst Commercial |
$14,079.00
|
| Rate for Payer: Healthfirst Essential Plan |
$44,695.46
|
| Rate for Payer: Healthfirst QHP |
$8,442.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19,864.65
|
| Rate for Payer: SOMOS Essential |
$44,695.46
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$44,695.46
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$44,695.46
|
| Rate for Payer: United Healthcare Medicaid |
$19,864.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$19,864.65
|
|
|
Major cranial/facial bone procedures
|
Facility
|
IP
|
$70,044.28
|
|
|
Service Code
|
APR-DRG 0892
|
| Min. Negotiated Rate |
$24,288.00 |
| Max. Negotiated Rate |
$70,044.28 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$70,044.28
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$70,044.28
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$31,130.79
|
| Rate for Payer: Amida Care Medicaid |
$31,130.79
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$70,044.28
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$31,130.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31,130.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37,356.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31,130.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31,130.79
|
| Rate for Payer: Healthfirst Commercial |
$37,510.00
|
| Rate for Payer: Healthfirst Essential Plan |
$70,044.28
|
| Rate for Payer: Healthfirst QHP |
$24,288.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31,130.79
|
| Rate for Payer: SOMOS Essential |
$70,044.28
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$70,044.28
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$70,044.28
|
| Rate for Payer: United Healthcare Medicaid |
$31,130.79
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$31,130.79
|
|
|
Major cranial/facial bone procedures
|
Facility
|
IP
|
$151,938.54
|
|
|
Service Code
|
APR-DRG 0894
|
| Min. Negotiated Rate |
$67,528.24 |
| Max. Negotiated Rate |
$151,938.54 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$151,938.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$151,938.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$67,528.24
|
| Rate for Payer: Amida Care Medicaid |
$67,528.24
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$151,938.54
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$67,528.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$67,528.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$81,033.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67,528.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67,528.24
|
| Rate for Payer: Healthfirst Commercial |
$107,217.00
|
| Rate for Payer: Healthfirst Essential Plan |
$151,938.54
|
| Rate for Payer: Healthfirst QHP |
$109,141.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$67,528.24
|
| Rate for Payer: SOMOS Essential |
$151,938.54
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$151,938.54
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$151,938.54
|
| Rate for Payer: United Healthcare Medicaid |
$67,528.24
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$67,528.24
|
|
|
Major cranial/facial bone procedures
|
Facility
|
IP
|
$99,024.91
|
|
|
Service Code
|
APR-DRG 0893
|
| Min. Negotiated Rate |
$40,398.00 |
| Max. Negotiated Rate |
$99,024.91 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$99,024.91
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$99,024.91
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$44,011.07
|
| Rate for Payer: Amida Care Medicaid |
$44,011.07
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$99,024.91
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$44,011.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$44,011.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$52,813.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44,011.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44,011.07
|
| Rate for Payer: Healthfirst Commercial |
$58,506.00
|
| Rate for Payer: Healthfirst Essential Plan |
$99,024.91
|
| Rate for Payer: Healthfirst QHP |
$40,398.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$44,011.07
|
| Rate for Payer: SOMOS Essential |
$99,024.91
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$99,024.91
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$99,024.91
|
| Rate for Payer: United Healthcare Medicaid |
$44,011.07
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$44,011.07
|
|
|
Major cranial/facial bone procedures
|
Facility
|
IP
|
$55,995.41
|
|
|
Service Code
|
APR-DRG 0891
|
| Min. Negotiated Rate |
$16,434.00 |
| Max. Negotiated Rate |
$55,995.41 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$55,995.41
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$55,995.41
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$24,886.85
|
| Rate for Payer: Amida Care Medicaid |
$24,886.85
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$55,995.41
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$24,886.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24,886.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29,864.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24,886.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24,886.85
|
| Rate for Payer: Healthfirst Commercial |
$25,475.00
|
| Rate for Payer: Healthfirst Essential Plan |
$55,995.41
|
| Rate for Payer: Healthfirst QHP |
$16,434.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24,886.85
|
| Rate for Payer: SOMOS Essential |
$55,995.41
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$55,995.41
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$55,995.41
|
| Rate for Payer: United Healthcare Medicaid |
$24,886.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$24,886.85
|
|
|
MAJOR DEPRESSIVE DIAGNOSES AND OTHER OR UNSPECIFIED PSYCHOSES
|
Facility
|
OP
|
$211.05
|
|
|
Service Code
|
EAPG 00821
|
| Min. Negotiated Rate |
$152.74 |
| Max. Negotiated Rate |
$211.05 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$152.74
|
| Rate for Payer: Healthfirst Commercial |
$211.05
|
|
|
Major depressive disorders & other/unspecified psychoses
|
Facility
|
IP
|
$10,166.00
|
|
|
Service Code
|
APR-DRG 7511
|
| Min. Negotiated Rate |
$3,327.98 |
| Max. Negotiated Rate |
$10,166.00 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,327.98
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,327.98
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,327.98
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$3,327.98
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$7,487.95
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$3,327.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,993.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,327.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,327.98
|
| Rate for Payer: Healthfirst Commercial |
$10,166.00
|
| Rate for Payer: Healthfirst Essential Plan |
$7,487.95
|
| Rate for Payer: Healthfirst QHP |
$6,056.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3,327.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7,487.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7,487.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,327.98
|
| Rate for Payer: SOMOS Essential |
$7,487.95
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$7,487.95
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$7,487.95
|
| Rate for Payer: United Healthcare Medicaid |
$3,327.98
|
|
|
Major depressive disorders & other/unspecified psychoses
|
Facility
|
IP
|
$24,962.00
|
|
|
Service Code
|
APR-DRG 7513
|
| Min. Negotiated Rate |
$3,412.10 |
| Max. Negotiated Rate |
$24,962.00 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,412.10
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,412.10
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,412.10
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$3,412.10
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$7,677.23
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$3,412.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,094.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,412.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,412.10
|
| Rate for Payer: Healthfirst Commercial |
$24,962.00
|
| Rate for Payer: Healthfirst Essential Plan |
$7,677.23
|
| Rate for Payer: Healthfirst QHP |
$6,210.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3,412.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7,677.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7,677.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,412.10
|
| Rate for Payer: SOMOS Essential |
$7,677.23
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$7,677.23
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$7,677.23
|
| Rate for Payer: United Healthcare Medicaid |
$3,412.10
|
|
|
Major depressive disorders & other/unspecified psychoses
|
Facility
|
IP
|
$25,517.00
|
|
|
Service Code
|
APR-DRG 7514
|
| Min. Negotiated Rate |
$3,470.64 |
| Max. Negotiated Rate |
$25,517.00 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,470.64
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,470.64
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,470.64
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$3,470.64
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$7,808.94
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$3,470.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,164.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,470.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,470.64
|
| Rate for Payer: Healthfirst Commercial |
$25,517.00
|
| Rate for Payer: Healthfirst Essential Plan |
$7,808.94
|
| Rate for Payer: Healthfirst QHP |
$6,316.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3,470.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7,808.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7,808.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,470.64
|
| Rate for Payer: SOMOS Essential |
$7,808.94
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$7,808.94
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$7,808.94
|
| Rate for Payer: United Healthcare Medicaid |
$3,470.64
|
|
|
Major depressive disorders & other/unspecified psychoses
|
Facility
|
IP
|
$11,302.00
|
|
|
Service Code
|
APR-DRG 7512
|
| Min. Negotiated Rate |
$3,393.31 |
| Max. Negotiated Rate |
$11,302.00 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,393.31
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,393.31
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,393.31
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$3,393.31
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$7,634.95
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$3,393.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,071.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,393.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,393.31
|
| Rate for Payer: Healthfirst Commercial |
$11,302.00
|
| Rate for Payer: Healthfirst Essential Plan |
$7,634.95
|
| Rate for Payer: Healthfirst QHP |
$6,175.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3,393.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7,634.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7,634.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,393.31
|
| Rate for Payer: SOMOS Essential |
$7,634.95
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$7,634.95
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$7,634.95
|
| Rate for Payer: United Healthcare Medicaid |
$3,393.31
|
|
|
Major esophageal disorders
|
Facility
|
IP
|
$53,971.09
|
|
|
Service Code
|
APR-DRG 2423
|
| Min. Negotiated Rate |
$13,425.00 |
| Max. Negotiated Rate |
$53,971.09 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$53,971.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$53,971.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$23,987.15
|
| Rate for Payer: Amida Care Medicaid |
$23,987.15
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$53,971.09
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$23,987.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23,987.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28,784.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23,987.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23,987.15
|
| Rate for Payer: Healthfirst Commercial |
$22,511.00
|
| Rate for Payer: Healthfirst Essential Plan |
$53,971.09
|
| Rate for Payer: Healthfirst QHP |
$13,425.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23,987.15
|
| Rate for Payer: SOMOS Essential |
$53,971.09
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$53,971.09
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$53,971.09
|
| Rate for Payer: United Healthcare Medicaid |
$23,987.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$23,987.15
|
|
|
Major esophageal disorders
|
Facility
|
IP
|
$41,733.74
|
|
|
Service Code
|
APR-DRG 2421
|
| Min. Negotiated Rate |
$6,542.00 |
| Max. Negotiated Rate |
$41,733.74 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$41,733.74
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$41,733.74
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$18,548.33
|
| Rate for Payer: Amida Care Medicaid |
$18,548.33
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$41,733.74
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$18,548.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18,548.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22,258.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18,548.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18,548.33
|
| Rate for Payer: Healthfirst Commercial |
$10,630.00
|
| Rate for Payer: Healthfirst Essential Plan |
$41,733.74
|
| Rate for Payer: Healthfirst QHP |
$6,542.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18,548.33
|
| Rate for Payer: SOMOS Essential |
$41,733.74
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$41,733.74
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$41,733.74
|
| Rate for Payer: United Healthcare Medicaid |
$18,548.33
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18,548.33
|
|
|
Major esophageal disorders
|
Facility
|
IP
|
$87,508.62
|
|
|
Service Code
|
APR-DRG 2424
|
| Min. Negotiated Rate |
$30,566.00 |
| Max. Negotiated Rate |
$87,508.62 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$87,508.62
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$87,508.62
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$38,892.72
|
| Rate for Payer: Amida Care Medicaid |
$38,892.72
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$87,508.62
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$38,892.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38,892.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$46,671.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38,892.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38,892.72
|
| Rate for Payer: Healthfirst Commercial |
$48,289.00
|
| Rate for Payer: Healthfirst Essential Plan |
$87,508.62
|
| Rate for Payer: Healthfirst QHP |
$30,566.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$38,892.72
|
| Rate for Payer: SOMOS Essential |
$87,508.62
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$87,508.62
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$87,508.62
|
| Rate for Payer: United Healthcare Medicaid |
$38,892.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$38,892.72
|
|
|
Major esophageal disorders
|
Facility
|
IP
|
$45,988.15
|
|
|
Service Code
|
APR-DRG 2422
|
| Min. Negotiated Rate |
$8,803.00 |
| Max. Negotiated Rate |
$45,988.15 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$45,988.15
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45,988.15
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20,439.18
|
| Rate for Payer: Amida Care Medicaid |
$20,439.18
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$45,988.15
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$20,439.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20,439.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24,527.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20,439.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20,439.18
|
| Rate for Payer: Healthfirst Commercial |
$14,217.00
|
| Rate for Payer: Healthfirst Essential Plan |
$45,988.15
|
| Rate for Payer: Healthfirst QHP |
$8,803.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20,439.18
|
| Rate for Payer: SOMOS Essential |
$45,988.15
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$45,988.15
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$45,988.15
|
| Rate for Payer: United Healthcare Medicaid |
$20,439.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20,439.18
|
|
|
Major gastrointestinal & peritoneal infections
|
Facility
|
IP
|
$46,902.69
|
|
|
Service Code
|
APR-DRG 2482
|
| Min. Negotiated Rate |
$9,248.00 |
| Max. Negotiated Rate |
$46,902.69 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$46,902.69
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$46,902.69
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20,845.64
|
| Rate for Payer: Amida Care Medicaid |
$20,845.64
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$46,902.69
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$20,845.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20,845.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25,014.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20,845.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20,845.64
|
| Rate for Payer: Healthfirst Commercial |
$15,998.00
|
| Rate for Payer: Healthfirst Essential Plan |
$46,902.69
|
| Rate for Payer: Healthfirst QHP |
$9,248.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20,845.64
|
| Rate for Payer: SOMOS Essential |
$46,902.69
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$46,902.69
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$46,902.69
|
| Rate for Payer: United Healthcare Medicaid |
$20,845.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20,845.64
|
|
|
Major gastrointestinal & peritoneal infections
|
Facility
|
IP
|
$55,212.77
|
|
|
Service Code
|
APR-DRG 2483
|
| Min. Negotiated Rate |
$13,876.00 |
| Max. Negotiated Rate |
$55,212.77 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$55,212.77
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$55,212.77
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$24,539.01
|
| Rate for Payer: Amida Care Medicaid |
$24,539.01
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$55,212.77
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$24,539.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24,539.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29,446.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24,539.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24,539.01
|
| Rate for Payer: Healthfirst Commercial |
$23,607.00
|
| Rate for Payer: Healthfirst Essential Plan |
$55,212.77
|
| Rate for Payer: Healthfirst QHP |
$13,876.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24,539.01
|
| Rate for Payer: SOMOS Essential |
$55,212.77
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$55,212.77
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$55,212.77
|
| Rate for Payer: United Healthcare Medicaid |
$24,539.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$24,539.01
|
|
|
Major gastrointestinal & peritoneal infections
|
Facility
|
IP
|
$88,938.49
|
|
|
Service Code
|
APR-DRG 2484
|
| Min. Negotiated Rate |
$27,562.00 |
| Max. Negotiated Rate |
$88,938.49 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$88,938.49
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$88,938.49
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$39,528.22
|
| Rate for Payer: Amida Care Medicaid |
$39,528.22
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$88,938.49
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$39,528.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39,528.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$47,433.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39,528.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39,528.22
|
| Rate for Payer: Healthfirst Commercial |
$47,506.00
|
| Rate for Payer: Healthfirst Essential Plan |
$88,938.49
|
| Rate for Payer: Healthfirst QHP |
$27,562.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39,528.22
|
| Rate for Payer: SOMOS Essential |
$88,938.49
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$88,938.49
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$88,938.49
|
| Rate for Payer: United Healthcare Medicaid |
$39,528.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$39,528.22
|
|
|
Major gastrointestinal & peritoneal infections
|
Facility
|
IP
|
$42,482.97
|
|
|
Service Code
|
APR-DRG 2481
|
| Min. Negotiated Rate |
$6,720.00 |
| Max. Negotiated Rate |
$42,482.97 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$42,482.97
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$42,482.97
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$18,881.32
|
| Rate for Payer: Amida Care Medicaid |
$18,881.32
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$42,482.97
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$18,881.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18,881.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22,657.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18,881.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18,881.32
|
| Rate for Payer: Healthfirst Commercial |
$11,729.00
|
| Rate for Payer: Healthfirst Essential Plan |
$42,482.97
|
| Rate for Payer: Healthfirst QHP |
$6,720.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18,881.32
|
| Rate for Payer: SOMOS Essential |
$42,482.97
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$42,482.97
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$42,482.97
|
| Rate for Payer: United Healthcare Medicaid |
$18,881.32
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18,881.32
|
|
|
Major hematologic/immunologic diag exc sickle cell crisis & coagul
|
Facility
|
IP
|
$119,567.05
|
|
|
Service Code
|
APR-DRG 6604
|
| Min. Negotiated Rate |
$53,140.91 |
| Max. Negotiated Rate |
$119,567.05 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$119,567.05
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$119,567.05
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$53,140.91
|
| Rate for Payer: Amida Care Medicaid |
$53,140.91
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$119,567.05
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$53,140.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$53,140.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$63,769.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53,140.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$53,140.91
|
| Rate for Payer: Healthfirst Commercial |
$105,830.00
|
| Rate for Payer: Healthfirst Essential Plan |
$119,567.05
|
| Rate for Payer: Healthfirst QHP |
$64,828.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$53,140.91
|
| Rate for Payer: SOMOS Essential |
$119,567.05
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$119,567.05
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$119,567.05
|
| Rate for Payer: United Healthcare Medicaid |
$53,140.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$53,140.91
|
|
|
Major hematologic/immunologic diag exc sickle cell crisis & coagul
|
Facility
|
IP
|
$47,843.62
|
|
|
Service Code
|
APR-DRG 6602
|
| Min. Negotiated Rate |
$11,299.00 |
| Max. Negotiated Rate |
$47,843.62 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$47,843.62
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$47,843.62
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$21,263.83
|
| Rate for Payer: Amida Care Medicaid |
$21,263.83
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$47,843.62
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$21,263.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21,263.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25,516.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21,263.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21,263.83
|
| Rate for Payer: Healthfirst Commercial |
$18,295.00
|
| Rate for Payer: Healthfirst Essential Plan |
$47,843.62
|
| Rate for Payer: Healthfirst QHP |
$11,299.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21,263.83
|
| Rate for Payer: SOMOS Essential |
$47,843.62
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$47,843.62
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$47,843.62
|
| Rate for Payer: United Healthcare Medicaid |
$21,263.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$21,263.83
|
|
|
Major hematologic/immunologic diag exc sickle cell crisis & coagul
|
Facility
|
IP
|
$58,779.52
|
|
|
Service Code
|
APR-DRG 6603
|
| Min. Negotiated Rate |
$19,220.00 |
| Max. Negotiated Rate |
$58,779.52 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$58,779.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$58,779.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$26,124.23
|
| Rate for Payer: Amida Care Medicaid |
$26,124.23
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$58,779.52
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$26,124.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26,124.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31,349.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26,124.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26,124.23
|
| Rate for Payer: Healthfirst Commercial |
$30,903.00
|
| Rate for Payer: Healthfirst Essential Plan |
$58,779.52
|
| Rate for Payer: Healthfirst QHP |
$19,220.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26,124.23
|
| Rate for Payer: SOMOS Essential |
$58,779.52
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$58,779.52
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$58,779.52
|
| Rate for Payer: United Healthcare Medicaid |
$26,124.23
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$26,124.23
|
|
|
Major hematologic/immunologic diag exc sickle cell crisis & coagul
|
Facility
|
IP
|
$44,280.40
|
|
|
Service Code
|
APR-DRG 6601
|
| Min. Negotiated Rate |
$8,312.00 |
| Max. Negotiated Rate |
$44,280.40 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$44,280.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$44,280.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$19,680.18
|
| Rate for Payer: Amida Care Medicaid |
$19,680.18
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$44,280.40
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$19,680.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19,680.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23,616.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19,680.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19,680.18
|
| Rate for Payer: Healthfirst Commercial |
$13,651.00
|
| Rate for Payer: Healthfirst Essential Plan |
$44,280.40
|
| Rate for Payer: Healthfirst QHP |
$8,312.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19,680.18
|
| Rate for Payer: SOMOS Essential |
$44,280.40
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$44,280.40
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$44,280.40
|
| Rate for Payer: United Healthcare Medicaid |
$19,680.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$19,680.18
|
|
|
Major larynx & trachea procedures
|
Facility
|
IP
|
$45,358.51
|
|
|
Service Code
|
APR-DRG 0901
|
| Min. Negotiated Rate |
$9,600.00 |
| Max. Negotiated Rate |
$45,358.51 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$45,358.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45,358.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20,159.34
|
| Rate for Payer: Amida Care Medicaid |
$20,159.34
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$45,358.51
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$20,159.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20,159.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24,191.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20,159.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20,159.34
|
| Rate for Payer: Healthfirst Commercial |
$13,650.00
|
| Rate for Payer: Healthfirst Essential Plan |
$45,358.51
|
| Rate for Payer: Healthfirst QHP |
$9,600.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20,159.34
|
| Rate for Payer: SOMOS Essential |
$45,358.51
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$45,358.51
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$45,358.51
|
| Rate for Payer: United Healthcare Medicaid |
$20,159.34
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20,159.34
|
|
|
Major larynx & trachea procedures
|
Facility
|
IP
|
$103,889.59
|
|
|
Service Code
|
APR-DRG 0903
|
| Min. Negotiated Rate |
$46,173.15 |
| Max. Negotiated Rate |
$103,889.59 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$103,889.59
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$103,889.59
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$46,173.15
|
| Rate for Payer: Amida Care Medicaid |
$46,173.15
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$103,889.59
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$46,173.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$46,173.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$55,407.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46,173.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$46,173.15
|
| Rate for Payer: Healthfirst Commercial |
$76,034.00
|
| Rate for Payer: Healthfirst Essential Plan |
$103,889.59
|
| Rate for Payer: Healthfirst QHP |
$48,324.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$46,173.15
|
| Rate for Payer: SOMOS Essential |
$103,889.59
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$103,889.59
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$103,889.59
|
| Rate for Payer: United Healthcare Medicaid |
$46,173.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$46,173.15
|
|
|
Major larynx & trachea procedures
|
Facility
|
IP
|
$71,977.14
|
|
|
Service Code
|
APR-DRG 0902
|
| Min. Negotiated Rate |
$24,484.00 |
| Max. Negotiated Rate |
$71,977.14 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$71,977.14
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$71,977.14
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$31,989.84
|
| Rate for Payer: Amida Care Medicaid |
$31,989.84
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$71,977.14
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$31,989.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31,989.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38,387.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31,989.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31,989.84
|
| Rate for Payer: Healthfirst Commercial |
$41,544.00
|
| Rate for Payer: Healthfirst Essential Plan |
$71,977.14
|
| Rate for Payer: Healthfirst QHP |
$24,484.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31,989.84
|
| Rate for Payer: SOMOS Essential |
$71,977.14
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$71,977.14
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$71,977.14
|
| Rate for Payer: United Healthcare Medicaid |
$31,989.84
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$31,989.84
|
|
