|
Other O.R. procedures for lymphatic/hematopoietic/other neoplasms
|
Facility
|
IP
|
$48,693.11
|
|
|
Service Code
|
APR-DRG 6811
|
| Min. Negotiated Rate |
$11,907.00 |
| Max. Negotiated Rate |
$48,693.11 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$48,693.11
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$48,693.11
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$21,641.38
|
| Rate for Payer: Amida Care Medicaid |
$21,641.38
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$48,693.11
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$21,641.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21,641.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25,969.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21,641.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21,641.38
|
| Rate for Payer: Healthfirst Commercial |
$19,799.00
|
| Rate for Payer: Healthfirst Essential Plan |
$48,693.11
|
| Rate for Payer: Healthfirst QHP |
$11,907.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21,641.38
|
| Rate for Payer: SOMOS Essential |
$48,693.11
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$48,693.11
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$48,693.11
|
| Rate for Payer: United Healthcare Medicaid |
$21,641.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$21,641.38
|
|
|
Other O.R. procedures for lymphatic/hematopoietic/other neoplasms
|
Facility
|
IP
|
$59,901.59
|
|
|
Service Code
|
APR-DRG 6812
|
| Min. Negotiated Rate |
$18,158.00 |
| Max. Negotiated Rate |
$59,901.59 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$59,901.59
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$59,901.59
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$26,622.93
|
| Rate for Payer: Amida Care Medicaid |
$26,622.93
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$59,901.59
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$26,622.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26,622.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31,947.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26,622.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26,622.93
|
| Rate for Payer: Healthfirst Commercial |
$28,635.00
|
| Rate for Payer: Healthfirst Essential Plan |
$59,901.59
|
| Rate for Payer: Healthfirst QHP |
$18,158.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26,622.93
|
| Rate for Payer: SOMOS Essential |
$59,901.59
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$59,901.59
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$59,901.59
|
| Rate for Payer: United Healthcare Medicaid |
$26,622.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$26,622.93
|
|
|
Other O.R. procedures for lymphatic/hematopoietic/other neoplasms
|
Facility
|
IP
|
$99,188.46
|
|
|
Service Code
|
APR-DRG 6813
|
| Min. Negotiated Rate |
$37,043.00 |
| Max. Negotiated Rate |
$99,188.46 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$99,188.46
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$99,188.46
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$44,083.76
|
| Rate for Payer: Amida Care Medicaid |
$44,083.76
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$99,188.46
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$44,083.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$44,083.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$52,900.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44,083.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44,083.76
|
| Rate for Payer: Healthfirst Commercial |
$59,653.00
|
| Rate for Payer: Healthfirst Essential Plan |
$99,188.46
|
| Rate for Payer: Healthfirst QHP |
$37,043.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$44,083.76
|
| Rate for Payer: SOMOS Essential |
$99,188.46
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$99,188.46
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$99,188.46
|
| Rate for Payer: United Healthcare Medicaid |
$44,083.76
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$44,083.76
|
|
|
Other O.R. proc for obstetric diagnoses except delivery diagnoses
|
Facility
|
IP
|
$61,456.32
|
|
|
Service Code
|
APR-DRG 5463
|
| Min. Negotiated Rate |
$19,236.00 |
| Max. Negotiated Rate |
$61,456.32 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$61,456.32
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$61,456.32
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$27,313.92
|
| Rate for Payer: Amida Care Medicaid |
$27,313.92
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$61,456.32
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$27,313.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27,313.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32,776.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27,313.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27,313.92
|
| Rate for Payer: Healthfirst Commercial |
$26,557.00
|
| Rate for Payer: Healthfirst Essential Plan |
$61,456.32
|
| Rate for Payer: Healthfirst QHP |
$19,236.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27,313.92
|
| Rate for Payer: SOMOS Essential |
$61,456.32
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$61,456.32
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$61,456.32
|
| Rate for Payer: United Healthcare Medicaid |
$27,313.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$27,313.92
|
|
|
Other O.R. proc for obstetric diagnoses except delivery diagnoses
|
Facility
|
IP
|
$42,136.49
|
|
|
Service Code
|
APR-DRG 5461
|
| Min. Negotiated Rate |
$5,873.00 |
| Max. Negotiated Rate |
$42,136.49 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$42,136.49
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$42,136.49
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$18,727.33
|
| Rate for Payer: Amida Care Medicaid |
$18,727.33
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$42,136.49
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$18,727.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18,727.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22,472.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18,727.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18,727.33
|
| Rate for Payer: Healthfirst Commercial |
$10,572.00
|
| Rate for Payer: Healthfirst Essential Plan |
$42,136.49
|
| Rate for Payer: Healthfirst QHP |
$5,873.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18,727.33
|
| Rate for Payer: SOMOS Essential |
$42,136.49
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$42,136.49
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$42,136.49
|
| Rate for Payer: United Healthcare Medicaid |
$18,727.33
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18,727.33
|
|
|
Other O.R. proc for obstetric diagnoses except delivery diagnoses
|
Facility
|
IP
|
$107,778.17
|
|
|
Service Code
|
APR-DRG 5464
|
| Min. Negotiated Rate |
$23,584.00 |
| Max. Negotiated Rate |
$107,778.17 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$107,778.17
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$107,778.17
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$47,901.41
|
| Rate for Payer: Amida Care Medicaid |
$47,901.41
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$107,778.17
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$47,901.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47,901.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$57,481.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47,901.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47,901.41
|
| Rate for Payer: Healthfirst Commercial |
$31,841.00
|
| Rate for Payer: Healthfirst Essential Plan |
$107,778.17
|
| Rate for Payer: Healthfirst QHP |
$23,584.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47,901.41
|
| Rate for Payer: SOMOS Essential |
$107,778.17
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$107,778.17
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$107,778.17
|
| Rate for Payer: United Healthcare Medicaid |
$47,901.41
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$47,901.41
|
|
|
Other O.R. proc for obstetric diagnoses except delivery diagnoses
|
Facility
|
IP
|
$45,726.10
|
|
|
Service Code
|
APR-DRG 5462
|
| Min. Negotiated Rate |
$8,491.00 |
| Max. Negotiated Rate |
$45,726.10 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$45,726.10
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45,726.10
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20,322.71
|
| Rate for Payer: Amida Care Medicaid |
$20,322.71
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$45,726.10
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$20,322.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20,322.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24,387.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20,322.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20,322.71
|
| Rate for Payer: Healthfirst Commercial |
$14,196.00
|
| Rate for Payer: Healthfirst Essential Plan |
$45,726.10
|
| Rate for Payer: Healthfirst QHP |
$8,491.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20,322.71
|
| Rate for Payer: SOMOS Essential |
$45,726.10
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$45,726.10
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$45,726.10
|
| Rate for Payer: United Healthcare Medicaid |
$20,322.71
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20,322.71
|
|
|
OTHER PATHOLOGICAL FRACTURES W/O MUSCULOSKELETAL MALIGNANCY
|
Facility
|
OP
|
$199.03
|
|
|
Service Code
|
EAPG 00649
|
| Min. Negotiated Rate |
$199.03 |
| Max. Negotiated Rate |
$199.03 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$199.03
|
|
|
Other peripheral vascular procedures #
|
Facility
|
IP
|
$142,325.23
|
|
|
Service Code
|
APR-DRG 1824
|
| Min. Negotiated Rate |
$63,255.66 |
| Max. Negotiated Rate |
$142,325.23 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$142,325.23
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$142,325.23
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$63,255.66
|
| Rate for Payer: Amida Care Medicaid |
$63,255.66
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$142,325.23
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$63,255.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$63,255.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$75,906.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63,255.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$63,255.66
|
| Rate for Payer: Healthfirst Essential Plan |
$142,325.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$63,255.66
|
| Rate for Payer: SOMOS Essential |
$142,325.23
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$142,325.23
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$142,325.23
|
| Rate for Payer: United Healthcare Medicaid |
$63,255.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$63,255.66
|
|
|
Other peripheral vascular procedures #
|
Facility
|
IP
|
$69,266.90
|
|
|
Service Code
|
APR-DRG 1822
|
| Min. Negotiated Rate |
$30,785.29 |
| Max. Negotiated Rate |
$69,266.90 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$69,266.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$69,266.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$30,785.29
|
| Rate for Payer: Amida Care Medicaid |
$30,785.29
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$69,266.90
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$30,785.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30,785.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36,942.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30,785.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30,785.29
|
| Rate for Payer: Healthfirst Essential Plan |
$69,266.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$30,785.29
|
| Rate for Payer: SOMOS Essential |
$69,266.90
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$69,266.90
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$69,266.90
|
| Rate for Payer: United Healthcare Medicaid |
$30,785.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$30,785.29
|
|
|
Other peripheral vascular procedures #
|
Facility
|
IP
|
$88,718.65
|
|
|
Service Code
|
APR-DRG 1823
|
| Min. Negotiated Rate |
$39,430.51 |
| Max. Negotiated Rate |
$88,718.65 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$88,718.65
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$88,718.65
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$39,430.51
|
| Rate for Payer: Amida Care Medicaid |
$39,430.51
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$88,718.65
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$39,430.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39,430.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$47,316.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39,430.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39,430.51
|
| Rate for Payer: Healthfirst Essential Plan |
$88,718.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39,430.51
|
| Rate for Payer: SOMOS Essential |
$88,718.65
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$88,718.65
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$88,718.65
|
| Rate for Payer: United Healthcare Medicaid |
$39,430.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$39,430.51
|
|
|
Other peripheral vascular procedures #
|
Facility
|
IP
|
$58,404.89
|
|
|
Service Code
|
APR-DRG 1821
|
| Min. Negotiated Rate |
$25,957.73 |
| Max. Negotiated Rate |
$58,404.89 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$58,404.89
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$58,404.89
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$25,957.73
|
| Rate for Payer: Amida Care Medicaid |
$25,957.73
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$58,404.89
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$25,957.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25,957.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31,149.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25,957.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25,957.73
|
| Rate for Payer: Healthfirst Essential Plan |
$58,404.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25,957.73
|
| Rate for Payer: SOMOS Essential |
$58,404.89
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$58,404.89
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$58,404.89
|
| Rate for Payer: United Healthcare Medicaid |
$25,957.73
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$25,957.73
|
|
|
Other pneumonia
|
Facility
|
IP
|
$43,946.24
|
|
|
Service Code
|
APR-DRG 1392
|
| Min. Negotiated Rate |
$7,758.00 |
| Max. Negotiated Rate |
$43,946.24 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$43,946.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$43,946.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$19,531.66
|
| Rate for Payer: Amida Care Medicaid |
$19,531.66
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$43,946.24
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$19,531.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19,531.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23,437.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19,531.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19,531.66
|
| Rate for Payer: Healthfirst Commercial |
$13,214.00
|
| Rate for Payer: Healthfirst Essential Plan |
$43,946.24
|
| Rate for Payer: Healthfirst QHP |
$7,758.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19,531.66
|
| Rate for Payer: SOMOS Essential |
$43,946.24
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$43,946.24
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$43,946.24
|
| Rate for Payer: United Healthcare Medicaid |
$19,531.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$19,531.66
|
|
|
Other pneumonia
|
Facility
|
IP
|
$70,177.95
|
|
|
Service Code
|
APR-DRG 1394
|
| Min. Negotiated Rate |
$20,130.00 |
| Max. Negotiated Rate |
$70,177.95 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$70,177.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$70,177.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$31,190.20
|
| Rate for Payer: Amida Care Medicaid |
$31,190.20
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$70,177.95
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$31,190.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31,190.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37,428.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31,190.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31,190.20
|
| Rate for Payer: Healthfirst Commercial |
$36,199.00
|
| Rate for Payer: Healthfirst Essential Plan |
$70,177.95
|
| Rate for Payer: Healthfirst QHP |
$20,130.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31,190.20
|
| Rate for Payer: SOMOS Essential |
$70,177.95
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$70,177.95
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$70,177.95
|
| Rate for Payer: United Healthcare Medicaid |
$31,190.20
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$31,190.20
|
|
|
Other pneumonia
|
Facility
|
IP
|
$52,032.96
|
|
|
Service Code
|
APR-DRG 1393
|
| Min. Negotiated Rate |
$11,682.00 |
| Max. Negotiated Rate |
$52,032.96 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$52,032.96
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$52,032.96
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$23,125.76
|
| Rate for Payer: Amida Care Medicaid |
$23,125.76
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$52,032.96
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$23,125.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23,125.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27,750.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23,125.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23,125.76
|
| Rate for Payer: Healthfirst Commercial |
$20,518.00
|
| Rate for Payer: Healthfirst Essential Plan |
$52,032.96
|
| Rate for Payer: Healthfirst QHP |
$11,682.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23,125.76
|
| Rate for Payer: SOMOS Essential |
$52,032.96
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$52,032.96
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$52,032.96
|
| Rate for Payer: United Healthcare Medicaid |
$23,125.76
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$23,125.76
|
|
|
Other pneumonia
|
Facility
|
IP
|
$41,051.34
|
|
|
Service Code
|
APR-DRG 1391
|
| Min. Negotiated Rate |
$5,862.00 |
| Max. Negotiated Rate |
$41,051.34 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$41,051.34
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$41,051.34
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$18,245.04
|
| Rate for Payer: Amida Care Medicaid |
$18,245.04
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$41,051.34
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$18,245.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18,245.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21,894.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18,245.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18,245.04
|
| Rate for Payer: Healthfirst Commercial |
$10,257.00
|
| Rate for Payer: Healthfirst Essential Plan |
$41,051.34
|
| Rate for Payer: Healthfirst QHP |
$5,862.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18,245.04
|
| Rate for Payer: SOMOS Essential |
$41,051.34
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$41,051.34
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$41,051.34
|
| Rate for Payer: United Healthcare Medicaid |
$18,245.04
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18,245.04
|
|
|
Other procedures for endocrine, nutritional & metabolic disorders
|
Facility
|
IP
|
$83,813.51
|
|
|
Service Code
|
APR-DRG 4053
|
| Min. Negotiated Rate |
$31,654.00 |
| Max. Negotiated Rate |
$83,813.51 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$83,813.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$83,813.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$37,250.45
|
| Rate for Payer: Amida Care Medicaid |
$37,250.45
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$83,813.51
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$37,250.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37,250.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$44,700.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37,250.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$37,250.45
|
| Rate for Payer: Healthfirst Commercial |
$55,216.00
|
| Rate for Payer: Healthfirst Essential Plan |
$83,813.51
|
| Rate for Payer: Healthfirst QHP |
$31,654.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$37,250.45
|
| Rate for Payer: SOMOS Essential |
$83,813.51
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$83,813.51
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$83,813.51
|
| Rate for Payer: United Healthcare Medicaid |
$37,250.45
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$37,250.45
|
|
|
Other procedures for endocrine, nutritional & metabolic disorders
|
Facility
|
IP
|
$61,802.80
|
|
|
Service Code
|
APR-DRG 4052
|
| Min. Negotiated Rate |
$19,712.00 |
| Max. Negotiated Rate |
$61,802.80 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$61,802.80
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$61,802.80
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$27,467.91
|
| Rate for Payer: Amida Care Medicaid |
$27,467.91
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$61,802.80
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$27,467.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27,467.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32,961.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27,467.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27,467.91
|
| Rate for Payer: Healthfirst Commercial |
$32,417.00
|
| Rate for Payer: Healthfirst Essential Plan |
$61,802.80
|
| Rate for Payer: Healthfirst QHP |
$19,712.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27,467.91
|
| Rate for Payer: SOMOS Essential |
$61,802.80
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$61,802.80
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$61,802.80
|
| Rate for Payer: United Healthcare Medicaid |
$27,467.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$27,467.91
|
|
|
Other procedures for endocrine, nutritional & metabolic disorders
|
Facility
|
IP
|
$179,542.06
|
|
|
Service Code
|
APR-DRG 4054
|
| Min. Negotiated Rate |
$79,796.47 |
| Max. Negotiated Rate |
$179,542.06 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$179,542.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$179,542.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$79,796.47
|
| Rate for Payer: Amida Care Medicaid |
$79,796.47
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$179,542.06
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$79,796.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$79,796.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$95,755.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$79,796.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$79,796.47
|
| Rate for Payer: Healthfirst Commercial |
$138,095.00
|
| Rate for Payer: Healthfirst Essential Plan |
$179,542.06
|
| Rate for Payer: Healthfirst QHP |
$89,909.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$79,796.47
|
| Rate for Payer: SOMOS Essential |
$179,542.06
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$179,542.06
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$179,542.06
|
| Rate for Payer: United Healthcare Medicaid |
$79,796.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$79,796.47
|
|
|
Other procedures for endocrine, nutritional & metabolic disorders
|
Facility
|
IP
|
$52,520.13
|
|
|
Service Code
|
APR-DRG 4051
|
| Min. Negotiated Rate |
$12,645.00 |
| Max. Negotiated Rate |
$52,520.13 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$52,520.13
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$52,520.13
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$23,342.28
|
| Rate for Payer: Amida Care Medicaid |
$23,342.28
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$52,520.13
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$23,342.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23,342.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28,010.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23,342.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23,342.28
|
| Rate for Payer: Healthfirst Commercial |
$20,232.00
|
| Rate for Payer: Healthfirst Essential Plan |
$52,520.13
|
| Rate for Payer: Healthfirst QHP |
$12,645.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23,342.28
|
| Rate for Payer: SOMOS Essential |
$52,520.13
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$52,520.13
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$52,520.13
|
| Rate for Payer: United Healthcare Medicaid |
$23,342.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$23,342.28
|
|
|
Other procedures of blood & blood-forming organs
|
Facility
|
IP
|
$50,330.50
|
|
|
Service Code
|
APR-DRG 6511
|
| Min. Negotiated Rate |
$11,779.00 |
| Max. Negotiated Rate |
$50,330.50 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$50,330.50
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$50,330.50
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$22,369.11
|
| Rate for Payer: Amida Care Medicaid |
$22,369.11
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$50,330.50
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$22,369.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22,369.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26,842.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22,369.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22,369.11
|
| Rate for Payer: Healthfirst Commercial |
$18,672.00
|
| Rate for Payer: Healthfirst Essential Plan |
$50,330.50
|
| Rate for Payer: Healthfirst QHP |
$11,779.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22,369.11
|
| Rate for Payer: SOMOS Essential |
$50,330.50
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$50,330.50
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$50,330.50
|
| Rate for Payer: United Healthcare Medicaid |
$22,369.11
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$22,369.11
|
|
|
Other procedures of blood & blood-forming organs
|
Facility
|
IP
|
$77,868.95
|
|
|
Service Code
|
APR-DRG 6513
|
| Min. Negotiated Rate |
$29,884.00 |
| Max. Negotiated Rate |
$77,868.95 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$77,868.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$77,868.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$34,608.42
|
| Rate for Payer: Amida Care Medicaid |
$34,608.42
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$77,868.95
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$34,608.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34,608.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41,530.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34,608.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34,608.42
|
| Rate for Payer: Healthfirst Commercial |
$51,338.00
|
| Rate for Payer: Healthfirst Essential Plan |
$77,868.95
|
| Rate for Payer: Healthfirst QHP |
$29,884.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$34,608.42
|
| Rate for Payer: SOMOS Essential |
$77,868.95
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$77,868.95
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$77,868.95
|
| Rate for Payer: United Healthcare Medicaid |
$34,608.42
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$34,608.42
|
|
|
Other procedures of blood & blood-forming organs
|
Facility
|
IP
|
$56,303.19
|
|
|
Service Code
|
APR-DRG 6512
|
| Min. Negotiated Rate |
$16,720.00 |
| Max. Negotiated Rate |
$56,303.19 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$56,303.19
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$56,303.19
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$25,023.64
|
| Rate for Payer: Amida Care Medicaid |
$25,023.64
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$56,303.19
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$25,023.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25,023.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30,028.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25,023.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25,023.64
|
| Rate for Payer: Healthfirst Commercial |
$29,207.00
|
| Rate for Payer: Healthfirst Essential Plan |
$56,303.19
|
| Rate for Payer: Healthfirst QHP |
$16,720.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25,023.64
|
| Rate for Payer: SOMOS Essential |
$56,303.19
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$56,303.19
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$56,303.19
|
| Rate for Payer: United Healthcare Medicaid |
$25,023.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$25,023.64
|
|
|
Other procedures of blood & blood-forming organs
|
Facility
|
IP
|
$130,862.00
|
|
|
Service Code
|
APR-DRG 6514
|
| Min. Negotiated Rate |
$43,713.25 |
| Max. Negotiated Rate |
$130,862.00 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$98,354.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$98,354.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$43,713.25
|
| Rate for Payer: Amida Care Medicaid |
$43,713.25
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$98,354.81
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$43,713.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43,713.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$52,455.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43,713.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43,713.25
|
| Rate for Payer: Healthfirst Commercial |
$130,862.00
|
| Rate for Payer: Healthfirst Essential Plan |
$98,354.81
|
| Rate for Payer: Healthfirst QHP |
$117,526.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$43,713.25
|
| Rate for Payer: SOMOS Essential |
$98,354.81
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$98,354.81
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$98,354.81
|
| Rate for Payer: United Healthcare Medicaid |
$43,713.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$43,713.25
|
|
|
Other respiratory & chest procedures
|
Facility
|
IP
|
$82,028.38
|
|
|
Service Code
|
APR-DRG 1213
|
| Min. Negotiated Rate |
$33,939.00 |
| Max. Negotiated Rate |
$82,028.38 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$82,028.38
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$82,028.38
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$36,457.06
|
| Rate for Payer: Amida Care Medicaid |
$36,457.06
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$82,028.38
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$36,457.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36,457.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43,748.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36,457.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36,457.06
|
| Rate for Payer: Healthfirst Commercial |
$55,561.00
|
| Rate for Payer: Healthfirst Essential Plan |
$82,028.38
|
| Rate for Payer: Healthfirst QHP |
$33,939.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36,457.06
|
| Rate for Payer: SOMOS Essential |
$82,028.38
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$82,028.38
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$82,028.38
|
| Rate for Payer: United Healthcare Medicaid |
$36,457.06
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$36,457.06
|
|
