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Charge Type Price  
Service Code APR-DRG 2403
Min. Negotiated Rate $17,113.00
Max. Negotiated Rate $57,491.10
Rate for Payer: Amida Care Medicaid $25,551.60
Rate for Payer: Fidelis CHP/HARP/Medicaid $25,551.60
Rate for Payer: Fidelis Qualified Health Plan $30,661.92
Rate for Payer: Hamaspik Choice Inc Medicaid $25,551.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid $25,551.60
Rate for Payer: Healthfirst Commercial $26,516.00
Rate for Payer: Healthfirst Essential Plan $57,491.10
Rate for Payer: Healthfirst QHP $17,113.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $25,551.60
Rate for Payer: SOMOS Essential $57,491.10
Rate for Payer: Wellcare CHP/FHP/Medicaid $25,551.60
Service Code APR-DRG 2404
Min. Negotiated Rate $31,040.00
Max. Negotiated Rate $81,946.48
Rate for Payer: Amida Care Medicaid $36,420.66
Rate for Payer: Fidelis CHP/HARP/Medicaid $36,420.66
Rate for Payer: Fidelis Qualified Health Plan $43,704.79
Rate for Payer: Hamaspik Choice Inc Medicaid $36,420.66
Rate for Payer: Healthfirst CHP/FHP/Medicaid $36,420.66
Rate for Payer: Healthfirst Commercial $51,649.00
Rate for Payer: Healthfirst Essential Plan $81,946.48
Rate for Payer: Healthfirst QHP $31,040.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $36,420.66
Rate for Payer: SOMOS Essential $81,946.48
Rate for Payer: Wellcare CHP/FHP/Medicaid $36,420.66
Service Code APR-DRG 2411
Min. Negotiated Rate $6,103.00
Max. Negotiated Rate $39,149.14
Rate for Payer: Amida Care Medicaid $17,399.62
Rate for Payer: Fidelis CHP/HARP/Medicaid $17,399.62
Rate for Payer: Fidelis Qualified Health Plan $20,879.54
Rate for Payer: Hamaspik Choice Inc Medicaid $17,399.62
Rate for Payer: Healthfirst CHP/FHP/Medicaid $17,399.62
Rate for Payer: Healthfirst Commercial $10,395.00
Rate for Payer: Healthfirst Essential Plan $39,149.14
Rate for Payer: Healthfirst QHP $6,103.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $17,399.62
Rate for Payer: SOMOS Essential $39,149.14
Rate for Payer: Wellcare CHP/FHP/Medicaid $17,399.62
Service Code APR-DRG 2412
Min. Negotiated Rate $8,326.00
Max. Negotiated Rate $43,285.72
Rate for Payer: Amida Care Medicaid $19,238.10
Rate for Payer: Fidelis CHP/HARP/Medicaid $19,238.10
Rate for Payer: Fidelis Qualified Health Plan $23,085.72
Rate for Payer: Hamaspik Choice Inc Medicaid $19,238.10
Rate for Payer: Healthfirst CHP/FHP/Medicaid $19,238.10
Rate for Payer: Healthfirst Commercial $13,919.00
Rate for Payer: Healthfirst Essential Plan $43,285.72
Rate for Payer: Healthfirst QHP $8,326.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $19,238.10
Rate for Payer: SOMOS Essential $43,285.72
Rate for Payer: Wellcare CHP/FHP/Medicaid $19,238.10
Service Code APR-DRG 2413
Min. Negotiated Rate $12,274.00
Max. Negotiated Rate $51,499.06
Rate for Payer: Amida Care Medicaid $22,888.47
Rate for Payer: Fidelis CHP/HARP/Medicaid $22,888.47
Rate for Payer: Fidelis Qualified Health Plan $27,466.16
Rate for Payer: Hamaspik Choice Inc Medicaid $22,888.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid $22,888.47
Rate for Payer: Healthfirst Commercial $22,085.00
Rate for Payer: Healthfirst Essential Plan $51,499.06
Rate for Payer: Healthfirst QHP $12,274.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $22,888.47
Rate for Payer: SOMOS Essential $51,499.06
Rate for Payer: Wellcare CHP/FHP/Medicaid $22,888.47
Service Code APR-DRG 2414
Min. Negotiated Rate $29,840.00
Max. Negotiated Rate $84,686.60
Rate for Payer: Amida Care Medicaid $37,638.49
Rate for Payer: Fidelis CHP/HARP/Medicaid $37,638.49
Rate for Payer: Fidelis Qualified Health Plan $45,166.19
Rate for Payer: Hamaspik Choice Inc Medicaid $37,638.49
Rate for Payer: Healthfirst CHP/FHP/Medicaid $37,638.49
Rate for Payer: Healthfirst Commercial $52,351.00
Rate for Payer: Healthfirst Essential Plan $84,686.60
Rate for Payer: Healthfirst QHP $29,840.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $37,638.49
Rate for Payer: SOMOS Essential $84,686.60
Rate for Payer: Wellcare CHP/FHP/Medicaid $37,638.49
Service Code APR-DRG 2421
Min. Negotiated Rate $6,542.00
Max. Negotiated Rate $39,360.20
Rate for Payer: Amida Care Medicaid $17,493.42
Rate for Payer: Fidelis CHP/HARP/Medicaid $17,493.42
Rate for Payer: Fidelis Qualified Health Plan $20,992.10
Rate for Payer: Hamaspik Choice Inc Medicaid $17,493.42
Rate for Payer: Healthfirst CHP/FHP/Medicaid $17,493.42
Rate for Payer: Healthfirst Commercial $10,630.00
Rate for Payer: Healthfirst Essential Plan $39,360.20
Rate for Payer: Healthfirst QHP $6,542.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $17,493.42
Rate for Payer: SOMOS Essential $39,360.20
Rate for Payer: Wellcare CHP/FHP/Medicaid $17,493.42
Service Code APR-DRG 2422
Min. Negotiated Rate $8,803.00
Max. Negotiated Rate $43,614.61
Rate for Payer: Amida Care Medicaid $19,384.27
Rate for Payer: Fidelis CHP/HARP/Medicaid $19,384.27
Rate for Payer: Fidelis Qualified Health Plan $23,261.12
Rate for Payer: Hamaspik Choice Inc Medicaid $19,384.27
Rate for Payer: Healthfirst CHP/FHP/Medicaid $19,384.27
Rate for Payer: Healthfirst Commercial $14,217.00
Rate for Payer: Healthfirst Essential Plan $43,614.61
Rate for Payer: Healthfirst QHP $8,803.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $19,384.27
Rate for Payer: SOMOS Essential $43,614.61
Rate for Payer: Wellcare CHP/FHP/Medicaid $19,384.27
Service Code APR-DRG 2423
Min. Negotiated Rate $13,425.00
Max. Negotiated Rate $51,597.54
Rate for Payer: Amida Care Medicaid $22,932.24
Rate for Payer: Fidelis CHP/HARP/Medicaid $22,932.24
Rate for Payer: Fidelis Qualified Health Plan $27,518.69
Rate for Payer: Hamaspik Choice Inc Medicaid $22,932.24
Rate for Payer: Healthfirst CHP/FHP/Medicaid $22,932.24
Rate for Payer: Healthfirst Commercial $22,511.00
Rate for Payer: Healthfirst Essential Plan $51,597.54
Rate for Payer: Healthfirst QHP $13,425.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $22,932.24
Rate for Payer: SOMOS Essential $51,597.54
Rate for Payer: Wellcare CHP/FHP/Medicaid $22,932.24
Service Code APR-DRG 2424
Min. Negotiated Rate $30,566.00
Max. Negotiated Rate $85,135.07
Rate for Payer: Amida Care Medicaid $37,837.81
Rate for Payer: Fidelis CHP/HARP/Medicaid $37,837.81
Rate for Payer: Fidelis Qualified Health Plan $45,405.37
Rate for Payer: Hamaspik Choice Inc Medicaid $37,837.81
Rate for Payer: Healthfirst CHP/FHP/Medicaid $37,837.81
Rate for Payer: Healthfirst Commercial $48,289.00
Rate for Payer: Healthfirst Essential Plan $85,135.07
Rate for Payer: Healthfirst QHP $30,566.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $37,837.81
Rate for Payer: SOMOS Essential $85,135.07
Rate for Payer: Wellcare CHP/FHP/Medicaid $37,837.81
Service Code APR-DRG 2431
Min. Negotiated Rate $5,324.00
Max. Negotiated Rate $37,286.64
Rate for Payer: Amida Care Medicaid $16,571.84
Rate for Payer: Fidelis CHP/HARP/Medicaid $16,571.84
Rate for Payer: Fidelis Qualified Health Plan $19,886.21
Rate for Payer: Hamaspik Choice Inc Medicaid $16,571.84
Rate for Payer: Healthfirst CHP/FHP/Medicaid $16,571.84
Rate for Payer: Healthfirst Commercial $9,030.00
Rate for Payer: Healthfirst Essential Plan $37,286.64
Rate for Payer: Healthfirst QHP $5,324.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $16,571.84
Rate for Payer: SOMOS Essential $37,286.64
Rate for Payer: Wellcare CHP/FHP/Medicaid $16,571.84
Service Code APR-DRG 2432
Min. Negotiated Rate $6,990.00
Max. Negotiated Rate $40,705.63
Rate for Payer: Amida Care Medicaid $18,091.39
Rate for Payer: Fidelis CHP/HARP/Medicaid $18,091.39
Rate for Payer: Fidelis Qualified Health Plan $21,709.67
Rate for Payer: Hamaspik Choice Inc Medicaid $18,091.39
Rate for Payer: Healthfirst CHP/FHP/Medicaid $18,091.39
Rate for Payer: Healthfirst Commercial $11,709.00
Rate for Payer: Healthfirst Essential Plan $40,705.63
Rate for Payer: Healthfirst QHP $6,990.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $18,091.39
Rate for Payer: SOMOS Essential $40,705.63
Rate for Payer: Wellcare CHP/FHP/Medicaid $18,091.39
Service Code APR-DRG 2433
Min. Negotiated Rate $10,746.00
Max. Negotiated Rate $48,199.66
Rate for Payer: Amida Care Medicaid $21,422.07
Rate for Payer: Fidelis CHP/HARP/Medicaid $21,422.07
Rate for Payer: Fidelis Qualified Health Plan $25,706.48
Rate for Payer: Hamaspik Choice Inc Medicaid $21,422.07
Rate for Payer: Healthfirst CHP/FHP/Medicaid $21,422.07
Rate for Payer: Healthfirst Commercial $19,314.00
Rate for Payer: Healthfirst Essential Plan $48,199.66
Rate for Payer: Healthfirst QHP $10,746.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $21,422.07
Rate for Payer: SOMOS Essential $48,199.66
Rate for Payer: Wellcare CHP/FHP/Medicaid $21,422.07
Service Code APR-DRG 2434
Min. Negotiated Rate $23,798.00
Max. Negotiated Rate $70,071.41
Rate for Payer: Amida Care Medicaid $31,142.85
Rate for Payer: Fidelis CHP/HARP/Medicaid $31,142.85
Rate for Payer: Fidelis Qualified Health Plan $37,371.42
Rate for Payer: Hamaspik Choice Inc Medicaid $31,142.85
Rate for Payer: Healthfirst CHP/FHP/Medicaid $31,142.85
Rate for Payer: Healthfirst Commercial $47,879.00
Rate for Payer: Healthfirst Essential Plan $70,071.41
Rate for Payer: Healthfirst QHP $23,798.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $31,142.85
Rate for Payer: SOMOS Essential $70,071.41
Rate for Payer: Wellcare CHP/FHP/Medicaid $31,142.85
Service Code APR-DRG 2441
Min. Negotiated Rate $6,394.00
Max. Negotiated Rate $38,792.12
Rate for Payer: Amida Care Medicaid $17,240.94
Rate for Payer: Fidelis CHP/HARP/Medicaid $17,240.94
Rate for Payer: Fidelis Qualified Health Plan $20,689.13
Rate for Payer: Hamaspik Choice Inc Medicaid $17,240.94
Rate for Payer: Healthfirst CHP/FHP/Medicaid $17,240.94
Rate for Payer: Healthfirst Commercial $10,476.00
Rate for Payer: Healthfirst Essential Plan $38,792.12
Rate for Payer: Healthfirst QHP $6,394.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $17,240.94
Rate for Payer: SOMOS Essential $38,792.12
Rate for Payer: Wellcare CHP/FHP/Medicaid $17,240.94
Service Code APR-DRG 2442
Min. Negotiated Rate $7,897.00
Max. Negotiated Rate $41,840.03
Rate for Payer: Amida Care Medicaid $18,595.57
Rate for Payer: Fidelis CHP/HARP/Medicaid $18,595.57
Rate for Payer: Fidelis Qualified Health Plan $22,314.68
Rate for Payer: Hamaspik Choice Inc Medicaid $18,595.57
Rate for Payer: Healthfirst CHP/FHP/Medicaid $18,595.57
Rate for Payer: Healthfirst Commercial $13,359.00
Rate for Payer: Healthfirst Essential Plan $41,840.03
Rate for Payer: Healthfirst QHP $7,897.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $18,595.57
Rate for Payer: SOMOS Essential $41,840.03
Rate for Payer: Wellcare CHP/FHP/Medicaid $18,595.57
Service Code APR-DRG 2443
Min. Negotiated Rate $11,589.00
Max. Negotiated Rate $50,074.47
Rate for Payer: Amida Care Medicaid $22,255.32
Rate for Payer: Fidelis CHP/HARP/Medicaid $22,255.32
Rate for Payer: Fidelis Qualified Health Plan $26,706.38
Rate for Payer: Hamaspik Choice Inc Medicaid $22,255.32
Rate for Payer: Healthfirst CHP/FHP/Medicaid $22,255.32
Rate for Payer: Healthfirst Commercial $20,937.00
Rate for Payer: Healthfirst Essential Plan $50,074.47
Rate for Payer: Healthfirst QHP $11,589.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $22,255.32
Rate for Payer: SOMOS Essential $50,074.47
Rate for Payer: Wellcare CHP/FHP/Medicaid $22,255.32
Service Code APR-DRG 2444
Min. Negotiated Rate $23,236.00
Max. Negotiated Rate $83,687.62
Rate for Payer: Amida Care Medicaid $37,194.50
Rate for Payer: Fidelis CHP/HARP/Medicaid $37,194.50
Rate for Payer: Fidelis Qualified Health Plan $44,633.40
Rate for Payer: Hamaspik Choice Inc Medicaid $37,194.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid $37,194.50
Rate for Payer: Healthfirst Commercial $47,285.00
Rate for Payer: Healthfirst Essential Plan $83,687.62
Rate for Payer: Healthfirst QHP $23,236.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $37,194.50
Rate for Payer: SOMOS Essential $83,687.62
Rate for Payer: Wellcare CHP/FHP/Medicaid $37,194.50
Service Code APR-DRG 2451
Min. Negotiated Rate $7,251.00
Max. Negotiated Rate $40,630.00
Rate for Payer: Amida Care Medicaid $18,057.78
Rate for Payer: Fidelis CHP/HARP/Medicaid $18,057.78
Rate for Payer: Fidelis Qualified Health Plan $21,669.34
Rate for Payer: Hamaspik Choice Inc Medicaid $18,057.78
Rate for Payer: Healthfirst CHP/FHP/Medicaid $18,057.78
Rate for Payer: Healthfirst Commercial $12,482.00
Rate for Payer: Healthfirst Essential Plan $40,630.00
Rate for Payer: Healthfirst QHP $7,251.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $18,057.78
Rate for Payer: SOMOS Essential $40,630.00
Rate for Payer: Wellcare CHP/FHP/Medicaid $18,057.78
Service Code APR-DRG 2452
Min. Negotiated Rate $8,753.00
Max. Negotiated Rate $43,282.19
Rate for Payer: Amida Care Medicaid $19,236.53
Rate for Payer: Fidelis CHP/HARP/Medicaid $19,236.53
Rate for Payer: Fidelis Qualified Health Plan $23,083.84
Rate for Payer: Hamaspik Choice Inc Medicaid $19,236.53
Rate for Payer: Healthfirst CHP/FHP/Medicaid $19,236.53
Rate for Payer: Healthfirst Commercial $14,401.00
Rate for Payer: Healthfirst Essential Plan $43,282.19
Rate for Payer: Healthfirst QHP $8,753.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $19,236.53
Rate for Payer: SOMOS Essential $43,282.19
Rate for Payer: Wellcare CHP/FHP/Medicaid $19,236.53
Service Code APR-DRG 2453
Min. Negotiated Rate $13,359.00
Max. Negotiated Rate $51,066.40
Rate for Payer: Amida Care Medicaid $22,696.18
Rate for Payer: Fidelis CHP/HARP/Medicaid $22,696.18
Rate for Payer: Fidelis Qualified Health Plan $27,235.42
Rate for Payer: Hamaspik Choice Inc Medicaid $22,696.18
Rate for Payer: Healthfirst CHP/FHP/Medicaid $22,696.18
Rate for Payer: Healthfirst Commercial $21,124.00
Rate for Payer: Healthfirst Essential Plan $51,066.40
Rate for Payer: Healthfirst QHP $13,359.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $22,696.18
Rate for Payer: SOMOS Essential $51,066.40
Rate for Payer: Wellcare CHP/FHP/Medicaid $22,696.18
Service Code APR-DRG 2454
Min. Negotiated Rate $21,928.00
Max. Negotiated Rate $67,551.14
Rate for Payer: Amida Care Medicaid $30,022.73
Rate for Payer: Fidelis CHP/HARP/Medicaid $30,022.73
Rate for Payer: Fidelis Qualified Health Plan $36,027.28
Rate for Payer: Hamaspik Choice Inc Medicaid $30,022.73
Rate for Payer: Healthfirst CHP/FHP/Medicaid $30,022.73
Rate for Payer: Healthfirst Commercial $38,546.00
Rate for Payer: Healthfirst Essential Plan $67,551.14
Rate for Payer: Healthfirst QHP $21,928.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $30,022.73
Rate for Payer: SOMOS Essential $67,551.14
Rate for Payer: Wellcare CHP/FHP/Medicaid $30,022.73
Service Code APR-DRG 2461
Min. Negotiated Rate $7,141.00
Max. Negotiated Rate $40,601.86
Rate for Payer: Amida Care Medicaid $18,045.27
Rate for Payer: Fidelis CHP/HARP/Medicaid $18,045.27
Rate for Payer: Fidelis Qualified Health Plan $21,654.32
Rate for Payer: Hamaspik Choice Inc Medicaid $18,045.27
Rate for Payer: Healthfirst CHP/FHP/Medicaid $18,045.27
Rate for Payer: Healthfirst Commercial $11,984.00
Rate for Payer: Healthfirst Essential Plan $40,601.86
Rate for Payer: Healthfirst QHP $7,141.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $18,045.27
Rate for Payer: SOMOS Essential $40,601.86
Rate for Payer: Wellcare CHP/FHP/Medicaid $18,045.27
Service Code APR-DRG 2462
Min. Negotiated Rate $8,891.00
Max. Negotiated Rate $43,442.24
Rate for Payer: Amida Care Medicaid $19,307.66
Rate for Payer: Fidelis CHP/HARP/Medicaid $19,307.66
Rate for Payer: Fidelis Qualified Health Plan $23,169.19
Rate for Payer: Hamaspik Choice Inc Medicaid $19,307.66
Rate for Payer: Healthfirst CHP/FHP/Medicaid $19,307.66
Rate for Payer: Healthfirst Commercial $14,665.00
Rate for Payer: Healthfirst Essential Plan $43,442.24
Rate for Payer: Healthfirst QHP $8,891.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $19,307.66
Rate for Payer: SOMOS Essential $43,442.24
Rate for Payer: Wellcare CHP/FHP/Medicaid $19,307.66
Service Code APR-DRG 2463
Min. Negotiated Rate $13,382.00
Max. Negotiated Rate $52,378.42
Rate for Payer: Amida Care Medicaid $23,279.30
Rate for Payer: Fidelis CHP/HARP/Medicaid $23,279.30
Rate for Payer: Fidelis Qualified Health Plan $27,935.16
Rate for Payer: Hamaspik Choice Inc Medicaid $23,279.30
Rate for Payer: Healthfirst CHP/FHP/Medicaid $23,279.30
Rate for Payer: Healthfirst Commercial $22,584.00
Rate for Payer: Healthfirst Essential Plan $52,378.42
Rate for Payer: Healthfirst QHP $13,382.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $23,279.30
Rate for Payer: SOMOS Essential $52,378.42
Rate for Payer: Wellcare CHP/FHP/Medicaid $23,279.30