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Charge Type Price  
Service Code APR-DRG 3013
Min. Negotiated Rate $31,107.00
Max. Negotiated Rate $74,257.24
Rate for Payer: Amida Care Medicaid $33,003.22
Rate for Payer: Fidelis CHP/HARP/Medicaid $33,003.22
Rate for Payer: Fidelis Qualified Health Plan $39,603.86
Rate for Payer: Hamaspik Choice Inc Medicaid $33,003.22
Rate for Payer: Healthfirst CHP/FHP/Medicaid $33,003.22
Rate for Payer: Healthfirst Commercial $50,384.00
Rate for Payer: Healthfirst Essential Plan $74,257.24
Rate for Payer: Healthfirst QHP $31,107.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $33,003.22
Rate for Payer: SOMOS Essential $74,257.24
Rate for Payer: Wellcare CHP/FHP/Medicaid $33,003.22
Service Code APR-DRG 3014
Min. Negotiated Rate $59,937.00
Max. Negotiated Rate $136,112.33
Rate for Payer: Amida Care Medicaid $60,494.37
Rate for Payer: Fidelis CHP/HARP/Medicaid $60,494.37
Rate for Payer: Fidelis Qualified Health Plan $72,593.24
Rate for Payer: Hamaspik Choice Inc Medicaid $60,494.37
Rate for Payer: Healthfirst CHP/FHP/Medicaid $60,494.37
Rate for Payer: Healthfirst Commercial $96,497.00
Rate for Payer: Healthfirst Essential Plan $136,112.33
Rate for Payer: Healthfirst QHP $59,937.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $60,494.37
Rate for Payer: SOMOS Essential $136,112.33
Rate for Payer: Wellcare CHP/FHP/Medicaid $60,494.37
Service Code APR-DRG 3021
Min. Negotiated Rate $22,164.00
Max. Negotiated Rate $60,827.44
Rate for Payer: Amida Care Medicaid $27,034.42
Rate for Payer: Fidelis CHP/HARP/Medicaid $27,034.42
Rate for Payer: Fidelis Qualified Health Plan $32,441.30
Rate for Payer: Hamaspik Choice Inc Medicaid $27,034.42
Rate for Payer: Healthfirst CHP/FHP/Medicaid $27,034.42
Rate for Payer: Healthfirst Commercial $35,147.00
Rate for Payer: Healthfirst Essential Plan $60,827.44
Rate for Payer: Healthfirst QHP $22,164.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $27,034.42
Rate for Payer: SOMOS Essential $60,827.44
Rate for Payer: Wellcare CHP/FHP/Medicaid $27,034.42
Service Code APR-DRG 3022
Min. Negotiated Rate $24,310.00
Max. Negotiated Rate $64,828.60
Rate for Payer: Amida Care Medicaid $28,812.71
Rate for Payer: Fidelis CHP/HARP/Medicaid $28,812.71
Rate for Payer: Fidelis Qualified Health Plan $34,575.25
Rate for Payer: Hamaspik Choice Inc Medicaid $28,812.71
Rate for Payer: Healthfirst CHP/FHP/Medicaid $28,812.71
Rate for Payer: Healthfirst Commercial $38,821.00
Rate for Payer: Healthfirst Essential Plan $64,828.60
Rate for Payer: Healthfirst QHP $24,310.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $28,812.71
Rate for Payer: SOMOS Essential $64,828.60
Rate for Payer: Wellcare CHP/FHP/Medicaid $28,812.71
Service Code APR-DRG 3023
Min. Negotiated Rate $29,855.00
Max. Negotiated Rate $77,016.71
Rate for Payer: Amida Care Medicaid $34,229.65
Rate for Payer: Fidelis CHP/HARP/Medicaid $34,229.65
Rate for Payer: Fidelis Qualified Health Plan $41,075.58
Rate for Payer: Hamaspik Choice Inc Medicaid $34,229.65
Rate for Payer: Healthfirst CHP/FHP/Medicaid $34,229.65
Rate for Payer: Healthfirst Commercial $49,462.00
Rate for Payer: Healthfirst Essential Plan $77,016.71
Rate for Payer: Healthfirst QHP $29,855.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $34,229.65
Rate for Payer: SOMOS Essential $77,016.71
Rate for Payer: Wellcare CHP/FHP/Medicaid $34,229.65
Service Code APR-DRG 3024
Min. Negotiated Rate $55,631.00
Max. Negotiated Rate $125,368.16
Rate for Payer: Amida Care Medicaid $55,719.18
Rate for Payer: Fidelis CHP/HARP/Medicaid $55,719.18
Rate for Payer: Fidelis Qualified Health Plan $66,863.02
Rate for Payer: Hamaspik Choice Inc Medicaid $55,719.18
Rate for Payer: Healthfirst CHP/FHP/Medicaid $55,719.18
Rate for Payer: Healthfirst Commercial $105,227.00
Rate for Payer: Healthfirst Essential Plan $125,368.16
Rate for Payer: Healthfirst QHP $55,631.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $55,719.18
Rate for Payer: SOMOS Essential $125,368.16
Rate for Payer: Wellcare CHP/FHP/Medicaid $55,719.18
Service Code APR-DRG 3031
Min. Negotiated Rate $47,722.75
Max. Negotiated Rate $107,376.19
Rate for Payer: Amida Care Medicaid $47,722.75
Rate for Payer: Fidelis CHP/HARP/Medicaid $47,722.75
Rate for Payer: Fidelis Qualified Health Plan $57,267.30
Rate for Payer: Hamaspik Choice Inc Medicaid $47,722.75
Rate for Payer: Healthfirst CHP/FHP/Medicaid $47,722.75
Rate for Payer: Healthfirst Commercial $75,039.00
Rate for Payer: Healthfirst Essential Plan $107,376.19
Rate for Payer: Healthfirst QHP $50,242.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $47,722.75
Rate for Payer: SOMOS Essential $107,376.19
Rate for Payer: Wellcare CHP/FHP/Medicaid $47,722.75
Service Code APR-DRG 3032
Min. Negotiated Rate $54,512.29
Max. Negotiated Rate $122,652.65
Rate for Payer: Amida Care Medicaid $54,512.29
Rate for Payer: Fidelis CHP/HARP/Medicaid $54,512.29
Rate for Payer: Fidelis Qualified Health Plan $65,414.75
Rate for Payer: Hamaspik Choice Inc Medicaid $54,512.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid $54,512.29
Rate for Payer: Healthfirst Commercial $87,832.00
Rate for Payer: Healthfirst Essential Plan $122,652.65
Rate for Payer: Healthfirst QHP $57,946.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $54,512.29
Rate for Payer: SOMOS Essential $122,652.65
Rate for Payer: Wellcare CHP/FHP/Medicaid $54,512.29
Service Code APR-DRG 3033
Min. Negotiated Rate $67,797.47
Max. Negotiated Rate $152,544.31
Rate for Payer: Amida Care Medicaid $67,797.47
Rate for Payer: Fidelis CHP/HARP/Medicaid $67,797.47
Rate for Payer: Fidelis Qualified Health Plan $81,356.96
Rate for Payer: Hamaspik Choice Inc Medicaid $67,797.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid $67,797.47
Rate for Payer: Healthfirst Commercial $116,372.00
Rate for Payer: Healthfirst Essential Plan $152,544.31
Rate for Payer: Healthfirst QHP $77,320.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $67,797.47
Rate for Payer: SOMOS Essential $152,544.31
Rate for Payer: Wellcare CHP/FHP/Medicaid $67,797.47
Service Code APR-DRG 3034
Min. Negotiated Rate $98,333.21
Max. Negotiated Rate $221,249.72
Rate for Payer: Amida Care Medicaid $98,333.21
Rate for Payer: Fidelis CHP/HARP/Medicaid $98,333.21
Rate for Payer: Fidelis Qualified Health Plan $117,999.85
Rate for Payer: Hamaspik Choice Inc Medicaid $98,333.21
Rate for Payer: Healthfirst CHP/FHP/Medicaid $98,333.21
Rate for Payer: Healthfirst Commercial $188,109.00
Rate for Payer: Healthfirst Essential Plan $221,249.72
Rate for Payer: Healthfirst QHP $125,866.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $98,333.21
Rate for Payer: SOMOS Essential $221,249.72
Rate for Payer: Wellcare CHP/FHP/Medicaid $98,333.21
Service Code APR-DRG 3041
Min. Negotiated Rate $34,725.00
Max. Negotiated Rate $83,568.04
Rate for Payer: Amida Care Medicaid $37,141.35
Rate for Payer: Fidelis CHP/HARP/Medicaid $37,141.35
Rate for Payer: Fidelis Qualified Health Plan $44,569.62
Rate for Payer: Hamaspik Choice Inc Medicaid $37,141.35
Rate for Payer: Healthfirst CHP/FHP/Medicaid $37,141.35
Rate for Payer: Healthfirst Commercial $57,533.00
Rate for Payer: Healthfirst Essential Plan $83,568.04
Rate for Payer: Healthfirst QHP $34,725.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $37,141.35
Rate for Payer: SOMOS Essential $83,568.04
Rate for Payer: Wellcare CHP/FHP/Medicaid $37,141.35
Service Code APR-DRG 3042
Min. Negotiated Rate $41,306.00
Max. Negotiated Rate $95,328.76
Rate for Payer: Amida Care Medicaid $42,368.34
Rate for Payer: Fidelis CHP/HARP/Medicaid $42,368.34
Rate for Payer: Fidelis Qualified Health Plan $50,842.01
Rate for Payer: Hamaspik Choice Inc Medicaid $42,368.34
Rate for Payer: Healthfirst CHP/FHP/Medicaid $42,368.34
Rate for Payer: Healthfirst Commercial $68,861.00
Rate for Payer: Healthfirst Essential Plan $95,328.76
Rate for Payer: Healthfirst QHP $41,306.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $42,368.34
Rate for Payer: SOMOS Essential $95,328.76
Rate for Payer: Wellcare CHP/FHP/Medicaid $42,368.34
Service Code APR-DRG 3043
Min. Negotiated Rate $54,818.70
Max. Negotiated Rate $123,342.08
Rate for Payer: Amida Care Medicaid $54,818.70
Rate for Payer: Fidelis CHP/HARP/Medicaid $54,818.70
Rate for Payer: Fidelis Qualified Health Plan $65,782.44
Rate for Payer: Hamaspik Choice Inc Medicaid $54,818.70
Rate for Payer: Healthfirst CHP/FHP/Medicaid $54,818.70
Rate for Payer: Healthfirst Commercial $95,106.00
Rate for Payer: Healthfirst Essential Plan $123,342.08
Rate for Payer: Healthfirst QHP $59,751.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $54,818.70
Rate for Payer: SOMOS Essential $123,342.08
Rate for Payer: Wellcare CHP/FHP/Medicaid $54,818.70
Service Code APR-DRG 3044
Min. Negotiated Rate $84,948.76
Max. Negotiated Rate $191,134.71
Rate for Payer: Amida Care Medicaid $84,948.76
Rate for Payer: Fidelis CHP/HARP/Medicaid $84,948.76
Rate for Payer: Fidelis Qualified Health Plan $101,938.51
Rate for Payer: Hamaspik Choice Inc Medicaid $84,948.76
Rate for Payer: Healthfirst CHP/FHP/Medicaid $84,948.76
Rate for Payer: Healthfirst Commercial $165,461.00
Rate for Payer: Healthfirst Essential Plan $191,134.71
Rate for Payer: Healthfirst QHP $104,376.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $84,948.76
Rate for Payer: SOMOS Essential $191,134.71
Rate for Payer: Wellcare CHP/FHP/Medicaid $84,948.76
Service Code APR-DRG 3051
Min. Negotiated Rate $15,487.00
Max. Negotiated Rate $53,583.16
Rate for Payer: Amida Care Medicaid $23,814.74
Rate for Payer: Fidelis CHP/HARP/Medicaid $23,814.74
Rate for Payer: Fidelis Qualified Health Plan $28,577.69
Rate for Payer: Hamaspik Choice Inc Medicaid $23,814.74
Rate for Payer: Healthfirst CHP/FHP/Medicaid $23,814.74
Rate for Payer: Healthfirst Commercial $29,901.00
Rate for Payer: Healthfirst Essential Plan $53,583.16
Rate for Payer: Healthfirst QHP $15,487.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $23,814.74
Rate for Payer: SOMOS Essential $53,583.16
Rate for Payer: Wellcare CHP/FHP/Medicaid $23,814.74
Service Code APR-DRG 3052
Min. Negotiated Rate $21,769.00
Max. Negotiated Rate $63,360.04
Rate for Payer: Amida Care Medicaid $28,160.02
Rate for Payer: Fidelis CHP/HARP/Medicaid $28,160.02
Rate for Payer: Fidelis Qualified Health Plan $33,792.02
Rate for Payer: Hamaspik Choice Inc Medicaid $28,160.02
Rate for Payer: Healthfirst CHP/FHP/Medicaid $28,160.02
Rate for Payer: Healthfirst Commercial $38,655.00
Rate for Payer: Healthfirst Essential Plan $63,360.04
Rate for Payer: Healthfirst QHP $21,769.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $28,160.02
Rate for Payer: SOMOS Essential $63,360.04
Rate for Payer: Wellcare CHP/FHP/Medicaid $28,160.02
Service Code APR-DRG 3053
Min. Negotiated Rate $33,121.00
Max. Negotiated Rate $89,122.16
Rate for Payer: Amida Care Medicaid $39,609.85
Rate for Payer: Fidelis CHP/HARP/Medicaid $39,609.85
Rate for Payer: Fidelis Qualified Health Plan $47,531.82
Rate for Payer: Hamaspik Choice Inc Medicaid $39,609.85
Rate for Payer: Healthfirst CHP/FHP/Medicaid $39,609.85
Rate for Payer: Healthfirst Commercial $57,153.00
Rate for Payer: Healthfirst Essential Plan $89,122.16
Rate for Payer: Healthfirst QHP $33,121.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $39,609.85
Rate for Payer: SOMOS Essential $89,122.16
Rate for Payer: Wellcare CHP/FHP/Medicaid $39,609.85
Service Code APR-DRG 3054
Min. Negotiated Rate $61,247.00
Max. Negotiated Rate $140,475.78
Rate for Payer: Amida Care Medicaid $62,433.68
Rate for Payer: Fidelis CHP/HARP/Medicaid $62,433.68
Rate for Payer: Fidelis Qualified Health Plan $74,920.42
Rate for Payer: Hamaspik Choice Inc Medicaid $62,433.68
Rate for Payer: Healthfirst CHP/FHP/Medicaid $62,433.68
Rate for Payer: Healthfirst Commercial $125,142.00
Rate for Payer: Healthfirst Essential Plan $140,475.78
Rate for Payer: Healthfirst QHP $61,247.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $62,433.68
Rate for Payer: SOMOS Essential $140,475.78
Rate for Payer: Wellcare CHP/FHP/Medicaid $62,433.68
Service Code APR-DRG 3081
Min. Negotiated Rate $14,878.00
Max. Negotiated Rate $53,132.94
Rate for Payer: Amida Care Medicaid $23,614.64
Rate for Payer: Fidelis CHP/HARP/Medicaid $23,614.64
Rate for Payer: Fidelis Qualified Health Plan $28,337.57
Rate for Payer: Hamaspik Choice Inc Medicaid $23,614.64
Rate for Payer: Healthfirst CHP/FHP/Medicaid $23,614.64
Rate for Payer: Healthfirst Commercial $26,042.00
Rate for Payer: Healthfirst Essential Plan $53,132.94
Rate for Payer: Healthfirst QHP $14,878.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $23,614.64
Rate for Payer: SOMOS Essential $53,132.94
Rate for Payer: Wellcare CHP/FHP/Medicaid $23,614.64
Service Code APR-DRG 3082
Min. Negotiated Rate $19,036.00
Max. Negotiated Rate $61,982.96
Rate for Payer: Amida Care Medicaid $27,547.98
Rate for Payer: Fidelis CHP/HARP/Medicaid $27,547.98
Rate for Payer: Fidelis Qualified Health Plan $33,057.58
Rate for Payer: Hamaspik Choice Inc Medicaid $27,547.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid $27,547.98
Rate for Payer: Healthfirst Commercial $32,196.00
Rate for Payer: Healthfirst Essential Plan $61,982.96
Rate for Payer: Healthfirst QHP $19,036.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $27,547.98
Rate for Payer: SOMOS Essential $61,982.96
Rate for Payer: Wellcare CHP/FHP/Medicaid $27,547.98
Service Code APR-DRG 3083
Min. Negotiated Rate $28,506.00
Max. Negotiated Rate $77,933.02
Rate for Payer: Amida Care Medicaid $34,636.90
Rate for Payer: Fidelis CHP/HARP/Medicaid $34,636.90
Rate for Payer: Fidelis Qualified Health Plan $41,564.28
Rate for Payer: Hamaspik Choice Inc Medicaid $34,636.90
Rate for Payer: Healthfirst CHP/FHP/Medicaid $34,636.90
Rate for Payer: Healthfirst Commercial $44,697.00
Rate for Payer: Healthfirst Essential Plan $77,933.02
Rate for Payer: Healthfirst QHP $28,506.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $34,636.90
Rate for Payer: SOMOS Essential $77,933.02
Rate for Payer: Wellcare CHP/FHP/Medicaid $34,636.90
Service Code APR-DRG 3084
Min. Negotiated Rate $53,759.00
Max. Negotiated Rate $131,101.67
Rate for Payer: Amida Care Medicaid $58,267.41
Rate for Payer: Fidelis CHP/HARP/Medicaid $58,267.41
Rate for Payer: Fidelis Qualified Health Plan $69,920.89
Rate for Payer: Hamaspik Choice Inc Medicaid $58,267.41
Rate for Payer: Healthfirst CHP/FHP/Medicaid $58,267.41
Rate for Payer: Healthfirst Commercial $82,315.00
Rate for Payer: Healthfirst Essential Plan $131,101.67
Rate for Payer: Healthfirst QHP $53,759.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $58,267.41
Rate for Payer: SOMOS Essential $131,101.67
Rate for Payer: Wellcare CHP/FHP/Medicaid $58,267.41
Service Code APR-DRG 3091
Min. Negotiated Rate $13,379.00
Max. Negotiated Rate $51,546.56
Rate for Payer: Amida Care Medicaid $22,909.58
Rate for Payer: Fidelis CHP/HARP/Medicaid $22,909.58
Rate for Payer: Fidelis Qualified Health Plan $27,491.50
Rate for Payer: Hamaspik Choice Inc Medicaid $22,909.58
Rate for Payer: Healthfirst CHP/FHP/Medicaid $22,909.58
Rate for Payer: Healthfirst Commercial $22,554.00
Rate for Payer: Healthfirst Essential Plan $51,546.56
Rate for Payer: Healthfirst QHP $13,379.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $22,909.58
Rate for Payer: SOMOS Essential $51,546.56
Rate for Payer: Wellcare CHP/FHP/Medicaid $22,909.58
Service Code APR-DRG 3092
Min. Negotiated Rate $19,223.00
Max. Negotiated Rate $62,616.10
Rate for Payer: Amida Care Medicaid $27,829.38
Rate for Payer: Fidelis CHP/HARP/Medicaid $27,829.38
Rate for Payer: Fidelis Qualified Health Plan $33,395.26
Rate for Payer: Hamaspik Choice Inc Medicaid $27,829.38
Rate for Payer: Healthfirst CHP/FHP/Medicaid $27,829.38
Rate for Payer: Healthfirst Commercial $32,958.00
Rate for Payer: Healthfirst Essential Plan $62,616.10
Rate for Payer: Healthfirst QHP $19,223.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $27,829.38
Rate for Payer: SOMOS Essential $62,616.10
Rate for Payer: Wellcare CHP/FHP/Medicaid $27,829.38
Service Code APR-DRG 3093
Min. Negotiated Rate $34,712.00
Max. Negotiated Rate $82,790.66
Rate for Payer: Amida Care Medicaid $36,795.85
Rate for Payer: Fidelis CHP/HARP/Medicaid $36,795.85
Rate for Payer: Fidelis Qualified Health Plan $44,155.02
Rate for Payer: Hamaspik Choice Inc Medicaid $36,795.85
Rate for Payer: Healthfirst CHP/FHP/Medicaid $36,795.85
Rate for Payer: Healthfirst Commercial $54,858.00
Rate for Payer: Healthfirst Essential Plan $82,790.66
Rate for Payer: Healthfirst QHP $34,712.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $36,795.85
Rate for Payer: SOMOS Essential $82,790.66
Rate for Payer: Wellcare CHP/FHP/Medicaid $36,795.85