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Charge Type Price  
Service Code APR-DRG 3171
Min. Negotiated Rate $10,079.00
Max. Negotiated Rate $45,468.32
Rate for Payer: Amida Care Medicaid $20,208.14
Rate for Payer: Fidelis CHP/HARP/Medicaid $20,208.14
Rate for Payer: Fidelis Qualified Health Plan $24,249.77
Rate for Payer: Hamaspik Choice Inc Medicaid $20,208.14
Rate for Payer: Healthfirst CHP/FHP/Medicaid $20,208.14
Rate for Payer: Healthfirst Commercial $17,202.00
Rate for Payer: Healthfirst Essential Plan $45,468.32
Rate for Payer: Healthfirst QHP $10,079.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $20,208.14
Rate for Payer: SOMOS Essential $45,468.32
Rate for Payer: Wellcare CHP/FHP/Medicaid $20,208.14
Service Code APR-DRG 3172
Min. Negotiated Rate $16,179.00
Max. Negotiated Rate $54,879.37
Rate for Payer: Amida Care Medicaid $24,390.83
Rate for Payer: Fidelis CHP/HARP/Medicaid $24,390.83
Rate for Payer: Fidelis Qualified Health Plan $29,269.00
Rate for Payer: Hamaspik Choice Inc Medicaid $24,390.83
Rate for Payer: Healthfirst CHP/FHP/Medicaid $24,390.83
Rate for Payer: Healthfirst Commercial $27,090.00
Rate for Payer: Healthfirst Essential Plan $54,879.37
Rate for Payer: Healthfirst QHP $16,179.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $24,390.83
Rate for Payer: SOMOS Essential $54,879.37
Rate for Payer: Wellcare CHP/FHP/Medicaid $24,390.83
Service Code APR-DRG 3173
Min. Negotiated Rate $26,951.00
Max. Negotiated Rate $75,507.70
Rate for Payer: Amida Care Medicaid $33,558.98
Rate for Payer: Fidelis CHP/HARP/Medicaid $33,558.98
Rate for Payer: Fidelis Qualified Health Plan $40,270.78
Rate for Payer: Hamaspik Choice Inc Medicaid $33,558.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid $33,558.98
Rate for Payer: Healthfirst Commercial $46,551.00
Rate for Payer: Healthfirst Essential Plan $75,507.70
Rate for Payer: Healthfirst QHP $26,951.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $33,558.98
Rate for Payer: SOMOS Essential $75,507.70
Rate for Payer: Wellcare CHP/FHP/Medicaid $33,558.98
Service Code APR-DRG 3174
Min. Negotiated Rate $62,560.31
Max. Negotiated Rate $140,760.70
Rate for Payer: Amida Care Medicaid $62,560.31
Rate for Payer: Fidelis CHP/HARP/Medicaid $62,560.31
Rate for Payer: Fidelis Qualified Health Plan $75,072.37
Rate for Payer: Hamaspik Choice Inc Medicaid $62,560.31
Rate for Payer: Healthfirst CHP/FHP/Medicaid $62,560.31
Rate for Payer: Healthfirst Commercial $121,158.00
Rate for Payer: Healthfirst Essential Plan $140,760.70
Rate for Payer: Healthfirst QHP $66,772.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $62,560.31
Rate for Payer: SOMOS Essential $140,760.70
Rate for Payer: Wellcare CHP/FHP/Medicaid $62,560.31
Service Code APR-DRG 3201
Min. Negotiated Rate $10,743.00
Max. Negotiated Rate $47,677.30
Rate for Payer: Amida Care Medicaid $21,189.91
Rate for Payer: Fidelis CHP/HARP/Medicaid $21,189.91
Rate for Payer: Fidelis Qualified Health Plan $25,427.89
Rate for Payer: Hamaspik Choice Inc Medicaid $21,189.91
Rate for Payer: Healthfirst CHP/FHP/Medicaid $21,189.91
Rate for Payer: Healthfirst Commercial $18,516.00
Rate for Payer: Healthfirst Essential Plan $47,677.30
Rate for Payer: Healthfirst QHP $10,743.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $21,189.91
Rate for Payer: SOMOS Essential $47,677.30
Rate for Payer: Wellcare CHP/FHP/Medicaid $21,189.91
Service Code APR-DRG 3202
Min. Negotiated Rate $17,953.00
Max. Negotiated Rate $58,271.98
Rate for Payer: Amida Care Medicaid $25,898.66
Rate for Payer: Fidelis CHP/HARP/Medicaid $25,898.66
Rate for Payer: Fidelis Qualified Health Plan $31,078.39
Rate for Payer: Hamaspik Choice Inc Medicaid $25,898.66
Rate for Payer: Healthfirst CHP/FHP/Medicaid $25,898.66
Rate for Payer: Healthfirst Commercial $30,130.00
Rate for Payer: Healthfirst Essential Plan $58,271.98
Rate for Payer: Healthfirst QHP $17,953.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $25,898.66
Rate for Payer: SOMOS Essential $58,271.98
Rate for Payer: Wellcare CHP/FHP/Medicaid $25,898.66
Service Code APR-DRG 3203
Min. Negotiated Rate $27,682.00
Max. Negotiated Rate $73,873.82
Rate for Payer: Amida Care Medicaid $32,832.81
Rate for Payer: Fidelis CHP/HARP/Medicaid $32,832.81
Rate for Payer: Fidelis Qualified Health Plan $39,399.37
Rate for Payer: Hamaspik Choice Inc Medicaid $32,832.81
Rate for Payer: Healthfirst CHP/FHP/Medicaid $32,832.81
Rate for Payer: Healthfirst Commercial $47,919.00
Rate for Payer: Healthfirst Essential Plan $73,873.82
Rate for Payer: Healthfirst QHP $27,682.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $32,832.81
Rate for Payer: SOMOS Essential $73,873.82
Rate for Payer: Wellcare CHP/FHP/Medicaid $32,832.81
Service Code APR-DRG 3204
Min. Negotiated Rate $52,286.11
Max. Negotiated Rate $117,643.75
Rate for Payer: Amida Care Medicaid $52,286.11
Rate for Payer: Fidelis CHP/HARP/Medicaid $52,286.11
Rate for Payer: Fidelis Qualified Health Plan $62,743.33
Rate for Payer: Hamaspik Choice Inc Medicaid $52,286.11
Rate for Payer: Healthfirst CHP/FHP/Medicaid $52,286.11
Rate for Payer: Healthfirst Commercial $107,294.00
Rate for Payer: Healthfirst Essential Plan $117,643.75
Rate for Payer: Healthfirst QHP $71,428.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $52,286.11
Rate for Payer: SOMOS Essential $117,643.75
Rate for Payer: Wellcare CHP/FHP/Medicaid $52,286.11
Service Code APR-DRG 3211
Min. Negotiated Rate $19,121.00
Max. Negotiated Rate $58,340.59
Rate for Payer: Amida Care Medicaid $25,929.15
Rate for Payer: Fidelis CHP/HARP/Medicaid $25,929.15
Rate for Payer: Fidelis Qualified Health Plan $31,114.98
Rate for Payer: Hamaspik Choice Inc Medicaid $25,929.15
Rate for Payer: Healthfirst CHP/FHP/Medicaid $25,929.15
Rate for Payer: Healthfirst Commercial $31,053.00
Rate for Payer: Healthfirst Essential Plan $58,340.59
Rate for Payer: Healthfirst QHP $19,121.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $25,929.15
Rate for Payer: SOMOS Essential $58,340.59
Rate for Payer: Wellcare CHP/FHP/Medicaid $25,929.15
Service Code APR-DRG 3212
Min. Negotiated Rate $24,410.00
Max. Negotiated Rate $67,405.16
Rate for Payer: Amida Care Medicaid $29,957.85
Rate for Payer: Fidelis CHP/HARP/Medicaid $29,957.85
Rate for Payer: Fidelis Qualified Health Plan $35,949.42
Rate for Payer: Hamaspik Choice Inc Medicaid $29,957.85
Rate for Payer: Healthfirst CHP/FHP/Medicaid $29,957.85
Rate for Payer: Healthfirst Commercial $41,505.00
Rate for Payer: Healthfirst Essential Plan $67,405.16
Rate for Payer: Healthfirst QHP $24,410.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $29,957.85
Rate for Payer: SOMOS Essential $67,405.16
Rate for Payer: Wellcare CHP/FHP/Medicaid $29,957.85
Service Code APR-DRG 3213
Min. Negotiated Rate $42,116.65
Max. Negotiated Rate $94,762.46
Rate for Payer: Amida Care Medicaid $42,116.65
Rate for Payer: Fidelis CHP/HARP/Medicaid $42,116.65
Rate for Payer: Fidelis Qualified Health Plan $50,539.98
Rate for Payer: Hamaspik Choice Inc Medicaid $42,116.65
Rate for Payer: Healthfirst CHP/FHP/Medicaid $42,116.65
Rate for Payer: Healthfirst Commercial $71,586.00
Rate for Payer: Healthfirst Essential Plan $94,762.46
Rate for Payer: Healthfirst QHP $45,114.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $42,116.65
Rate for Payer: SOMOS Essential $94,762.46
Rate for Payer: Wellcare CHP/FHP/Medicaid $42,116.65
Service Code APR-DRG 3214
Min. Negotiated Rate $68,393.10
Max. Negotiated Rate $153,884.48
Rate for Payer: Amida Care Medicaid $68,393.10
Rate for Payer: Fidelis CHP/HARP/Medicaid $68,393.10
Rate for Payer: Fidelis Qualified Health Plan $82,071.72
Rate for Payer: Hamaspik Choice Inc Medicaid $68,393.10
Rate for Payer: Healthfirst CHP/FHP/Medicaid $68,393.10
Rate for Payer: Healthfirst Commercial $140,740.00
Rate for Payer: Healthfirst Essential Plan $153,884.48
Rate for Payer: Healthfirst QHP $85,302.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $68,393.10
Rate for Payer: SOMOS Essential $153,884.48
Rate for Payer: Wellcare CHP/FHP/Medicaid $68,393.10
Service Code APR-DRG 3221
Min. Negotiated Rate $25,527.37
Max. Negotiated Rate $57,436.58
Rate for Payer: Amida Care Medicaid $25,527.37
Rate for Payer: Fidelis CHP/HARP/Medicaid $25,527.37
Rate for Payer: Fidelis Qualified Health Plan $30,632.84
Rate for Payer: Hamaspik Choice Inc Medicaid $25,527.37
Rate for Payer: Healthfirst CHP/FHP/Medicaid $25,527.37
Rate for Payer: Healthfirst Essential Plan $57,436.58
Rate for Payer: SOMOS CHP/HARP/Medicaid $25,527.37
Rate for Payer: SOMOS Essential $57,436.58
Rate for Payer: Wellcare CHP/FHP/Medicaid $25,527.37
Service Code APR-DRG 3222
Min. Negotiated Rate $26,819.46
Max. Negotiated Rate $60,343.78
Rate for Payer: Amida Care Medicaid $26,819.46
Rate for Payer: Fidelis CHP/HARP/Medicaid $26,819.46
Rate for Payer: Fidelis Qualified Health Plan $32,183.35
Rate for Payer: Hamaspik Choice Inc Medicaid $26,819.46
Rate for Payer: Healthfirst CHP/FHP/Medicaid $26,819.46
Rate for Payer: Healthfirst Essential Plan $60,343.78
Rate for Payer: SOMOS CHP/HARP/Medicaid $26,819.46
Rate for Payer: SOMOS Essential $60,343.78
Rate for Payer: Wellcare CHP/FHP/Medicaid $26,819.46
Service Code APR-DRG 3223
Min. Negotiated Rate $36,027.48
Max. Negotiated Rate $81,061.83
Rate for Payer: Amida Care Medicaid $36,027.48
Rate for Payer: Fidelis CHP/HARP/Medicaid $36,027.48
Rate for Payer: Fidelis Qualified Health Plan $43,232.98
Rate for Payer: Hamaspik Choice Inc Medicaid $36,027.48
Rate for Payer: Healthfirst CHP/FHP/Medicaid $36,027.48
Rate for Payer: Healthfirst Essential Plan $81,061.83
Rate for Payer: SOMOS CHP/HARP/Medicaid $36,027.48
Rate for Payer: SOMOS Essential $81,061.83
Rate for Payer: Wellcare CHP/FHP/Medicaid $36,027.48
Service Code APR-DRG 3224
Min. Negotiated Rate $39,895.16
Max. Negotiated Rate $89,764.11
Rate for Payer: Amida Care Medicaid $39,895.16
Rate for Payer: Fidelis CHP/HARP/Medicaid $39,895.16
Rate for Payer: Fidelis Qualified Health Plan $47,874.19
Rate for Payer: Hamaspik Choice Inc Medicaid $39,895.16
Rate for Payer: Healthfirst CHP/FHP/Medicaid $39,895.16
Rate for Payer: Healthfirst Essential Plan $89,764.11
Rate for Payer: SOMOS CHP/HARP/Medicaid $39,895.16
Rate for Payer: SOMOS Essential $89,764.11
Rate for Payer: Wellcare CHP/FHP/Medicaid $39,895.16
Service Code APR-DRG 3401
Min. Negotiated Rate $7,074.00
Max. Negotiated Rate $38,941.60
Rate for Payer: Amida Care Medicaid $17,307.38
Rate for Payer: Fidelis CHP/HARP/Medicaid $17,307.38
Rate for Payer: Fidelis Qualified Health Plan $20,768.86
Rate for Payer: Hamaspik Choice Inc Medicaid $17,307.38
Rate for Payer: Healthfirst CHP/FHP/Medicaid $17,307.38
Rate for Payer: Healthfirst Commercial $11,587.00
Rate for Payer: Healthfirst Essential Plan $38,941.60
Rate for Payer: Healthfirst QHP $7,074.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $17,307.38
Rate for Payer: SOMOS Essential $38,941.60
Rate for Payer: Wellcare CHP/FHP/Medicaid $17,307.38
Service Code APR-DRG 3402
Min. Negotiated Rate $8,238.00
Max. Negotiated Rate $42,096.80
Rate for Payer: Amida Care Medicaid $18,709.69
Rate for Payer: Fidelis CHP/HARP/Medicaid $18,709.69
Rate for Payer: Fidelis Qualified Health Plan $22,451.63
Rate for Payer: Hamaspik Choice Inc Medicaid $18,709.69
Rate for Payer: Healthfirst CHP/FHP/Medicaid $18,709.69
Rate for Payer: Healthfirst Commercial $13,300.00
Rate for Payer: Healthfirst Essential Plan $42,096.80
Rate for Payer: Healthfirst QHP $8,238.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $18,709.69
Rate for Payer: SOMOS Essential $42,096.80
Rate for Payer: Wellcare CHP/FHP/Medicaid $18,709.69
Service Code APR-DRG 3403
Min. Negotiated Rate $13,069.00
Max. Negotiated Rate $59,603.36
Rate for Payer: Amida Care Medicaid $26,490.38
Rate for Payer: Fidelis CHP/HARP/Medicaid $26,490.38
Rate for Payer: Fidelis Qualified Health Plan $31,788.46
Rate for Payer: Hamaspik Choice Inc Medicaid $26,490.38
Rate for Payer: Healthfirst CHP/FHP/Medicaid $26,490.38
Rate for Payer: Healthfirst Commercial $19,303.00
Rate for Payer: Healthfirst Essential Plan $59,603.36
Rate for Payer: Healthfirst QHP $13,069.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $26,490.38
Rate for Payer: SOMOS Essential $59,603.36
Rate for Payer: Wellcare CHP/FHP/Medicaid $26,490.38
Service Code APR-DRG 3404
Min. Negotiated Rate $25,036.00
Max. Negotiated Rate $70,412.62
Rate for Payer: Amida Care Medicaid $31,294.50
Rate for Payer: Fidelis CHP/HARP/Medicaid $31,294.50
Rate for Payer: Fidelis Qualified Health Plan $37,553.40
Rate for Payer: Hamaspik Choice Inc Medicaid $31,294.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid $31,294.50
Rate for Payer: Healthfirst Commercial $38,321.00
Rate for Payer: Healthfirst Essential Plan $70,412.62
Rate for Payer: Healthfirst QHP $25,036.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $31,294.50
Rate for Payer: SOMOS Essential $70,412.62
Rate for Payer: Wellcare CHP/FHP/Medicaid $31,294.50
Service Code APR-DRG 3411
Min. Negotiated Rate $6,475.00
Max. Negotiated Rate $39,711.94
Rate for Payer: Amida Care Medicaid $17,649.75
Rate for Payer: Fidelis CHP/HARP/Medicaid $17,649.75
Rate for Payer: Fidelis Qualified Health Plan $21,179.70
Rate for Payer: Hamaspik Choice Inc Medicaid $17,649.75
Rate for Payer: Healthfirst CHP/FHP/Medicaid $17,649.75
Rate for Payer: Healthfirst Commercial $11,025.00
Rate for Payer: Healthfirst Essential Plan $39,711.94
Rate for Payer: Healthfirst QHP $6,475.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $17,649.75
Rate for Payer: SOMOS Essential $39,711.94
Rate for Payer: Wellcare CHP/FHP/Medicaid $17,649.75
Service Code APR-DRG 3412
Min. Negotiated Rate $8,423.00
Max. Negotiated Rate $42,197.04
Rate for Payer: Amida Care Medicaid $18,754.24
Rate for Payer: Fidelis CHP/HARP/Medicaid $18,754.24
Rate for Payer: Fidelis Qualified Health Plan $22,505.09
Rate for Payer: Hamaspik Choice Inc Medicaid $18,754.24
Rate for Payer: Healthfirst CHP/FHP/Medicaid $18,754.24
Rate for Payer: Healthfirst Commercial $13,501.00
Rate for Payer: Healthfirst Essential Plan $42,197.04
Rate for Payer: Healthfirst QHP $8,423.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $18,754.24
Rate for Payer: SOMOS Essential $42,197.04
Rate for Payer: Wellcare CHP/FHP/Medicaid $18,754.24
Service Code APR-DRG 3413
Min. Negotiated Rate $11,554.00
Max. Negotiated Rate $46,564.02
Rate for Payer: Amida Care Medicaid $20,695.12
Rate for Payer: Fidelis CHP/HARP/Medicaid $20,695.12
Rate for Payer: Fidelis Qualified Health Plan $24,834.14
Rate for Payer: Hamaspik Choice Inc Medicaid $20,695.12
Rate for Payer: Healthfirst CHP/FHP/Medicaid $20,695.12
Rate for Payer: Healthfirst Commercial $20,398.00
Rate for Payer: Healthfirst Essential Plan $46,564.02
Rate for Payer: Healthfirst QHP $11,554.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $20,695.12
Rate for Payer: SOMOS Essential $46,564.02
Rate for Payer: Wellcare CHP/FHP/Medicaid $20,695.12
Service Code APR-DRG 3414
Min. Negotiated Rate $21,177.41
Max. Negotiated Rate $47,649.17
Rate for Payer: Amida Care Medicaid $21,177.41
Rate for Payer: Fidelis CHP/HARP/Medicaid $21,177.41
Rate for Payer: Fidelis Qualified Health Plan $25,412.89
Rate for Payer: Hamaspik Choice Inc Medicaid $21,177.41
Rate for Payer: Healthfirst CHP/FHP/Medicaid $21,177.41
Rate for Payer: Healthfirst Commercial $44,058.00
Rate for Payer: Healthfirst Essential Plan $47,649.17
Rate for Payer: Healthfirst QHP $25,272.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $21,177.41
Rate for Payer: SOMOS Essential $47,649.17
Rate for Payer: Wellcare CHP/FHP/Medicaid $21,177.41
Service Code APR-DRG 3421
Min. Negotiated Rate $5,490.00
Max. Negotiated Rate $37,462.50
Rate for Payer: Amida Care Medicaid $16,650.00
Rate for Payer: Fidelis CHP/HARP/Medicaid $16,650.00
Rate for Payer: Fidelis Qualified Health Plan $19,980.00
Rate for Payer: Hamaspik Choice Inc Medicaid $16,650.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid $16,650.00
Rate for Payer: Healthfirst Commercial $9,443.00
Rate for Payer: Healthfirst Essential Plan $37,462.50
Rate for Payer: Healthfirst QHP $5,490.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $16,650.00
Rate for Payer: SOMOS Essential $37,462.50
Rate for Payer: Wellcare CHP/FHP/Medicaid $16,650.00