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Charge Type Price  
Service Code APR-DRG 4811
Min. Negotiated Rate $8,285.00
Max. Negotiated Rate $42,694.78
Rate for Payer: Amida Care Medicaid $18,975.46
Rate for Payer: Fidelis CHP/HARP/Medicaid $18,975.46
Rate for Payer: Fidelis Qualified Health Plan $22,770.55
Rate for Payer: Hamaspik Choice Inc Medicaid $18,975.46
Rate for Payer: Healthfirst CHP/FHP/Medicaid $18,975.46
Rate for Payer: Healthfirst Commercial $14,916.00
Rate for Payer: Healthfirst Essential Plan $42,694.78
Rate for Payer: Healthfirst QHP $8,285.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $18,975.46
Rate for Payer: SOMOS Essential $42,694.78
Rate for Payer: Wellcare CHP/FHP/Medicaid $18,975.46
Service Code APR-DRG 4812
Min. Negotiated Rate $14,220.00
Max. Negotiated Rate $51,091.02
Rate for Payer: Amida Care Medicaid $22,707.12
Rate for Payer: Fidelis CHP/HARP/Medicaid $22,707.12
Rate for Payer: Fidelis Qualified Health Plan $27,248.54
Rate for Payer: Hamaspik Choice Inc Medicaid $22,707.12
Rate for Payer: Healthfirst CHP/FHP/Medicaid $22,707.12
Rate for Payer: Healthfirst Commercial $22,568.00
Rate for Payer: Healthfirst Essential Plan $51,091.02
Rate for Payer: Healthfirst QHP $14,220.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $22,707.12
Rate for Payer: SOMOS Essential $51,091.02
Rate for Payer: Wellcare CHP/FHP/Medicaid $22,707.12
Service Code APR-DRG 4813
Min. Negotiated Rate $23,493.00
Max. Negotiated Rate $64,019.56
Rate for Payer: Amida Care Medicaid $28,453.14
Rate for Payer: Fidelis CHP/HARP/Medicaid $28,453.14
Rate for Payer: Fidelis Qualified Health Plan $34,143.77
Rate for Payer: Hamaspik Choice Inc Medicaid $28,453.14
Rate for Payer: Healthfirst CHP/FHP/Medicaid $28,453.14
Rate for Payer: Healthfirst Commercial $46,489.00
Rate for Payer: Healthfirst Essential Plan $64,019.56
Rate for Payer: Healthfirst QHP $23,493.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $28,453.14
Rate for Payer: SOMOS Essential $64,019.56
Rate for Payer: Wellcare CHP/FHP/Medicaid $28,453.14
Service Code APR-DRG 4814
Min. Negotiated Rate $29,327.05
Max. Negotiated Rate $65,985.86
Rate for Payer: Amida Care Medicaid $29,327.05
Rate for Payer: Fidelis CHP/HARP/Medicaid $29,327.05
Rate for Payer: Fidelis Qualified Health Plan $35,192.46
Rate for Payer: Hamaspik Choice Inc Medicaid $29,327.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid $29,327.05
Rate for Payer: Healthfirst Commercial $64,204.00
Rate for Payer: Healthfirst Essential Plan $65,985.86
Rate for Payer: Healthfirst QHP $30,778.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $29,327.05
Rate for Payer: SOMOS Essential $65,985.86
Rate for Payer: Wellcare CHP/FHP/Medicaid $29,327.05
Service Code APR-DRG 4821
Min. Negotiated Rate $6,795.00
Max. Negotiated Rate $40,283.53
Rate for Payer: Amida Care Medicaid $17,903.79
Rate for Payer: Fidelis CHP/HARP/Medicaid $17,903.79
Rate for Payer: Fidelis Qualified Health Plan $21,484.55
Rate for Payer: Hamaspik Choice Inc Medicaid $17,903.79
Rate for Payer: Healthfirst CHP/FHP/Medicaid $17,903.79
Rate for Payer: Healthfirst Commercial $11,501.00
Rate for Payer: Healthfirst Essential Plan $40,283.53
Rate for Payer: Healthfirst QHP $6,795.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $17,903.79
Rate for Payer: SOMOS Essential $40,283.53
Rate for Payer: Wellcare CHP/FHP/Medicaid $17,903.79
Service Code APR-DRG 4822
Min. Negotiated Rate $8,033.00
Max. Negotiated Rate $44,553.78
Rate for Payer: Amida Care Medicaid $19,801.68
Rate for Payer: Fidelis CHP/HARP/Medicaid $19,801.68
Rate for Payer: Fidelis Qualified Health Plan $23,762.02
Rate for Payer: Hamaspik Choice Inc Medicaid $19,801.68
Rate for Payer: Healthfirst CHP/FHP/Medicaid $19,801.68
Rate for Payer: Healthfirst Commercial $15,997.00
Rate for Payer: Healthfirst Essential Plan $44,553.78
Rate for Payer: Healthfirst QHP $8,033.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $19,801.68
Rate for Payer: SOMOS Essential $44,553.78
Rate for Payer: Wellcare CHP/FHP/Medicaid $19,801.68
Service Code APR-DRG 4823
Min. Negotiated Rate $16,520.00
Max. Negotiated Rate $71,042.24
Rate for Payer: Amida Care Medicaid $31,574.33
Rate for Payer: Fidelis CHP/HARP/Medicaid $31,574.33
Rate for Payer: Fidelis Qualified Health Plan $37,889.20
Rate for Payer: Hamaspik Choice Inc Medicaid $31,574.33
Rate for Payer: Healthfirst CHP/FHP/Medicaid $31,574.33
Rate for Payer: Healthfirst Commercial $38,248.00
Rate for Payer: Healthfirst Essential Plan $71,042.24
Rate for Payer: Healthfirst QHP $16,520.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $31,574.33
Rate for Payer: SOMOS Essential $71,042.24
Rate for Payer: Wellcare CHP/FHP/Medicaid $31,574.33
Service Code APR-DRG 4824
Min. Negotiated Rate $18,345.00
Max. Negotiated Rate $77,229.52
Rate for Payer: Amida Care Medicaid $34,324.23
Rate for Payer: Fidelis CHP/HARP/Medicaid $34,324.23
Rate for Payer: Fidelis Qualified Health Plan $41,189.08
Rate for Payer: Hamaspik Choice Inc Medicaid $34,324.23
Rate for Payer: Healthfirst CHP/FHP/Medicaid $34,324.23
Rate for Payer: Healthfirst Commercial $42,085.00
Rate for Payer: Healthfirst Essential Plan $77,229.52
Rate for Payer: Healthfirst QHP $18,345.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $34,324.23
Rate for Payer: SOMOS Essential $77,229.52
Rate for Payer: Wellcare CHP/FHP/Medicaid $34,324.23
Service Code APR-DRG 4831
Min. Negotiated Rate $6,880.00
Max. Negotiated Rate $40,753.12
Rate for Payer: Amida Care Medicaid $18,112.50
Rate for Payer: Fidelis CHP/HARP/Medicaid $18,112.50
Rate for Payer: Fidelis Qualified Health Plan $21,735.00
Rate for Payer: Hamaspik Choice Inc Medicaid $18,112.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid $18,112.50
Rate for Payer: Healthfirst Commercial $11,840.00
Rate for Payer: Healthfirst Essential Plan $40,753.12
Rate for Payer: Healthfirst QHP $6,880.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $18,112.50
Rate for Payer: SOMOS Essential $40,753.12
Rate for Payer: Wellcare CHP/FHP/Medicaid $18,112.50
Service Code APR-DRG 4832
Min. Negotiated Rate $12,335.00
Max. Negotiated Rate $52,172.66
Rate for Payer: Amida Care Medicaid $23,187.85
Rate for Payer: Fidelis CHP/HARP/Medicaid $23,187.85
Rate for Payer: Fidelis Qualified Health Plan $27,825.42
Rate for Payer: Hamaspik Choice Inc Medicaid $23,187.85
Rate for Payer: Healthfirst CHP/FHP/Medicaid $23,187.85
Rate for Payer: Healthfirst Commercial $21,929.00
Rate for Payer: Healthfirst Essential Plan $52,172.66
Rate for Payer: Healthfirst QHP $12,335.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $23,187.85
Rate for Payer: SOMOS Essential $52,172.66
Rate for Payer: Wellcare CHP/FHP/Medicaid $23,187.85
Service Code APR-DRG 4833
Min. Negotiated Rate $25,398.00
Max. Negotiated Rate $85,597.63
Rate for Payer: Amida Care Medicaid $38,043.39
Rate for Payer: Fidelis CHP/HARP/Medicaid $38,043.39
Rate for Payer: Fidelis Qualified Health Plan $45,652.07
Rate for Payer: Hamaspik Choice Inc Medicaid $38,043.39
Rate for Payer: Healthfirst CHP/FHP/Medicaid $38,043.39
Rate for Payer: Healthfirst Commercial $45,797.00
Rate for Payer: Healthfirst Essential Plan $85,597.63
Rate for Payer: Healthfirst QHP $25,398.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $38,043.39
Rate for Payer: SOMOS Essential $85,597.63
Rate for Payer: Wellcare CHP/FHP/Medicaid $38,043.39
Service Code APR-DRG 4834
Min. Negotiated Rate $35,867.00
Max. Negotiated Rate $104,882.29
Rate for Payer: Amida Care Medicaid $46,614.35
Rate for Payer: Fidelis CHP/HARP/Medicaid $46,614.35
Rate for Payer: Fidelis Qualified Health Plan $55,937.22
Rate for Payer: Hamaspik Choice Inc Medicaid $46,614.35
Rate for Payer: Healthfirst CHP/FHP/Medicaid $46,614.35
Rate for Payer: Healthfirst Commercial $48,352.00
Rate for Payer: Healthfirst Essential Plan $104,882.29
Rate for Payer: Healthfirst QHP $35,867.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $46,614.35
Rate for Payer: SOMOS Essential $104,882.29
Rate for Payer: Wellcare CHP/FHP/Medicaid $46,614.35
Service Code APR-DRG 4841
Min. Negotiated Rate $8,303.00
Max. Negotiated Rate $45,091.96
Rate for Payer: Amida Care Medicaid $20,040.87
Rate for Payer: Fidelis CHP/HARP/Medicaid $20,040.87
Rate for Payer: Fidelis Qualified Health Plan $24,049.04
Rate for Payer: Hamaspik Choice Inc Medicaid $20,040.87
Rate for Payer: Healthfirst CHP/FHP/Medicaid $20,040.87
Rate for Payer: Healthfirst Commercial $14,034.00
Rate for Payer: Healthfirst Essential Plan $45,091.96
Rate for Payer: Healthfirst QHP $8,303.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $20,040.87
Rate for Payer: SOMOS Essential $45,091.96
Rate for Payer: Wellcare CHP/FHP/Medicaid $20,040.87
Service Code APR-DRG 4842
Min. Negotiated Rate $12,076.00
Max. Negotiated Rate $50,336.53
Rate for Payer: Amida Care Medicaid $22,371.79
Rate for Payer: Fidelis CHP/HARP/Medicaid $22,371.79
Rate for Payer: Fidelis Qualified Health Plan $26,846.15
Rate for Payer: Hamaspik Choice Inc Medicaid $22,371.79
Rate for Payer: Healthfirst CHP/FHP/Medicaid $22,371.79
Rate for Payer: Healthfirst Commercial $22,059.00
Rate for Payer: Healthfirst Essential Plan $50,336.53
Rate for Payer: Healthfirst QHP $12,076.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $22,371.79
Rate for Payer: SOMOS Essential $50,336.53
Rate for Payer: Wellcare CHP/FHP/Medicaid $22,371.79
Service Code APR-DRG 4843
Min. Negotiated Rate $16,906.00
Max. Negotiated Rate $64,325.59
Rate for Payer: Amida Care Medicaid $28,589.15
Rate for Payer: Fidelis CHP/HARP/Medicaid $28,589.15
Rate for Payer: Fidelis Qualified Health Plan $34,306.98
Rate for Payer: Hamaspik Choice Inc Medicaid $28,589.15
Rate for Payer: Healthfirst CHP/FHP/Medicaid $28,589.15
Rate for Payer: Healthfirst Commercial $30,458.00
Rate for Payer: Healthfirst Essential Plan $64,325.59
Rate for Payer: Healthfirst QHP $16,906.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $28,589.15
Rate for Payer: SOMOS Essential $64,325.59
Rate for Payer: Wellcare CHP/FHP/Medicaid $28,589.15
Service Code APR-DRG 4844
Min. Negotiated Rate $19,543.00
Max. Negotiated Rate $67,419.22
Rate for Payer: Amida Care Medicaid $29,964.10
Rate for Payer: Fidelis CHP/HARP/Medicaid $29,964.10
Rate for Payer: Fidelis Qualified Health Plan $35,956.92
Rate for Payer: Hamaspik Choice Inc Medicaid $29,964.10
Rate for Payer: Healthfirst CHP/FHP/Medicaid $29,964.10
Rate for Payer: Healthfirst Commercial $31,526.00
Rate for Payer: Healthfirst Essential Plan $67,419.22
Rate for Payer: Healthfirst QHP $19,543.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $29,964.10
Rate for Payer: SOMOS Essential $67,419.22
Rate for Payer: Wellcare CHP/FHP/Medicaid $29,964.10
Service Code APR-DRG 5001
Min. Negotiated Rate $5,507.00
Max. Negotiated Rate $37,063.26
Rate for Payer: Amida Care Medicaid $16,472.56
Rate for Payer: Fidelis CHP/HARP/Medicaid $16,472.56
Rate for Payer: Fidelis Qualified Health Plan $19,767.07
Rate for Payer: Hamaspik Choice Inc Medicaid $16,472.56
Rate for Payer: Healthfirst CHP/FHP/Medicaid $16,472.56
Rate for Payer: Healthfirst Commercial $10,264.00
Rate for Payer: Healthfirst Essential Plan $37,063.26
Rate for Payer: Healthfirst QHP $5,507.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $16,472.56
Rate for Payer: SOMOS Essential $37,063.26
Rate for Payer: Wellcare CHP/FHP/Medicaid $16,472.56
Service Code APR-DRG 5002
Min. Negotiated Rate $10,273.00
Max. Negotiated Rate $46,222.83
Rate for Payer: Amida Care Medicaid $20,543.48
Rate for Payer: Fidelis CHP/HARP/Medicaid $20,543.48
Rate for Payer: Fidelis Qualified Health Plan $24,652.18
Rate for Payer: Hamaspik Choice Inc Medicaid $20,543.48
Rate for Payer: Healthfirst CHP/FHP/Medicaid $20,543.48
Rate for Payer: Healthfirst Commercial $16,493.00
Rate for Payer: Healthfirst Essential Plan $46,222.83
Rate for Payer: Healthfirst QHP $10,273.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $20,543.48
Rate for Payer: SOMOS Essential $46,222.83
Rate for Payer: Wellcare CHP/FHP/Medicaid $20,543.48
Service Code APR-DRG 5003
Min. Negotiated Rate $13,208.00
Max. Negotiated Rate $57,426.03
Rate for Payer: Amida Care Medicaid $25,522.68
Rate for Payer: Fidelis CHP/HARP/Medicaid $25,522.68
Rate for Payer: Fidelis Qualified Health Plan $30,627.22
Rate for Payer: Hamaspik Choice Inc Medicaid $25,522.68
Rate for Payer: Healthfirst CHP/FHP/Medicaid $25,522.68
Rate for Payer: Healthfirst Commercial $24,628.00
Rate for Payer: Healthfirst Essential Plan $57,426.03
Rate for Payer: Healthfirst QHP $13,208.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $25,522.68
Rate for Payer: SOMOS Essential $57,426.03
Rate for Payer: Wellcare CHP/FHP/Medicaid $25,522.68
Service Code APR-DRG 5004
Min. Negotiated Rate $14,479.00
Max. Negotiated Rate $70,609.00
Rate for Payer: Amida Care Medicaid $27,571.43
Rate for Payer: Fidelis CHP/HARP/Medicaid $27,571.43
Rate for Payer: Fidelis Qualified Health Plan $33,085.72
Rate for Payer: Hamaspik Choice Inc Medicaid $27,571.43
Rate for Payer: Healthfirst CHP/FHP/Medicaid $27,571.43
Rate for Payer: Healthfirst Commercial $70,609.00
Rate for Payer: Healthfirst Essential Plan $62,035.72
Rate for Payer: Healthfirst QHP $14,479.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $27,571.43
Rate for Payer: SOMOS Essential $62,035.72
Rate for Payer: Wellcare CHP/FHP/Medicaid $27,571.43
Service Code APR-DRG 5011
Min. Negotiated Rate $5,681.00
Max. Negotiated Rate $38,144.90
Rate for Payer: Amida Care Medicaid $16,953.29
Rate for Payer: Fidelis CHP/HARP/Medicaid $16,953.29
Rate for Payer: Fidelis Qualified Health Plan $20,343.95
Rate for Payer: Hamaspik Choice Inc Medicaid $16,953.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid $16,953.29
Rate for Payer: Healthfirst Commercial $9,623.00
Rate for Payer: Healthfirst Essential Plan $38,144.90
Rate for Payer: Healthfirst QHP $5,681.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $16,953.29
Rate for Payer: SOMOS Essential $38,144.90
Rate for Payer: Wellcare CHP/FHP/Medicaid $16,953.29
Service Code APR-DRG 5012
Min. Negotiated Rate $7,295.00
Max. Negotiated Rate $41,706.36
Rate for Payer: Amida Care Medicaid $18,536.16
Rate for Payer: Fidelis CHP/HARP/Medicaid $18,536.16
Rate for Payer: Fidelis Qualified Health Plan $22,243.39
Rate for Payer: Hamaspik Choice Inc Medicaid $18,536.16
Rate for Payer: Healthfirst CHP/FHP/Medicaid $18,536.16
Rate for Payer: Healthfirst Commercial $12,359.00
Rate for Payer: Healthfirst Essential Plan $41,706.36
Rate for Payer: Healthfirst QHP $7,295.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $18,536.16
Rate for Payer: SOMOS Essential $41,706.36
Rate for Payer: Wellcare CHP/FHP/Medicaid $18,536.16
Service Code APR-DRG 5013
Min. Negotiated Rate $10,221.00
Max. Negotiated Rate $49,388.56
Rate for Payer: Amida Care Medicaid $21,950.47
Rate for Payer: Fidelis CHP/HARP/Medicaid $21,950.47
Rate for Payer: Fidelis Qualified Health Plan $26,340.56
Rate for Payer: Hamaspik Choice Inc Medicaid $21,950.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid $21,950.47
Rate for Payer: Healthfirst Commercial $18,314.00
Rate for Payer: Healthfirst Essential Plan $49,388.56
Rate for Payer: Healthfirst QHP $10,221.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $21,950.47
Rate for Payer: SOMOS Essential $49,388.56
Rate for Payer: Wellcare CHP/FHP/Medicaid $21,950.47
Service Code APR-DRG 5014
Min. Negotiated Rate $18,508.00
Max. Negotiated Rate $67,150.15
Rate for Payer: Amida Care Medicaid $29,844.51
Rate for Payer: Fidelis CHP/HARP/Medicaid $29,844.51
Rate for Payer: Fidelis Qualified Health Plan $35,813.41
Rate for Payer: Hamaspik Choice Inc Medicaid $29,844.51
Rate for Payer: Healthfirst CHP/FHP/Medicaid $29,844.51
Rate for Payer: Healthfirst Commercial $38,065.00
Rate for Payer: Healthfirst Essential Plan $67,150.15
Rate for Payer: Healthfirst QHP $18,508.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $29,844.51
Rate for Payer: SOMOS Essential $67,150.15
Rate for Payer: Wellcare CHP/FHP/Medicaid $29,844.51
Service Code APR-DRG 5101
Min. Negotiated Rate $14,321.00
Max. Negotiated Rate $49,418.46
Rate for Payer: Amida Care Medicaid $21,963.76
Rate for Payer: Fidelis CHP/HARP/Medicaid $21,963.76
Rate for Payer: Fidelis Qualified Health Plan $26,356.51
Rate for Payer: Hamaspik Choice Inc Medicaid $21,963.76
Rate for Payer: Healthfirst CHP/FHP/Medicaid $21,963.76
Rate for Payer: Healthfirst Commercial $24,839.00
Rate for Payer: Healthfirst Essential Plan $49,418.46
Rate for Payer: Healthfirst QHP $14,321.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $21,963.76
Rate for Payer: SOMOS Essential $49,418.46
Rate for Payer: Wellcare CHP/FHP/Medicaid $21,963.76