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Charge Type Price  
Service Code APR-DRG 6633
Min. Negotiated Rate $11,012.00
Max. Negotiated Rate $49,172.24
Rate for Payer: Amida Care Medicaid $21,854.33
Rate for Payer: Fidelis CHP/HARP/Medicaid $21,854.33
Rate for Payer: Fidelis Qualified Health Plan $26,225.20
Rate for Payer: Hamaspik Choice Inc Medicaid $21,854.33
Rate for Payer: Healthfirst CHP/FHP/Medicaid $21,854.33
Rate for Payer: Healthfirst Commercial $19,159.00
Rate for Payer: Healthfirst Essential Plan $49,172.24
Rate for Payer: Healthfirst QHP $11,012.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $21,854.33
Rate for Payer: SOMOS Essential $49,172.24
Rate for Payer: Wellcare CHP/FHP/Medicaid $21,854.33
Service Code APR-DRG 6634
Min. Negotiated Rate $22,326.00
Max. Negotiated Rate $71,068.64
Rate for Payer: Amida Care Medicaid $31,586.06
Rate for Payer: Fidelis CHP/HARP/Medicaid $31,586.06
Rate for Payer: Fidelis Qualified Health Plan $37,903.27
Rate for Payer: Hamaspik Choice Inc Medicaid $31,586.06
Rate for Payer: Healthfirst CHP/FHP/Medicaid $31,586.06
Rate for Payer: Healthfirst Commercial $35,258.00
Rate for Payer: Healthfirst Essential Plan $71,068.64
Rate for Payer: Healthfirst QHP $22,326.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $31,586.06
Rate for Payer: SOMOS Essential $71,068.64
Rate for Payer: Wellcare CHP/FHP/Medicaid $31,586.06
Service Code APR-DRG 6801
Min. Negotiated Rate $16,208.00
Max. Negotiated Rate $53,984.16
Rate for Payer: Amida Care Medicaid $23,992.96
Rate for Payer: Fidelis CHP/HARP/Medicaid $23,992.96
Rate for Payer: Fidelis Qualified Health Plan $28,791.55
Rate for Payer: Hamaspik Choice Inc Medicaid $23,992.96
Rate for Payer: Healthfirst CHP/FHP/Medicaid $23,992.96
Rate for Payer: Healthfirst Commercial $26,132.00
Rate for Payer: Healthfirst Essential Plan $53,984.16
Rate for Payer: Healthfirst QHP $16,208.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $23,992.96
Rate for Payer: SOMOS Essential $53,984.16
Rate for Payer: Wellcare CHP/FHP/Medicaid $23,992.96
Service Code APR-DRG 6802
Min. Negotiated Rate $23,968.00
Max. Negotiated Rate $68,013.70
Rate for Payer: Amida Care Medicaid $30,228.31
Rate for Payer: Fidelis CHP/HARP/Medicaid $30,228.31
Rate for Payer: Fidelis Qualified Health Plan $36,273.97
Rate for Payer: Hamaspik Choice Inc Medicaid $30,228.31
Rate for Payer: Healthfirst CHP/FHP/Medicaid $30,228.31
Rate for Payer: Healthfirst Commercial $41,236.00
Rate for Payer: Healthfirst Essential Plan $68,013.70
Rate for Payer: Healthfirst QHP $23,968.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $30,228.31
Rate for Payer: SOMOS Essential $68,013.70
Rate for Payer: Wellcare CHP/FHP/Medicaid $30,228.31
Service Code APR-DRG 6803
Min. Negotiated Rate $43,414.99
Max. Negotiated Rate $97,683.73
Rate for Payer: Amida Care Medicaid $43,414.99
Rate for Payer: Fidelis CHP/HARP/Medicaid $43,414.99
Rate for Payer: Fidelis Qualified Health Plan $52,097.99
Rate for Payer: Hamaspik Choice Inc Medicaid $43,414.99
Rate for Payer: Healthfirst CHP/FHP/Medicaid $43,414.99
Rate for Payer: Healthfirst Commercial $70,278.00
Rate for Payer: Healthfirst Essential Plan $97,683.73
Rate for Payer: Healthfirst QHP $46,133.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $43,414.99
Rate for Payer: SOMOS Essential $97,683.73
Rate for Payer: Wellcare CHP/FHP/Medicaid $43,414.99
Service Code APR-DRG 6804
Min. Negotiated Rate $83,104.82
Max. Negotiated Rate $191,719.00
Rate for Payer: Amida Care Medicaid $83,104.82
Rate for Payer: Fidelis CHP/HARP/Medicaid $83,104.82
Rate for Payer: Fidelis Qualified Health Plan $99,725.78
Rate for Payer: Hamaspik Choice Inc Medicaid $83,104.82
Rate for Payer: Healthfirst CHP/FHP/Medicaid $83,104.82
Rate for Payer: Healthfirst Commercial $191,719.00
Rate for Payer: Healthfirst Essential Plan $186,985.84
Rate for Payer: Healthfirst QHP $121,742.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $83,104.82
Rate for Payer: SOMOS Essential $186,985.84
Rate for Payer: Wellcare CHP/FHP/Medicaid $83,104.82
Service Code APR-DRG 6811
Min. Negotiated Rate $11,907.00
Max. Negotiated Rate $46,319.56
Rate for Payer: Amida Care Medicaid $20,586.47
Rate for Payer: Fidelis CHP/HARP/Medicaid $20,586.47
Rate for Payer: Fidelis Qualified Health Plan $24,703.76
Rate for Payer: Hamaspik Choice Inc Medicaid $20,586.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid $20,586.47
Rate for Payer: Healthfirst Commercial $19,799.00
Rate for Payer: Healthfirst Essential Plan $46,319.56
Rate for Payer: Healthfirst QHP $11,907.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $20,586.47
Rate for Payer: SOMOS Essential $46,319.56
Rate for Payer: Wellcare CHP/FHP/Medicaid $20,586.47
Service Code APR-DRG 6812
Min. Negotiated Rate $18,158.00
Max. Negotiated Rate $57,528.04
Rate for Payer: Amida Care Medicaid $25,568.02
Rate for Payer: Fidelis CHP/HARP/Medicaid $25,568.02
Rate for Payer: Fidelis Qualified Health Plan $30,681.62
Rate for Payer: Hamaspik Choice Inc Medicaid $25,568.02
Rate for Payer: Healthfirst CHP/FHP/Medicaid $25,568.02
Rate for Payer: Healthfirst Commercial $28,635.00
Rate for Payer: Healthfirst Essential Plan $57,528.04
Rate for Payer: Healthfirst QHP $18,158.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $25,568.02
Rate for Payer: SOMOS Essential $57,528.04
Rate for Payer: Wellcare CHP/FHP/Medicaid $25,568.02
Service Code APR-DRG 6813
Min. Negotiated Rate $37,043.00
Max. Negotiated Rate $96,814.91
Rate for Payer: Amida Care Medicaid $43,028.85
Rate for Payer: Fidelis CHP/HARP/Medicaid $43,028.85
Rate for Payer: Fidelis Qualified Health Plan $51,634.62
Rate for Payer: Hamaspik Choice Inc Medicaid $43,028.85
Rate for Payer: Healthfirst CHP/FHP/Medicaid $43,028.85
Rate for Payer: Healthfirst Commercial $59,653.00
Rate for Payer: Healthfirst Essential Plan $96,814.91
Rate for Payer: Healthfirst QHP $37,043.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $43,028.85
Rate for Payer: SOMOS Essential $96,814.91
Rate for Payer: Wellcare CHP/FHP/Medicaid $43,028.85
Service Code APR-DRG 6814
Min. Negotiated Rate $83,299.45
Max. Negotiated Rate $187,423.76
Rate for Payer: Amida Care Medicaid $83,299.45
Rate for Payer: Fidelis CHP/HARP/Medicaid $83,299.45
Rate for Payer: Fidelis Qualified Health Plan $99,959.34
Rate for Payer: Hamaspik Choice Inc Medicaid $83,299.45
Rate for Payer: Healthfirst CHP/FHP/Medicaid $83,299.45
Rate for Payer: Healthfirst Commercial $143,474.00
Rate for Payer: Healthfirst Essential Plan $187,423.76
Rate for Payer: Healthfirst QHP $93,926.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $83,299.45
Rate for Payer: SOMOS Essential $187,423.76
Rate for Payer: Wellcare CHP/FHP/Medicaid $83,299.45
Service Code APR-DRG 6901
Min. Negotiated Rate $15,442.00
Max. Negotiated Rate $53,152.29
Rate for Payer: Amida Care Medicaid $23,623.24
Rate for Payer: Fidelis CHP/HARP/Medicaid $23,623.24
Rate for Payer: Fidelis Qualified Health Plan $28,347.89
Rate for Payer: Hamaspik Choice Inc Medicaid $23,623.24
Rate for Payer: Healthfirst CHP/FHP/Medicaid $23,623.24
Rate for Payer: Healthfirst Commercial $22,399.00
Rate for Payer: Healthfirst Essential Plan $53,152.29
Rate for Payer: Healthfirst QHP $15,442.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $23,623.24
Rate for Payer: SOMOS Essential $53,152.29
Rate for Payer: Wellcare CHP/FHP/Medicaid $23,623.24
Service Code APR-DRG 6902
Min. Negotiated Rate $31,706.00
Max. Negotiated Rate $77,458.16
Rate for Payer: Amida Care Medicaid $34,425.85
Rate for Payer: Fidelis CHP/HARP/Medicaid $34,425.85
Rate for Payer: Fidelis Qualified Health Plan $41,311.02
Rate for Payer: Hamaspik Choice Inc Medicaid $34,425.85
Rate for Payer: Healthfirst CHP/FHP/Medicaid $34,425.85
Rate for Payer: Healthfirst Commercial $43,079.00
Rate for Payer: Healthfirst Essential Plan $77,458.16
Rate for Payer: Healthfirst QHP $31,706.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $34,425.85
Rate for Payer: SOMOS Essential $77,458.16
Rate for Payer: Wellcare CHP/FHP/Medicaid $34,425.85
Service Code APR-DRG 6903
Min. Negotiated Rate $60,566.29
Max. Negotiated Rate $136,274.15
Rate for Payer: Amida Care Medicaid $60,566.29
Rate for Payer: Fidelis CHP/HARP/Medicaid $60,566.29
Rate for Payer: Fidelis Qualified Health Plan $72,679.55
Rate for Payer: Hamaspik Choice Inc Medicaid $60,566.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid $60,566.29
Rate for Payer: Healthfirst Commercial $90,583.00
Rate for Payer: Healthfirst Essential Plan $136,274.15
Rate for Payer: Healthfirst QHP $62,704.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $60,566.29
Rate for Payer: SOMOS Essential $136,274.15
Rate for Payer: Wellcare CHP/FHP/Medicaid $60,566.29
Service Code APR-DRG 6904
Min. Negotiated Rate $81,594.64
Max. Negotiated Rate $183,587.94
Rate for Payer: Amida Care Medicaid $81,594.64
Rate for Payer: Fidelis CHP/HARP/Medicaid $81,594.64
Rate for Payer: Fidelis Qualified Health Plan $97,913.57
Rate for Payer: Hamaspik Choice Inc Medicaid $81,594.64
Rate for Payer: Healthfirst CHP/FHP/Medicaid $81,594.64
Rate for Payer: Healthfirst Commercial $161,483.00
Rate for Payer: Healthfirst Essential Plan $183,587.94
Rate for Payer: Healthfirst QHP $103,813.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $81,594.64
Rate for Payer: SOMOS Essential $183,587.94
Rate for Payer: Wellcare CHP/FHP/Medicaid $81,594.64
Service Code APR-DRG 6911
Min. Negotiated Rate $10,891.00
Max. Negotiated Rate $47,629.82
Rate for Payer: Amida Care Medicaid $21,168.81
Rate for Payer: Fidelis CHP/HARP/Medicaid $21,168.81
Rate for Payer: Fidelis Qualified Health Plan $25,402.57
Rate for Payer: Hamaspik Choice Inc Medicaid $21,168.81
Rate for Payer: Healthfirst CHP/FHP/Medicaid $21,168.81
Rate for Payer: Healthfirst Commercial $18,425.00
Rate for Payer: Healthfirst Essential Plan $47,629.82
Rate for Payer: Healthfirst QHP $10,891.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $21,168.81
Rate for Payer: SOMOS Essential $47,629.82
Rate for Payer: Wellcare CHP/FHP/Medicaid $21,168.81
Service Code APR-DRG 6912
Min. Negotiated Rate $15,881.00
Max. Negotiated Rate $55,742.92
Rate for Payer: Amida Care Medicaid $24,774.63
Rate for Payer: Fidelis CHP/HARP/Medicaid $24,774.63
Rate for Payer: Fidelis Qualified Health Plan $29,729.56
Rate for Payer: Hamaspik Choice Inc Medicaid $24,774.63
Rate for Payer: Healthfirst CHP/FHP/Medicaid $24,774.63
Rate for Payer: Healthfirst Commercial $25,363.00
Rate for Payer: Healthfirst Essential Plan $55,742.92
Rate for Payer: Healthfirst QHP $15,881.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $24,774.63
Rate for Payer: SOMOS Essential $55,742.92
Rate for Payer: Wellcare CHP/FHP/Medicaid $24,774.63
Service Code APR-DRG 6913
Min. Negotiated Rate $26,441.00
Max. Negotiated Rate $73,835.14
Rate for Payer: Amida Care Medicaid $32,815.62
Rate for Payer: Fidelis CHP/HARP/Medicaid $32,815.62
Rate for Payer: Fidelis Qualified Health Plan $39,378.74
Rate for Payer: Hamaspik Choice Inc Medicaid $32,815.62
Rate for Payer: Healthfirst CHP/FHP/Medicaid $32,815.62
Rate for Payer: Healthfirst Commercial $44,809.00
Rate for Payer: Healthfirst Essential Plan $73,835.14
Rate for Payer: Healthfirst QHP $26,441.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $32,815.62
Rate for Payer: SOMOS Essential $73,835.14
Rate for Payer: Wellcare CHP/FHP/Medicaid $32,815.62
Service Code APR-DRG 6914
Min. Negotiated Rate $57,238.00
Max. Negotiated Rate $141,021.00
Rate for Payer: Amida Care Medicaid $62,676.00
Rate for Payer: Fidelis CHP/HARP/Medicaid $62,676.00
Rate for Payer: Fidelis Qualified Health Plan $75,211.20
Rate for Payer: Hamaspik Choice Inc Medicaid $62,676.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid $62,676.00
Rate for Payer: Healthfirst Commercial $105,299.00
Rate for Payer: Healthfirst Essential Plan $141,021.00
Rate for Payer: Healthfirst QHP $57,238.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $62,676.00
Rate for Payer: SOMOS Essential $141,021.00
Rate for Payer: Wellcare CHP/FHP/Medicaid $62,676.00
Service Code APR-DRG 6921
Min. Negotiated Rate $6,714.00
Max. Negotiated Rate $40,123.48
Rate for Payer: Amida Care Medicaid $17,832.66
Rate for Payer: Fidelis CHP/HARP/Medicaid $17,832.66
Rate for Payer: Fidelis Qualified Health Plan $21,399.19
Rate for Payer: Hamaspik Choice Inc Medicaid $17,832.66
Rate for Payer: Healthfirst CHP/FHP/Medicaid $17,832.66
Rate for Payer: Healthfirst Commercial $11,685.00
Rate for Payer: Healthfirst Essential Plan $40,123.48
Rate for Payer: Healthfirst QHP $6,714.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $17,832.66
Rate for Payer: SOMOS Essential $40,123.48
Rate for Payer: Wellcare CHP/FHP/Medicaid $17,832.66
Service Code APR-DRG 6922
Min. Negotiated Rate $12,707.00
Max. Negotiated Rate $52,522.65
Rate for Payer: Amida Care Medicaid $23,343.40
Rate for Payer: Fidelis CHP/HARP/Medicaid $23,343.40
Rate for Payer: Fidelis Qualified Health Plan $28,012.08
Rate for Payer: Hamaspik Choice Inc Medicaid $23,343.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid $23,343.40
Rate for Payer: Healthfirst Commercial $20,705.00
Rate for Payer: Healthfirst Essential Plan $52,522.65
Rate for Payer: Healthfirst QHP $12,707.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $23,343.40
Rate for Payer: SOMOS Essential $52,522.65
Rate for Payer: Wellcare CHP/FHP/Medicaid $23,343.40
Service Code APR-DRG 6923
Min. Negotiated Rate $26,647.00
Max. Negotiated Rate $78,603.10
Rate for Payer: Amida Care Medicaid $34,934.71
Rate for Payer: Fidelis CHP/HARP/Medicaid $34,934.71
Rate for Payer: Fidelis Qualified Health Plan $41,921.65
Rate for Payer: Hamaspik Choice Inc Medicaid $34,934.71
Rate for Payer: Healthfirst CHP/FHP/Medicaid $34,934.71
Rate for Payer: Healthfirst Commercial $46,446.00
Rate for Payer: Healthfirst Essential Plan $78,603.10
Rate for Payer: Healthfirst QHP $26,647.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $34,934.71
Rate for Payer: SOMOS Essential $78,603.10
Rate for Payer: Wellcare CHP/FHP/Medicaid $34,934.71
Service Code APR-DRG 6924
Min. Negotiated Rate $30,265.00
Max. Negotiated Rate $84,581.08
Rate for Payer: Amida Care Medicaid $37,591.59
Rate for Payer: Fidelis CHP/HARP/Medicaid $37,591.59
Rate for Payer: Fidelis Qualified Health Plan $45,109.91
Rate for Payer: Hamaspik Choice Inc Medicaid $37,591.59
Rate for Payer: Healthfirst CHP/FHP/Medicaid $37,591.59
Rate for Payer: Healthfirst Commercial $49,714.00
Rate for Payer: Healthfirst Essential Plan $84,581.08
Rate for Payer: Healthfirst QHP $30,265.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $37,591.59
Rate for Payer: SOMOS Essential $84,581.08
Rate for Payer: Wellcare CHP/FHP/Medicaid $37,591.59
Service Code APR-DRG 6941
Min. Negotiated Rate $6,419.00
Max. Negotiated Rate $40,594.84
Rate for Payer: Amida Care Medicaid $18,042.15
Rate for Payer: Fidelis CHP/HARP/Medicaid $18,042.15
Rate for Payer: Fidelis Qualified Health Plan $21,650.58
Rate for Payer: Hamaspik Choice Inc Medicaid $18,042.15
Rate for Payer: Healthfirst CHP/FHP/Medicaid $18,042.15
Rate for Payer: Healthfirst Commercial $12,138.00
Rate for Payer: Healthfirst Essential Plan $40,594.84
Rate for Payer: Healthfirst QHP $6,419.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $18,042.15
Rate for Payer: SOMOS Essential $40,594.84
Rate for Payer: Wellcare CHP/FHP/Medicaid $18,042.15
Service Code APR-DRG 6942
Min. Negotiated Rate $10,205.00
Max. Negotiated Rate $46,905.21
Rate for Payer: Amida Care Medicaid $20,846.76
Rate for Payer: Fidelis CHP/HARP/Medicaid $20,846.76
Rate for Payer: Fidelis Qualified Health Plan $25,016.11
Rate for Payer: Hamaspik Choice Inc Medicaid $20,846.76
Rate for Payer: Healthfirst CHP/FHP/Medicaid $20,846.76
Rate for Payer: Healthfirst Commercial $14,870.00
Rate for Payer: Healthfirst Essential Plan $46,905.21
Rate for Payer: Healthfirst QHP $10,205.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $20,846.76
Rate for Payer: SOMOS Essential $46,905.21
Rate for Payer: Wellcare CHP/FHP/Medicaid $20,846.76
Service Code APR-DRG 6943
Min. Negotiated Rate $16,448.00
Max. Negotiated Rate $58,150.64
Rate for Payer: Amida Care Medicaid $25,844.73
Rate for Payer: Fidelis CHP/HARP/Medicaid $25,844.73
Rate for Payer: Fidelis Qualified Health Plan $31,013.68
Rate for Payer: Hamaspik Choice Inc Medicaid $25,844.73
Rate for Payer: Healthfirst CHP/FHP/Medicaid $25,844.73
Rate for Payer: Healthfirst Commercial $25,508.00
Rate for Payer: Healthfirst Essential Plan $58,150.64
Rate for Payer: Healthfirst QHP $16,448.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $25,844.73
Rate for Payer: SOMOS Essential $58,150.64
Rate for Payer: Wellcare CHP/FHP/Medicaid $25,844.73