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Charge Type Price  
Service Code APR-DRG 1762
Min. Negotiated Rate $33,813.80
Max. Negotiated Rate $76,081.05
Rate for Payer: Amida Care Medicaid $33,813.80
Rate for Payer: Fidelis CHP/HARP/Medicaid $33,813.80
Rate for Payer: Fidelis Qualified Health Plan $40,576.56
Rate for Payer: Hamaspik Choice Inc Medicaid $33,813.80
Rate for Payer: Healthfirst CHP/FHP/Medicaid $33,813.80
Rate for Payer: Healthfirst Commercial $47,587.00
Rate for Payer: Healthfirst Essential Plan $76,081.05
Rate for Payer: Healthfirst QHP $43,368.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $33,813.80
Rate for Payer: SOMOS Essential $76,081.05
Rate for Payer: Wellcare CHP/FHP/Medicaid $33,813.80
Service Code APR-DRG 1763
Min. Negotiated Rate $39,474.62
Max. Negotiated Rate $88,817.90
Rate for Payer: Amida Care Medicaid $39,474.62
Rate for Payer: Fidelis CHP/HARP/Medicaid $39,474.62
Rate for Payer: Fidelis Qualified Health Plan $47,369.54
Rate for Payer: Hamaspik Choice Inc Medicaid $39,474.62
Rate for Payer: Healthfirst CHP/FHP/Medicaid $39,474.62
Rate for Payer: Healthfirst Commercial $52,768.00
Rate for Payer: Healthfirst Essential Plan $88,817.90
Rate for Payer: Healthfirst QHP $42,968.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $39,474.62
Rate for Payer: SOMOS Essential $88,817.90
Rate for Payer: Wellcare CHP/FHP/Medicaid $39,474.62
Service Code APR-DRG 1764
Min. Negotiated Rate $40,932.43
Max. Negotiated Rate $92,097.97
Rate for Payer: Amida Care Medicaid $40,932.43
Rate for Payer: Fidelis CHP/HARP/Medicaid $40,932.43
Rate for Payer: Fidelis Qualified Health Plan $49,118.92
Rate for Payer: Hamaspik Choice Inc Medicaid $40,932.43
Rate for Payer: Healthfirst CHP/FHP/Medicaid $40,932.43
Rate for Payer: Healthfirst Commercial $54,844.00
Rate for Payer: Healthfirst Essential Plan $92,097.97
Rate for Payer: Healthfirst QHP $42,968.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $40,932.43
Rate for Payer: SOMOS Essential $92,097.97
Rate for Payer: Wellcare CHP/FHP/Medicaid $40,932.43
Service Code APR-DRG 1771
Min. Negotiated Rate $14,541.00
Max. Negotiated Rate $54,163.55
Rate for Payer: Amida Care Medicaid $24,072.69
Rate for Payer: Fidelis CHP/HARP/Medicaid $24,072.69
Rate for Payer: Fidelis Qualified Health Plan $28,887.23
Rate for Payer: Hamaspik Choice Inc Medicaid $24,072.69
Rate for Payer: Healthfirst CHP/FHP/Medicaid $24,072.69
Rate for Payer: Healthfirst Commercial $26,973.00
Rate for Payer: Healthfirst Essential Plan $54,163.55
Rate for Payer: Healthfirst QHP $14,541.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $24,072.69
Rate for Payer: SOMOS Essential $54,163.55
Rate for Payer: Wellcare CHP/FHP/Medicaid $24,072.69
Service Code APR-DRG 1772
Min. Negotiated Rate $20,523.00
Max. Negotiated Rate $60,371.93
Rate for Payer: Amida Care Medicaid $26,831.97
Rate for Payer: Fidelis CHP/HARP/Medicaid $26,831.97
Rate for Payer: Fidelis Qualified Health Plan $32,198.36
Rate for Payer: Hamaspik Choice Inc Medicaid $26,831.97
Rate for Payer: Healthfirst CHP/FHP/Medicaid $26,831.97
Rate for Payer: Healthfirst Commercial $34,323.00
Rate for Payer: Healthfirst Essential Plan $60,371.93
Rate for Payer: Healthfirst QHP $20,523.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $26,831.97
Rate for Payer: SOMOS Essential $60,371.93
Rate for Payer: Wellcare CHP/FHP/Medicaid $26,831.97
Service Code APR-DRG 1773
Min. Negotiated Rate $27,716.00
Max. Negotiated Rate $76,788.07
Rate for Payer: Amida Care Medicaid $34,128.03
Rate for Payer: Fidelis CHP/HARP/Medicaid $34,128.03
Rate for Payer: Fidelis Qualified Health Plan $40,953.64
Rate for Payer: Hamaspik Choice Inc Medicaid $34,128.03
Rate for Payer: Healthfirst CHP/FHP/Medicaid $34,128.03
Rate for Payer: Healthfirst Commercial $50,471.00
Rate for Payer: Healthfirst Essential Plan $76,788.07
Rate for Payer: Healthfirst QHP $27,716.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $34,128.03
Rate for Payer: SOMOS Essential $76,788.07
Rate for Payer: Wellcare CHP/FHP/Medicaid $34,128.03
Service Code APR-DRG 1774
Min. Negotiated Rate $62,000.00
Max. Negotiated Rate $141,052.66
Rate for Payer: Amida Care Medicaid $62,690.07
Rate for Payer: Fidelis CHP/HARP/Medicaid $62,690.07
Rate for Payer: Fidelis Qualified Health Plan $75,228.08
Rate for Payer: Hamaspik Choice Inc Medicaid $62,690.07
Rate for Payer: Healthfirst CHP/FHP/Medicaid $62,690.07
Rate for Payer: Healthfirst Commercial $125,515.00
Rate for Payer: Healthfirst Essential Plan $141,052.66
Rate for Payer: Healthfirst QHP $62,000.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $62,690.07
Rate for Payer: SOMOS Essential $141,052.66
Rate for Payer: Wellcare CHP/FHP/Medicaid $62,690.07
Service Code APR-DRG 1801
Min. Negotiated Rate $13,536.00
Max. Negotiated Rate $49,675.23
Rate for Payer: Amida Care Medicaid $22,077.88
Rate for Payer: Fidelis CHP/HARP/Medicaid $22,077.88
Rate for Payer: Fidelis Qualified Health Plan $26,493.46
Rate for Payer: Hamaspik Choice Inc Medicaid $22,077.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid $22,077.88
Rate for Payer: Healthfirst Commercial $23,162.00
Rate for Payer: Healthfirst Essential Plan $49,675.23
Rate for Payer: Healthfirst QHP $13,536.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $22,077.88
Rate for Payer: SOMOS Essential $49,675.23
Rate for Payer: Wellcare CHP/FHP/Medicaid $22,077.88
Service Code APR-DRG 1802
Min. Negotiated Rate $19,402.00
Max. Negotiated Rate $58,595.60
Rate for Payer: Amida Care Medicaid $26,042.49
Rate for Payer: Fidelis CHP/HARP/Medicaid $26,042.49
Rate for Payer: Fidelis Qualified Health Plan $31,250.99
Rate for Payer: Hamaspik Choice Inc Medicaid $26,042.49
Rate for Payer: Healthfirst CHP/FHP/Medicaid $26,042.49
Rate for Payer: Healthfirst Commercial $32,071.00
Rate for Payer: Healthfirst Essential Plan $58,595.60
Rate for Payer: Healthfirst QHP $19,402.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $26,042.49
Rate for Payer: SOMOS Essential $58,595.60
Rate for Payer: Wellcare CHP/FHP/Medicaid $26,042.49
Service Code APR-DRG 1803
Min. Negotiated Rate $29,867.00
Max. Negotiated Rate $72,195.98
Rate for Payer: Amida Care Medicaid $32,087.10
Rate for Payer: Fidelis CHP/HARP/Medicaid $32,087.10
Rate for Payer: Fidelis Qualified Health Plan $38,504.52
Rate for Payer: Hamaspik Choice Inc Medicaid $32,087.10
Rate for Payer: Healthfirst CHP/FHP/Medicaid $32,087.10
Rate for Payer: Healthfirst Commercial $51,273.00
Rate for Payer: Healthfirst Essential Plan $72,195.98
Rate for Payer: Healthfirst QHP $29,867.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $32,087.10
Rate for Payer: SOMOS Essential $72,195.98
Rate for Payer: Wellcare CHP/FHP/Medicaid $32,087.10
Service Code APR-DRG 1804
Min. Negotiated Rate $50,843.94
Max. Negotiated Rate $114,398.86
Rate for Payer: Amida Care Medicaid $50,843.94
Rate for Payer: Fidelis CHP/HARP/Medicaid $50,843.94
Rate for Payer: Fidelis Qualified Health Plan $61,012.73
Rate for Payer: Hamaspik Choice Inc Medicaid $50,843.94
Rate for Payer: Healthfirst CHP/FHP/Medicaid $50,843.94
Rate for Payer: Healthfirst Commercial $93,996.00
Rate for Payer: Healthfirst Essential Plan $114,398.86
Rate for Payer: Healthfirst QHP $56,430.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $50,843.94
Rate for Payer: SOMOS Essential $114,398.86
Rate for Payer: Wellcare CHP/FHP/Medicaid $50,843.94
Service Code APR-DRG 1811
Min. Negotiated Rate $24,391.61
Max. Negotiated Rate $54,881.12
Rate for Payer: Amida Care Medicaid $24,391.61
Rate for Payer: Fidelis CHP/HARP/Medicaid $24,391.61
Rate for Payer: Fidelis Qualified Health Plan $29,269.93
Rate for Payer: Hamaspik Choice Inc Medicaid $24,391.61
Rate for Payer: Healthfirst CHP/FHP/Medicaid $24,391.61
Rate for Payer: Healthfirst Essential Plan $54,881.12
Rate for Payer: SOMOS CHP/HARP/Medicaid $24,391.61
Rate for Payer: SOMOS Essential $54,881.12
Rate for Payer: Wellcare CHP/FHP/Medicaid $24,391.61
Service Code APR-DRG 1812
Min. Negotiated Rate $30,978.70
Max. Negotiated Rate $69,702.08
Rate for Payer: Amida Care Medicaid $30,978.70
Rate for Payer: Fidelis CHP/HARP/Medicaid $30,978.70
Rate for Payer: Fidelis Qualified Health Plan $37,174.44
Rate for Payer: Hamaspik Choice Inc Medicaid $30,978.70
Rate for Payer: Healthfirst CHP/FHP/Medicaid $30,978.70
Rate for Payer: Healthfirst Essential Plan $69,702.08
Rate for Payer: SOMOS CHP/HARP/Medicaid $30,978.70
Rate for Payer: SOMOS Essential $69,702.08
Rate for Payer: Wellcare CHP/FHP/Medicaid $30,978.70
Service Code APR-DRG 1813
Min. Negotiated Rate $45,147.16
Max. Negotiated Rate $101,581.11
Rate for Payer: Amida Care Medicaid $45,147.16
Rate for Payer: Fidelis CHP/HARP/Medicaid $45,147.16
Rate for Payer: Fidelis Qualified Health Plan $54,176.59
Rate for Payer: Hamaspik Choice Inc Medicaid $45,147.16
Rate for Payer: Healthfirst CHP/FHP/Medicaid $45,147.16
Rate for Payer: Healthfirst Essential Plan $101,581.11
Rate for Payer: SOMOS CHP/HARP/Medicaid $45,147.16
Rate for Payer: SOMOS Essential $101,581.11
Rate for Payer: Wellcare CHP/FHP/Medicaid $45,147.16
Service Code APR-DRG 1814
Min. Negotiated Rate $64,893.58
Max. Negotiated Rate $146,010.56
Rate for Payer: Amida Care Medicaid $64,893.58
Rate for Payer: Fidelis CHP/HARP/Medicaid $64,893.58
Rate for Payer: Fidelis Qualified Health Plan $77,872.30
Rate for Payer: Hamaspik Choice Inc Medicaid $64,893.58
Rate for Payer: Healthfirst CHP/FHP/Medicaid $64,893.58
Rate for Payer: Healthfirst Essential Plan $146,010.56
Rate for Payer: SOMOS CHP/HARP/Medicaid $64,893.58
Rate for Payer: SOMOS Essential $146,010.56
Rate for Payer: Wellcare CHP/FHP/Medicaid $64,893.58
Service Code APR-DRG 1821
Min. Negotiated Rate $24,902.82
Max. Negotiated Rate $56,031.34
Rate for Payer: Amida Care Medicaid $24,902.82
Rate for Payer: Fidelis CHP/HARP/Medicaid $24,902.82
Rate for Payer: Fidelis Qualified Health Plan $29,883.38
Rate for Payer: Hamaspik Choice Inc Medicaid $24,902.82
Rate for Payer: Healthfirst CHP/FHP/Medicaid $24,902.82
Rate for Payer: Healthfirst Essential Plan $56,031.34
Rate for Payer: SOMOS CHP/HARP/Medicaid $24,902.82
Rate for Payer: SOMOS Essential $56,031.34
Rate for Payer: Wellcare CHP/FHP/Medicaid $24,902.82
Service Code APR-DRG 1822
Min. Negotiated Rate $29,730.38
Max. Negotiated Rate $66,893.36
Rate for Payer: Amida Care Medicaid $29,730.38
Rate for Payer: Fidelis CHP/HARP/Medicaid $29,730.38
Rate for Payer: Fidelis Qualified Health Plan $35,676.46
Rate for Payer: Hamaspik Choice Inc Medicaid $29,730.38
Rate for Payer: Healthfirst CHP/FHP/Medicaid $29,730.38
Rate for Payer: Healthfirst Essential Plan $66,893.36
Rate for Payer: SOMOS CHP/HARP/Medicaid $29,730.38
Rate for Payer: SOMOS Essential $66,893.36
Rate for Payer: Wellcare CHP/FHP/Medicaid $29,730.38
Service Code APR-DRG 1823
Min. Negotiated Rate $38,375.60
Max. Negotiated Rate $86,345.10
Rate for Payer: Amida Care Medicaid $38,375.60
Rate for Payer: Fidelis CHP/HARP/Medicaid $38,375.60
Rate for Payer: Fidelis Qualified Health Plan $46,050.72
Rate for Payer: Hamaspik Choice Inc Medicaid $38,375.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid $38,375.60
Rate for Payer: Healthfirst Essential Plan $86,345.10
Rate for Payer: SOMOS CHP/HARP/Medicaid $38,375.60
Rate for Payer: SOMOS Essential $86,345.10
Rate for Payer: Wellcare CHP/FHP/Medicaid $38,375.60
Service Code APR-DRG 1824
Min. Negotiated Rate $62,200.75
Max. Negotiated Rate $139,951.69
Rate for Payer: Amida Care Medicaid $62,200.75
Rate for Payer: Fidelis CHP/HARP/Medicaid $62,200.75
Rate for Payer: Fidelis Qualified Health Plan $74,640.90
Rate for Payer: Hamaspik Choice Inc Medicaid $62,200.75
Rate for Payer: Healthfirst CHP/FHP/Medicaid $62,200.75
Rate for Payer: Healthfirst Essential Plan $139,951.69
Rate for Payer: SOMOS CHP/HARP/Medicaid $62,200.75
Rate for Payer: SOMOS Essential $139,951.69
Rate for Payer: Wellcare CHP/FHP/Medicaid $62,200.75
Service Code APR-DRG 1901
Min. Negotiated Rate $8,833.00
Max. Negotiated Rate $42,582.22
Rate for Payer: Amida Care Medicaid $18,925.43
Rate for Payer: Fidelis CHP/HARP/Medicaid $18,925.43
Rate for Payer: Fidelis Qualified Health Plan $22,710.52
Rate for Payer: Hamaspik Choice Inc Medicaid $18,925.43
Rate for Payer: Healthfirst CHP/FHP/Medicaid $18,925.43
Rate for Payer: Healthfirst Commercial $14,788.00
Rate for Payer: Healthfirst Essential Plan $42,582.22
Rate for Payer: Healthfirst QHP $8,833.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $18,925.43
Rate for Payer: SOMOS Essential $42,582.22
Rate for Payer: Wellcare CHP/FHP/Medicaid $18,925.43
Service Code APR-DRG 1902
Min. Negotiated Rate $10,375.00
Max. Negotiated Rate $46,497.20
Rate for Payer: Amida Care Medicaid $20,665.42
Rate for Payer: Fidelis CHP/HARP/Medicaid $20,665.42
Rate for Payer: Fidelis Qualified Health Plan $24,798.50
Rate for Payer: Hamaspik Choice Inc Medicaid $20,665.42
Rate for Payer: Healthfirst CHP/FHP/Medicaid $20,665.42
Rate for Payer: Healthfirst Commercial $18,561.00
Rate for Payer: Healthfirst Essential Plan $46,497.20
Rate for Payer: Healthfirst QHP $10,375.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $20,665.42
Rate for Payer: SOMOS Essential $46,497.20
Rate for Payer: Wellcare CHP/FHP/Medicaid $20,665.42
Service Code APR-DRG 1903
Min. Negotiated Rate $14,364.00
Max. Negotiated Rate $55,159.02
Rate for Payer: Amida Care Medicaid $24,515.12
Rate for Payer: Fidelis CHP/HARP/Medicaid $24,515.12
Rate for Payer: Fidelis Qualified Health Plan $29,418.14
Rate for Payer: Hamaspik Choice Inc Medicaid $24,515.12
Rate for Payer: Healthfirst CHP/FHP/Medicaid $24,515.12
Rate for Payer: Healthfirst Commercial $26,129.00
Rate for Payer: Healthfirst Essential Plan $55,159.02
Rate for Payer: Healthfirst QHP $14,364.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $24,515.12
Rate for Payer: SOMOS Essential $55,159.02
Rate for Payer: Wellcare CHP/FHP/Medicaid $24,515.12
Service Code APR-DRG 1904
Min. Negotiated Rate $24,966.00
Max. Negotiated Rate $79,120.17
Rate for Payer: Amida Care Medicaid $35,164.52
Rate for Payer: Fidelis CHP/HARP/Medicaid $35,164.52
Rate for Payer: Fidelis Qualified Health Plan $42,197.42
Rate for Payer: Hamaspik Choice Inc Medicaid $35,164.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid $35,164.52
Rate for Payer: Healthfirst Commercial $45,975.00
Rate for Payer: Healthfirst Essential Plan $79,120.17
Rate for Payer: Healthfirst QHP $24,966.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $35,164.52
Rate for Payer: SOMOS Essential $79,120.17
Rate for Payer: Wellcare CHP/FHP/Medicaid $35,164.52
Service Code APR-DRG 1911
Min. Negotiated Rate $9,497.00
Max. Negotiated Rate $42,253.34
Rate for Payer: Amida Care Medicaid $18,779.26
Rate for Payer: Fidelis CHP/HARP/Medicaid $18,779.26
Rate for Payer: Fidelis Qualified Health Plan $22,535.11
Rate for Payer: Hamaspik Choice Inc Medicaid $18,779.26
Rate for Payer: Healthfirst CHP/FHP/Medicaid $18,779.26
Rate for Payer: Healthfirst Commercial $16,705.00
Rate for Payer: Healthfirst Essential Plan $42,253.34
Rate for Payer: Healthfirst QHP $9,497.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $18,779.26
Rate for Payer: SOMOS Essential $42,253.34
Rate for Payer: Wellcare CHP/FHP/Medicaid $18,779.26
Service Code APR-DRG 1912
Min. Negotiated Rate $11,373.00
Max. Negotiated Rate $45,053.26
Rate for Payer: Amida Care Medicaid $20,023.67
Rate for Payer: Fidelis CHP/HARP/Medicaid $20,023.67
Rate for Payer: Fidelis Qualified Health Plan $24,028.40
Rate for Payer: Hamaspik Choice Inc Medicaid $20,023.67
Rate for Payer: Healthfirst CHP/FHP/Medicaid $20,023.67
Rate for Payer: Healthfirst Commercial $20,456.00
Rate for Payer: Healthfirst Essential Plan $45,053.26
Rate for Payer: Healthfirst QHP $11,373.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $20,023.67
Rate for Payer: SOMOS Essential $45,053.26
Rate for Payer: Wellcare CHP/FHP/Medicaid $20,023.67