Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

COMPLERA 200MG-25MG-300MG

Facility

$470.34

Service Code	NDC 61958110101
Hospital Charge Code	6063943371
Hospital Revenue Code	250
Min. Negotiated Rate	$70.55
Max. Negotiated Rate	$70.55
Rate for Payer: Qualcare PPO/HMO/WC	$70.55

COMPLETE BLOOD COUNT (CBC)

Facility

$861.62

Service Code	HCPCS 85025
Hospital Charge Code	3005402
Hospital Revenue Code	305
Min. Negotiated Rate	$6.22
Max. Negotiated Rate	$430.81
Rate for Payer: Aetna Commercial	$21.13
Rate for Payer: Aetna Medicare Advantage	$25.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.05
Rate for Payer: Cigna Commercial	$430.81
Rate for Payer: Cigna Medicare Advantage	$7.77
Rate for Payer: Clover Medicare Advantage	$7.38
Rate for Payer: EmblemHealth Commercial	$23.31
Rate for Payer: Humana Medicare Advantage	$8.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$258.49
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$129.24
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.77
Rate for Payer: Wellcare Medicare Advantage	$7.77
Rate for Payer: Wellpoint Medicaid Managed Care	$22.83

COMPLETE BLOOD COUNT (CBC)

Facility

$861.62

Service Code	HCPCS 85025
Hospital Charge Code	3005402
Hospital Revenue Code	305
Min. Negotiated Rate	$129.24
Max. Negotiated Rate	$129.24
Rate for Payer: Qualcare PPO/HMO/WC	$129.24

COMPLETE BLOOD COUNT (CBC) RPT

Facility

$909.02

Service Code	HCPCS 8502591
Hospital Charge Code	3005402R
Hospital Revenue Code	305
Min. Negotiated Rate	$136.35
Max. Negotiated Rate	$136.35
Rate for Payer: Qualcare PPO/HMO/WC	$136.35

COMPLETE BLOOD COUNT (CBC) RPT

Facility

$909.02

Service Code	HCPCS 8502591
Hospital Charge Code	3005402R
Hospital Revenue Code	305
Min. Negotiated Rate	$21.91
Max. Negotiated Rate	$454.51
Rate for Payer: Aetna Commercial	$345.43
Rate for Payer: Aetna Medicare Advantage	$272.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$231.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$231.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$231.80
Rate for Payer: Cigna Commercial	$454.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.71
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$136.35
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$21.91
Rate for Payer: Wellpoint Medicaid Managed Care	$24.09

COMPLETE BLOOD COUNT (CBC) RPT

Facility

$531.04

Service Code	HCPCS 8502591
Hospital Charge Code	3005405
Hospital Revenue Code	305
Min. Negotiated Rate	$12.80
Max. Negotiated Rate	$265.52
Rate for Payer: Aetna Commercial	$201.80
Rate for Payer: Aetna Medicare Advantage	$159.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$135.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$135.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$135.42
Rate for Payer: Cigna Commercial	$265.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.31
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$79.66
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.80
Rate for Payer: Wellpoint Medicaid Managed Care	$14.07

COMPLETE BLOOD COUNT (CBC) RPT

Facility

$531.04

Service Code	HCPCS 8502591
Hospital Charge Code	3005405
Hospital Revenue Code	305
Min. Negotiated Rate	$79.66
Max. Negotiated Rate	$79.66
Rate for Payer: Qualcare PPO/HMO/WC	$79.66

COMPLETE HEART CATH

Facility

$16,190.00

Service Code	HCPCS 93453
Hospital Charge Code	74110017
Hospital Revenue Code	481
Min. Negotiated Rate	$2,428.50
Max. Negotiated Rate	$2,428.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,428.50

COMPLETE HEART CATH

Facility

$16,190.00

Service Code	HCPCS 93453
Hospital Charge Code	74110017
Hospital Revenue Code	481
Min. Negotiated Rate	$390.18
Max. Negotiated Rate	$13,902.76
Rate for Payer: Aetna Commercial	$10,476.08
Rate for Payer: Aetna Medicare Advantage	$12,478.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,902.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,902.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,851.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,902.76
Rate for Payer: Cigna Commercial	$7,720.31
Rate for Payer: Cigna Medicare Advantage	$3,851.50
Rate for Payer: Clover Medicare Advantage	$3,658.93
Rate for Payer: EmblemHealth Commercial	$11,554.50
Rate for Payer: Humana Medicare Advantage	$3,967.05
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,851.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,857.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,428.50
Rate for Payer: UnitedHealthcare Commercial	$12,870.00
Rate for Payer: UnitedHealthcare Community & State	$390.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,851.50
Rate for Payer: Wellcare Medicare Advantage	$3,851.50
Rate for Payer: Wellpoint Medicaid Managed Care	$429.04

COMPLETE HEART CATH

Facility

$16,190.00

Service Code	HCPCS 93453
Hospital Charge Code	5100144
Hospital Revenue Code	481
Min. Negotiated Rate	$2,428.50
Max. Negotiated Rate	$2,428.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,428.50

COMPLETE HEART CATH

Facility

$16,190.00

Service Code	HCPCS 93453
Hospital Charge Code	5100144
Hospital Revenue Code	481
Min. Negotiated Rate	$390.18
Max. Negotiated Rate	$13,902.76
Rate for Payer: Aetna Commercial	$10,476.08
Rate for Payer: Aetna Medicare Advantage	$12,478.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,902.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,902.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,851.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,902.76
Rate for Payer: Cigna Commercial	$7,720.31
Rate for Payer: Cigna Medicare Advantage	$3,851.50
Rate for Payer: Clover Medicare Advantage	$3,658.93
Rate for Payer: EmblemHealth Commercial	$11,554.50
Rate for Payer: Humana Medicare Advantage	$3,967.05
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,851.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,857.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,428.50
Rate for Payer: UnitedHealthcare Commercial	$12,870.00
Rate for Payer: UnitedHealthcare Community & State	$390.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,851.50
Rate for Payer: Wellcare Medicare Advantage	$3,851.50
Rate for Payer: Wellpoint Medicaid Managed Care	$429.04

COMPLETE HEART CATH

Facility

$16,190.00

Service Code	HCPCS 93453
Hospital Charge Code	366893453
Hospital Revenue Code	481
Min. Negotiated Rate	$2,428.50
Max. Negotiated Rate	$2,428.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,428.50

COMPLETE HEART CATH

Facility

$16,190.00

Service Code	HCPCS 93453
Hospital Charge Code	366893453
Hospital Revenue Code	481
Min. Negotiated Rate	$390.18
Max. Negotiated Rate	$13,902.76
Rate for Payer: Aetna Commercial	$10,476.08
Rate for Payer: Aetna Medicare Advantage	$12,478.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,902.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,902.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,851.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,902.76
Rate for Payer: Cigna Commercial	$7,720.31
Rate for Payer: Cigna Medicare Advantage	$3,851.50
Rate for Payer: Clover Medicare Advantage	$3,658.93
Rate for Payer: EmblemHealth Commercial	$11,554.50
Rate for Payer: Humana Medicare Advantage	$3,967.05
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,851.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,857.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,428.50
Rate for Payer: UnitedHealthcare Commercial	$12,870.00
Rate for Payer: UnitedHealthcare Community & State	$390.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,851.50
Rate for Payer: Wellcare Medicare Advantage	$3,851.50
Rate for Payer: Wellpoint Medicaid Managed Care	$429.04

COMPLETER GUIDE FOR

Facility

$977.30

Hospital Charge Code	27065910
Hospital Revenue Code	271
Min. Negotiated Rate	$23.55
Max. Negotiated Rate	$488.65
Rate for Payer: Aetna Commercial	$371.37
Rate for Payer: Aetna Medicare Advantage	$293.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$249.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$249.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$249.21
Rate for Payer: Cigna Commercial	$488.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$293.19
Rate for Payer: Oxford Commercial	$195.46
Rate for Payer: Qualcare PPO/HMO/WC	$146.59
Rate for Payer: UnitedHealthcare Commercial	$195.46
Rate for Payer: UnitedHealthcare Community & State	$23.55
Rate for Payer: Wellpoint Medicaid Managed Care	$25.90

COMPLETER GUIDE FOR

Facility

$977.30

Hospital Charge Code	27065910
Hospital Revenue Code	271
Min. Negotiated Rate	$146.59
Max. Negotiated Rate	$146.59
Rate for Payer: Qualcare PPO/HMO/WC	$146.59

COMPLEX AORTIC ARCH PROCEDURES

Facility

$367,976.39

Service Code	MSDRG 209
Min. Negotiated Rate	$112,044.09
Max. Negotiated Rate	$367,976.39
Rate for Payer: Aetna Commercial	$253,099.05
Rate for Payer: Aetna Medicare Advantage	$367,976.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$117,941.15
Rate for Payer: Cigna Commercial	$211,820.02
Rate for Payer: Cigna Medicare Advantage	$117,941.15
Rate for Payer: Clover Medicare Advantage	$112,044.09
Rate for Payer: EmblemHealth Commercial	$353,823.45
Rate for Payer: Humana Medicare Advantage	$121,479.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$117,941.15
Rate for Payer: Oxford Commercial	$152,237.86
Rate for Payer: UnitedHealthcare Commercial	$266,953.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$117,941.15
Rate for Payer: Wellcare Medicare Advantage	$117,941.15

COMPL EXC 5TH METATRSL HEAD

Facility

$19,998.60

Service Code	HCPCS 28113
Hospital Charge Code	16000513
Hospital Revenue Code	360
Min. Negotiated Rate	$2,999.79
Max. Negotiated Rate	$2,999.79
Rate for Payer: Qualcare PPO/HMO/WC	$2,999.79

COMPL EXC 5TH METATRSL HEAD

Facility

$19,998.60

Service Code	HCPCS 28113
Hospital Charge Code	16000513
Hospital Revenue Code	360
Min. Negotiated Rate	$481.97
Max. Negotiated Rate	$14,031.70
Rate for Payer: Aetna Commercial	$10,573.24
Rate for Payer: Aetna Medicare Advantage	$12,594.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,887.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,031.70
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: Cigna Medicare Advantage	$3,887.22
Rate for Payer: Clover Medicare Advantage	$3,692.86
Rate for Payer: EmblemHealth Commercial	$11,661.66
Rate for Payer: Humana Medicare Advantage	$4,003.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,887.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,999.58
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,999.79
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$481.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare Medicare Advantage	$3,887.22
Rate for Payer: Wellpoint Medicaid Managed Care	$529.96

COMPL EXC 5TH METATRSL HEAD

Facility

$19,998.60

Service Code	HCPCS 28113
Hospital Charge Code	1600000624
Hospital Revenue Code	360
Min. Negotiated Rate	$481.97
Max. Negotiated Rate	$14,031.70
Rate for Payer: Aetna Commercial	$10,573.24
Rate for Payer: Aetna Medicare Advantage	$12,594.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,887.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,031.70
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: Cigna Medicare Advantage	$3,887.22
Rate for Payer: Clover Medicare Advantage	$3,692.86
Rate for Payer: EmblemHealth Commercial	$11,661.66
Rate for Payer: Humana Medicare Advantage	$4,003.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,887.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,999.58
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,999.79
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$481.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare Medicare Advantage	$3,887.22
Rate for Payer: Wellpoint Medicaid Managed Care	$529.96

COMPL EXC 5TH METATRSL HEAD

Facility

$19,998.60

Service Code	HCPCS 28113
Hospital Charge Code	1600000624
Hospital Revenue Code	360
Min. Negotiated Rate	$2,999.79
Max. Negotiated Rate	$2,999.79
Rate for Payer: Qualcare PPO/HMO/WC	$2,999.79

COMPL EXC OTHR METATRSL HEAD

Facility

$19,998.60

Service Code	HCPCS 28112
Hospital Charge Code	16000450
Hospital Revenue Code	360
Min. Negotiated Rate	$2,999.79
Max. Negotiated Rate	$2,999.79
Rate for Payer: Qualcare PPO/HMO/WC	$2,999.79

COMPL EXC OTHR METATRSL HEAD

Facility

$19,998.60

Service Code	HCPCS 28112
Hospital Charge Code	16000450
Hospital Revenue Code	360
Min. Negotiated Rate	$481.97
Max. Negotiated Rate	$14,031.70
Rate for Payer: Aetna Commercial	$10,573.24
Rate for Payer: Aetna Medicare Advantage	$12,594.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,887.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,031.70
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: Cigna Medicare Advantage	$3,887.22
Rate for Payer: Clover Medicare Advantage	$3,692.86
Rate for Payer: EmblemHealth Commercial	$11,661.66
Rate for Payer: Humana Medicare Advantage	$4,003.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,887.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,999.58
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,999.79
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$481.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare Medicare Advantage	$3,887.22
Rate for Payer: Wellpoint Medicaid Managed Care	$529.96

COMPLICATED PEPTIC ULCER WITH CC

Facility

$37,154.61

Service Code	MSDRG 381
Min. Negotiated Rate	$11,313.10
Max. Negotiated Rate	$37,154.61
Rate for Payer: Aetna Commercial	$25,786.78
Rate for Payer: Aetna Medicare Advantage	$37,154.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24,889.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24,889.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11,908.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24,889.27
Rate for Payer: Cigna Commercial	$20,276.62
Rate for Payer: Cigna Medicare Advantage	$11,908.53
Rate for Payer: Clover Medicare Advantage	$11,313.10
Rate for Payer: EmblemHealth Commercial	$35,725.59
Rate for Payer: Humana Medicare Advantage	$12,265.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11,908.53
Rate for Payer: Oxford Commercial	$14,573.08
Rate for Payer: UnitedHealthcare Commercial	$25,554.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$11,908.53
Rate for Payer: Wellcare Medicare Advantage	$11,908.53

COMPLICATED PEPTIC ULCER WITH MCC

Facility

$65,555.66

Service Code	MSDRG 380
Min. Negotiated Rate	$19,960.86
Max. Negotiated Rate	$65,555.66
Rate for Payer: Aetna Commercial	$45,301.54
Rate for Payer: Aetna Medicare Advantage	$65,555.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45,358.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45,358.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21,011.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45,358.95
Rate for Payer: Cigna Commercial	$36,720.61
Rate for Payer: Cigna Medicare Advantage	$21,011.43
Rate for Payer: Clover Medicare Advantage	$19,960.86
Rate for Payer: EmblemHealth Commercial	$63,034.29
Rate for Payer: Humana Medicare Advantage	$21,641.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21,011.43
Rate for Payer: Oxford Commercial	$26,391.59
Rate for Payer: UnitedHealthcare Commercial	$46,278.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$21,011.43
Rate for Payer: Wellcare Medicare Advantage	$21,011.43

COMPLICATED PEPTIC ULCER WITHOUT CC/MCC

Facility

$28,010.80

Service Code	MSDRG 382
Min. Negotiated Rate	$8,528.93
Max. Negotiated Rate	$28,010.80
Rate for Payer: Aetna Commercial	$19,503.94
Rate for Payer: Aetna Medicare Advantage	$28,010.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17,678.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17,678.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,977.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17,678.36
Rate for Payer: Cigna Commercial	$14,982.43
Rate for Payer: Cigna Medicare Advantage	$8,977.82
Rate for Payer: Clover Medicare Advantage	$8,528.93
Rate for Payer: EmblemHealth Commercial	$26,933.46
Rate for Payer: Humana Medicare Advantage	$9,247.15
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,977.82
Rate for Payer: Oxford Commercial	$10,768.07
Rate for Payer: UnitedHealthcare Commercial	$18,882.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,977.82
Rate for Payer: Wellcare Medicare Advantage	$8,977.82

Know your out-of-pocket cost for care.

All Charges