Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ER FB REMOVAL ARM/ELBOW DEEP

Facility

$7,392.00

Service Code	HCPCS 24201
Hospital Charge Code	5700739
Hospital Revenue Code	450
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$12,518.07
Rate for Payer: Aetna Commercial	$9,386.39
Rate for Payer: Aetna Medicare Advantage	$11,180.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,518.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,518.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,450.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$192.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,518.07
Rate for Payer: Cigna Commercial	$6,917.28
Rate for Payer: Cigna Medicare Advantage	$3,450.88
Rate for Payer: Clover Medicare Advantage	$3,278.34
Rate for Payer: EmblemHealth Commercial	$10,352.64
Rate for Payer: Humana Medicare Advantage	$3,554.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,450.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,921.92
Rate for Payer: Qualcare PPO/HMO/WC	$1,108.80
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,450.88
Rate for Payer: Wellcare Medicare Advantage	$3,450.88
Rate for Payer: Wellpoint Medicaid Managed Care	$209.93

ER FB REMOVAL ARM/ELBOW DEEP

Facility

$7,392.00

Service Code	HCPCS 24201
Hospital Charge Code	5700739
Hospital Revenue Code	450
Min. Negotiated Rate	$1,108.80
Max. Negotiated Rate	$1,108.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,108.80

ER FB REMOVAL ARM/ELBOW SQ

Facility

$2,081.00

Service Code	HCPCS 24200
Hospital Charge Code	5700738
Hospital Revenue Code	450
Min. Negotiated Rate	$59.10
Max. Negotiated Rate	$7,117.66
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,117.66
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$541.06
Rate for Payer: Qualcare PPO/HMO/WC	$312.15
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$59.10

ER FB REMOVAL ARM/ELBOW SQ

Facility

$2,081.00

Service Code	HCPCS 24200
Hospital Charge Code	5700738
Hospital Revenue Code	450
Min. Negotiated Rate	$312.15
Max. Negotiated Rate	$312.15
Rate for Payer: Qualcare PPO/HMO/WC	$312.15

ER FB REMOVAL FOOT COMPX

Facility

$3,473.00

Service Code	HCPCS 28193
Hospital Charge Code	5700767
Hospital Revenue Code	450
Min. Negotiated Rate	$78.54
Max. Negotiated Rate	$7,117.66
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,117.66
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$902.98
Rate for Payer: Qualcare PPO/HMO/WC	$520.95
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$98.63

ER FB REMOVAL FOOT COMPX

Facility

$3,473.00

Service Code	HCPCS 28193
Hospital Charge Code	5700767
Hospital Revenue Code	450
Min. Negotiated Rate	$520.95
Max. Negotiated Rate	$520.95
Rate for Payer: Qualcare PPO/HMO/WC	$520.95

ER FB REMOVAL FOOT DEEP

Facility

$7,392.00

Service Code	HCPCS 28192
Hospital Charge Code	5700766
Hospital Revenue Code	450
Min. Negotiated Rate	$78.54
Max. Negotiated Rate	$7,117.66
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,117.66
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,921.92
Rate for Payer: Qualcare PPO/HMO/WC	$1,108.80
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$209.93

ER FB REMOVAL FOOT DEEP

Facility

$7,392.00

Service Code	HCPCS 28192
Hospital Charge Code	5700766
Hospital Revenue Code	450
Min. Negotiated Rate	$1,108.80
Max. Negotiated Rate	$1,108.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,108.80

ER FB REMOVAL HIP/PELVIS SQ

Facility

$3,473.00

Service Code	HCPCS 27086
Hospital Charge Code	5700752
Hospital Revenue Code	450
Min. Negotiated Rate	$35.94
Max. Negotiated Rate	$12,518.07
Rate for Payer: Aetna Commercial	$9,386.39
Rate for Payer: Aetna Medicare Advantage	$11,180.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,518.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,518.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,450.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,518.07
Rate for Payer: Cigna Commercial	$6,917.28
Rate for Payer: Cigna Medicare Advantage	$3,450.88
Rate for Payer: Clover Medicare Advantage	$3,278.34
Rate for Payer: EmblemHealth Commercial	$10,352.64
Rate for Payer: Humana Medicare Advantage	$3,554.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,450.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$902.98
Rate for Payer: Qualcare PPO/HMO/WC	$520.95
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,450.88
Rate for Payer: Wellcare Medicare Advantage	$3,450.88
Rate for Payer: Wellpoint Medicaid Managed Care	$98.63

ER FB REMOVAL HIP/PELVIS SQ

Facility

$3,473.00

Service Code	HCPCS 27086
Hospital Charge Code	5700752
Hospital Revenue Code	450
Min. Negotiated Rate	$520.95
Max. Negotiated Rate	$520.95
Rate for Payer: Qualcare PPO/HMO/WC	$520.95

ER FB REMOVAL SHOULDER SQ

Facility

$3,473.00

Service Code	HCPCS 23330
Hospital Charge Code	5700730
Hospital Revenue Code	450
Min. Negotiated Rate	$520.95
Max. Negotiated Rate	$520.95
Rate for Payer: Qualcare PPO/HMO/WC	$520.95

ER FB REMOVAL SHOULDER SQ

Facility

$3,473.00

Service Code	HCPCS 23330
Hospital Charge Code	5700730
Hospital Revenue Code	450
Min. Negotiated Rate	$41.58
Max. Negotiated Rate	$7,117.66
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,117.66
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$902.98
Rate for Payer: Qualcare PPO/HMO/WC	$520.95
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$98.63

ER FB REMOV MOUTH EMBED SIM

Facility

$3,717.20

Service Code	HCPCS 40804
Hospital Charge Code	5700790
Hospital Revenue Code	450
Min. Negotiated Rate	$557.58
Max. Negotiated Rate	$557.58
Rate for Payer: Qualcare PPO/HMO/WC	$557.58

ER FB REMOV MOUTH EMBED SIM

Facility

$3,717.20

Service Code	HCPCS 40804
Hospital Charge Code	5700790
Hospital Revenue Code	450
Min. Negotiated Rate	$27.72
Max. Negotiated Rate	$3,908.70
Rate for Payer: Aetna Commercial	$2,930.85
Rate for Payer: Aetna Medicare Advantage	$3,491.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,908.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,908.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,077.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,908.70
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: Cigna Medicare Advantage	$1,077.52
Rate for Payer: Clover Medicare Advantage	$1,023.64
Rate for Payer: EmblemHealth Commercial	$3,232.56
Rate for Payer: Humana Medicare Advantage	$1,109.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,077.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$966.47
Rate for Payer: Qualcare PPO/HMO/WC	$557.58
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,077.52
Rate for Payer: Wellcare Medicare Advantage	$1,077.52
Rate for Payer: Wellpoint Medicaid Managed Care	$105.57

ER FB SQ TISSUE COMPLEX

Facility

$7,392.00

Service Code	HCPCS 10121
Hospital Charge Code	5700505
Hospital Revenue Code	450
Min. Negotiated Rate	$1,108.80
Max. Negotiated Rate	$1,108.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,108.80

ER FB SQ TISSUE COMPLEX

Facility

$7,392.00

Service Code	HCPCS 10121
Hospital Charge Code	5700505
Hospital Revenue Code	450
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$7,117.66
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$168.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,117.66
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,921.92
Rate for Payer: Qualcare PPO/HMO/WC	$1,108.80
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$4,474.27
Rate for Payer: Wellpoint Medicaid Managed Care	$209.93

ER FINE NDL ASPIR W/O IMAGING

Facility

$1,870.85

Service Code	HCPCS 10021
Hospital Charge Code	5700501
Hospital Revenue Code	450
Min. Negotiated Rate	$53.13
Max. Negotiated Rate	$1,751.90
Rate for Payer: Aetna Commercial	$1,313.62
Rate for Payer: Aetna Medicare Advantage	$1,564.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,751.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,751.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$482.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$91.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,751.90
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: Cigna Medicare Advantage	$482.95
Rate for Payer: Clover Medicare Advantage	$458.80
Rate for Payer: EmblemHealth Commercial	$1,448.85
Rate for Payer: Humana Medicare Advantage	$497.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$482.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$486.42
Rate for Payer: Qualcare PPO/HMO/WC	$280.63
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellpoint Medicaid Managed Care	$53.13

ER FINE NDL ASPIR W/O IMAGING

Facility

$1,870.85

Service Code	HCPCS 10021
Hospital Charge Code	5700501
Hospital Revenue Code	450
Min. Negotiated Rate	$280.63
Max. Negotiated Rate	$280.63
Rate for Payer: Qualcare PPO/HMO/WC	$280.63

ER FINGER SPLINT DYNAMIC

Facility

$322.82

Service Code	HCPCS 29131
Hospital Charge Code	5700311
Hospital Revenue Code	450
Min. Negotiated Rate	$9.17
Max. Negotiated Rate	$254.22
Rate for Payer: Aetna Commercial	$190.62
Rate for Payer: Aetna Medicare Advantage	$227.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$254.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$254.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$70.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$254.22
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: Cigna Medicare Advantage	$70.08
Rate for Payer: Clover Medicare Advantage	$66.58
Rate for Payer: EmblemHealth Commercial	$210.24
Rate for Payer: Humana Medicare Advantage	$72.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$70.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.93
Rate for Payer: Qualcare PPO/HMO/WC	$48.42
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.08
Rate for Payer: Wellcare Medicare Advantage	$70.08
Rate for Payer: Wellpoint Medicaid Managed Care	$9.17

ER FINGER SPLINT DYNAMIC

Facility

$322.82

Service Code	HCPCS 29131
Hospital Charge Code	5700311
Hospital Revenue Code	450
Min. Negotiated Rate	$48.42
Max. Negotiated Rate	$48.42
Rate for Payer: Qualcare PPO/HMO/WC	$48.42

ER FINGR/HAND FLEXOR TENDN REP

Facility

$12,172.00

Service Code	HCPCS 26350
Hospital Charge Code	5700750
Hospital Revenue Code	450
Min. Negotiated Rate	$1,825.80
Max. Negotiated Rate	$1,825.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,825.80

ER FINGR/HAND FLEXOR TENDN REP

Facility

$12,172.00

Service Code	HCPCS 26350
Hospital Charge Code	5700750
Hospital Revenue Code	450
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$14,100.89
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	$14,100.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,100.89
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	$226.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,100.89
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	$3,164.72
Rate for Payer: Qualcare PPO/HMO/WC	$1,825.80
Rate for Payer: UnitedHealthcare Community & State	$140.00
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	$345.68

ER-FORESKIN MANIPULATION

Facility

$1,345.70

Service Code	HCPCS 54450
Hospital Charge Code	5790180
Hospital Revenue Code	450
Min. Negotiated Rate	$201.85
Max. Negotiated Rate	$201.85
Rate for Payer: Qualcare PPO/HMO/WC	$201.85

ER-FORESKIN MANIPULATION

Facility

$1,345.70

Service Code	HCPCS 54450
Hospital Charge Code	5790180
Hospital Revenue Code	450
Min. Negotiated Rate	$38.22
Max. Negotiated Rate	$1,076.75
Rate for Payer: Aetna Commercial	$807.38
Rate for Payer: Aetna Medicare Advantage	$961.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,076.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,076.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$296.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,076.75
Rate for Payer: Cigna Commercial	$594.98
Rate for Payer: Cigna Medicare Advantage	$296.83
Rate for Payer: Clover Medicare Advantage	$281.99
Rate for Payer: EmblemHealth Commercial	$890.49
Rate for Payer: Humana Medicare Advantage	$305.73
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$296.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$349.88
Rate for Payer: Qualcare PPO/HMO/WC	$201.85
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$296.83
Rate for Payer: Wellcare Medicare Advantage	$296.83
Rate for Payer: Wellpoint Medicaid Managed Care	$38.22

ER GASTRIC LAVAGE

Facility

$528.00

Service Code	HCPCS 43753
Hospital Charge Code	5700811
Hospital Revenue Code	450
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$930.53
Rate for Payer: Aetna Commercial	$697.73
Rate for Payer: Aetna Medicare Advantage	$831.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$930.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$930.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$256.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$930.53
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: Cigna Medicare Advantage	$256.52
Rate for Payer: Clover Medicare Advantage	$243.69
Rate for Payer: EmblemHealth Commercial	$769.56
Rate for Payer: Humana Medicare Advantage	$264.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$256.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.28
Rate for Payer: Qualcare PPO/HMO/WC	$79.20
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$256.52
Rate for Payer: Wellcare Medicare Advantage	$256.52
Rate for Payer: Wellpoint Medicaid Managed Care	$15.00

Know your out-of-pocket cost for care.

All Charges