Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CESAREAN SECTION WITH STERILIZATION

Facility

$9,559.65

Service Code	APR-DRG 5392
Min. Negotiated Rate	$9,372.21
Max. Negotiated Rate	$9,559.65
Rate for Payer: UnitedHealthcare Community & State	$9,372.21
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$9,559.65
Rate for Payer: Wellpoint Medicaid Managed Care	$9,372.21

CESAREAN SECTION WITH STERILIZATION

Facility

$31,237.65

Service Code	APR-DRG 5394
Min. Negotiated Rate	$30,625.15
Max. Negotiated Rate	$31,237.65
Rate for Payer: UnitedHealthcare Community & State	$30,625.15
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$31,237.65
Rate for Payer: Wellpoint Medicaid Managed Care	$30,625.15

CESAREAN SECTION WITH STERILIZATION

Facility

$13,519.97

Service Code	APR-DRG 5393
Min. Negotiated Rate	$13,254.87
Max. Negotiated Rate	$13,519.97
Rate for Payer: UnitedHealthcare Community & State	$13,254.87
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$13,519.97
Rate for Payer: Wellpoint Medicaid Managed Care	$13,254.87

CESAREAN SECTION WITH STERILIZATION WITH CC

Facility

$52,956.98

Service Code	MSDRG 784
Min. Negotiated Rate	$16,124.72
Max. Negotiated Rate	$52,956.98
Rate for Payer: Aetna Commercial	$39,575.06
Rate for Payer: Aetna Medicare Advantage	$52,956.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28,259.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28,259.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16,973.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28,259.10
Rate for Payer: Cigna Commercial	$23,632.81
Rate for Payer: Cigna Medicare Advantage	$16,973.39
Rate for Payer: Clover Medicare Advantage	$16,124.72
Rate for Payer: EmblemHealth Commercial	$50,920.17
Rate for Payer: Humana Medicare Advantage	$17,482.59
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16,973.39
Rate for Payer: Oxford Commercial	$31,182.00
Rate for Payer: UnitedHealthcare Commercial	$35,393.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$16,973.39
Rate for Payer: Wellcare Medicare Advantage	$16,973.39

CESAREAN SECTION WITH STERILIZATION WITH MCC

Facility

$97,030.00

Service Code	MSDRG 783
Min. Negotiated Rate	$29,544.39
Max. Negotiated Rate	$97,030.00
Rate for Payer: Aetna Commercial	$70,964.38
Rate for Payer: Aetna Medicare Advantage	$97,030.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49,037.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49,037.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$31,099.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49,037.85
Rate for Payer: Cigna Commercial	$54,731.54
Rate for Payer: Cigna Medicare Advantage	$31,099.36
Rate for Payer: Clover Medicare Advantage	$29,544.39
Rate for Payer: EmblemHealth Commercial	$93,298.08
Rate for Payer: Humana Medicare Advantage	$32,032.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$31,099.36
Rate for Payer: Oxford Commercial	$31,182.00
Rate for Payer: UnitedHealthcare Commercial	$35,393.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$31,099.36
Rate for Payer: Wellcare Medicare Advantage	$31,099.36

CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC

Facility

$49,724.97

Service Code	MSDRG 785
Min. Negotiated Rate	$15,140.62
Max. Negotiated Rate	$49,724.97
Rate for Payer: Aetna Commercial	$37,273.22
Rate for Payer: Aetna Medicare Advantage	$49,724.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24,103.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24,103.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15,937.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24,103.35
Rate for Payer: Cigna Commercial	$21,352.24
Rate for Payer: Cigna Medicare Advantage	$15,937.49
Rate for Payer: Clover Medicare Advantage	$15,140.62
Rate for Payer: EmblemHealth Commercial	$47,812.47
Rate for Payer: Humana Medicare Advantage	$16,415.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15,937.49
Rate for Payer: Oxford Commercial	$31,182.00
Rate for Payer: UnitedHealthcare Commercial	$35,393.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$15,937.49
Rate for Payer: Wellcare Medicare Advantage	$15,937.49

CESSJ THERAPY CATH REMOVAL

Facility

$13,241.04

Service Code	HCPCS 37214
Hospital Charge Code	2692245
Hospital Revenue Code	361
Min. Negotiated Rate	$376.05
Max. Negotiated Rate	$13,607.37
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,607.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,607.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,607.37
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,442.67
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,986.16
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$418.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$376.05

CESSJ THERAPY CATH REMOVAL

Facility

$13,241.04

Service Code	HCPCS 37214
Hospital Charge Code	2692245
Hospital Revenue Code	361
Min. Negotiated Rate	$1,986.16
Max. Negotiated Rate	$1,986.16
Rate for Payer: Qualcare PPO/HMO/WC	$1,986.16

CESSJ THERAPY CATH REMOVAL

Facility

$6,404.20

Service Code	HCPCS 37214
Hospital Charge Code	5600232
Hospital Revenue Code	361
Min. Negotiated Rate	$960.63
Max. Negotiated Rate	$960.63
Rate for Payer: Qualcare PPO/HMO/WC	$960.63

CESSJ THERAPY CATH REMOVAL

Facility

$6,404.20

Service Code	HCPCS 37214
Hospital Charge Code	5600232
Hospital Revenue Code	361
Min. Negotiated Rate	$181.88
Max. Negotiated Rate	$13,607.37
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,607.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,607.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,607.37
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,665.09
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$960.63
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$202.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$181.88

CESSJ THERAPY CATH REMOVAL

Facility

$6,404.20

Service Code	HCPCS 37214
Hospital Charge Code	321037214
Hospital Revenue Code	361
Min. Negotiated Rate	$181.88
Max. Negotiated Rate	$13,607.37
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,607.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,607.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,607.37
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,665.09
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$960.63
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$202.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$181.88

CESSJ THERAPY CATH REMOVAL

Facility

$6,404.20

Service Code	HCPCS 37214
Hospital Charge Code	321037214
Hospital Revenue Code	361
Min. Negotiated Rate	$960.63
Max. Negotiated Rate	$960.63
Rate for Payer: Qualcare PPO/HMO/WC	$960.63

CETUXIMAB 100 MG/50 ML

Facility

$3,216.00

Service Code	HCPCS J9055
Hospital Charge Code	60629340
Hospital Revenue Code	636
Min. Negotiated Rate	$482.40
Max. Negotiated Rate	$778.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$778.27
Rate for Payer: Qualcare PPO/HMO/WC	$482.40

CETUXIMAB 100 MG/50 ML

Facility

$3,216.00

Service Code	HCPCS J9055
Hospital Charge Code	60629340
Hospital Revenue Code	636
Min. Negotiated Rate	$76.44
Max. Negotiated Rate	$778.27
Rate for Payer: Aetna Commercial	$218.85
Rate for Payer: Aetna Medicare Advantage	$260.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$291.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$291.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$80.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$291.87
Rate for Payer: Cigna Medicare Advantage	$80.46
Rate for Payer: Clover Medicare Advantage	$76.44
Rate for Payer: EmblemHealth Commercial	$241.38
Rate for Payer: Humana Medicare Advantage	$82.87
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$80.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$778.27
Rate for Payer: Qualcare PPO/HMO/WC	$482.40
Rate for Payer: UnitedHealthcare Community & State	$101.63
Rate for Payer: UnitedHealthcare Medicare Advantage	$80.46
Rate for Payer: Wellcare Medicare Advantage	$80.46
Rate for Payer: Wellpoint Medicaid Managed Care	$91.33

CF,CARRIER SCREEN

Facility

$395.00

Service Code	HCPCS 81220
Hospital Charge Code	39900014
Hospital Revenue Code	310
Min. Negotiated Rate	$59.25
Max. Negotiated Rate	$59.25
Rate for Payer: Qualcare PPO/HMO/WC	$59.25

CF,CARRIER SCREEN

Facility

$395.00

Service Code	HCPCS 81220
Hospital Charge Code	39900014
Hospital Revenue Code	310
Min. Negotiated Rate	$11.22
Max. Negotiated Rate	$2,019.07
Rate for Payer: Aetna Commercial	$1,513.95
Rate for Payer: Aetna Medicare Advantage	$1,803.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,019.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,019.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$556.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,019.07
Rate for Payer: Cigna Commercial	$197.50
Rate for Payer: Cigna Medicare Advantage	$556.60
Rate for Payer: Clover Medicare Advantage	$528.77
Rate for Payer: EmblemHealth Commercial	$1,669.80
Rate for Payer: Humana Medicare Advantage	$573.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$556.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.70
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.25
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$445.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$556.60
Rate for Payer: Wellcare Medicare Advantage	$556.60
Rate for Payer: Wellpoint Medicaid Managed Care	$11.22

CFH ACETAMINOPHEN 160MG

Facility

$4.00

Hospital Charge Code	83652675
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

CFH ACETAMINOPHEN 160MG

Facility

$4.00

Hospital Charge Code	83652675
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

CFH ANOSCOPY

Facility

$274.00

Service Code	HCPCS 46600
Hospital Charge Code	83652105
Hospital Revenue Code	361
Min. Negotiated Rate	$7.78
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.36
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.24
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$41.10
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$8.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$7.78

CFH ANOSCOPY

Facility

$274.00

Service Code	HCPCS 46600
Hospital Charge Code	83652105
Hospital Revenue Code	361
Min. Negotiated Rate	$41.10
Max. Negotiated Rate	$41.10
Rate for Payer: Qualcare PPO/HMO/WC	$41.10

CFH COLPOSCOPY W BIOPSY

Facility

$1,480.00

Service Code	HCPCS 57455
Hospital Charge Code	83652141
Hospital Revenue Code	361
Min. Negotiated Rate	$42.03
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$984.72
Rate for Payer: Aetna Medicare Advantage	$1,172.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,313.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,313.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$362.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,313.26
Rate for Payer: Cigna Commercial	$725.69
Rate for Payer: Cigna Medicare Advantage	$362.03
Rate for Payer: Clover Medicare Advantage	$343.93
Rate for Payer: EmblemHealth Commercial	$1,086.09
Rate for Payer: Humana Medicare Advantage	$372.89
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$362.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$384.80
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$222.00
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$46.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$362.03
Rate for Payer: Wellcare Medicare Advantage	$362.03
Rate for Payer: Wellpoint Medicaid Managed Care	$42.03

CFH COLPOSCOPY W BIOPSY

Facility

$1,480.00

Service Code	HCPCS 57455
Hospital Charge Code	83652141
Hospital Revenue Code	361
Min. Negotiated Rate	$222.00
Max. Negotiated Rate	$222.00
Rate for Payer: Qualcare PPO/HMO/WC	$222.00

CFH CRYOCAUTERY OF CERVIX

Facility

$669.00

Service Code	HCPCS 57511
Hospital Charge Code	83652149
Hospital Revenue Code	361
Min. Negotiated Rate	$100.35
Max. Negotiated Rate	$100.35
Rate for Payer: Qualcare PPO/HMO/WC	$100.35

CFH CRYOCAUTERY OF CERVIX

Facility

$669.00

Service Code	HCPCS 57511
Hospital Charge Code	83652149
Hospital Revenue Code	361
Min. Negotiated Rate	$19.00
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$984.72
Rate for Payer: Aetna Medicare Advantage	$1,172.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,313.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,313.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$362.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,313.26
Rate for Payer: Cigna Commercial	$725.69
Rate for Payer: Cigna Medicare Advantage	$362.03
Rate for Payer: Clover Medicare Advantage	$343.93
Rate for Payer: EmblemHealth Commercial	$1,086.09
Rate for Payer: Humana Medicare Advantage	$372.89
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$362.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.94
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.35
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$21.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$362.03
Rate for Payer: Wellcare Medicare Advantage	$362.03
Rate for Payer: Wellpoint Medicaid Managed Care	$19.00

CFH DIGITAL RECTAL EXAM

Facility

$67.00

Service Code	HCPCS G0102
Hospital Charge Code	83652527
Hospital Revenue Code	510
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$33.50
Rate for Payer: Aetna Commercial	$25.46
Rate for Payer: Aetna Medicare Advantage	$20.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.09
Rate for Payer: Cigna Commercial	$33.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.42
Rate for Payer: Qualcare PPO/HMO/WC	$10.05
Rate for Payer: UnitedHealthcare Community & State	$2.12
Rate for Payer: Wellpoint Medicaid Managed Care	$1.90

Know your out-of-pocket cost for care.

All Charges