Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

COMPLEMENT,TOTAL (CH50)

Facility

$390.00

Service Code	HCPCS 86162
Hospital Charge Code	39900197
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$55.27
Rate for Payer: Aetna Medicare Advantage	$65.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.71
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$20.32
Rate for Payer: Clover Medicare Advantage	$19.30
Rate for Payer: EmblemHealth Commercial	$60.96
Rate for Payer: Humana Medicare Advantage	$20.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.32
Rate for Payer: Wellcare Medicare Advantage	$20.32
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

COMPLEMENT,TOTAL (CH50)

Facility

$390.00

Service Code	HCPCS 86162
Hospital Charge Code	39900197
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

COMPLERA 200MG-25MG-300MG

Facility

$470.34

Service Code	NDC 61958110101
Hospital Charge Code	6063943371
Hospital Revenue Code	250
Min. Negotiated Rate	$13.36
Max. Negotiated Rate	$235.17
Rate for Payer: Aetna Commercial	$178.73
Rate for Payer: Aetna Medicare Advantage	$141.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$119.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$119.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$119.94
Rate for Payer: Cigna Commercial	$235.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.29
Rate for Payer: Oxford Commercial	$94.07
Rate for Payer: Qualcare PPO/HMO/WC	$70.55
Rate for Payer: UnitedHealthcare Commercial	$94.07
Rate for Payer: UnitedHealthcare Community & State	$14.86
Rate for Payer: Wellpoint Medicaid Managed Care	$13.36

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	$129.24
Max. Negotiated Rate	$129.24
Rate for Payer: Qualcare PPO/HMO/WC	$129.24

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	$28.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.19
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	$8.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.19
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	$224.02
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$129.24
Rate for Payer: UnitedHealthcare Commercial	$156.00
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	$24.47

COMPLETE BLOOD COUNT (CBC) RPT

Facility

$909.02

Service Code	HCPCS 8502591
Hospital Charge Code	3005402R
Hospital Revenue Code	305
Min. Negotiated Rate	$25.82
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	$236.35
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$136.35
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$28.73
Rate for Payer: Wellpoint Medicaid Managed Care	$25.82

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 HEART CATH

Facility

$16,190.00

Service Code	HCPCS 93453
Hospital Charge Code	74110017
Hospital Revenue Code	481
Min. Negotiated Rate	$459.80
Max. Negotiated Rate	$13,971.32
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	$13,971.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,971.32
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	$4,213.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,971.32
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	$4,209.40
Rate for Payer: Oxford Commercial	$11,677.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,428.50
Rate for Payer: UnitedHealthcare Commercial	$12,906.00
Rate for Payer: UnitedHealthcare Community & State	$511.60
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	$459.80

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	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	$459.80
Max. Negotiated Rate	$13,971.32
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	$13,971.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,971.32
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	$4,213.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,971.32
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	$4,209.40
Rate for Payer: Oxford Commercial	$11,677.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,428.50
Rate for Payer: UnitedHealthcare Commercial	$12,906.00
Rate for Payer: UnitedHealthcare Community & State	$511.60
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	$459.80

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	5100144
Hospital Revenue Code	481
Min. Negotiated Rate	$459.80
Max. Negotiated Rate	$13,971.32
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	$13,971.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,971.32
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	$4,213.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,971.32
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	$4,209.40
Rate for Payer: Oxford Commercial	$11,677.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,428.50
Rate for Payer: UnitedHealthcare Commercial	$12,906.00
Rate for Payer: UnitedHealthcare Community & State	$511.60
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	$459.80

COMPLEX AORTIC ARCH PROCEDURES

Facility

$377,065.88

Service Code	MSDRG 209
Min. Negotiated Rate	$114,811.73
Max. Negotiated Rate	$377,065.88
Rate for Payer: Aetna Commercial	$270,409.15
Rate for Payer: Aetna Medicare Advantage	$377,065.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$120,854.45
Rate for Payer: Cigna Commercial	$252,330.01
Rate for Payer: Cigna Medicare Advantage	$120,854.45
Rate for Payer: Clover Medicare Advantage	$114,811.73
Rate for Payer: EmblemHealth Commercial	$362,563.35
Rate for Payer: Humana Medicare Advantage	$124,480.08
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$120,854.45
Rate for Payer: Oxford Commercial	$199,437.26
Rate for Payer: UnitedHealthcare Commercial	$266,953.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$120,854.45
Rate for Payer: Wellcare Medicare Advantage	$120,854.45

COMPL EXC 5TH METATRSL HEAD

Facility

$19,998.60

Service Code	HCPCS 28113
Hospital Charge Code	1600000624
Hospital Revenue Code	360
Min. Negotiated Rate	$567.96
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	$3,536.00
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	$5,199.64
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,999.79
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$631.96
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	$567.96

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	$567.96
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	$3,536.00
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	$5,199.64
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,999.79
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$631.96
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	$567.96

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	$567.96
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	$3,536.00
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	$5,199.64
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,999.79
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$631.96
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	$567.96

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

COMPLICATED PEPTIC ULCER WITH CC

Facility

$53,696.26

Service Code	MSDRG 381
Min. Negotiated Rate	$16,349.82
Max. Negotiated Rate	$53,696.26
Rate for Payer: Aetna Commercial	$40,101.59
Rate for Payer: Aetna Medicare Advantage	$53,696.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29,644.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29,644.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17,210.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29,644.35
Rate for Payer: Cigna Commercial	$24,154.47
Rate for Payer: Cigna Medicare Advantage	$17,210.34
Rate for Payer: Clover Medicare Advantage	$16,349.82
Rate for Payer: EmblemHealth Commercial	$51,631.02
Rate for Payer: Humana Medicare Advantage	$17,726.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17,210.34
Rate for Payer: Oxford Commercial	$19,091.27
Rate for Payer: UnitedHealthcare Commercial	$25,554.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$17,210.34
Rate for Payer: Wellcare Medicare Advantage	$17,210.34

COMPLICATED PEPTIC ULCER WITH MCC

Facility

$81,457.55

Service Code	MSDRG 380
Min. Negotiated Rate	$24,802.78
Max. Negotiated Rate	$81,457.55
Rate for Payer: Aetna Commercial	$59,873.51
Rate for Payer: Aetna Medicare Advantage	$81,457.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54,024.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54,024.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26,108.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54,024.75
Rate for Payer: Cigna Commercial	$43,743.32
Rate for Payer: Cigna Medicare Advantage	$26,108.19
Rate for Payer: Clover Medicare Advantage	$24,802.78
Rate for Payer: EmblemHealth Commercial	$78,324.57
Rate for Payer: Humana Medicare Advantage	$26,891.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$26,108.19
Rate for Payer: Oxford Commercial	$34,573.96
Rate for Payer: UnitedHealthcare Commercial	$46,278.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$26,108.19
Rate for Payer: Wellcare Medicare Advantage	$26,108.19

COMPLICATED PEPTIC ULCER WITHOUT CC/MCC

Facility

$44,758.46

Service Code	MSDRG 382
Min. Negotiated Rate	$13,628.38
Max. Negotiated Rate	$44,758.46
Rate for Payer: Aetna Commercial	$33,736.00
Rate for Payer: Aetna Medicare Advantage	$44,758.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,055.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,055.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14,345.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21,055.80
Rate for Payer: Cigna Commercial	$17,847.78
Rate for Payer: Cigna Medicare Advantage	$14,345.66
Rate for Payer: Clover Medicare Advantage	$13,628.38
Rate for Payer: EmblemHealth Commercial	$43,036.98
Rate for Payer: Humana Medicare Advantage	$14,776.03
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14,345.66
Rate for Payer: Oxford Commercial	$14,106.57
Rate for Payer: UnitedHealthcare Commercial	$18,882.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$14,345.66
Rate for Payer: Wellcare Medicare Advantage	$14,345.66

COMPLICATIONS OF TREATMENT WITH CC

Facility

$51,130.87

Service Code	MSDRG 920
Min. Negotiated Rate	$15,568.69
Max. Negotiated Rate	$51,130.87
Rate for Payer: Aetna Commercial	$38,274.49
Rate for Payer: Aetna Medicare Advantage	$51,130.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28,536.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28,536.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16,388.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28,536.15
Rate for Payer: Cigna Commercial	$22,344.27
Rate for Payer: Cigna Medicare Advantage	$16,388.10
Rate for Payer: Clover Medicare Advantage	$15,568.69
Rate for Payer: EmblemHealth Commercial	$49,164.30
Rate for Payer: Humana Medicare Advantage	$16,879.74
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16,388.10
Rate for Payer: Oxford Commercial	$17,660.53
Rate for Payer: UnitedHealthcare Commercial	$23,639.25
Rate for Payer: UnitedHealthcare Medicare Advantage	$16,388.10
Rate for Payer: Wellcare Medicare Advantage	$16,388.10

Know your out-of-pocket cost for care.

All Charges