Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
Dsmt Group 30 Min
Summit, NJ
See all hospitals reporting HCPCS G0109 →Price type
Overlook Medical Center’s median price of $124 is 371% above the median hospital's median price ($26), higher than 97% of the 1,867 hospitals reporting HCPCS G0109. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 18 payers, 50 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | Tricare omc tricare-east (humana military) fee schedule · both | $14 | $14 | — | — | — | $14 – $14 |
| 2 | Tricare omc tricare contract fee schedule · both | $14 | $14 | — | — | — | $14 – $14 |
| 3 | Aetna omc aetna nnj prime fee schedule · both | $15 | $15 | — | — | — | $15 – $15 |
| 4 | Aetna omc aetna ahs employee fee schedule · both | $17 | $17 | — | — | — | $17 – $17 |
| 5 | Aetna omc aetna medicare fee schedule · both | $17 | $17 | — | — | — | $17 – $17 |
| 6 | Anthem omc horizon braven fee schedule · both | $17 | $17 | — | — | — | $17 – $17 |
| 7 | Blue Cross Blue Shield omc horizon braven fee schedule · both | $17 | $17 | — | — | — | $17 – $17 |
| 8 | Cigna omc cigna medicare fee schedule · both | $17 | $17 | — | — | — | $17 – $17 |
| 9 | Highmark omc horizon braven fee schedule · both | $17 | $17 | — | — | — | $17 – $17 |
| 10 | Amerihealth Caritas omc amerihealth caritas fee schedule · both | $17 | $17 | — | — | — | $17 – $17 |
| 11 | WellCare omc wellcare phw fee schedule · both | $18 | $18 | — | — | — | $18 – $18 |
| 12 | WellCare omc wellcare/fedelis medicare fee schedule · both | $18 | $18 | — | — | — | $18 – $18 |
| 13 | Highmark omc highmark wholecare / gateway health plan inc fee schedule · both | $19 | $19 | — | — | — | $19 – $19 |
| 14 | Aetna omc aetna htc fee schedule · both | $24 | $24 | — | — | — | $24 – $24 |
| 15 | Ambetter omc ambetter wellcare of nj fee schedule · both | $35 | $35 | — | — | — | $35 – $35 |
| 16 | Anthem omc medicaid percent of total billed charges · bothfrom % of charges | $48 | $48 | — | — | — | $48 – $48 |
| 17 | Medicaid omc medicaid percent of total billed charges · bothfrom % of charges | $48 | $48 | — | — | — | $48 – $48 |
| 18 | Tricare omc tricare-east (humana military) fee schedule · outpatient | $55 | $55 | — | — | — | $55 – $55 |
| 19 | Tricare omc tricare contract fee schedule · outpatient | $57 | $57 | — | — | — | $57 – $57 |
| 20 | Aetna Better Health omc aetna better health percent of total billed charges · bothfrom % of charges | $58 | $58 | — | — | — | $58 – $58 |
| 21 | Aetna omc aetna nnj prime fee schedule · outpatient | $61 | $61 | — | — | — | $61 – $61 |
| 22 | Aetna omc aetna ahs employee fee schedule · outpatient | $68 | $68 | — | — | — | $68 – $68 |
| 23 | Aetna omc aetna medicare fee schedule · outpatient | $68 | $68 | — | — | — | $68 – $68 |
| 24 | Anthem omc horizon braven fee schedule · outpatient | $68 | $68 | — | — | — | $68 – $68 |
| 25 | Blue Cross Blue Shield omc horizon braven fee schedule · outpatient | $68 | $68 | — | — | — | $68 – $68 |
Last updated: Apr 1, 2026
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