Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PEGFILGRASTIM 6 MG/0.6 ML INJ

Facility

$26,692.93

Service Code	HCPCS J2505
Hospital Charge Code	60629301
Hospital Revenue Code	636
Min. Negotiated Rate	$643.30
Max. Negotiated Rate	$13,346.47
Rate for Payer: Aetna Commercial	$10,143.31
Rate for Payer: Aetna Medicare Advantage	$8,007.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,806.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,806.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,806.70
Rate for Payer: Cigna Commercial	$13,346.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,459.69
Rate for Payer: Qualcare PPO/HMO/WC	$4,003.94
Rate for Payer: UnitedHealthcare Community & State	$643.30
Rate for Payer: Wellpoint Medicaid Managed Care	$707.36

PEGFILGRASTIM-JMDB 6MG/0.6ML

Facility

$26,539.57

Service Code	HCPCS Q5108
Hospital Charge Code	606390197
Hospital Revenue Code	636
Min. Negotiated Rate	$3,980.94
Max. Negotiated Rate	$6,422.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,422.58
Rate for Payer: Qualcare PPO/HMO/WC	$3,980.94

PEGFILGRASTIM-JMDB 6MG/0.6ML

Facility

$26,539.57

Service Code	HCPCS Q5108
Hospital Charge Code	606390197
Hospital Revenue Code	636
Min. Negotiated Rate	$75.53
Max. Negotiated Rate	$6,422.58
Rate for Payer: Aetna Commercial	$216.24
Rate for Payer: Aetna Medicare Advantage	$257.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$286.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$286.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$79.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$286.97
Rate for Payer: Cigna Medicare Advantage	$79.50
Rate for Payer: Clover Medicare Advantage	$75.53
Rate for Payer: EmblemHealth Commercial	$238.50
Rate for Payer: Humana Medicare Advantage	$81.89
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$79.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,422.58
Rate for Payer: Qualcare PPO/HMO/WC	$3,980.94
Rate for Payer: UnitedHealthcare Community & State	$639.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$79.50
Rate for Payer: Wellcare Medicare Advantage	$79.50
Rate for Payer: Wellpoint Medicaid Managed Care	$703.30

PEG, FLTD LCKNG 2.3X20MM TI

Facility

$570.00

Service Code	HCPCS C1713
Hospital Charge Code	270686701
Hospital Revenue Code	278
Min. Negotiated Rate	$85.50
Max. Negotiated Rate	$137.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$114.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$125.40
Rate for Payer: Qualcare PPO/HMO/WC	$85.50

PEG, FLTD LCKNG 2.3X20MM TI

Facility

$570.00

Service Code	HCPCS C1713
Hospital Charge Code	270686701
Hospital Revenue Code	278
Min. Negotiated Rate	$13.74
Max. Negotiated Rate	$285.00
Rate for Payer: Aetna Commercial	$216.60
Rate for Payer: Aetna Medicare Advantage	$171.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$145.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$145.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$114.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$145.35
Rate for Payer: Cigna Commercial	$285.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$125.40
Rate for Payer: Qualcare PPO/HMO/WC	$85.50
Rate for Payer: UnitedHealthcare Community & State	$13.74
Rate for Payer: Wellpoint Medicaid Managed Care	$15.11

PEG FULLY THRD 2.5x20mm FP-20

Facility

$347.25

Hospital Charge Code	270635664
Hospital Revenue Code	272
Min. Negotiated Rate	$8.37
Max. Negotiated Rate	$173.62
Rate for Payer: Aetna Commercial	$131.96
Rate for Payer: Aetna Medicare Advantage	$104.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.55
Rate for Payer: Cigna Commercial	$173.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.17
Rate for Payer: Oxford Commercial	$69.45
Rate for Payer: Qualcare PPO/HMO/WC	$52.09
Rate for Payer: UnitedHealthcare Commercial	$69.45
Rate for Payer: UnitedHealthcare Community & State	$8.37
Rate for Payer: Wellpoint Medicaid Managed Care	$9.20

PEG FULLY THRD 2.5x20mm FP-20

Facility

$347.25

Hospital Charge Code	270635664
Hospital Revenue Code	272
Min. Negotiated Rate	$52.09
Max. Negotiated Rate	$52.09
Rate for Payer: Qualcare PPO/HMO/WC	$52.09

PEG HI COMPRESS LOCKING 2.7X16

Facility

$520.00

Service Code	HCPCS C1713
Hospital Charge Code	270664355
Hospital Revenue Code	278
Min. Negotiated Rate	$12.53
Max. Negotiated Rate	$260.00
Rate for Payer: Aetna Commercial	$197.60
Rate for Payer: Aetna Medicare Advantage	$156.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$132.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$132.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$132.60
Rate for Payer: Cigna Commercial	$260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$114.40
Rate for Payer: Qualcare PPO/HMO/WC	$78.00
Rate for Payer: UnitedHealthcare Community & State	$12.53
Rate for Payer: Wellpoint Medicaid Managed Care	$13.78

PEG HI COMPRESS LOCKING 2.7X16

Facility

$520.00

Service Code	HCPCS C1713
Hospital Charge Code	270664355
Hospital Revenue Code	278
Min. Negotiated Rate	$78.00
Max. Negotiated Rate	$125.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$114.40
Rate for Payer: Qualcare PPO/HMO/WC	$78.00

PEG HI COMPRESS LOCKING 2.7X18

Facility

$495.00

Service Code	HCPCS C1713
Hospital Charge Code	270664356
Hospital Revenue Code	278
Min. Negotiated Rate	$11.93
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna Commercial	$188.10
Rate for Payer: Aetna Medicare Advantage	$148.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.22
Rate for Payer: Cigna Commercial	$247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$108.90
Rate for Payer: Qualcare PPO/HMO/WC	$74.25
Rate for Payer: UnitedHealthcare Community & State	$11.93
Rate for Payer: Wellpoint Medicaid Managed Care	$13.12

PEG HI COMPRESS LOCKING 2.7X18

Facility

$495.00

Service Code	HCPCS C1713
Hospital Charge Code	270664356
Hospital Revenue Code	278
Min. Negotiated Rate	$74.25
Max. Negotiated Rate	$119.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$108.90
Rate for Payer: Qualcare PPO/HMO/WC	$74.25

PEG HIGH COMP LOCKING 2.7x22MM

Facility

$520.00

Service Code	HCPCS C1713
Hospital Charge Code	270664393
Hospital Revenue Code	278
Min. Negotiated Rate	$78.00
Max. Negotiated Rate	$125.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$114.40
Rate for Payer: Qualcare PPO/HMO/WC	$78.00

PEG HIGH COMP LOCKING 2.7x22MM

Facility

$520.00

Service Code	HCPCS C1713
Hospital Charge Code	270664393
Hospital Revenue Code	278
Min. Negotiated Rate	$12.53
Max. Negotiated Rate	$260.00
Rate for Payer: Aetna Commercial	$197.60
Rate for Payer: Aetna Medicare Advantage	$156.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$132.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$132.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$132.60
Rate for Payer: Cigna Commercial	$260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$114.40
Rate for Payer: Qualcare PPO/HMO/WC	$78.00
Rate for Payer: UnitedHealthcare Community & State	$12.53
Rate for Payer: Wellpoint Medicaid Managed Care	$13.78

PEG HIGH COMPRESSION 2.7 X 14

Facility

$495.00

Hospital Charge Code	270664390
Hospital Revenue Code	278
Min. Negotiated Rate	$74.25
Max. Negotiated Rate	$119.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$108.90
Rate for Payer: Qualcare PPO/HMO/WC	$74.25

PEG HIGH COMPRESSION 2.7 X 14

Facility

$495.00

Hospital Charge Code	270664390
Hospital Revenue Code	278
Min. Negotiated Rate	$11.93
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna Commercial	$188.10
Rate for Payer: Aetna Medicare Advantage	$148.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.22
Rate for Payer: Cigna Commercial	$247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$108.90
Rate for Payer: Qualcare PPO/HMO/WC	$74.25
Rate for Payer: UnitedHealthcare Community & State	$11.93
Rate for Payer: Wellpoint Medicaid Managed Care	$13.12

PEG HIGH COMPRESSION 2.7 X 21

Facility

$495.00

Hospital Charge Code	270664392
Hospital Revenue Code	278
Min. Negotiated Rate	$74.25
Max. Negotiated Rate	$119.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$108.90
Rate for Payer: Qualcare PPO/HMO/WC	$74.25

PEG HIGH COMPRESSION 2.7 X 21

Facility

$495.00

Hospital Charge Code	270664392
Hospital Revenue Code	278
Min. Negotiated Rate	$11.93
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna Commercial	$188.10
Rate for Payer: Aetna Medicare Advantage	$148.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.22
Rate for Payer: Cigna Commercial	$247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$108.90
Rate for Payer: Qualcare PPO/HMO/WC	$74.25
Rate for Payer: UnitedHealthcare Community & State	$11.93
Rate for Payer: Wellpoint Medicaid Managed Care	$13.12

PEG HIGH COMPRESSION 2.7X24

Facility

$495.00

Hospital Charge Code	270664395
Hospital Revenue Code	278
Min. Negotiated Rate	$74.25
Max. Negotiated Rate	$119.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$108.90
Rate for Payer: Qualcare PPO/HMO/WC	$74.25

PEG HIGH COMPRESSION 2.7X24

Facility

$495.00

Hospital Charge Code	270664395
Hospital Revenue Code	278
Min. Negotiated Rate	$11.93
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna Commercial	$188.10
Rate for Payer: Aetna Medicare Advantage	$148.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.22
Rate for Payer: Cigna Commercial	$247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$108.90
Rate for Payer: Qualcare PPO/HMO/WC	$74.25
Rate for Payer: UnitedHealthcare Community & State	$11.93
Rate for Payer: Wellpoint Medicaid Managed Care	$13.12

PEG HIGH COMPR LKG TI 2.7X23MM

Facility

$495.00

Service Code	HCPCS C1713
Hospital Charge Code	270664394
Hospital Revenue Code	278
Min. Negotiated Rate	$11.93
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna Commercial	$188.10
Rate for Payer: Aetna Medicare Advantage	$148.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.22
Rate for Payer: Cigna Commercial	$247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$108.90
Rate for Payer: Qualcare PPO/HMO/WC	$74.25
Rate for Payer: UnitedHealthcare Community & State	$11.93
Rate for Payer: Wellpoint Medicaid Managed Care	$13.12

PEG HIGH COMPR LKG TI 2.7X23MM

Facility

$495.00

Service Code	HCPCS C1713
Hospital Charge Code	270664394
Hospital Revenue Code	278
Min. Negotiated Rate	$74.25
Max. Negotiated Rate	$119.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$108.90
Rate for Payer: Qualcare PPO/HMO/WC	$74.25

PEG HIGH COMPR LOCKNG 2.7X19MM

Facility

$442.00

Service Code	HCPCS C1713
Hospital Charge Code	270664391
Hospital Revenue Code	278
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$221.00
Rate for Payer: Aetna Commercial	$167.96
Rate for Payer: Aetna Medicare Advantage	$132.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$88.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.71
Rate for Payer: Cigna Commercial	$221.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$97.24
Rate for Payer: Qualcare PPO/HMO/WC	$66.30
Rate for Payer: UnitedHealthcare Community & State	$10.65
Rate for Payer: Wellpoint Medicaid Managed Care	$11.71

PEG HIGH COMPR LOCKNG 2.7X19MM

Facility

$442.00

Service Code	HCPCS C1713
Hospital Charge Code	270664391
Hospital Revenue Code	278
Min. Negotiated Rate	$66.30
Max. Negotiated Rate	$106.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$88.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$97.24
Rate for Payer: Qualcare PPO/HMO/WC	$66.30

PEG KIT 20FR

Facility

$442.18

Hospital Charge Code	270690646
Hospital Revenue Code	272
Min. Negotiated Rate	$66.33
Max. Negotiated Rate	$66.33
Rate for Payer: Qualcare PPO/HMO/WC	$66.33

PEG KIT 20FR

Facility

$442.18

Hospital Charge Code	270690646
Hospital Revenue Code	272
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$221.09
Rate for Payer: Aetna Commercial	$168.03
Rate for Payer: Aetna Medicare Advantage	$132.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.76
Rate for Payer: Cigna Commercial	$221.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.65
Rate for Payer: Oxford Commercial	$88.44
Rate for Payer: Qualcare PPO/HMO/WC	$66.33
Rate for Payer: UnitedHealthcare Commercial	$88.44
Rate for Payer: UnitedHealthcare Community & State	$10.66
Rate for Payer: Wellpoint Medicaid Managed Care	$11.72

Know your out-of-pocket cost for care.

All Charges