Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PEG KIT ENDOVIVE STD 24FR

Facility

$1,200.00

Hospital Charge Code	270693120
Hospital Revenue Code	272
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$180.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.00

PEG KIT ENDOVIVE STD 24FR

Facility

$1,200.00

Hospital Charge Code	270693120
Hospital Revenue Code	272
Min. Negotiated Rate	$28.92
Max. Negotiated Rate	$600.00
Rate for Payer: Aetna Commercial	$456.00
Rate for Payer: Aetna Medicare Advantage	$360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$306.00
Rate for Payer: Cigna Commercial	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$360.00
Rate for Payer: Oxford Commercial	$240.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.00
Rate for Payer: UnitedHealthcare Commercial	$240.00
Rate for Payer: UnitedHealthcare Community & State	$28.92
Rate for Payer: Wellpoint Medicaid Managed Care	$31.80

PEG KIT MIC 24 FR

Facility

$448.45

Hospital Charge Code	270686527
Hospital Revenue Code	272
Min. Negotiated Rate	$67.27
Max. Negotiated Rate	$67.27
Rate for Payer: Qualcare PPO/HMO/WC	$67.27

PEG KIT MIC 24 FR

Facility

$448.45

Hospital Charge Code	270686527
Hospital Revenue Code	272
Min. Negotiated Rate	$10.81
Max. Negotiated Rate	$224.22
Rate for Payer: Aetna Commercial	$170.41
Rate for Payer: Aetna Medicare Advantage	$134.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.35
Rate for Payer: Cigna Commercial	$224.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$134.53
Rate for Payer: Oxford Commercial	$89.69
Rate for Payer: Qualcare PPO/HMO/WC	$67.27
Rate for Payer: UnitedHealthcare Commercial	$89.69
Rate for Payer: UnitedHealthcare Community & State	$10.81
Rate for Payer: Wellpoint Medicaid Managed Care	$11.88

PEG LKG T8 2.0X18MM

Facility

$1,242.30

Service Code	HCPCS C1713
Hospital Charge Code	270700516
Hospital Revenue Code	278
Min. Negotiated Rate	$186.34
Max. Negotiated Rate	$300.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$248.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$300.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$273.31
Rate for Payer: Qualcare PPO/HMO/WC	$186.34

PEG LKG T8 2.0X18MM

Facility

$1,242.30

Service Code	HCPCS C1713
Hospital Charge Code	270700516
Hospital Revenue Code	278
Min. Negotiated Rate	$29.94
Max. Negotiated Rate	$621.15
Rate for Payer: Aetna Commercial	$472.07
Rate for Payer: Aetna Medicare Advantage	$372.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$316.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$316.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$248.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$316.79
Rate for Payer: Cigna Commercial	$621.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$300.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$273.31
Rate for Payer: Qualcare PPO/HMO/WC	$186.34
Rate for Payer: UnitedHealthcare Community & State	$29.94
Rate for Payer: Wellpoint Medicaid Managed Care	$32.92

PEG LOCKING 2.0MM X 20MM

Facility

$875.00

Hospital Charge Code	270667226
Hospital Revenue Code	278
Min. Negotiated Rate	$21.09
Max. Negotiated Rate	$437.50
Rate for Payer: Aetna Commercial	$332.50
Rate for Payer: Aetna Medicare Advantage	$262.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.12
Rate for Payer: Cigna Commercial	$437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$211.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$192.50
Rate for Payer: Qualcare PPO/HMO/WC	$131.25
Rate for Payer: UnitedHealthcare Community & State	$21.09
Rate for Payer: Wellpoint Medicaid Managed Care	$23.19

PEG LOCKING 2.0MM X 20MM

Facility

$875.00

Hospital Charge Code	270667226
Hospital Revenue Code	278
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$211.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$211.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$192.50
Rate for Payer: Qualcare PPO/HMO/WC	$131.25

PEG LOCKING 2.0x16mm

Facility

$588.90

Service Code	HCPCS C1713
Hospital Charge Code	270667225
Hospital Revenue Code	278
Min. Negotiated Rate	$14.19
Max. Negotiated Rate	$294.45
Rate for Payer: Aetna Commercial	$223.78
Rate for Payer: Aetna Medicare Advantage	$176.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$150.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$150.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$117.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$150.17
Rate for Payer: Cigna Commercial	$294.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$129.56
Rate for Payer: Qualcare PPO/HMO/WC	$88.33
Rate for Payer: UnitedHealthcare Community & State	$14.19
Rate for Payer: Wellpoint Medicaid Managed Care	$15.61

PEG LOCKING 2.0x16mm

Facility

$588.90

Service Code	HCPCS C1713
Hospital Charge Code	270667225
Hospital Revenue Code	278
Min. Negotiated Rate	$88.33
Max. Negotiated Rate	$142.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$117.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$129.56
Rate for Payer: Qualcare PPO/HMO/WC	$88.33

PEG LOCKING 2.3x16MM

Facility

$540.00

Service Code	HCPCS C1713
Hospital Charge Code	270677342
Hospital Revenue Code	278
Min. Negotiated Rate	$13.01
Max. Negotiated Rate	$270.00
Rate for Payer: Aetna Commercial	$205.20
Rate for Payer: Aetna Medicare Advantage	$162.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$137.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$137.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$108.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$137.70
Rate for Payer: Cigna Commercial	$270.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$118.80
Rate for Payer: Qualcare PPO/HMO/WC	$81.00
Rate for Payer: UnitedHealthcare Community & State	$13.01
Rate for Payer: Wellpoint Medicaid Managed Care	$14.31

PEG LOCKING 2.3x16MM

Facility

$540.00

Service Code	HCPCS C1713
Hospital Charge Code	270677342
Hospital Revenue Code	278
Min. Negotiated Rate	$81.00
Max. Negotiated Rate	$130.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$108.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$118.80
Rate for Payer: Qualcare PPO/HMO/WC	$81.00

PEG LOCKING 2.3x18MM

Facility

$540.00

Service Code	HCPCS C1713
Hospital Charge Code	270677343
Hospital Revenue Code	278
Min. Negotiated Rate	$13.01
Max. Negotiated Rate	$270.00
Rate for Payer: Aetna Commercial	$205.20
Rate for Payer: Aetna Medicare Advantage	$162.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$137.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$137.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$108.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$137.70
Rate for Payer: Cigna Commercial	$270.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$118.80
Rate for Payer: Qualcare PPO/HMO/WC	$81.00
Rate for Payer: UnitedHealthcare Community & State	$13.01
Rate for Payer: Wellpoint Medicaid Managed Care	$14.31

PEG LOCKING 2.3x18MM

Facility

$540.00

Service Code	HCPCS C1713
Hospital Charge Code	270677343
Hospital Revenue Code	278
Min. Negotiated Rate	$81.00
Max. Negotiated Rate	$130.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$108.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$118.80
Rate for Payer: Qualcare PPO/HMO/WC	$81.00

PEG LOCKING T8 2X16MM

Facility

$1,242.30

Service Code	HCPCS C1713
Hospital Charge Code	270700515
Hospital Revenue Code	278
Min. Negotiated Rate	$29.94
Max. Negotiated Rate	$621.15
Rate for Payer: Aetna Commercial	$472.07
Rate for Payer: Aetna Medicare Advantage	$372.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$316.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$316.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$248.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$316.79
Rate for Payer: Cigna Commercial	$621.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$300.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$273.31
Rate for Payer: Qualcare PPO/HMO/WC	$186.34
Rate for Payer: UnitedHealthcare Community & State	$29.94
Rate for Payer: Wellpoint Medicaid Managed Care	$32.92

PEG LOCKING T8 2X16MM

Facility

$1,242.30

Service Code	HCPCS C1713
Hospital Charge Code	270700515
Hospital Revenue Code	278
Min. Negotiated Rate	$186.34
Max. Negotiated Rate	$300.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$248.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$300.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$273.31
Rate for Payer: Qualcare PPO/HMO/WC	$186.34

PEGLOTICASE 8 MG/ML INJ

Facility

$36,113.00

Service Code	NDC 75987008010
Hospital Charge Code	60630208
Hospital Revenue Code	260
Min. Negotiated Rate	$5,416.95
Max. Negotiated Rate	$5,416.95
Rate for Payer: Qualcare PPO/HMO/WC	$5,416.95

PEGLOTICASE 8 MG/ML INJ

Facility

$36,113.00

Service Code	NDC 75987008010
Hospital Charge Code	60630208
Hospital Revenue Code	260
Min. Negotiated Rate	$707.00
Max. Negotiated Rate	$18,056.50
Rate for Payer: Aetna Commercial	$13,722.94
Rate for Payer: Aetna Medicare Advantage	$10,833.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,208.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,208.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,208.82
Rate for Payer: Cigna Commercial	$18,056.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,833.90
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,416.95
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$870.32
Rate for Payer: Wellpoint Medicaid Managed Care	$956.99

PEG PETELLA CEMENTED 32MM

Facility

$1,575.00

Hospital Charge Code	270674367
Hospital Revenue Code	278
Min. Negotiated Rate	$236.25
Max. Negotiated Rate	$381.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$315.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$381.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$346.50
Rate for Payer: Qualcare PPO/HMO/WC	$236.25

PEG PETELLA CEMENTED 32MM

Facility

$1,575.00

Hospital Charge Code	270674367
Hospital Revenue Code	278
Min. Negotiated Rate	$37.96
Max. Negotiated Rate	$787.50
Rate for Payer: Aetna Commercial	$598.50
Rate for Payer: Aetna Medicare Advantage	$472.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$401.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$401.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$401.62
Rate for Payer: Cigna Commercial	$787.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$381.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$346.50
Rate for Payer: Qualcare PPO/HMO/WC	$236.25
Rate for Payer: UnitedHealthcare Community & State	$37.96
Rate for Payer: Wellpoint Medicaid Managed Care	$41.74

PEGS 3-4 GLENOID SIZE M

Facility

$6,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270692130
Hospital Revenue Code	278
Min. Negotiated Rate	$156.65
Max. Negotiated Rate	$3,250.00
Rate for Payer: Aetna Commercial	$2,470.00
Rate for Payer: Aetna Medicare Advantage	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,657.50
Rate for Payer: Cigna Commercial	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00
Rate for Payer: UnitedHealthcare Community & State	$156.65
Rate for Payer: Wellpoint Medicaid Managed Care	$172.25

PEGS 3-4 GLENOID SIZE M

Facility

$6,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270692130
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$1,573.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

PEG SCREW

Facility

$955.00

Hospital Charge Code	270661756
Hospital Revenue Code	278
Min. Negotiated Rate	$23.02
Max. Negotiated Rate	$477.50
Rate for Payer: Aetna Commercial	$362.90
Rate for Payer: Aetna Medicare Advantage	$286.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$243.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$243.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$191.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$243.53
Rate for Payer: Cigna Commercial	$477.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$210.10
Rate for Payer: Qualcare PPO/HMO/WC	$143.25
Rate for Payer: UnitedHealthcare Community & State	$23.02
Rate for Payer: Wellpoint Medicaid Managed Care	$25.31

PEG SCREW

Facility

$955.00

Hospital Charge Code	270661756
Hospital Revenue Code	278
Min. Negotiated Rate	$143.25
Max. Negotiated Rate	$231.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$191.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$210.10
Rate for Payer: Qualcare PPO/HMO/WC	$143.25

PEGS DISTAL FEMORAL 183099

Facility

$1,045.00

Hospital Charge Code	270641309
Hospital Revenue Code	278
Min. Negotiated Rate	$25.18
Max. Negotiated Rate	$522.50
Rate for Payer: Aetna Commercial	$397.10
Rate for Payer: Aetna Medicare Advantage	$313.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$266.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$266.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$266.48
Rate for Payer: Cigna Commercial	$522.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$252.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$229.90
Rate for Payer: Qualcare PPO/HMO/WC	$156.75
Rate for Payer: UnitedHealthcare Community & State	$25.18
Rate for Payer: Wellpoint Medicaid Managed Care	$27.69

Know your out-of-pocket cost for care.

All Charges