Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PEEK SWIVELOCK 3.9 X 17.9 MM

Facility

$1,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270687857
Hospital Revenue Code	278
Min. Negotiated Rate	$281.25
Max. Negotiated Rate	$453.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$453.75
Rate for Payer: Qualcare PPO/HMO/WC	$281.25

PEEK SWIVELOCK 4.75 X 191

Facility

$2,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270690218
Hospital Revenue Code	278
Min. Negotiated Rate	$60.35
Max. Negotiated Rate	$1,062.50
Rate for Payer: Aetna Commercial	$807.50
Rate for Payer: Aetna Medicare Advantage	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$541.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$541.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$541.88
Rate for Payer: Cigna Commercial	$1,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$514.25
Rate for Payer: Qualcare PPO/HMO/WC	$318.75
Rate for Payer: UnitedHealthcare Community & State	$67.15
Rate for Payer: Wellpoint Medicaid Managed Care	$60.35

PEEK SWIVELOCK 4.75 X 191

Facility

$2,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270690218
Hospital Revenue Code	278
Min. Negotiated Rate	$318.75
Max. Negotiated Rate	$514.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$514.25
Rate for Payer: Qualcare PPO/HMO/WC	$318.75

PEEL AWAY SHEATH SET 12FR.

Facility

$241.00

Hospital Charge Code	270330508
Hospital Revenue Code	278
Min. Negotiated Rate	$6.84
Max. Negotiated Rate	$120.50
Rate for Payer: Aetna Commercial	$91.58
Rate for Payer: Aetna Medicare Advantage	$72.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.45
Rate for Payer: Cigna Commercial	$120.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.32
Rate for Payer: Qualcare PPO/HMO/WC	$36.15
Rate for Payer: UnitedHealthcare Community & State	$7.62
Rate for Payer: Wellpoint Medicaid Managed Care	$6.84

PEEL AWAY SHEATH SET 12FR.

Facility

$241.00

Hospital Charge Code	270330508
Hospital Revenue Code	278
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$58.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.32
Rate for Payer: Qualcare PPO/HMO/WC	$36.15

PEG 2.7MM X 20MM LOCKING

Facility

$495.00

Service Code	HCPCS C1713
Hospital Charge Code	270664186
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: Qualcare PPO/HMO/WC	$74.25

PEG 2.7MM X 20MM LOCKING

Facility

$495.00

Service Code	HCPCS C1713
Hospital Charge Code	270664186
Hospital Revenue Code	278
Min. Negotiated Rate	$14.06
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: Qualcare PPO/HMO/WC	$74.25
Rate for Payer: UnitedHealthcare Community & State	$15.64
Rate for Payer: Wellpoint Medicaid Managed Care	$14.06

PEG DRIVER 2.0mm FAST

Facility

$275.00

Hospital Charge Code	270638005
Hospital Revenue Code	278
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$66.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.55
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

PEG DRIVER 2.0mm FAST

Facility

$275.00

Hospital Charge Code	270638005
Hospital Revenue Code	278
Min. Negotiated Rate	$7.81
Max. Negotiated Rate	$137.50
Rate for Payer: Aetna Commercial	$104.50
Rate for Payer: Aetna Medicare Advantage	$82.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.12
Rate for Payer: Cigna Commercial	$137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.55
Rate for Payer: Qualcare PPO/HMO/WC	$41.25
Rate for Payer: UnitedHealthcare Community & State	$8.69
Rate for Payer: Wellpoint Medicaid Managed Care	$7.81

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	$4,003.94
Max. Negotiated Rate	$6,459.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,459.69
Rate for Payer: Qualcare PPO/HMO/WC	$4,003.94

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	$758.08
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	$843.50
Rate for Payer: Wellpoint Medicaid Managed Care	$758.08

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	$288.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$288.39
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	$288.39
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	$838.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$79.50
Rate for Payer: Wellcare Medicare Advantage	$79.50
Rate for Payer: Wellpoint Medicaid Managed Care	$753.72

PEG, FLTD LCKNG 2.3X20MM TI

Facility

$570.00

Service Code	HCPCS C1713
Hospital Charge Code	270686701
Hospital Revenue Code	278
Min. Negotiated Rate	$16.19
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: Qualcare PPO/HMO/WC	$85.50
Rate for Payer: UnitedHealthcare Community & State	$18.01
Rate for Payer: Wellpoint Medicaid Managed Care	$16.19

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: Qualcare PPO/HMO/WC	$85.50

PEG HI COMPRESS LOCKING 2.7X16

Facility

$520.00

Service Code	HCPCS C1713
Hospital Charge Code	270664355
Hospital Revenue Code	278
Min. Negotiated Rate	$14.77
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: Qualcare PPO/HMO/WC	$78.00
Rate for Payer: UnitedHealthcare Community & State	$16.43
Rate for Payer: Wellpoint Medicaid Managed Care	$14.77

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: 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	$14.06
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: Qualcare PPO/HMO/WC	$74.25
Rate for Payer: UnitedHealthcare Community & State	$15.64
Rate for Payer: Wellpoint Medicaid Managed Care	$14.06

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: 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: 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	$14.77
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: Qualcare PPO/HMO/WC	$78.00
Rate for Payer: UnitedHealthcare Community & State	$16.43
Rate for Payer: Wellpoint Medicaid Managed Care	$14.77

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: 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	$14.06
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: Qualcare PPO/HMO/WC	$74.25
Rate for Payer: UnitedHealthcare Community & State	$15.64
Rate for Payer: Wellpoint Medicaid Managed Care	$14.06

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: 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	$14.06
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: Qualcare PPO/HMO/WC	$74.25
Rate for Payer: UnitedHealthcare Community & State	$15.64
Rate for Payer: Wellpoint Medicaid Managed Care	$14.06

Know your out-of-pocket cost for care.

All Charges