Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

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: Qualcare PPO/HMO/WC	$74.25

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	$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 COMPR LOCKNG 2.7X19MM

Facility

$442.00

Service Code	HCPCS C1713
Hospital Charge Code	270664391
Hospital Revenue Code	278
Min. Negotiated Rate	$12.55
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: Qualcare PPO/HMO/WC	$66.30
Rate for Payer: UnitedHealthcare Community & State	$13.97
Rate for Payer: Wellpoint Medicaid Managed Care	$12.55

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: Qualcare PPO/HMO/WC	$66.30

PEG KIT 20FR

Facility

$442.18

Hospital Charge Code	270690646
Hospital Revenue Code	272
Min. Negotiated Rate	$12.56
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	$114.97
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	$13.97
Rate for Payer: Wellpoint Medicaid Managed Care	$12.56

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 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	$34.08
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	$312.00
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	$37.92
Rate for Payer: Wellpoint Medicaid Managed Care	$34.08

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	$12.74
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	$116.60
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	$14.17
Rate for Payer: Wellpoint Medicaid Managed Care	$12.74

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: 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	$35.28
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: Qualcare PPO/HMO/WC	$186.34
Rate for Payer: UnitedHealthcare Community & State	$39.26
Rate for Payer: Wellpoint Medicaid Managed Care	$35.28

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: Qualcare PPO/HMO/WC	$131.25

PEG LOCKING 2.0MM X 20MM

Facility

$875.00

Hospital Charge Code	270667226
Hospital Revenue Code	278
Min. Negotiated Rate	$24.85
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: Qualcare PPO/HMO/WC	$131.25
Rate for Payer: UnitedHealthcare Community & State	$27.65
Rate for Payer: Wellpoint Medicaid Managed Care	$24.85

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: Qualcare PPO/HMO/WC	$88.33

PEG LOCKING 2.0x16mm

Facility

$588.90

Service Code	HCPCS C1713
Hospital Charge Code	270667225
Hospital Revenue Code	278
Min. Negotiated Rate	$16.72
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: Qualcare PPO/HMO/WC	$88.33
Rate for Payer: UnitedHealthcare Community & State	$18.61
Rate for Payer: Wellpoint Medicaid Managed Care	$16.72

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: Qualcare PPO/HMO/WC	$81.00

PEG LOCKING 2.3x16MM

Facility

$540.00

Service Code	HCPCS C1713
Hospital Charge Code	270677342
Hospital Revenue Code	278
Min. Negotiated Rate	$15.34
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: Qualcare PPO/HMO/WC	$81.00
Rate for Payer: UnitedHealthcare Community & State	$17.06
Rate for Payer: Wellpoint Medicaid Managed Care	$15.34

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: 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	$15.34
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: Qualcare PPO/HMO/WC	$81.00
Rate for Payer: UnitedHealthcare Community & State	$17.06
Rate for Payer: Wellpoint Medicaid Managed Care	$15.34

PEG LOCKING T8 2X16MM

Facility

$1,242.30

Service Code	HCPCS C1713
Hospital Charge Code	270700515
Hospital Revenue Code	278
Min. Negotiated Rate	$35.28
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: Qualcare PPO/HMO/WC	$186.34
Rate for Payer: UnitedHealthcare Community & State	$39.26
Rate for Payer: Wellpoint Medicaid Managed Care	$35.28

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: 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	$1,025.61
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	$9,389.38
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,416.95
Rate for Payer: UnitedHealthcare Commercial	$1,235.00
Rate for Payer: UnitedHealthcare Community & State	$1,141.17
Rate for Payer: Wellpoint Medicaid Managed Care	$1,025.61

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

PEG PETELLA CEMENTED 32MM

Facility

$1,575.00

Hospital Charge Code	270674367
Hospital Revenue Code	278
Min. Negotiated Rate	$44.73
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: Qualcare PPO/HMO/WC	$236.25
Rate for Payer: UnitedHealthcare Community & State	$49.77
Rate for Payer: Wellpoint Medicaid Managed Care	$44.73

Know your out-of-pocket cost for care.

All Charges