Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CFH FP MMR VACCINE

Facility

$130.00

Service Code	HCPCS 90707
Hospital Charge Code	83652327
Hospital Revenue Code	636
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$31.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.46
Rate for Payer: Qualcare PPO/HMO/WC	$19.50

CFH FP MMR VACCINE

Facility

$130.00

Service Code	HCPCS 90707
Hospital Charge Code	83652327
Hospital Revenue Code	636
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$105.76
Rate for Payer: Aetna Commercial	$49.40
Rate for Payer: Aetna Medicare Advantage	$39.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.15
Rate for Payer: Cigna Commercial	$65.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.46
Rate for Payer: Qualcare PPO/HMO/WC	$19.50
Rate for Payer: UnitedHealthcare Community & State	$3.13
Rate for Payer: Wellpoint Medicaid Managed Care	$3.44

CFH FP PARING BENIGN LES 1

Facility

$512.00

Service Code	HCPCS 11055
Hospital Charge Code	83652019
Hospital Revenue Code	761
Min. Negotiated Rate	$76.80
Max. Negotiated Rate	$76.80
Rate for Payer: Qualcare PPO/HMO/WC	$76.80

CFH FP PARING BENIGN LES 1

Facility

$512.00

Service Code	HCPCS 11055
Hospital Charge Code	83652019
Hospital Revenue Code	761
Min. Negotiated Rate	$12.34
Max. Negotiated Rate	$860.41
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$54.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$860.41
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$238.36
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$153.60
Rate for Payer: Oxford Commercial	$102.40
Rate for Payer: Qualcare PPO/HMO/WC	$76.80
Rate for Payer: UnitedHealthcare Commercial	$102.40
Rate for Payer: UnitedHealthcare Community & State	$12.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$13.57

CFH FP PEAKFLOW

Facility

$241.00

Service Code	HCPCS 94150
Hospital Charge Code	83652377
Hospital Revenue Code	460
Min. Negotiated Rate	$5.81
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$415.81
Rate for Payer: Aetna Medicare Advantage	$495.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$551.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$551.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$152.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$551.81
Rate for Payer: Cigna Commercial	$306.43
Rate for Payer: Cigna Medicare Advantage	$152.87
Rate for Payer: Clover Medicare Advantage	$145.23
Rate for Payer: EmblemHealth Commercial	$458.61
Rate for Payer: Humana Medicare Advantage	$157.46
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$152.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.30
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.15
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$5.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$152.87
Rate for Payer: Wellcare Medicare Advantage	$152.87
Rate for Payer: Wellpoint Medicaid Managed Care	$6.39

CFH FP PEAKFLOW

Facility

$241.00

Service Code	HCPCS 94150
Hospital Charge Code	83652377
Hospital Revenue Code	460
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$36.15
Rate for Payer: Qualcare PPO/HMO/WC	$36.15

CFH FP PULSE OXIMETRY

Facility

$10.41

Service Code	HCPCS 94760
Hospital Charge Code	83652383
Hospital Revenue Code	460
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$1.56
Rate for Payer: Qualcare PPO/HMO/WC	$1.56

CFH FP PULSE OXIMETRY

Facility

$10.41

Service Code	HCPCS 94760
Hospital Charge Code	83652383
Hospital Revenue Code	460
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$3.96
Rate for Payer: Aetna Medicare Advantage	$3.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.65
Rate for Payer: Cigna Commercial	$5.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.12
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.56
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$0.28

CFH FP TETANUS/DIPHTHERIA

Facility

$2,913.40

Service Code	HCPCS 90715
Hospital Charge Code	83652329
Hospital Revenue Code	636
Min. Negotiated Rate	$70.21
Max. Negotiated Rate	$1,456.70
Rate for Payer: Aetna Commercial	$1,107.09
Rate for Payer: Aetna Medicare Advantage	$874.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$742.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$742.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$742.92
Rate for Payer: Cigna Commercial	$1,456.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$705.04
Rate for Payer: Qualcare PPO/HMO/WC	$437.01
Rate for Payer: UnitedHealthcare Community & State	$70.21
Rate for Payer: Wellpoint Medicaid Managed Care	$77.21

CFH FP TETANUS/DIPHTHERIA

Facility

$2,913.40

Service Code	HCPCS 90715
Hospital Charge Code	83652329
Hospital Revenue Code	636
Min. Negotiated Rate	$437.01
Max. Negotiated Rate	$705.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$705.04
Rate for Payer: Qualcare PPO/HMO/WC	$437.01

CFH FP TYMPANOMETER

Facility

$194.00

Service Code	HCPCS 92567
Hospital Charge Code	83652365
Hospital Revenue Code	471
Min. Negotiated Rate	$29.10
Max. Negotiated Rate	$29.10
Rate for Payer: Qualcare PPO/HMO/WC	$29.10

CFH FP TYMPANOMETER

Facility

$194.00

Service Code	HCPCS 92567
Hospital Charge Code	83652365
Hospital Revenue Code	471
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$1,823.00
Rate for Payer: Aetna Commercial	$120.69
Rate for Payer: Aetna Medicare Advantage	$143.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$81.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.16
Rate for Payer: Cigna Commercial	$88.94
Rate for Payer: Cigna Medicare Advantage	$44.37
Rate for Payer: Clover Medicare Advantage	$42.15
Rate for Payer: EmblemHealth Commercial	$133.11
Rate for Payer: Humana Medicare Advantage	$45.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.20
Rate for Payer: Oxford Commercial	$1,040.00
Rate for Payer: Qualcare PPO/HMO/WC	$29.10
Rate for Payer: UnitedHealthcare Commercial	$1,823.00
Rate for Payer: UnitedHealthcare Community & State	$4.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.37
Rate for Payer: Wellcare Medicare Advantage	$44.37
Rate for Payer: Wellpoint Medicaid Managed Care	$5.14

CFH FP VARICELLA VIRUS VACCINE

Facility

$91.00

Service Code	HCPCS 90716
Hospital Charge Code	83652331
Hospital Revenue Code	636
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$160.26
Rate for Payer: Aetna Commercial	$34.58
Rate for Payer: Aetna Medicare Advantage	$27.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$160.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.20
Rate for Payer: Cigna Commercial	$45.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.02
Rate for Payer: Qualcare PPO/HMO/WC	$13.65
Rate for Payer: UnitedHealthcare Community & State	$2.19
Rate for Payer: Wellpoint Medicaid Managed Care	$2.41

CFH FP VARICELLA VIRUS VACCINE

Facility

$91.00

Service Code	HCPCS 90716
Hospital Charge Code	83652331
Hospital Revenue Code	636
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$22.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.02
Rate for Payer: Qualcare PPO/HMO/WC	$13.65

CFH FUROSEMIDE 20MG LASIX TAB

Facility

$2.00

Hospital Charge Code	83652680
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna Commercial	$0.76
Rate for Payer: Aetna Medicare Advantage	$0.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.51
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.60
Rate for Payer: Oxford Commercial	$0.40
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$0.40
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

CFH FUROSEMIDE 20MG LASIX TAB

Facility

$2.00

Hospital Charge Code	83652680
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

CFH GLUCOSE 5GM TAB

Facility

$2.00

Hospital Charge Code	83652685
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

CFH GLUCOSE 5GM TAB

Facility

$2.00

Hospital Charge Code	83652685
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna Commercial	$0.76
Rate for Payer: Aetna Medicare Advantage	$0.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.51
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.60
Rate for Payer: Oxford Commercial	$0.40
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$0.40
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

CFH HSTART POST PARTUM

Facility

$139.00

Service Code	HCPCS 9924152
Hospital Charge Code	83652517
Hospital Revenue Code	514
Min. Negotiated Rate	$3.35
Max. Negotiated Rate	$69.50
Rate for Payer: Aetna Commercial	$52.82
Rate for Payer: Aetna Medicare Advantage	$41.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.45
Rate for Payer: Cigna Commercial	$69.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.70
Rate for Payer: Qualcare PPO/HMO/WC	$20.85
Rate for Payer: UnitedHealthcare Community & State	$3.35
Rate for Payer: Wellpoint Medicaid Managed Care	$3.68

CFH HSTART POST PARTUM

Facility

$139.00

Service Code	HCPCS 9924152
Hospital Charge Code	83652517
Hospital Revenue Code	514
Min. Negotiated Rate	$20.85
Max. Negotiated Rate	$20.85
Rate for Payer: Qualcare PPO/HMO/WC	$20.85

CFH IBUPROFEN 100MG

Facility

$3.00

Hospital Charge Code	83652690
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

CFH IBUPROFEN 100MG

Facility

$3.00

Hospital Charge Code	83652690
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

CFH IBUPROFEN 400MG

Facility

$2.00

Hospital Charge Code	83652695
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna Commercial	$0.76
Rate for Payer: Aetna Medicare Advantage	$0.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.51
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.60
Rate for Payer: Oxford Commercial	$0.40
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$0.40
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

CFH IBUPROFEN 400MG

Facility

$2.00

Hospital Charge Code	83652695
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

CFH IMPLANT INSERTION

Facility

$715.00

Service Code	HCPCS 11981
Hospital Charge Code	83652635
Hospital Revenue Code	761
Min. Negotiated Rate	$17.23
Max. Negotiated Rate	$570.55
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$193.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.55
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$214.50
Rate for Payer: Oxford Commercial	$143.00
Rate for Payer: Qualcare PPO/HMO/WC	$107.25
Rate for Payer: UnitedHealthcare Commercial	$143.00
Rate for Payer: UnitedHealthcare Community & State	$17.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$361.89
Rate for Payer: Wellpoint Medicaid Managed Care	$18.95

Know your out-of-pocket cost for care.

All Charges