Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CFH RW HEPATITS A VACC ADULT

Facility

$91.00

Service Code	HCPCS 90632
Hospital Charge Code	83652303
Hospital Revenue Code	636
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$153.60
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	$153.60
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 RW HEPATITS A VACC ADULT

Facility

$91.00

Service Code	HCPCS 90632
Hospital Charge Code	83652303
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 RW PSYCHATRIC DIAGNOSTIC

Facility

$1,296.00

Service Code	HCPCS 90801
Hospital Charge Code	83652343
Hospital Revenue Code	900
Min. Negotiated Rate	$194.40
Max. Negotiated Rate	$194.40
Rate for Payer: Qualcare PPO/HMO/WC	$194.40

CFH RW PSYCHATRIC DIAGNOSTIC

Facility

$1,296.00

Service Code	HCPCS 90801
Hospital Charge Code	83652343
Hospital Revenue Code	900
Min. Negotiated Rate	$31.23
Max. Negotiated Rate	$3,081.00
Rate for Payer: Aetna Commercial	$492.48
Rate for Payer: Aetna Medicare Advantage	$388.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$330.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$330.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$330.48
Rate for Payer: Cigna Commercial	$648.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$388.80
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$194.40
Rate for Payer: UnitedHealthcare Commercial	$3,081.00
Rate for Payer: UnitedHealthcare Community & State	$31.23
Rate for Payer: Wellpoint Medicaid Managed Care	$34.34

CFH RW PSY INDIV. 20-30MTS

Facility

$730.00

Service Code	HCPCS 90805
Hospital Charge Code	83652347
Hospital Revenue Code	914
Min. Negotiated Rate	$109.50
Max. Negotiated Rate	$109.50
Rate for Payer: Qualcare PPO/HMO/WC	$109.50

CFH RW PSY INDIV. 20-30MTS

Facility

$730.00

Service Code	HCPCS 90805
Hospital Charge Code	83652347
Hospital Revenue Code	914
Min. Negotiated Rate	$17.59
Max. Negotiated Rate	$365.00
Rate for Payer: Aetna Commercial	$277.40
Rate for Payer: Aetna Medicare Advantage	$219.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$186.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$186.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$186.15
Rate for Payer: Cigna Commercial	$365.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$219.00
Rate for Payer: Qualcare PPO/HMO/WC	$109.50
Rate for Payer: UnitedHealthcare Community & State	$17.59
Rate for Payer: Wellpoint Medicaid Managed Care	$19.34

CFH RW PSY INDIV MD 45-50 MIN

Facility

$1,080.00

Service Code	HCPCS 90807
Hospital Charge Code	83652351
Hospital Revenue Code	914
Min. Negotiated Rate	$162.00
Max. Negotiated Rate	$162.00
Rate for Payer: Qualcare PPO/HMO/WC	$162.00

CFH RW PSY INDIV MD 45-50 MIN

Facility

$1,080.00

Service Code	HCPCS 90807
Hospital Charge Code	83652351
Hospital Revenue Code	914
Min. Negotiated Rate	$26.03
Max. Negotiated Rate	$540.00
Rate for Payer: Aetna Commercial	$410.40
Rate for Payer: Aetna Medicare Advantage	$324.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$275.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$275.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$275.40
Rate for Payer: Cigna Commercial	$540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$324.00
Rate for Payer: Qualcare PPO/HMO/WC	$162.00
Rate for Payer: UnitedHealthcare Community & State	$26.03
Rate for Payer: Wellpoint Medicaid Managed Care	$28.62

CFH RW TETANUS/DIPHTHERIA (TD)

Facility

$49.00

Service Code	HCPCS 90718
Hospital Charge Code	83652333
Hospital Revenue Code	250
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$24.50
Rate for Payer: Aetna Commercial	$18.62
Rate for Payer: Aetna Medicare Advantage	$14.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.49
Rate for Payer: Cigna Commercial	$24.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.70
Rate for Payer: Oxford Commercial	$9.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.35
Rate for Payer: UnitedHealthcare Commercial	$9.80
Rate for Payer: UnitedHealthcare Community & State	$1.18
Rate for Payer: Wellpoint Medicaid Managed Care	$1.30

CFH RW TETANUS/DIPHTHERIA (TD)

Facility

$49.00

Service Code	HCPCS 90718
Hospital Charge Code	83652333
Hospital Revenue Code	250
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$7.35
Rate for Payer: Qualcare PPO/HMO/WC	$7.35

CFH RW TETANUS TOXOID

Facility

$130.00

Hospital Charge Code	83652323
Hospital Revenue Code	636
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$65.00
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) 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 RW TETANUS TOXOID

Facility

$130.00

Hospital Charge Code	83652323
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 SCREENING PELVIC EXAM

Facility

$125.00

Service Code	HCPCS G0101
Hospital Charge Code	83652525
Hospital Revenue Code	770
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

CFH SCREENING PELVIC EXAM

Facility

$125.00

Service Code	HCPCS G0101
Hospital Charge Code	83652525
Hospital Revenue Code	770
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$435.65
Rate for Payer: Aetna Commercial	$328.28
Rate for Payer: Aetna Medicare Advantage	$391.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$435.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$435.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$120.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$435.65
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: Cigna Medicare Advantage	$120.69
Rate for Payer: Clover Medicare Advantage	$114.66
Rate for Payer: EmblemHealth Commercial	$362.07
Rate for Payer: Humana Medicare Advantage	$124.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$120.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.50
Rate for Payer: Oxford Commercial	$25.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$25.00
Rate for Payer: UnitedHealthcare Community & State	$3.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$120.69
Rate for Payer: Wellcare Medicare Advantage	$120.69
Rate for Payer: Wellpoint Medicaid Managed Care	$3.31

CFH SHAVE BIOPSY DERMAL LESION

Facility

$69.00

Service Code	HCPCS 11300
Hospital Charge Code	83652035
Hospital Revenue Code	510
Min. Negotiated Rate	$10.35
Max. Negotiated Rate	$10.35
Rate for Payer: Qualcare PPO/HMO/WC	$10.35

CFH SHAVE BIOPSY DERMAL LESION

Facility

$69.00

Service Code	HCPCS 11300
Hospital Charge Code	83652035
Hospital Revenue Code	510
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$1,743.30
Rate for Payer: Aetna Commercial	$1,313.62
Rate for Payer: Aetna Medicare Advantage	$1,564.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$482.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,743.30
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: Cigna Medicare Advantage	$482.95
Rate for Payer: Clover Medicare Advantage	$458.80
Rate for Payer: EmblemHealth Commercial	$1,448.85
Rate for Payer: Humana Medicare Advantage	$497.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$482.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.70
Rate for Payer: Qualcare PPO/HMO/WC	$10.35
Rate for Payer: UnitedHealthcare Community & State	$1.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellpoint Medicaid Managed Care	$1.83

CFH STREP SCREEN

Facility

$115.00

Service Code	HCPCS 86403
Hospital Charge Code	83652283
Hospital Revenue Code	302
Min. Negotiated Rate	$17.25
Max. Negotiated Rate	$17.25
Rate for Payer: Qualcare PPO/HMO/WC	$17.25

CFH STREP SCREEN

Facility

$115.00

Service Code	HCPCS 86403
Hospital Charge Code	83652283
Hospital Revenue Code	302
Min. Negotiated Rate	$3.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$31.39
Rate for Payer: Aetna Medicare Advantage	$37.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.66
Rate for Payer: Cigna Commercial	$57.50
Rate for Payer: Cigna Medicare Advantage	$11.54
Rate for Payer: Clover Medicare Advantage	$10.96
Rate for Payer: EmblemHealth Commercial	$34.62
Rate for Payer: Humana Medicare Advantage	$11.89
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.54
Rate for Payer: Wellcare Medicare Advantage	$11.54
Rate for Payer: Wellpoint Medicaid Managed Care	$3.05

CFH TRIGGER POINT INJECTION

Facility

$174.75

Service Code	HCPCS 20552
Hospital Charge Code	83652091
Hospital Revenue Code	761
Min. Negotiated Rate	$4.21
Max. Negotiated Rate	$1,316.35
Rate for Payer: Aetna Commercial	$991.90
Rate for Payer: Aetna Medicare Advantage	$1,181.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,316.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,316.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$364.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,316.35
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: Cigna Medicare Advantage	$364.67
Rate for Payer: Clover Medicare Advantage	$346.44
Rate for Payer: EmblemHealth Commercial	$1,094.01
Rate for Payer: Humana Medicare Advantage	$375.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$364.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.42
Rate for Payer: Oxford Commercial	$34.95
Rate for Payer: Qualcare PPO/HMO/WC	$26.21
Rate for Payer: UnitedHealthcare Commercial	$34.95
Rate for Payer: UnitedHealthcare Community & State	$4.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$364.67
Rate for Payer: Wellcare Medicare Advantage	$364.67
Rate for Payer: Wellpoint Medicaid Managed Care	$4.63

CFH TRIGGER POINT INJECTION

Facility

$174.75

Service Code	HCPCS 20552
Hospital Charge Code	83652091
Hospital Revenue Code	761
Min. Negotiated Rate	$26.21
Max. Negotiated Rate	$26.21
Rate for Payer: Qualcare PPO/HMO/WC	$26.21

CFH WC CERV/VAG BX-SINGLE-MULT

Facility

$290.00

Service Code	HCPCS 57500
Hospital Charge Code	83652145
Hospital Revenue Code	361
Min. Negotiated Rate	$6.99
Max. Negotiated Rate	$3,949.84
Rate for Payer: Aetna Commercial	$2,976.31
Rate for Payer: Aetna Medicare Advantage	$3,545.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,949.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,949.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,094.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,949.84
Rate for Payer: Cigna Commercial	$2,193.38
Rate for Payer: Cigna Medicare Advantage	$1,094.23
Rate for Payer: Clover Medicare Advantage	$1,039.52
Rate for Payer: EmblemHealth Commercial	$3,282.69
Rate for Payer: Humana Medicare Advantage	$1,127.06
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,094.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.00
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.50
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$6.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,094.23
Rate for Payer: Wellcare Medicare Advantage	$1,094.23
Rate for Payer: Wellpoint Medicaid Managed Care	$7.68

CFH WC CERV/VAG BX-SINGLE-MULT

Facility

$290.00

Service Code	HCPCS 57500
Hospital Charge Code	83652145
Hospital Revenue Code	361
Min. Negotiated Rate	$43.50
Max. Negotiated Rate	$43.50
Rate for Payer: Qualcare PPO/HMO/WC	$43.50

CFH WC COLPOSCOPY OF CERVIX

Facility

$669.00

Service Code	HCPCS 57452
Hospital Charge Code	83652137
Hospital Revenue Code	361
Min. Negotiated Rate	$100.35
Max. Negotiated Rate	$100.35
Rate for Payer: Qualcare PPO/HMO/WC	$100.35

CFH WC COLPOSCOPY OF CERVIX

Facility

$669.00

Service Code	HCPCS 57452
Hospital Charge Code	83652137
Hospital Revenue Code	361
Min. Negotiated Rate	$16.12
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$653.29
Rate for Payer: Aetna Medicare Advantage	$778.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$866.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$866.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$240.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$866.98
Rate for Payer: Cigna Commercial	$481.45
Rate for Payer: Cigna Medicare Advantage	$240.18
Rate for Payer: Clover Medicare Advantage	$228.17
Rate for Payer: EmblemHealth Commercial	$720.54
Rate for Payer: Humana Medicare Advantage	$247.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$240.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.70
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.35
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$16.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$240.18
Rate for Payer: Wellcare Medicare Advantage	$240.18
Rate for Payer: Wellpoint Medicaid Managed Care	$17.73

CFH WC COLPOSCOPY WITH BIOPSY

Facility

$863.00

Service Code	HCPCS 57454
Hospital Charge Code	83652139
Hospital Revenue Code	361
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$984.72
Rate for Payer: Aetna Medicare Advantage	$1,172.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,306.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,306.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$362.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,306.82
Rate for Payer: Cigna Commercial	$725.69
Rate for Payer: Cigna Medicare Advantage	$362.03
Rate for Payer: Clover Medicare Advantage	$343.93
Rate for Payer: EmblemHealth Commercial	$1,086.09
Rate for Payer: Humana Medicare Advantage	$372.89
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$362.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$258.90
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$129.45
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$20.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$362.03
Rate for Payer: Wellcare Medicare Advantage	$362.03
Rate for Payer: Wellpoint Medicaid Managed Care	$22.87

Know your out-of-pocket cost for care.

All Charges