Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CFH WC PRIV PT POST PARTUM

Facility

$139.00

Service Code	HCPCS 59430
Hospital Charge Code	83652229
Hospital Revenue Code	514
Min. Negotiated Rate	$3.35
Max. Negotiated Rate	$185.86
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) NJ Health	$185.86
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 WC PRIV PT POST PARTUM

Facility

$139.00

Service Code	HCPCS 59430
Hospital Charge Code	83652229
Hospital Revenue Code	514
Min. Negotiated Rate	$20.85
Max. Negotiated Rate	$20.85
Rate for Payer: Qualcare PPO/HMO/WC	$20.85

CFH WC RUBELLA VAC

Facility

$98.00

Hospital Charge Code	83652325
Hospital Revenue Code	636
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$49.00
Rate for Payer: Aetna Commercial	$37.24
Rate for Payer: Aetna Medicare Advantage	$29.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.99
Rate for Payer: Cigna Commercial	$49.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.72
Rate for Payer: Qualcare PPO/HMO/WC	$14.70
Rate for Payer: UnitedHealthcare Community & State	$2.36
Rate for Payer: Wellpoint Medicaid Managed Care	$2.60

CFH WC RUBELLA VAC

Facility

$98.00

Hospital Charge Code	83652325
Hospital Revenue Code	636
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$23.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.72
Rate for Payer: Qualcare PPO/HMO/WC	$14.70

CFH WC SIMPLE CLOSURE

Facility

$1,519.00

Service Code	HCPCS 12020
Hospital Charge Code	83652069
Hospital Revenue Code	761
Min. Negotiated Rate	$36.61
Max. Negotiated Rate	$3,169.46
Rate for Payer: Aetna Commercial	$2,388.27
Rate for Payer: Aetna Medicare Advantage	$2,844.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,169.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,169.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$878.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,169.46
Rate for Payer: Cigna Commercial	$1,760.02
Rate for Payer: Cigna Medicare Advantage	$878.04
Rate for Payer: Clover Medicare Advantage	$834.14
Rate for Payer: EmblemHealth Commercial	$2,634.12
Rate for Payer: Humana Medicare Advantage	$904.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$878.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$455.70
Rate for Payer: Oxford Commercial	$303.80
Rate for Payer: Qualcare PPO/HMO/WC	$227.85
Rate for Payer: UnitedHealthcare Commercial	$303.80
Rate for Payer: UnitedHealthcare Community & State	$36.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$878.04
Rate for Payer: Wellcare Medicare Advantage	$878.04
Rate for Payer: Wellpoint Medicaid Managed Care	$40.25

CFH WC SIMPLE CLOSURE

Facility

$1,519.00

Service Code	HCPCS 12020
Hospital Charge Code	83652069
Hospital Revenue Code	761
Min. Negotiated Rate	$227.85
Max. Negotiated Rate	$227.85
Rate for Payer: Qualcare PPO/HMO/WC	$227.85

CFH WC SUP-CERV ABD HYSTERTMY

Professional

Both

$9,489.90

Service Code	HCPCS 58180
Hospital Charge Code	83652161
Hospital Revenue Code	960
Min. Negotiated Rate	$268.83
Max. Negotiated Rate	$268.83
Rate for Payer: Aetna Commercial	$268.83
Rate for Payer: Aetna Medicare Advantage	$268.83

CFH WC TUBAL LIAGATION W C/S

Professional

Both

$17,601.15

Service Code	HCPCS 58611
Hospital Charge Code	83652177
Hospital Revenue Code	960
Min. Negotiated Rate	$79.15
Max. Negotiated Rate	$168.40
Rate for Payer: Aetna Medicare Advantage	$168.40
Rate for Payer: Cigna Commercial	$168.40
Rate for Payer: Cigna Medicare Advantage	$168.40
Rate for Payer: Wellpoint Medicaid Managed Care	$79.15

CFH WC UA DIPSTICK/TAB

Facility

$390.00

Service Code	HCPCS 81002
Hospital Charge Code	83652273
Hospital Revenue Code	307
Min. Negotiated Rate	$1.94
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$9.47
Rate for Payer: Aetna Medicare Advantage	$11.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.56
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$3.48
Rate for Payer: Clover Medicare Advantage	$3.31
Rate for Payer: EmblemHealth Commercial	$10.44
Rate for Payer: Humana Medicare Advantage	$3.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.48
Rate for Payer: Wellcare Medicare Advantage	$3.48
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

CFH WC UA DIPSTICK/TAB

Facility

$390.00

Service Code	HCPCS 81002
Hospital Charge Code	83652273
Hospital Revenue Code	307
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CFH WC URINE PREGNANCY TEST

Facility

$414.40

Service Code	HCPCS 81025
Hospital Charge Code	83652275
Hospital Revenue Code	307
Min. Negotiated Rate	$5.81
Max. Negotiated Rate	$207.20
Rate for Payer: Aetna Commercial	$23.42
Rate for Payer: Aetna Medicare Advantage	$27.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.08
Rate for Payer: Cigna Commercial	$207.20
Rate for Payer: Cigna Medicare Advantage	$8.61
Rate for Payer: Clover Medicare Advantage	$8.18
Rate for Payer: EmblemHealth Commercial	$25.83
Rate for Payer: Humana Medicare Advantage	$8.87
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.32
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.16
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.61
Rate for Payer: Wellcare Medicare Advantage	$8.61
Rate for Payer: Wellpoint Medicaid Managed Care	$10.98

CFH WC URINE PREGNANCY TEST

Facility

$414.40

Service Code	HCPCS 81025
Hospital Charge Code	83652275
Hospital Revenue Code	307
Min. Negotiated Rate	$62.16
Max. Negotiated Rate	$62.16
Rate for Payer: Qualcare PPO/HMO/WC	$62.16

CFH WC V BAC ONLY

Professional

Both

$2,395.00

Service Code	HCPCS 59612
Hospital Charge Code	83652239
Hospital Revenue Code	960
Min. Negotiated Rate	$357.95
Max. Negotiated Rate	$2,721.55
Rate for Payer: Aetna Medicare Advantage	$2,721.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,721.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,721.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,721.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,721.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,721.55
Rate for Payer: UnitedHealthcare Commercial	$357.95
Rate for Payer: UnitedHealthcare Community & State	$357.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$357.95

CFH WC VENIPUNCTURE

Facility

$51.00

Service Code	HCPCS 36415
Hospital Charge Code	83652101
Hospital Revenue Code	300
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$7.65
Rate for Payer: Qualcare PPO/HMO/WC	$7.65

CFH WC VENIPUNCTURE

Facility

$51.00

Service Code	HCPCS 36415
Hospital Charge Code	83652101
Hospital Revenue Code	300
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$25.40
Rate for Payer: Aetna Medicare Advantage	$30.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.71
Rate for Payer: Cigna Commercial	$25.50
Rate for Payer: Cigna Medicare Advantage	$9.34
Rate for Payer: Clover Medicare Advantage	$8.87
Rate for Payer: EmblemHealth Commercial	$28.02
Rate for Payer: Humana Medicare Advantage	$9.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.65
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.34
Rate for Payer: Wellcare Medicare Advantage	$9.34
Rate for Payer: Wellpoint Medicaid Managed Care	$1.35

CFH WC WET MOUNT/KOH

Facility

$390.00

Service Code	HCPCS 87210
Hospital Charge Code	83652287
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CFH WC WET MOUNT/KOH

Facility

$390.00

Service Code	HCPCS 87210
Hospital Charge Code	83652287
Hospital Revenue Code	309
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$15.83
Rate for Payer: Aetna Medicare Advantage	$18.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.01
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.82
Rate for Payer: Clover Medicare Advantage	$5.53
Rate for Payer: EmblemHealth Commercial	$17.46
Rate for Payer: Humana Medicare Advantage	$5.99
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.82
Rate for Payer: Wellcare Medicare Advantage	$5.82
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

CFH WELLNESS EST PT 18-39 YRS

Facility

$64.00

Service Code	HCPCS 99395
Hospital Charge Code	83652491
Hospital Revenue Code	514
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$32.00
Rate for Payer: Aetna Commercial	$24.32
Rate for Payer: Aetna Medicare Advantage	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.32
Rate for Payer: Cigna Commercial	$32.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$9.60
Rate for Payer: UnitedHealthcare Community & State	$1.54
Rate for Payer: Wellpoint Medicaid Managed Care	$1.70

CFH WELLNESS EST PT 18-39 YRS

Facility

$64.00

Service Code	HCPCS 99395
Hospital Charge Code	83652491
Hospital Revenue Code	514
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$9.60

CFH WELLNESS EST PT 40-64 YRS

Facility

$84.00

Service Code	HCPCS 99396
Hospital Charge Code	83652493
Hospital Revenue Code	514
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$42.00
Rate for Payer: Aetna Commercial	$31.92
Rate for Payer: Aetna Medicare Advantage	$25.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.42
Rate for Payer: Cigna Commercial	$42.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.20
Rate for Payer: Qualcare PPO/HMO/WC	$12.60
Rate for Payer: UnitedHealthcare Community & State	$2.02
Rate for Payer: Wellpoint Medicaid Managed Care	$2.23

CFH WELLNESS EST PT 40-64 YRS

Facility

$84.00

Service Code	HCPCS 99396
Hospital Charge Code	83652493
Hospital Revenue Code	514
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$12.60
Rate for Payer: Qualcare PPO/HMO/WC	$12.60

CFH WELLNESS EST PT >64 YRS

Facility

$97.00

Service Code	HCPCS 99397
Hospital Charge Code	83652495
Hospital Revenue Code	514
Min. Negotiated Rate	$14.55
Max. Negotiated Rate	$14.55
Rate for Payer: Qualcare PPO/HMO/WC	$14.55

CFH WELLNESS EST PT >64 YRS

Facility

$97.00

Service Code	HCPCS 99397
Hospital Charge Code	83652495
Hospital Revenue Code	514
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$48.50
Rate for Payer: Aetna Commercial	$36.86
Rate for Payer: Aetna Medicare Advantage	$29.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.73
Rate for Payer: Cigna Commercial	$48.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.10
Rate for Payer: Qualcare PPO/HMO/WC	$14.55
Rate for Payer: UnitedHealthcare Community & State	$2.34
Rate for Payer: Wellpoint Medicaid Managed Care	$2.57

CFH WELLNESS NEW PT 18-39 YRS

Facility

$92.00

Service Code	HCPCS 99385
Hospital Charge Code	83652477
Hospital Revenue Code	514
Min. Negotiated Rate	$13.80
Max. Negotiated Rate	$13.80
Rate for Payer: Qualcare PPO/HMO/WC	$13.80

CFH WELLNESS NEW PT 18-39 YRS

Facility

$92.00

Service Code	HCPCS 99385
Hospital Charge Code	83652477
Hospital Revenue Code	514
Min. Negotiated Rate	$2.22
Max. Negotiated Rate	$46.00
Rate for Payer: Aetna Commercial	$34.96
Rate for Payer: Aetna Medicare Advantage	$27.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.46
Rate for Payer: Cigna Commercial	$46.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.60
Rate for Payer: Qualcare PPO/HMO/WC	$13.80
Rate for Payer: UnitedHealthcare Community & State	$2.22
Rate for Payer: Wellpoint Medicaid Managed Care	$2.44

Know your out-of-pocket cost for care.

All Charges