Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CNS IND THRPY W/MED MGT 20-30

Facility

$381.00

Service Code	HCPCS 90805
Hospital Charge Code	94810020
Hospital Revenue Code	914
Min. Negotiated Rate	$57.15
Max. Negotiated Rate	$57.15
Rate for Payer: Qualcare PPO/HMO/WC	$57.15

CNS IND THRPY W/MED MGT 45-50

Facility

$477.00

Service Code	HCPCS 90807
Hospital Charge Code	94810030
Hospital Revenue Code	914
Min. Negotiated Rate	$11.50
Max. Negotiated Rate	$238.50
Rate for Payer: Aetna Commercial	$181.26
Rate for Payer: Aetna Medicare Advantage	$143.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.64
Rate for Payer: Cigna Commercial	$238.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.10
Rate for Payer: Qualcare PPO/HMO/WC	$71.55
Rate for Payer: UnitedHealthcare Community & State	$11.50
Rate for Payer: Wellpoint Medicaid Managed Care	$12.64

CNS IND THRPY W/MED MGT 45-50

Facility

$477.00

Service Code	HCPCS 90807
Hospital Charge Code	94810030
Hospital Revenue Code	914
Min. Negotiated Rate	$71.55
Max. Negotiated Rate	$71.55
Rate for Payer: Qualcare PPO/HMO/WC	$71.55

CNS INITIAL EVALUATION

Facility

$1,879.97

Service Code	HCPCS 90801
Hospital Charge Code	94810010
Hospital Revenue Code	900
Min. Negotiated Rate	$45.31
Max. Negotiated Rate	$3,081.00
Rate for Payer: Aetna Commercial	$714.39
Rate for Payer: Aetna Medicare Advantage	$563.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$479.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$479.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$479.39
Rate for Payer: Cigna Commercial	$939.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$563.99
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$282.00
Rate for Payer: UnitedHealthcare Commercial	$3,081.00
Rate for Payer: UnitedHealthcare Community & State	$45.31
Rate for Payer: Wellpoint Medicaid Managed Care	$49.82

CNS INITIAL EVALUATION

Facility

$1,879.97

Service Code	HCPCS 90801
Hospital Charge Code	94810010
Hospital Revenue Code	900
Min. Negotiated Rate	$282.00
Max. Negotiated Rate	$282.00
Rate for Payer: Qualcare PPO/HMO/WC	$282.00

CNS MED MONITOR 2 UNITS/30MIN

Facility

$473.90

Service Code	HCPCS 90862
Hospital Charge Code	94810065
Hospital Revenue Code	914
Min. Negotiated Rate	$71.08
Max. Negotiated Rate	$71.08
Rate for Payer: Qualcare PPO/HMO/WC	$71.08

CNS MED MONITOR 2 UNITS/30MIN

Facility

$473.90

Service Code	HCPCS 90862
Hospital Charge Code	94810065
Hospital Revenue Code	914
Min. Negotiated Rate	$11.42
Max. Negotiated Rate	$236.95
Rate for Payer: Aetna Commercial	$180.08
Rate for Payer: Aetna Medicare Advantage	$142.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$120.84
Rate for Payer: Cigna Commercial	$236.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.17
Rate for Payer: Qualcare PPO/HMO/WC	$71.08
Rate for Payer: UnitedHealthcare Community & State	$11.42
Rate for Payer: Wellpoint Medicaid Managed Care	$12.56

CNS MULTIPLE FAMILY THERAPY

Facility

$286.00

Service Code	HCPCS 90849
Hospital Charge Code	94810045
Hospital Revenue Code	916
Min. Negotiated Rate	$6.89
Max. Negotiated Rate	$761.18
Rate for Payer: Aetna Commercial	$573.57
Rate for Payer: Aetna Medicare Advantage	$683.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$761.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$761.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$210.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$761.18
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: Cigna Medicare Advantage	$210.87
Rate for Payer: Clover Medicare Advantage	$200.33
Rate for Payer: EmblemHealth Commercial	$632.61
Rate for Payer: Humana Medicare Advantage	$217.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$210.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.80
Rate for Payer: Qualcare PPO/HMO/WC	$42.90
Rate for Payer: UnitedHealthcare Community & State	$6.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellpoint Medicaid Managed Care	$7.58

CNS MULTIPLE FAMILY THERAPY

Facility

$286.00

Service Code	HCPCS 90849
Hospital Charge Code	94810045
Hospital Revenue Code	916
Min. Negotiated Rate	$42.90
Max. Negotiated Rate	$42.90
Rate for Payer: Qualcare PPO/HMO/WC	$42.90

CNS PA-GROUP

Facility

$183.00

Service Code	HCPCS 90857
Hospital Charge Code	94810055
Hospital Revenue Code	915
Min. Negotiated Rate	$4.41
Max. Negotiated Rate	$91.50
Rate for Payer: Aetna Commercial	$69.54
Rate for Payer: Aetna Medicare Advantage	$54.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.66
Rate for Payer: Cigna Commercial	$91.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.90
Rate for Payer: Qualcare PPO/HMO/WC	$27.45
Rate for Payer: UnitedHealthcare Community & State	$4.41
Rate for Payer: Wellpoint Medicaid Managed Care	$4.85

CNS PA-GROUP

Facility

$183.00

Service Code	HCPCS 90857
Hospital Charge Code	94810055
Hospital Revenue Code	915
Min. Negotiated Rate	$27.45
Max. Negotiated Rate	$27.45
Rate for Payer: Qualcare PPO/HMO/WC	$27.45

CNS PHARMACOLOGIC MANAGEMENT

Facility

$473.90

Service Code	HCPCS 90863
Hospital Charge Code	94810060
Hospital Revenue Code	914
Min. Negotiated Rate	$71.08
Max. Negotiated Rate	$71.08
Rate for Payer: Qualcare PPO/HMO/WC	$71.08

CNS PHARMACOLOGIC MANAGEMENT

Facility

$473.90

Service Code	HCPCS 90863
Hospital Charge Code	94810060
Hospital Revenue Code	914
Min. Negotiated Rate	$11.42
Max. Negotiated Rate	$236.95
Rate for Payer: Aetna Commercial	$180.08
Rate for Payer: Aetna Medicare Advantage	$142.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$120.84
Rate for Payer: Cigna Commercial	$236.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.17
Rate for Payer: Qualcare PPO/HMO/WC	$71.08
Rate for Payer: UnitedHealthcare Community & State	$11.42
Rate for Payer: Wellpoint Medicaid Managed Care	$12.56

CNS PSC-WF-INDIVID 45-50

Facility

$1,017.00

Service Code	HCPCS 90806HF
Hospital Charge Code	94810095
Hospital Revenue Code	914
Min. Negotiated Rate	$152.55
Max. Negotiated Rate	$152.55
Rate for Payer: Qualcare PPO/HMO/WC	$152.55

CNS PSC-WF-INDIVID 45-50

Facility

$1,017.00

Service Code	HCPCS 90806HF
Hospital Charge Code	94810095
Hospital Revenue Code	914
Min. Negotiated Rate	$24.51
Max. Negotiated Rate	$508.50
Rate for Payer: Aetna Commercial	$386.46
Rate for Payer: Aetna Medicare Advantage	$305.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$259.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$259.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$259.33
Rate for Payer: Cigna Commercial	$508.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$305.10
Rate for Payer: Qualcare PPO/HMO/WC	$152.55
Rate for Payer: UnitedHealthcare Community & State	$24.51
Rate for Payer: Wellpoint Medicaid Managed Care	$26.95

CNS PSC-WF-IND PSYCH TX 20-30

Facility

$1,296.00

Service Code	HCPCS 90804HF
Hospital Charge Code	94810090
Hospital Revenue Code	914
Min. Negotiated Rate	$194.40
Max. Negotiated Rate	$194.40
Rate for Payer: Qualcare PPO/HMO/WC	$194.40

CNS PSC-WF-IND PSYCH TX 20-30

Facility

$1,296.00

Service Code	HCPCS 90804HF
Hospital Charge Code	94810090
Hospital Revenue Code	914
Min. Negotiated Rate	$31.23
Max. Negotiated Rate	$648.00
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: Qualcare PPO/HMO/WC	$194.40
Rate for Payer: UnitedHealthcare Community & State	$31.23
Rate for Payer: Wellpoint Medicaid Managed Care	$34.34

CNS PSC-WF-INITAL INTAKE EVAL

Facility

$1,879.97

Service Code	HCPCS 9080152
Hospital Charge Code	94810075
Hospital Revenue Code	900
Min. Negotiated Rate	$282.00
Max. Negotiated Rate	$282.00
Rate for Payer: Qualcare PPO/HMO/WC	$282.00

CNS PSC-WF-INITAL INTAKE EVAL

Facility

$1,879.97

Service Code	HCPCS 9080152
Hospital Charge Code	94810075
Hospital Revenue Code	900
Min. Negotiated Rate	$45.31
Max. Negotiated Rate	$3,081.00
Rate for Payer: Aetna Commercial	$714.39
Rate for Payer: Aetna Medicare Advantage	$563.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$479.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$479.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$479.39
Rate for Payer: Cigna Commercial	$939.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$563.99
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$282.00
Rate for Payer: UnitedHealthcare Commercial	$3,081.00
Rate for Payer: UnitedHealthcare Community & State	$45.31
Rate for Payer: Wellpoint Medicaid Managed Care	$49.82

CNS PSC-WF IOP-GROUP

Facility

$188.00

Service Code	HCPCS 90857HF
Hospital Charge Code	94810100
Hospital Revenue Code	915
Min. Negotiated Rate	$28.20
Max. Negotiated Rate	$28.20
Rate for Payer: Qualcare PPO/HMO/WC	$28.20

CNS PSC-WF IOP-GROUP

Facility

$188.00

Service Code	HCPCS 90857HF
Hospital Charge Code	94810100
Hospital Revenue Code	915
Min. Negotiated Rate	$4.53
Max. Negotiated Rate	$94.00
Rate for Payer: Aetna Commercial	$71.44
Rate for Payer: Aetna Medicare Advantage	$56.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.94
Rate for Payer: Cigna Commercial	$94.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.40
Rate for Payer: Qualcare PPO/HMO/WC	$28.20
Rate for Payer: UnitedHealthcare Community & State	$4.53
Rate for Payer: Wellpoint Medicaid Managed Care	$4.98

CNS PSC-WF-URINE SCREEN

Facility

$578.00

Hospital Charge Code	94810085
Hospital Revenue Code	301
Min. Negotiated Rate	$13.93
Max. Negotiated Rate	$289.00
Rate for Payer: Aetna Commercial	$219.64
Rate for Payer: Aetna Medicare Advantage	$173.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$147.39
Rate for Payer: Cigna Commercial	$289.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$86.70
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.93
Rate for Payer: Wellpoint Medicaid Managed Care	$15.32

CNS PSC-WF-URINE SCREEN

Facility

$578.00

Hospital Charge Code	94810085
Hospital Revenue Code	301
Min. Negotiated Rate	$86.70
Max. Negotiated Rate	$86.70
Rate for Payer: Qualcare PPO/HMO/WC	$86.70

CNS URINE CONFIRMATION

Facility

$375.00

Service Code	HCPCS 80102
Hospital Charge Code	94810005
Hospital Revenue Code	301
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

CNS URINE CONFIRMATION

Facility

$375.00

Service Code	HCPCS 80102
Hospital Charge Code	94810005
Hospital Revenue Code	301
Min. Negotiated Rate	$9.04
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.04
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

Know your out-of-pocket cost for care.

All Charges