Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CRISIS PSYCHOTHERAPY ADD30MINS

Facility

$1,094.00

Service Code	HCPCS 90840
Hospital Charge Code	97504050
Hospital Revenue Code	914
Min. Negotiated Rate	$164.10
Max. Negotiated Rate	$164.10
Rate for Payer: Qualcare PPO/HMO/WC	$164.10

CRISIS PSYCHOTHERAPY ADD30MINS

Facility

$275.00

Service Code	HCPCS 90840
Hospital Charge Code	84310095
Hospital Revenue Code	914
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$137.50
Rate for Payer: Aetna Commercial	$104.50
Rate for Payer: Aetna Medicare Advantage	$82.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.12
Rate for Payer: Cigna Commercial	$137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$41.25
Rate for Payer: UnitedHealthcare Community & State	$6.63
Rate for Payer: Wellpoint Medicaid Managed Care	$7.29

CRISIS PSYCHOTHERAPY EACH ADD

Facility

$275.00

Service Code	HCPCS 90840
Hospital Charge Code	4546778
Hospital Revenue Code	914
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$137.50
Rate for Payer: Aetna Commercial	$104.50
Rate for Payer: Aetna Medicare Advantage	$82.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.12
Rate for Payer: Cigna Commercial	$137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$41.25
Rate for Payer: UnitedHealthcare Community & State	$6.63
Rate for Payer: Wellpoint Medicaid Managed Care	$7.29

CRISIS PSYCHOTHERAPY EACH ADD

Facility

$275.00

Service Code	HCPCS 90840
Hospital Charge Code	4546778
Hospital Revenue Code	914
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

CRISIS PSYCHOTHERAPY; FIRST 60

Facility

$2,000.00

Service Code	HCPCS 90839
Hospital Charge Code	4546777
Hospital Revenue Code	914
Min. Negotiated Rate	$48.20
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	$120.67
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	$600.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$48.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellpoint Medicaid Managed Care	$53.00

CRISIS PSYCHOTHERAPY; FIRST 60

Facility

$2,000.00

Service Code	HCPCS 90839
Hospital Charge Code	45467777
Hospital Revenue Code	914
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

CRISIS PSYCHOTHERAPY; FIRST 60

Facility

$2,000.00

Service Code	HCPCS 90839
Hospital Charge Code	45467777
Hospital Revenue Code	914
Min. Negotiated Rate	$48.20
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	$120.67
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	$600.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$48.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellpoint Medicaid Managed Care	$53.00

CRISIS PSYCHOTHERAPY; FIRST 60

Facility

$2,000.00

Service Code	HCPCS 90839
Hospital Charge Code	4546777
Hospital Revenue Code	914
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

CRISIS PSYCHOTX 1ST HOUR ADULT

Facility

$2,000.00

Service Code	HCPCS 90839
Hospital Charge Code	4824510
Hospital Revenue Code	914
Min. Negotiated Rate	$48.20
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	$120.67
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	$600.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$48.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellpoint Medicaid Managed Care	$53.00

CRISIS PSYCHOTX 1ST HOUR ADULT

Facility

$2,000.00

Service Code	HCPCS 90839
Hospital Charge Code	4832510
Hospital Revenue Code	914
Min. Negotiated Rate	$48.20
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	$120.67
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	$600.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$48.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellpoint Medicaid Managed Care	$53.00

CRISIS PSYCHOTX 1ST HOUR ADULT

Facility

$2,000.00

Service Code	HCPCS 90839
Hospital Charge Code	4818510
Hospital Revenue Code	914
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

CRISIS PSYCHOTX 1ST HOUR ADULT

Facility

$2,000.00

Service Code	HCPCS 90839
Hospital Charge Code	4822510
Hospital Revenue Code	914
Min. Negotiated Rate	$48.20
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	$120.67
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	$600.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$48.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellpoint Medicaid Managed Care	$53.00

CRISIS PSYCHOTX 1ST HOUR ADULT

Facility

$2,000.00

Service Code	HCPCS 90839
Hospital Charge Code	4832510
Hospital Revenue Code	914
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

CRISIS PSYCHOTX 1ST HOUR ADULT

Facility

$2,000.00

Service Code	HCPCS 90839
Hospital Charge Code	4509510
Hospital Revenue Code	914
Min. Negotiated Rate	$48.20
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	$120.67
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	$600.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$48.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellpoint Medicaid Managed Care	$53.00

CRISIS PSYCHOTX 1ST HOUR ADULT

Facility

$2,000.00

Service Code	HCPCS 90839
Hospital Charge Code	4822510
Hospital Revenue Code	914
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

CRISIS PSYCHOTX 1ST HOUR ADULT

Facility

$2,000.00

Service Code	HCPCS 90839
Hospital Charge Code	4535510
Hospital Revenue Code	914
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

CRISIS PSYCHOTX 1ST HOUR ADULT

Facility

$2,000.00

Service Code	HCPCS 90839
Hospital Charge Code	4535510
Hospital Revenue Code	914
Min. Negotiated Rate	$48.20
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	$120.67
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	$600.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$48.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellpoint Medicaid Managed Care	$53.00

CRISIS PSYCHOTX 1ST HOUR ADULT

Facility

$2,000.00

Service Code	HCPCS 90839
Hospital Charge Code	4502510
Hospital Revenue Code	914
Min. Negotiated Rate	$48.20
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	$120.67
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	$600.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$48.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellpoint Medicaid Managed Care	$53.00

CRISIS PSYCHOTX 1ST HOUR ADULT

Facility

$2,000.00

Service Code	HCPCS 90839
Hospital Charge Code	4502510
Hospital Revenue Code	914
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

CRISIS PSYCHOTX 1ST HOUR ADULT

Facility

$2,000.00

Service Code	HCPCS 90839
Hospital Charge Code	4509510
Hospital Revenue Code	914
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

CRISIS PSYCHOTX 1ST HOUR ADULT

Facility

$2,000.00

Service Code	HCPCS 90839
Hospital Charge Code	4511510
Hospital Revenue Code	914
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

CRISIS PSYCHOTX 1ST HOUR ADULT

Facility

$2,000.00

Service Code	HCPCS 90839
Hospital Charge Code	4511510
Hospital Revenue Code	914
Min. Negotiated Rate	$48.20
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	$120.67
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	$600.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$48.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellpoint Medicaid Managed Care	$53.00

CRISIS PSYCHOTX 1ST HOUR ADULT

Facility

$2,000.00

Service Code	HCPCS 90839
Hospital Charge Code	4818510
Hospital Revenue Code	914
Min. Negotiated Rate	$48.20
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	$120.67
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	$600.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$48.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellpoint Medicaid Managed Care	$53.00

CRISIS PSYCHOTX 1ST HOUR ADULT

Facility

$2,000.00

Service Code	HCPCS 90839
Hospital Charge Code	4824510
Hospital Revenue Code	914
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

CRISIS PSYCHOTX 1ST HOUR ADULT

Facility

$2,000.00

Service Code	HCPCS 90839
Hospital Charge Code	4504510
Hospital Revenue Code	914
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

Know your out-of-pocket cost for care.

All Charges