Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE

Facility

$6,006.92

Service Code	APR-DRG 8172
Min. Negotiated Rate	$5,889.14
Max. Negotiated Rate	$6,006.92
Rate for Payer: UnitedHealthcare Community & State	$5,889.14
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$6,006.92
Rate for Payer: Wellpoint Medicaid Managed Care	$5,889.14

INTERAC INDIV PT OP 20-30M W/O

Facility

$534.40

Service Code	HCPCS 90810
Hospital Charge Code	9310130
Hospital Revenue Code	914
Min. Negotiated Rate	$80.16
Max. Negotiated Rate	$80.16
Rate for Payer: Qualcare PPO/HMO/WC	$80.16

INTERAC INDIV PT OP 20-30M W/O

Facility

$534.40

Service Code	HCPCS 90810
Hospital Charge Code	9310130
Hospital Revenue Code	914
Min. Negotiated Rate	$12.88
Max. Negotiated Rate	$267.20
Rate for Payer: Aetna Commercial	$203.07
Rate for Payer: Aetna Medicare Advantage	$160.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$136.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$136.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$136.27
Rate for Payer: Cigna Commercial	$267.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.32
Rate for Payer: Qualcare PPO/HMO/WC	$80.16
Rate for Payer: UnitedHealthcare Community & State	$12.88
Rate for Payer: Wellpoint Medicaid Managed Care	$14.16

INTERAC INDIV PT OP 45-50M W/O

Facility

$751.40

Service Code	HCPCS 90812
Hospital Charge Code	9310135
Hospital Revenue Code	914
Min. Negotiated Rate	$112.71
Max. Negotiated Rate	$112.71
Rate for Payer: Qualcare PPO/HMO/WC	$112.71

INTERAC INDIV PT OP 45-50M W/O

Facility

$751.40

Service Code	HCPCS 90812
Hospital Charge Code	9310135
Hospital Revenue Code	914
Min. Negotiated Rate	$18.11
Max. Negotiated Rate	$375.70
Rate for Payer: Aetna Commercial	$285.53
Rate for Payer: Aetna Medicare Advantage	$225.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.61
Rate for Payer: Cigna Commercial	$375.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.42
Rate for Payer: Qualcare PPO/HMO/WC	$112.71
Rate for Payer: UnitedHealthcare Community & State	$18.11
Rate for Payer: Wellpoint Medicaid Managed Care	$19.91

INTERACT COMPLEX MD (ADD ON CO

Facility

$275.00

Service Code	HCPCS 90785
Hospital Charge Code	4527709
Hospital Revenue Code	914
Min. Negotiated Rate	$5.20
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) NJ Health	$5.20
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

INTERACT COMPLEX MD (ADD ON CO

Facility

$275.00

Service Code	HCPCS 90785
Hospital Charge Code	4517709
Hospital Revenue Code	914
Min. Negotiated Rate	$5.20
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) NJ Health	$5.20
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

INTERACT COMPLEX MD (ADD ON CO

Facility

$275.00

Service Code	HCPCS 90785
Hospital Charge Code	4517709
Hospital Revenue Code	914
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

INTERACT COMPLEX MD (ADD ON CO

Facility

$275.00

Service Code	HCPCS 90785
Hospital Charge Code	4818709
Hospital Revenue Code	914
Min. Negotiated Rate	$5.20
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) NJ Health	$5.20
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

INTERACT COMPLEX MD (ADD ON CO

Facility

$275.00

Service Code	HCPCS 90785
Hospital Charge Code	4504709
Hospital Revenue Code	914
Min. Negotiated Rate	$5.20
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) NJ Health	$5.20
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

INTERACT COMPLEX MD (ADD ON CO

Facility

$275.00

Service Code	HCPCS 90785
Hospital Charge Code	4504709
Hospital Revenue Code	914
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

INTERACT COMPLEX MD (ADD ON CO

Facility

$275.00

Service Code	HCPCS 90785
Hospital Charge Code	4824709
Hospital Revenue Code	914
Min. Negotiated Rate	$5.20
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) NJ Health	$5.20
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

INTERACT COMPLEX MD (ADD ON CO

Facility

$275.00

Service Code	HCPCS 90785
Hospital Charge Code	4502709
Hospital Revenue Code	914
Min. Negotiated Rate	$5.20
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) NJ Health	$5.20
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

INTERACT COMPLEX MD (ADD ON CO

Facility

$275.00

Service Code	HCPCS 90785
Hospital Charge Code	4511709
Hospital Revenue Code	914
Min. Negotiated Rate	$5.20
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) NJ Health	$5.20
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

INTERACT COMPLEX MD (ADD ON CO

Facility

$275.00

Service Code	HCPCS 90785
Hospital Charge Code	4511709
Hospital Revenue Code	914
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

INTERACT COMPLEX MD (ADD ON CO

Facility

$275.00

Service Code	HCPCS 90785
Hospital Charge Code	4824709
Hospital Revenue Code	914
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

INTERACT COMPLEX MD (ADD ON CO

Facility

$275.00

Service Code	HCPCS 90785
Hospital Charge Code	4509709
Hospital Revenue Code	914
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

INTERACT COMPLEX MD (ADD ON CO

Facility

$275.00

Service Code	HCPCS 90785
Hospital Charge Code	4509709
Hospital Revenue Code	914
Min. Negotiated Rate	$5.20
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) NJ Health	$5.20
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

INTERACT COMPLEX MD (ADD ON CO

Facility

$275.00

Service Code	HCPCS 90785
Hospital Charge Code	4510709
Hospital Revenue Code	914
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

INTERACT COMPLEX MD (ADD ON CO

Facility

$275.00

Service Code	HCPCS 90785
Hospital Charge Code	4822709
Hospital Revenue Code	914
Min. Negotiated Rate	$5.20
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) NJ Health	$5.20
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

INTERACT COMPLEX MD (ADD ON CO

Facility

$275.00

Service Code	HCPCS 90785
Hospital Charge Code	4822709
Hospital Revenue Code	914
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

INTERACT COMPLEX MD (ADD ON CO

Facility

$275.00

Service Code	HCPCS 90785
Hospital Charge Code	4510709
Hospital Revenue Code	914
Min. Negotiated Rate	$5.20
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) NJ Health	$5.20
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

INTERACT COMPLEX MD (ADD ON CO

Facility

$275.00

Service Code	HCPCS 90785
Hospital Charge Code	4818709
Hospital Revenue Code	914
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

INTERACT COMPLEX MD (ADD ON CO

Facility

$275.00

Service Code	HCPCS 90785
Hospital Charge Code	4546709
Hospital Revenue Code	914
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

INTERACT COMPLEX MD (ADD ON CO

Facility

$275.00

Service Code	HCPCS 90785
Hospital Charge Code	4546709
Hospital Revenue Code	914
Min. Negotiated Rate	$5.20
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) NJ Health	$5.20
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

Know your out-of-pocket cost for care.

All Charges