Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

INTERACT COMPLEX NON MD CHILD

Facility

$750.00

Service Code	HCPCS 90785
Hospital Charge Code	4511501
Hospital Revenue Code	914
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

INTERACT COMPLEX NON MD CHILD

Facility

$750.00

Service Code	HCPCS 90785
Hospital Charge Code	4515501
Hospital Revenue Code	914
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

INTERACTIVE COMPLEXITY

Facility

$76.25

Service Code	HCPCS 90785
Hospital Charge Code	84517049
Hospital Revenue Code	900
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$3,081.00
Rate for Payer: Aetna Commercial	$28.98
Rate for Payer: Aetna Medicare Advantage	$22.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.44
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	$19.44
Rate for Payer: Cigna Commercial	$38.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.88
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.44
Rate for Payer: UnitedHealthcare Commercial	$3,081.00
Rate for Payer: UnitedHealthcare Community & State	$1.84
Rate for Payer: Wellpoint Medicaid Managed Care	$2.02

INTERACTIVE COMPLEXITY

Facility

$76.25

Service Code	HCPCS 90785
Hospital Charge Code	84517049
Hospital Revenue Code	900
Min. Negotiated Rate	$11.44
Max. Negotiated Rate	$11.44
Rate for Payer: Qualcare PPO/HMO/WC	$11.44

INTERACTIVE COMPLEXITY

Facility

$76.25

Service Code	HCPCS 90785
Hospital Charge Code	84518049
Hospital Revenue Code	900
Min. Negotiated Rate	$11.44
Max. Negotiated Rate	$11.44
Rate for Payer: Qualcare PPO/HMO/WC	$11.44

INTERACTIVE COMPLEXITY

Facility

$76.25

Service Code	HCPCS 90785
Hospital Charge Code	84518049
Hospital Revenue Code	900
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$3,081.00
Rate for Payer: Aetna Commercial	$28.98
Rate for Payer: Aetna Medicare Advantage	$22.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.44
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	$19.44
Rate for Payer: Cigna Commercial	$38.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.88
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.44
Rate for Payer: UnitedHealthcare Commercial	$3,081.00
Rate for Payer: UnitedHealthcare Community & State	$1.84
Rate for Payer: Wellpoint Medicaid Managed Care	$2.02

INTERACTIVE COMPLEXITY

Facility

$76.25

Service Code	HCPCS 90785
Hospital Charge Code	84509049
Hospital Revenue Code	900
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$3,081.00
Rate for Payer: Aetna Commercial	$28.98
Rate for Payer: Aetna Medicare Advantage	$22.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.44
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	$19.44
Rate for Payer: Cigna Commercial	$38.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.88
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.44
Rate for Payer: UnitedHealthcare Commercial	$3,081.00
Rate for Payer: UnitedHealthcare Community & State	$1.84
Rate for Payer: Wellpoint Medicaid Managed Care	$2.02

INTERACTIVE COMPLEXITY

Facility

$76.25

Service Code	HCPCS 90785
Hospital Charge Code	84511049
Hospital Revenue Code	900
Min. Negotiated Rate	$11.44
Max. Negotiated Rate	$11.44
Rate for Payer: Qualcare PPO/HMO/WC	$11.44

INTERACTIVE COMPLEXITY

Facility

$6,800.00

Service Code	HCPCS 90785
Hospital Charge Code	83246150
Hospital Revenue Code	900
Min. Negotiated Rate	$1,020.00
Max. Negotiated Rate	$1,020.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00

INTERACTIVE COMPLEXITY

Facility

$76.25

Service Code	HCPCS 90785
Hospital Charge Code	84509049
Hospital Revenue Code	900
Min. Negotiated Rate	$11.44
Max. Negotiated Rate	$11.44
Rate for Payer: Qualcare PPO/HMO/WC	$11.44

INTERACTIVE COMPLEXITY

Facility

$550.00

Service Code	HCPCS 90785
Hospital Charge Code	87504130
Hospital Revenue Code	900
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$3,081.00
Rate for Payer: Aetna Commercial	$209.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
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	$140.25
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.00
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Commercial	$3,081.00
Rate for Payer: UnitedHealthcare Community & State	$13.26
Rate for Payer: Wellpoint Medicaid Managed Care	$14.57

INTERACTIVE COMPLEXITY

Facility

$6,800.00

Service Code	HCPCS 90785
Hospital Charge Code	83246150
Hospital Revenue Code	900
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$3,400.00
Rate for Payer: Aetna Commercial	$2,584.00
Rate for Payer: Aetna Medicare Advantage	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,734.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,734.00
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	$1,734.00
Rate for Payer: Cigna Commercial	$3,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,040.00
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00
Rate for Payer: UnitedHealthcare Commercial	$3,081.00
Rate for Payer: UnitedHealthcare Community & State	$163.88
Rate for Payer: Wellpoint Medicaid Managed Care	$180.20

INTERACTIVE COMPLEXITY

Facility

$76.25

Service Code	HCPCS 90785
Hospital Charge Code	84511049
Hospital Revenue Code	900
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$3,081.00
Rate for Payer: Aetna Commercial	$28.98
Rate for Payer: Aetna Medicare Advantage	$22.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.44
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	$19.44
Rate for Payer: Cigna Commercial	$38.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.88
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.44
Rate for Payer: UnitedHealthcare Commercial	$3,081.00
Rate for Payer: UnitedHealthcare Community & State	$1.84
Rate for Payer: Wellpoint Medicaid Managed Care	$2.02

INTERACTIVE COMPLEXITY

Facility

$550.00

Service Code	HCPCS 90785
Hospital Charge Code	87504130
Hospital Revenue Code	900
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

INTERACTIVE COMPLEXITY NON MD

Facility

$275.00

Service Code	HCPCS 90785
Hospital Charge Code	4546776
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

INTERACTIVE COMPLEXITY NON MD

Facility

$275.00

Service Code	HCPCS 90785
Hospital Charge Code	4546776
Hospital Revenue Code	914
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

INTERACTIVE COMPLXTY CLIN

Facility

$6,800.00

Service Code	HCPCS 90785
Hospital Charge Code	94810140
Hospital Revenue Code	900
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$3,400.00
Rate for Payer: Aetna Commercial	$2,584.00
Rate for Payer: Aetna Medicare Advantage	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,734.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,734.00
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	$1,734.00
Rate for Payer: Cigna Commercial	$3,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,040.00
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00
Rate for Payer: UnitedHealthcare Commercial	$3,081.00
Rate for Payer: UnitedHealthcare Community & State	$163.88
Rate for Payer: Wellpoint Medicaid Managed Care	$180.20

INTERACTIVE COMPLXTY CLIN

Facility

$6,800.00

Service Code	HCPCS 90785
Hospital Charge Code	94810140
Hospital Revenue Code	900
Min. Negotiated Rate	$1,020.00
Max. Negotiated Rate	$1,020.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00

INTERACTIVE GROUP PSYCHOTHERPY

Facility

$628.50

Service Code	HCPCS 90857
Hospital Charge Code	9310145
Hospital Revenue Code	915
Min. Negotiated Rate	$94.28
Max. Negotiated Rate	$94.28
Rate for Payer: Qualcare PPO/HMO/WC	$94.28

INTERACTIVE GROUP PSYCHOTHERPY

Facility

$628.50

Service Code	HCPCS 90857
Hospital Charge Code	9310145
Hospital Revenue Code	915
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$314.25
Rate for Payer: Aetna Commercial	$238.83
Rate for Payer: Aetna Medicare Advantage	$188.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.27
Rate for Payer: Cigna Commercial	$314.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.55
Rate for Payer: Qualcare PPO/HMO/WC	$94.28
Rate for Payer: UnitedHealthcare Community & State	$15.15
Rate for Payer: Wellpoint Medicaid Managed Care	$16.66

INTERACT PSYCH DX INTERVIEW

Facility

$751.40

Service Code	HCPCS 90802
Hospital Charge Code	9310125
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 PSYCH DX INTERVIEW

Facility

$751.40

Service Code	HCPCS 90802
Hospital Charge Code	9310125
Hospital Revenue Code	914
Min. Negotiated Rate	$112.71
Max. Negotiated Rate	$112.71
Rate for Payer: Qualcare PPO/HMO/WC	$112.71

INTERBODY 14MM X 12MM X 7MM 7

Facility

$12,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270686932
Hospital Revenue Code	278
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$2,904.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,640.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

INTERBODY 14MM X 12MM X 7MM 7

Facility

$12,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270686932
Hospital Revenue Code	278
Min. Negotiated Rate	$289.20
Max. Negotiated Rate	$6,000.00
Rate for Payer: Aetna Commercial	$4,560.00
Rate for Payer: Aetna Medicare Advantage	$3,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$6,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,640.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Community & State	$289.20
Rate for Payer: Wellpoint Medicaid Managed Care	$318.00

INTERBODY 14 MM X 12 MM X 8 MM

Facility

$12,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270687502
Hospital Revenue Code	278
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$2,904.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,640.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

Know your out-of-pocket cost for care.

All Charges