Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PED PREV E&M NP 5-11 YRS OLD

Facility

$59.00

Service Code	HCPCS 99383
Hospital Charge Code	83652473
Hospital Revenue Code	515
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$29.50
Rate for Payer: Aetna Commercial	$22.42
Rate for Payer: Aetna Medicare Advantage	$17.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.04
Rate for Payer: Cigna Commercial	$29.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.70
Rate for Payer: Qualcare PPO/HMO/WC	$8.85
Rate for Payer: UnitedHealthcare Community & State	$1.42
Rate for Payer: Wellpoint Medicaid Managed Care	$1.56

PED PREV E&M NP 5-11 YRS OLD

Facility

$175.00

Service Code	HCPCS 99383
Hospital Charge Code	87502800
Hospital Revenue Code	515
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

PED PREV E&M NP 5-11 YRS OLD

Facility

$175.00

Service Code	HCPCS 99383
Hospital Charge Code	87502800
Hospital Revenue Code	515
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$66.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$26.25
Rate for Payer: UnitedHealthcare Community & State	$4.22
Rate for Payer: Wellpoint Medicaid Managed Care	$4.64

PED PREV EST PT 12 TO 17 YRS

Facility

$175.00

Service Code	HCPCS 99394
Hospital Charge Code	83652489
Hospital Revenue Code	515
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

PED PREV EST PT 12 TO 17 YRS

Facility

$175.00

Service Code	HCPCS 99394
Hospital Charge Code	83652489
Hospital Revenue Code	515
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$66.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$26.25
Rate for Payer: UnitedHealthcare Community & State	$4.22
Rate for Payer: Wellpoint Medicaid Managed Care	$4.64

PED PREV EST PT 5 TO 11 YRS

Facility

$175.00

Service Code	HCPCS 99393
Hospital Charge Code	83652487
Hospital Revenue Code	515
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$66.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$26.25
Rate for Payer: UnitedHealthcare Community & State	$4.22
Rate for Payer: Wellpoint Medicaid Managed Care	$4.64

PED PREV EST PT 5 TO 11 YRS

Facility

$175.00

Service Code	HCPCS 99393
Hospital Charge Code	83652487
Hospital Revenue Code	515
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

PED PSYCH PRIVATE

Facility

$18,000.00

Hospital Charge Code	100801
Hospital Revenue Code	114
Min. Negotiated Rate	$1,115.00
Max. Negotiated Rate	$3,360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,115.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,360.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,700.00

PED PSYCH SEMI-PRIVATE

Facility

$18,000.00

Hospital Charge Code	100802
Hospital Revenue Code	124
Min. Negotiated Rate	$1,115.00
Max. Negotiated Rate	$3,360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,115.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,360.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,700.00

PEDS DEVELOP SCRE & INTERP

Facility

$546.00

Service Code	HCPCS 96110
Hospital Charge Code	87502390
Hospital Revenue Code	918
Min. Negotiated Rate	$9.46
Max. Negotiated Rate	$3,081.00
Rate for Payer: Aetna Commercial	$207.48
Rate for Payer: Aetna Medicare Advantage	$163.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$139.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$139.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$139.23
Rate for Payer: Cigna Commercial	$273.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.80
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$81.90
Rate for Payer: UnitedHealthcare Commercial	$3,081.00
Rate for Payer: UnitedHealthcare Community & State	$13.16
Rate for Payer: Wellpoint Medicaid Managed Care	$14.47

PEDS DEVELOP SCRE & INTERP

Facility

$546.00

Service Code	HCPCS 96110
Hospital Charge Code	87502390
Hospital Revenue Code	918
Min. Negotiated Rate	$81.90
Max. Negotiated Rate	$81.90
Rate for Payer: Qualcare PPO/HMO/WC	$81.90

PEDS DEVLOPMNTL SCRN & INTERP

Facility

$546.00

Service Code	HCPCS 96110
Hospital Charge Code	73050860
Hospital Revenue Code	918
Min. Negotiated Rate	$81.90
Max. Negotiated Rate	$81.90
Rate for Payer: Qualcare PPO/HMO/WC	$81.90

PEDS DEVLOPMNTL SCRN & INTERP

Facility

$546.00

Service Code	HCPCS 96110
Hospital Charge Code	73050860
Hospital Revenue Code	918
Min. Negotiated Rate	$9.46
Max. Negotiated Rate	$3,081.00
Rate for Payer: Aetna Commercial	$207.48
Rate for Payer: Aetna Medicare Advantage	$163.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$139.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$139.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$139.23
Rate for Payer: Cigna Commercial	$273.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.80
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$81.90
Rate for Payer: UnitedHealthcare Commercial	$3,081.00
Rate for Payer: UnitedHealthcare Community & State	$13.16
Rate for Payer: Wellpoint Medicaid Managed Care	$14.47

PEDS DEVLOPMNTL SCRN & INTERP

Facility

$546.00

Service Code	HCPCS 96110
Hospital Charge Code	83652385
Hospital Revenue Code	918
Min. Negotiated Rate	$81.90
Max. Negotiated Rate	$81.90
Rate for Payer: Qualcare PPO/HMO/WC	$81.90

PEDS DEVLOPMNTL SCRN & INTERP

Facility

$546.00

Service Code	HCPCS 96110
Hospital Charge Code	83652385
Hospital Revenue Code	918
Min. Negotiated Rate	$9.46
Max. Negotiated Rate	$3,081.00
Rate for Payer: Aetna Commercial	$207.48
Rate for Payer: Aetna Medicare Advantage	$163.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$139.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$139.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$139.23
Rate for Payer: Cigna Commercial	$273.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.80
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$81.90
Rate for Payer: UnitedHealthcare Commercial	$3,081.00
Rate for Payer: UnitedHealthcare Community & State	$13.16
Rate for Payer: Wellpoint Medicaid Managed Care	$14.47

PEDS PED DTAP < 7 YEARS OLD

Facility

$105.00

Service Code	HCPCS 90700
Hospital Charge Code	73050801
Hospital Revenue Code	636
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$52.50
Rate for Payer: Aetna Commercial	$39.90
Rate for Payer: Aetna Medicare Advantage	$31.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.77
Rate for Payer: Cigna Commercial	$52.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.41
Rate for Payer: Qualcare PPO/HMO/WC	$15.75
Rate for Payer: UnitedHealthcare Community & State	$2.53
Rate for Payer: Wellpoint Medicaid Managed Care	$2.78

PEDS PED DTAP < 7 YEARS OLD

Facility

$105.00

Service Code	HCPCS 90700
Hospital Charge Code	73050801
Hospital Revenue Code	636
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$25.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.41
Rate for Payer: Qualcare PPO/HMO/WC	$15.75

PEDS PREV E&M NP 1-4 YRS OLD

Facility

$59.00

Service Code	HCPCS 99382
Hospital Charge Code	73050820
Hospital Revenue Code	515
Min. Negotiated Rate	$8.85
Max. Negotiated Rate	$8.85
Rate for Payer: Qualcare PPO/HMO/WC	$8.85

PEDS PREV E&M NP 1-4 YRS OLD

Facility

$59.00

Service Code	HCPCS 99382
Hospital Charge Code	73050820
Hospital Revenue Code	515
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$29.50
Rate for Payer: Aetna Commercial	$22.42
Rate for Payer: Aetna Medicare Advantage	$17.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.04
Rate for Payer: Cigna Commercial	$29.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.70
Rate for Payer: Qualcare PPO/HMO/WC	$8.85
Rate for Payer: UnitedHealthcare Community & State	$1.42
Rate for Payer: Wellpoint Medicaid Managed Care	$1.56

PEDS PREV. E&M NP < 1 YEAR OLD

Facility

$59.00

Service Code	HCPCS 99381
Hospital Charge Code	73050815
Hospital Revenue Code	515
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$29.50
Rate for Payer: Aetna Commercial	$22.42
Rate for Payer: Aetna Medicare Advantage	$17.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.04
Rate for Payer: Cigna Commercial	$29.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.70
Rate for Payer: Qualcare PPO/HMO/WC	$8.85
Rate for Payer: UnitedHealthcare Community & State	$1.42
Rate for Payer: Wellpoint Medicaid Managed Care	$1.56

PEDS PREV. E&M NP < 1 YEAR OLD

Facility

$59.00

Service Code	HCPCS 99381
Hospital Charge Code	73050815
Hospital Revenue Code	515
Min. Negotiated Rate	$8.85
Max. Negotiated Rate	$8.85
Rate for Payer: Qualcare PPO/HMO/WC	$8.85

PEDS PREV E&M NP 5-11 YRS OLD

Facility

$59.00

Service Code	HCPCS 99383
Hospital Charge Code	73050825
Hospital Revenue Code	515
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$29.50
Rate for Payer: Aetna Commercial	$22.42
Rate for Payer: Aetna Medicare Advantage	$17.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.04
Rate for Payer: Cigna Commercial	$29.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.70
Rate for Payer: Qualcare PPO/HMO/WC	$8.85
Rate for Payer: UnitedHealthcare Community & State	$1.42
Rate for Payer: Wellpoint Medicaid Managed Care	$1.56

PEDS PREV E&M NP 5-11 YRS OLD

Facility

$59.00

Service Code	HCPCS 99383
Hospital Charge Code	73050825
Hospital Revenue Code	515
Min. Negotiated Rate	$8.85
Max. Negotiated Rate	$8.85
Rate for Payer: Qualcare PPO/HMO/WC	$8.85

PEDS PREV EST PT 12 TO 17 YRS

Facility

$175.00

Service Code	HCPCS 99394
Hospital Charge Code	73050850
Hospital Revenue Code	515
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

PEDS PREV EST PT 12 TO 17 YRS

Facility

$175.00

Service Code	HCPCS 99394
Hospital Charge Code	73050850
Hospital Revenue Code	515
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$66.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$26.25
Rate for Payer: UnitedHealthcare Community & State	$4.22
Rate for Payer: Wellpoint Medicaid Managed Care	$4.64

Know your out-of-pocket cost for care.

All Charges