Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PSYCH DIAG EVAL NON MD CHILD

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4509503
Hospital Revenue Code	900
Min. Negotiated Rate	$163.88
Max. Negotiated Rate	$3,081.00
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	$267.07
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	$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: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$171.99
Rate for Payer: Wellpoint Medicaid Managed Care	$180.20

PSYCH DIAG EVAL NON MD CHILD

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4822503
Hospital Revenue Code	900
Min. Negotiated Rate	$163.88
Max. Negotiated Rate	$3,081.00
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	$267.07
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	$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: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$171.99
Rate for Payer: Wellpoint Medicaid Managed Care	$180.20

PSYCH DIAG EVAL NON MD CHILD

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4824503
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

PSYCH DIAG EVAL NON MD CHILD

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4546503
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

PSYCH DIAG EVAL NON MD CHILD

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4822503
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

PSYCH DIAG EVAL NON MD CHILD

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4509503
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

PSYCH DIAG EVAL NON MD CHILD

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4527503
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

PSYCH DIAG EVAL NON MD CHILD

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4510503
Hospital Revenue Code	900
Min. Negotiated Rate	$163.88
Max. Negotiated Rate	$3,081.00
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	$267.07
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	$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: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$171.99
Rate for Payer: Wellpoint Medicaid Managed Care	$180.20

PSYCH DIAG EVAL NON MD CHILD

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4535503
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

PSYCH DIAG EVAL NON MD CHILD

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4535503
Hospital Revenue Code	900
Min. Negotiated Rate	$163.88
Max. Negotiated Rate	$3,081.00
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	$267.07
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	$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: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$171.99
Rate for Payer: Wellpoint Medicaid Managed Care	$180.20

PSYCH DIAG EVAL NON MD CHILD

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4504503
Hospital Revenue Code	900
Min. Negotiated Rate	$163.88
Max. Negotiated Rate	$3,081.00
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	$267.07
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	$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: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$171.99
Rate for Payer: Wellpoint Medicaid Managed Care	$180.20

PSYCH DIAG EVAL NON MD CHILD

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4504503
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

PSYCH DIAG EVAL NON MD CHILD

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4511503
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

PSYCH DIAG EVAL W/MED SER

Facility

$6,800.00

Service Code	HCPCS 90792
Hospital Charge Code	94810160
Hospital Revenue Code	900
Min. Negotiated Rate	$163.88
Max. Negotiated Rate	$3,081.00
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	$663.81
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	$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: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$437.76
Rate for Payer: Wellpoint Medicaid Managed Care	$180.20

PSYCH DIAG EVAL W/MED SER

Facility

$6,800.00

Service Code	HCPCS 90792
Hospital Charge Code	94810160
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

PSYCH DIAG EVAL W/MED SERVCS

Facility

$1,879.97

Service Code	HCPCS 90792
Hospital Charge Code	7500130
Hospital Revenue Code	900
Min. Negotiated Rate	$45.31
Max. Negotiated Rate	$3,081.00
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	$663.81
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	$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: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$437.76
Rate for Payer: Wellpoint Medicaid Managed Care	$49.82

PSYCH DIAG EVAL W/MED SERVCS

Facility

$1,879.97

Service Code	HCPCS 90792
Hospital Charge Code	7500130
Hospital Revenue Code	900
Min. Negotiated Rate	$282.00
Max. Negotiated Rate	$282.00
Rate for Payer: Qualcare PPO/HMO/WC	$282.00

PSYCH DIAG EVAL W/MS

Facility

$550.00

Service Code	HCPCS 90792
Hospital Charge Code	84310005
Hospital Revenue Code	900
Min. Negotiated Rate	$13.26
Max. Negotiated Rate	$3,081.00
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	$663.81
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	$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: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$437.76
Rate for Payer: Wellpoint Medicaid Managed Care	$14.57

PSYCH DIAG EVAL W/MS

Facility

$550.00

Service Code	HCPCS 90792
Hospital Charge Code	84310005
Hospital Revenue Code	900
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

PSYCH DIAGNOSTIC EVAL

Facility

$682.20

Service Code	HCPCS 90791
Hospital Charge Code	73237003
Hospital Revenue Code	900
Min. Negotiated Rate	$16.44
Max. Negotiated Rate	$3,081.00
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	$267.07
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	$204.66
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$102.33
Rate for Payer: UnitedHealthcare Commercial	$3,081.00
Rate for Payer: UnitedHealthcare Community & State	$16.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$171.99
Rate for Payer: Wellpoint Medicaid Managed Care	$18.08

PSYCH DIAGNOSTIC EVAL

Facility

$550.00

Service Code	HCPCS 90791
Hospital Charge Code	84310001
Hospital Revenue Code	900
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

PSYCH DIAGNOSTIC EVAL

Facility

$682.20

Service Code	HCPCS 90791
Hospital Charge Code	73237003
Hospital Revenue Code	900
Min. Negotiated Rate	$102.33
Max. Negotiated Rate	$102.33
Rate for Payer: Qualcare PPO/HMO/WC	$102.33

PSYCH DIAGNOSTIC EVAL

Facility

$550.00

Service Code	HCPCS 90791
Hospital Charge Code	84310001
Hospital Revenue Code	900
Min. Negotiated Rate	$13.26
Max. Negotiated Rate	$3,081.00
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	$267.07
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	$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: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$171.99
Rate for Payer: Wellpoint Medicaid Managed Care	$14.57

PSYCH DIAGNOSTIC EVAL MD

Facility

$550.00

Service Code	HCPCS 90792
Hospital Charge Code	83246145
Hospital Revenue Code	900
Min. Negotiated Rate	$13.26
Max. Negotiated Rate	$3,081.00
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	$663.81
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	$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: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$437.76
Rate for Payer: Wellpoint Medicaid Managed Care	$14.57

PSYCH DIAGNOSTIC EVAL MD

Facility

$550.00

Service Code	HCPCS 90792
Hospital Charge Code	83246145
Hospital Revenue Code	900
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

Know your out-of-pocket cost for care.

All Charges