Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PSYCH-ED GROUP SLEEP/DISCOMFOR

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	83246075
Hospital Revenue Code	915
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$120.12
Rate for Payer: Qualcare PPO/HMO/WC	$120.12

PSYCH-ED GROUP SLEEP/DISCOMFOR

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	83246075
Hospital Revenue Code	915
Min. Negotiated Rate	$19.30
Max. Negotiated Rate	$435.65
Rate for Payer: Aetna Commercial	$328.28
Rate for Payer: Aetna Medicare Advantage	$391.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$435.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$435.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$120.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$435.65
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: Cigna Medicare Advantage	$120.69
Rate for Payer: Clover Medicare Advantage	$114.66
Rate for Payer: EmblemHealth Commercial	$362.07
Rate for Payer: Humana Medicare Advantage	$124.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$120.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.24
Rate for Payer: Qualcare PPO/HMO/WC	$120.12
Rate for Payer: UnitedHealthcare Community & State	$19.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$120.69
Rate for Payer: Wellcare Medicare Advantage	$120.69
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27.48
Rate for Payer: Wellpoint Medicaid Managed Care	$21.22

PSYCH-ED GROUP STRESS/COPING

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	83246055
Hospital Revenue Code	915
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$120.12
Rate for Payer: Qualcare PPO/HMO/WC	$120.12

PSYCH-ED GROUP STRESS/COPING

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	83246055
Hospital Revenue Code	915
Min. Negotiated Rate	$19.30
Max. Negotiated Rate	$435.65
Rate for Payer: Aetna Commercial	$328.28
Rate for Payer: Aetna Medicare Advantage	$391.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$435.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$435.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$120.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$435.65
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: Cigna Medicare Advantage	$120.69
Rate for Payer: Clover Medicare Advantage	$114.66
Rate for Payer: EmblemHealth Commercial	$362.07
Rate for Payer: Humana Medicare Advantage	$124.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$120.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.24
Rate for Payer: Qualcare PPO/HMO/WC	$120.12
Rate for Payer: UnitedHealthcare Community & State	$19.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$120.69
Rate for Payer: Wellcare Medicare Advantage	$120.69
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27.48
Rate for Payer: Wellpoint Medicaid Managed Care	$21.22

PSYCH-ED WRAP UP GROUP

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	83246065
Hospital Revenue Code	915
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$120.12
Rate for Payer: Qualcare PPO/HMO/WC	$120.12

PSYCH-ED WRAP UP GROUP

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	83246065
Hospital Revenue Code	915
Min. Negotiated Rate	$19.30
Max. Negotiated Rate	$435.65
Rate for Payer: Aetna Commercial	$328.28
Rate for Payer: Aetna Medicare Advantage	$391.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$435.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$435.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$120.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$435.65
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: Cigna Medicare Advantage	$120.69
Rate for Payer: Clover Medicare Advantage	$114.66
Rate for Payer: EmblemHealth Commercial	$362.07
Rate for Payer: Humana Medicare Advantage	$124.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$120.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.24
Rate for Payer: Qualcare PPO/HMO/WC	$120.12
Rate for Payer: UnitedHealthcare Community & State	$19.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$120.69
Rate for Payer: Wellcare Medicare Advantage	$120.69
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27.48
Rate for Payer: Wellpoint Medicaid Managed Care	$21.22

PSYCH EMERGENCY SCREENING

Facility

$1,296.00

Service Code	HCPCS 90832
Hospital Charge Code	84310190
Hospital Revenue Code	914
Min. Negotiated Rate	$31.23
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	$115.26
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	$388.80
Rate for Payer: Qualcare PPO/HMO/WC	$194.40
Rate for Payer: UnitedHealthcare Community & State	$31.23
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	$71.39
Rate for Payer: Wellpoint Medicaid Managed Care	$34.34

PSYCH EMERGENCY SCREENING

Facility

$1,296.00

Service Code	HCPCS 90832
Hospital Charge Code	84310190
Hospital Revenue Code	914
Min. Negotiated Rate	$194.40
Max. Negotiated Rate	$194.40
Rate for Payer: Qualcare PPO/HMO/WC	$194.40

PSYCH E&M LEVEL I 10 MINS

Facility

$433.40

Hospital Charge Code	84310140
Hospital Revenue Code	513
Min. Negotiated Rate	$65.01
Max. Negotiated Rate	$65.01
Rate for Payer: Qualcare PPO/HMO/WC	$65.01

PSYCH E&M LEVEL I 10 MINS

Facility

$433.40

Hospital Charge Code	84310140
Hospital Revenue Code	513
Min. Negotiated Rate	$10.44
Max. Negotiated Rate	$216.70
Rate for Payer: Aetna Commercial	$164.69
Rate for Payer: Aetna Medicare Advantage	$130.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$110.52
Rate for Payer: Cigna Commercial	$216.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.02
Rate for Payer: Qualcare PPO/HMO/WC	$65.01
Rate for Payer: UnitedHealthcare Community & State	$10.44
Rate for Payer: Wellpoint Medicaid Managed Care	$11.49

PSYCH E&M LEVEL II 20MINS

Facility

$367.85

Hospital Charge Code	84310145
Hospital Revenue Code	513
Min. Negotiated Rate	$8.87
Max. Negotiated Rate	$183.93
Rate for Payer: Aetna Commercial	$139.78
Rate for Payer: Aetna Medicare Advantage	$110.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.80
Rate for Payer: Cigna Commercial	$183.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.36
Rate for Payer: Qualcare PPO/HMO/WC	$55.18
Rate for Payer: UnitedHealthcare Community & State	$8.87
Rate for Payer: Wellpoint Medicaid Managed Care	$9.75

PSYCH E&M LEVEL II 20MINS

Facility

$367.85

Hospital Charge Code	84310145
Hospital Revenue Code	513
Min. Negotiated Rate	$55.18
Max. Negotiated Rate	$55.18
Rate for Payer: Qualcare PPO/HMO/WC	$55.18

PSYCH E&M LEVEL III 30MINS

Facility

$484.05

Hospital Charge Code	84310150
Hospital Revenue Code	513
Min. Negotiated Rate	$72.61
Max. Negotiated Rate	$72.61
Rate for Payer: Qualcare PPO/HMO/WC	$72.61

PSYCH E&M LEVEL III 30MINS

Facility

$484.05

Hospital Charge Code	84310150
Hospital Revenue Code	513
Min. Negotiated Rate	$11.67
Max. Negotiated Rate	$242.03
Rate for Payer: Aetna Commercial	$183.94
Rate for Payer: Aetna Medicare Advantage	$145.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$123.43
Rate for Payer: Cigna Commercial	$242.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.22
Rate for Payer: Qualcare PPO/HMO/WC	$72.61
Rate for Payer: UnitedHealthcare Community & State	$11.67
Rate for Payer: Wellpoint Medicaid Managed Care	$12.83

PSYCH E&M LEVEL IV 45 MINS

Facility

$641.45

Hospital Charge Code	84310155
Hospital Revenue Code	513
Min. Negotiated Rate	$96.22
Max. Negotiated Rate	$96.22
Rate for Payer: Qualcare PPO/HMO/WC	$96.22

PSYCH E&M LEVEL IV 45 MINS

Facility

$641.45

Hospital Charge Code	84310155
Hospital Revenue Code	513
Min. Negotiated Rate	$15.46
Max. Negotiated Rate	$320.73
Rate for Payer: Aetna Commercial	$243.75
Rate for Payer: Aetna Medicare Advantage	$192.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$163.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$163.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$163.57
Rate for Payer: Cigna Commercial	$320.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$192.44
Rate for Payer: Qualcare PPO/HMO/WC	$96.22
Rate for Payer: UnitedHealthcare Community & State	$15.46
Rate for Payer: Wellpoint Medicaid Managed Care	$17.00

PSYCH E&M LEVEL V 60 MINS

Facility

$877.65

Hospital Charge Code	84310160
Hospital Revenue Code	513
Min. Negotiated Rate	$21.15
Max. Negotiated Rate	$438.82
Rate for Payer: Aetna Commercial	$333.51
Rate for Payer: Aetna Medicare Advantage	$263.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.80
Rate for Payer: Cigna Commercial	$438.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$263.30
Rate for Payer: Qualcare PPO/HMO/WC	$131.65
Rate for Payer: UnitedHealthcare Community & State	$21.15
Rate for Payer: Wellpoint Medicaid Managed Care	$23.26

PSYCH E&M LEVEL V 60 MINS

Facility

$877.65

Hospital Charge Code	84310160
Hospital Revenue Code	513
Min. Negotiated Rate	$131.65
Max. Negotiated Rate	$131.65
Rate for Payer: Qualcare PPO/HMO/WC	$131.65

PSYCH E/R 1 1/2 TO 2 1/2 HR***

Facility

$846.00

Service Code	HCPCS 90808
Hospital Charge Code	7500036
Hospital Revenue Code	914
Min. Negotiated Rate	$126.90
Max. Negotiated Rate	$126.90
Rate for Payer: Qualcare PPO/HMO/WC	$126.90

PSYCH E/R 1 1/2 TO 2 1/2 HR***

Facility

$846.00

Service Code	HCPCS 90808
Hospital Charge Code	7500036
Hospital Revenue Code	914
Min. Negotiated Rate	$20.39
Max. Negotiated Rate	$423.00
Rate for Payer: Aetna Commercial	$321.48
Rate for Payer: Aetna Medicare Advantage	$253.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.73
Rate for Payer: Cigna Commercial	$423.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.80
Rate for Payer: Qualcare PPO/HMO/WC	$126.90
Rate for Payer: UnitedHealthcare Community & State	$20.39
Rate for Payer: Wellpoint Medicaid Managed Care	$22.42

PSYCH E/R 1/2 TO 1 1/2 HR*****

Facility

$261.80

Service Code	HCPCS 90804
Hospital Charge Code	7500028
Hospital Revenue Code	914
Min. Negotiated Rate	$39.27
Max. Negotiated Rate	$39.27
Rate for Payer: Qualcare PPO/HMO/WC	$39.27

PSYCH E/R 1/2 TO 1 1/2 HR*****

Facility

$261.80

Service Code	HCPCS 90804
Hospital Charge Code	7500028
Hospital Revenue Code	914
Min. Negotiated Rate	$6.31
Max. Negotiated Rate	$130.90
Rate for Payer: Aetna Commercial	$99.48
Rate for Payer: Aetna Medicare Advantage	$78.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.76
Rate for Payer: Cigna Commercial	$130.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.54
Rate for Payer: Qualcare PPO/HMO/WC	$39.27
Rate for Payer: UnitedHealthcare Community & State	$6.31
Rate for Payer: Wellpoint Medicaid Managed Care	$6.94

PSYCH E/R 2 1/2 TO 3 1/2 HR***

Facility

$427.90

Hospital Charge Code	7500085
Hospital Revenue Code	914
Min. Negotiated Rate	$64.19
Max. Negotiated Rate	$64.19
Rate for Payer: Qualcare PPO/HMO/WC	$64.19

PSYCH E/R 2 1/2 TO 3 1/2 HR***

Facility

$427.90

Hospital Charge Code	7500085
Hospital Revenue Code	914
Min. Negotiated Rate	$10.31
Max. Negotiated Rate	$213.95
Rate for Payer: Aetna Commercial	$162.60
Rate for Payer: Aetna Medicare Advantage	$128.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.11
Rate for Payer: Cigna Commercial	$213.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$128.37
Rate for Payer: Qualcare PPO/HMO/WC	$64.19
Rate for Payer: UnitedHealthcare Community & State	$10.31
Rate for Payer: Wellpoint Medicaid Managed Care	$11.34

PSYCH E/R GROUP****

Facility

$130.00

Hospital Charge Code	7500101
Hospital Revenue Code	914
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$65.00
Rate for Payer: Aetna Commercial	$49.40
Rate for Payer: Aetna Medicare Advantage	$39.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.15
Rate for Payer: Cigna Commercial	$65.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.50
Rate for Payer: UnitedHealthcare Community & State	$3.13
Rate for Payer: Wellpoint Medicaid Managed Care	$3.44

Know your out-of-pocket cost for care.

All Charges