Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PSYDX EVAL NONMD CHILD CAID

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4822630
Hospital Revenue Code	918
Min. Negotiated Rate	$1,020.00
Max. Negotiated Rate	$1,020.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00

PSYDX EVAL NONMD CHILD CAID

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4518609
Hospital Revenue Code	918
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

PSYDX EVAL NONMD CHILD CAID

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4515609
Hospital Revenue Code	918
Min. Negotiated Rate	$1,020.00
Max. Negotiated Rate	$1,020.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00

PSYDX EVAL NONMD CHILD CAID

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4824609
Hospital Revenue Code	918
Min. Negotiated Rate	$1,020.00
Max. Negotiated Rate	$1,020.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00

PSYDX EVAL NONMD CHILD CAID

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4515609
Hospital Revenue Code	918
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

PSYDX EVAL NONMD CHILD CAID

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4504609
Hospital Revenue Code	918
Min. Negotiated Rate	$1,020.00
Max. Negotiated Rate	$1,020.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00

PSYDX EVAL NONMD CHILD CAID

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4510630
Hospital Revenue Code	918
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

PSYDX EVAL NONMD CHILD CAID

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4510630
Hospital Revenue Code	918
Min. Negotiated Rate	$1,020.00
Max. Negotiated Rate	$1,020.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00

PSYDX EVAL NONMD CHILD CAID

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4504609
Hospital Revenue Code	918
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

PSY-ED GR MEDS REINFORCEM

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	83246115
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

PSY-ED GR MEDS REINFORCEM

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	83246115
Hospital Revenue Code	915
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$120.12
Rate for Payer: Qualcare PPO/HMO/WC	$120.12

PSYLLIUM 3.5 G PACKET

Facility

$4.00

Service Code	NDC 38485080855
Hospital Charge Code	60628136
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

PSYLLIUM 3.5 G PACKET

Facility

$4.00

Service Code	NDC 38485080855
Hospital Charge Code	60628136
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PSY TX COMPLEX INTERACTIVE

Facility

$682.20

Service Code	HCPCS 90785
Hospital Charge Code	73237001
Hospital Revenue Code	900
Min. Negotiated Rate	$102.33
Max. Negotiated Rate	$102.33
Rate for Payer: Qualcare PPO/HMO/WC	$102.33

PSY TX COMPLEX INTERACTIVE

Facility

$682.20

Service Code	HCPCS 90785
Hospital Charge Code	73237001
Hospital Revenue Code	900
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$3,081.00
Rate for Payer: Aetna Commercial	$259.24
Rate for Payer: Aetna Medicare Advantage	$204.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.96
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	$173.96
Rate for Payer: Cigna Commercial	$341.10
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: Wellpoint Medicaid Managed Care	$18.08

PSY TX PT/FAM 30 MIN

Facility

$501.15

Service Code	HCPCS 90832
Hospital Charge Code	73237007
Hospital Revenue Code	914
Min. Negotiated Rate	$12.08
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	$150.34
Rate for Payer: Qualcare PPO/HMO/WC	$75.17
Rate for Payer: UnitedHealthcare Community & State	$12.08
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	$13.28

PSY TX PT/FAM 30 MIN

Facility

$501.15

Service Code	HCPCS 90832
Hospital Charge Code	73237007
Hospital Revenue Code	914
Min. Negotiated Rate	$75.17
Max. Negotiated Rate	$75.17
Rate for Payer: Qualcare PPO/HMO/WC	$75.17

PSY TX PT/FAM 30 MIN W E/M

Facility

$501.15

Service Code	HCPCS 90833
Hospital Charge Code	73237009
Hospital Revenue Code	914
Min. Negotiated Rate	$75.17
Max. Negotiated Rate	$75.17
Rate for Payer: Qualcare PPO/HMO/WC	$75.17

PSY TX PT/FAM 30 MIN W E/M

Facility

$501.15

Service Code	HCPCS 90833
Hospital Charge Code	73237009
Hospital Revenue Code	914
Min. Negotiated Rate	$12.08
Max. Negotiated Rate	$250.57
Rate for Payer: Aetna Commercial	$190.44
Rate for Payer: Aetna Medicare Advantage	$150.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$106.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.79
Rate for Payer: Cigna Commercial	$250.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.34
Rate for Payer: Qualcare PPO/HMO/WC	$75.17
Rate for Payer: UnitedHealthcare Community & State	$12.08
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$73.61
Rate for Payer: Wellpoint Medicaid Managed Care	$13.28

PSY TX PT/FAM 45 MIN

Facility

$682.20

Service Code	HCPCS 90834
Hospital Charge Code	73237011
Hospital Revenue Code	914
Min. Negotiated Rate	$102.33
Max. Negotiated Rate	$102.33
Rate for Payer: Qualcare PPO/HMO/WC	$102.33

PSY TX PT/FAM 45 MIN

Facility

$682.20

Service Code	HCPCS 90834
Hospital Charge Code	73237011
Hospital Revenue Code	914
Min. Negotiated Rate	$16.44
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	$130.22
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: Qualcare PPO/HMO/WC	$102.33
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	$94.46
Rate for Payer: Wellpoint Medicaid Managed Care	$18.08

PSY TX PT/FAM 45 MIN W E/M

Facility

$682.20

Service Code	HCPCS 90836
Hospital Charge Code	73237013
Hospital Revenue Code	914
Min. Negotiated Rate	$102.33
Max. Negotiated Rate	$102.33
Rate for Payer: Qualcare PPO/HMO/WC	$102.33

PSY TX PT/FAM 45 MIN W E/M

Facility

$682.20

Service Code	HCPCS 90836
Hospital Charge Code	73237013
Hospital Revenue Code	914
Min. Negotiated Rate	$16.44
Max. Negotiated Rate	$341.10
Rate for Payer: Aetna Commercial	$259.24
Rate for Payer: Aetna Medicare Advantage	$204.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$128.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.96
Rate for Payer: Cigna Commercial	$341.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.66
Rate for Payer: Qualcare PPO/HMO/WC	$102.33
Rate for Payer: UnitedHealthcare Community & State	$16.44
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$94.46
Rate for Payer: Wellpoint Medicaid Managed Care	$18.08

PSY TX PT/FAM 60 MIN

Facility

$682.20

Service Code	HCPCS 90837
Hospital Charge Code	73237015
Hospital Revenue Code	914
Min. Negotiated Rate	$102.33
Max. Negotiated Rate	$102.33
Rate for Payer: Qualcare PPO/HMO/WC	$102.33

PSY TX PT/FAM 60 MIN

Facility

$682.20

Service Code	HCPCS 90837
Hospital Charge Code	73237015
Hospital Revenue Code	914
Min. Negotiated Rate	$16.44
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	$117.34
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: Qualcare PPO/HMO/WC	$102.33
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: Wellpoint Medicaid Managed Care	$18.08

Know your out-of-pocket cost for care.

All Charges