Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MOLD ID FUNGAL IDENTIFICATION

Facility

$93.65

Service Code	HCPCS 87106
Hospital Charge Code	3006780
Hospital Revenue Code	309
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$28.07
Rate for Payer: Aetna Medicare Advantage	$33.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.25
Rate for Payer: Cigna Commercial	$46.83
Rate for Payer: Cigna Medicare Advantage	$10.32
Rate for Payer: Clover Medicare Advantage	$9.80
Rate for Payer: EmblemHealth Commercial	$30.96
Rate for Payer: Humana Medicare Advantage	$10.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$8.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.32
Rate for Payer: Wellcare Medicare Advantage	$10.32
Rate for Payer: Wellpoint Medicaid Managed Care	$2.48

MOLD ID FUNGAL IDENTIFICATION

Facility

$93.65

Service Code	HCPCS 87106
Hospital Charge Code	3006780
Hospital Revenue Code	309
Min. Negotiated Rate	$14.05
Max. Negotiated Rate	$14.05
Rate for Payer: Qualcare PPO/HMO/WC	$14.05

MOLD TIB CEMENT SPACER 75MM

Facility

$6,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270677431
Hospital Revenue Code	278
Min. Negotiated Rate	$156.05
Max. Negotiated Rate	$3,237.50
Rate for Payer: Aetna Commercial	$2,460.50
Rate for Payer: Aetna Medicare Advantage	$1,942.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,651.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,651.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,651.12
Rate for Payer: Cigna Commercial	$3,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,566.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,424.50
Rate for Payer: Qualcare PPO/HMO/WC	$971.25
Rate for Payer: UnitedHealthcare Community & State	$156.05
Rate for Payer: Wellpoint Medicaid Managed Care	$171.59

MOLD TIB CEMENT SPACER 75MM

Facility

$6,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270677431
Hospital Revenue Code	278
Min. Negotiated Rate	$971.25
Max. Negotiated Rate	$1,566.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,566.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,424.50
Rate for Payer: Qualcare PPO/HMO/WC	$971.25

MOLEC DIAG AMP SIGNAL EA SEQ

Facility

$118.69

Service Code	HCPCS 83908
Hospital Charge Code	38477141
Hospital Revenue Code	301
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$45.10
Rate for Payer: Aetna Medicare Advantage	$35.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.27
Rate for Payer: Cigna Commercial	$59.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.61
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.86
Rate for Payer: Wellpoint Medicaid Managed Care	$3.15

MOLEC DIAG AMP SIGNAL EA SEQ

Facility

$118.69

Service Code	HCPCS 83908
Hospital Charge Code	38477141
Hospital Revenue Code	301
Min. Negotiated Rate	$17.80
Max. Negotiated Rate	$17.80
Rate for Payer: Qualcare PPO/HMO/WC	$17.80

MOLEC DX MUTATION ID SEQ @ SEG

Facility

$118.69

Service Code	HCPCS 83904
Hospital Charge Code	38477140
Hospital Revenue Code	301
Min. Negotiated Rate	$17.80
Max. Negotiated Rate	$17.80
Rate for Payer: Qualcare PPO/HMO/WC	$17.80

MOLEC DX MUTATION ID SEQ @ SEG

Facility

$118.69

Service Code	HCPCS 83904
Hospital Charge Code	38477140
Hospital Revenue Code	301
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$45.10
Rate for Payer: Aetna Medicare Advantage	$35.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.27
Rate for Payer: Cigna Commercial	$59.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.61
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.86
Rate for Payer: Wellpoint Medicaid Managed Care	$3.15

MOLEC.DX REVERSE TRANS

Facility

$100.55

Service Code	HCPCS 83902
Hospital Charge Code	38472507
Hospital Revenue Code	301
Min. Negotiated Rate	$15.08
Max. Negotiated Rate	$15.08
Rate for Payer: Qualcare PPO/HMO/WC	$15.08

MOLEC.DX REVERSE TRANS

Facility

$100.55

Service Code	HCPCS 83902
Hospital Charge Code	38472507
Hospital Revenue Code	301
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$38.21
Rate for Payer: Aetna Medicare Advantage	$30.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.64
Rate for Payer: Cigna Commercial	$50.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.16
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.08
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.42
Rate for Payer: Wellpoint Medicaid Managed Care	$2.66

MOLECULAR DIAG AMPLIFICATION

Facility

$293.00

Service Code	HCPCS 83898
Hospital Charge Code	38479468
Hospital Revenue Code	301
Min. Negotiated Rate	$43.95
Max. Negotiated Rate	$43.95
Rate for Payer: Qualcare PPO/HMO/WC	$43.95

MOLECULAR DIAG AMPLIFICATION

Facility

$293.00

Service Code	HCPCS 83898
Hospital Charge Code	38479468
Hospital Revenue Code	301
Min. Negotiated Rate	$7.06
Max. Negotiated Rate	$146.50
Rate for Payer: Aetna Commercial	$111.34
Rate for Payer: Aetna Medicare Advantage	$87.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.72
Rate for Payer: Cigna Commercial	$146.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.06
Rate for Payer: Wellpoint Medicaid Managed Care	$7.76

MOLECULAR DIAG AMPLIFICATION

Facility

$240.10

Hospital Charge Code	3036025D
Hospital Revenue Code	309
Min. Negotiated Rate	$36.02
Max. Negotiated Rate	$36.02
Rate for Payer: Qualcare PPO/HMO/WC	$36.02

MOLECULAR DIAG AMPLIFICATION

Facility

$240.10

Hospital Charge Code	3036025D
Hospital Revenue Code	309
Min. Negotiated Rate	$5.79
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$91.24
Rate for Payer: Aetna Medicare Advantage	$72.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.23
Rate for Payer: Cigna Commercial	$120.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.03
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.02
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.79
Rate for Payer: Wellpoint Medicaid Managed Care	$6.36

MOLECULAR DIAG AMPLIFICATION 1

Facility

$293.00

Service Code	HCPCS 83898
Hospital Charge Code	38473138
Hospital Revenue Code	301
Min. Negotiated Rate	$43.95
Max. Negotiated Rate	$43.95
Rate for Payer: Qualcare PPO/HMO/WC	$43.95

MOLECULAR DIAG AMPLIFICATION 1

Facility

$293.00

Service Code	HCPCS 83898
Hospital Charge Code	38473138
Hospital Revenue Code	301
Min. Negotiated Rate	$7.06
Max. Negotiated Rate	$146.50
Rate for Payer: Aetna Commercial	$111.34
Rate for Payer: Aetna Medicare Advantage	$87.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.72
Rate for Payer: Cigna Commercial	$146.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.06
Rate for Payer: Wellpoint Medicaid Managed Care	$7.76

MOLECULAR DIAG AMPLIFICATION 8

Facility

$293.00

Service Code	HCPCS 83898
Hospital Charge Code	38473149
Hospital Revenue Code	301
Min. Negotiated Rate	$7.06
Max. Negotiated Rate	$146.50
Rate for Payer: Aetna Commercial	$111.34
Rate for Payer: Aetna Medicare Advantage	$87.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.72
Rate for Payer: Cigna Commercial	$146.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.06
Rate for Payer: Wellpoint Medicaid Managed Care	$7.76

MOLECULAR DIAG AMPLIFICATION 8

Facility

$293.00

Service Code	HCPCS 83898
Hospital Charge Code	38473149
Hospital Revenue Code	301
Min. Negotiated Rate	$43.95
Max. Negotiated Rate	$43.95
Rate for Payer: Qualcare PPO/HMO/WC	$43.95

MOLECULAR DIAG DNA

Facility

$111.00

Hospital Charge Code	3036025C
Hospital Revenue Code	301
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$42.18
Rate for Payer: Aetna Medicare Advantage	$33.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.30
Rate for Payer: Cigna Commercial	$55.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.65
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.68
Rate for Payer: Wellpoint Medicaid Managed Care	$2.94

MOLECULAR DIAG DNA

Facility

$111.00

Hospital Charge Code	3036025C
Hospital Revenue Code	301
Min. Negotiated Rate	$16.65
Max. Negotiated Rate	$16.65
Rate for Payer: Qualcare PPO/HMO/WC	$16.65

MOLECULAR DIAG INTERPRETATION

Facility

$85.00

Service Code	HCPCS 83912
Hospital Charge Code	38473145
Hospital Revenue Code	301
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$32.30
Rate for Payer: Aetna Medicare Advantage	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.68
Rate for Payer: Cigna Commercial	$42.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.05
Rate for Payer: Wellpoint Medicaid Managed Care	$2.25

MOLECULAR DIAG INTERPRETATION

Facility

$85.00

Hospital Charge Code	38479455
Hospital Revenue Code	301
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$32.30
Rate for Payer: Aetna Medicare Advantage	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.68
Rate for Payer: Cigna Commercial	$42.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.05
Rate for Payer: Wellpoint Medicaid Managed Care	$2.25

MOLECULAR DIAG INTERPRETATION

Facility

$85.00

Service Code	HCPCS 83912
Hospital Charge Code	38473145
Hospital Revenue Code	301
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$12.75
Rate for Payer: Qualcare PPO/HMO/WC	$12.75

MOLECULAR DIAG INTERPRETATION

Facility

$85.00

Hospital Charge Code	38479455
Hospital Revenue Code	301
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$12.75
Rate for Payer: Qualcare PPO/HMO/WC	$12.75

MOLECULAR DIAG INTERPRETATION2

Facility

$84.00

Service Code	HCPCS 83912
Hospital Charge Code	38473150
Hospital Revenue Code	301
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$31.92
Rate for Payer: Aetna Medicare Advantage	$25.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.42
Rate for Payer: Cigna Commercial	$42.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.02
Rate for Payer: Wellpoint Medicaid Managed Care	$2.23

Know your out-of-pocket cost for care.

All Charges