Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MOLECULAR DIAG INTERPRETATION2

Facility

$84.00

Service Code	HCPCS 83912
Hospital Charge Code	38473150
Hospital Revenue Code	301
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$12.60
Rate for Payer: Qualcare PPO/HMO/WC	$12.60

MOLECULAR DIAG INTER W REPORT

Facility

$111.00

Hospital Charge Code	3036025B
Hospital Revenue Code	309
Min. Negotiated Rate	$16.65
Max. Negotiated Rate	$16.65
Rate for Payer: Qualcare PPO/HMO/WC	$16.65

MOLECULAR DIAG INTER W REPORT

Facility

$111.00

Hospital Charge Code	3036025B
Hospital Revenue Code	309
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 DIAGNOSTIC - CYSTIC

Facility

$111.00

Hospital Charge Code	3036006A
Hospital Revenue Code	301
Min. Negotiated Rate	$16.65
Max. Negotiated Rate	$16.65
Rate for Payer: Qualcare PPO/HMO/WC	$16.65

MOLECULAR DIAGNOSTIC - CYSTIC

Facility

$111.00

Hospital Charge Code	3036006A
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 DIAGNOSTICS

Facility

$105.00

Hospital Charge Code	3004168B
Hospital Revenue Code	301
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$124.00
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) PPO	$26.77
Rate for Payer: Cigna Commercial	$52.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.53
Rate for Payer: Wellpoint Medicaid Managed Care	$2.78

MOLECULAR DIAGNOSTICS

Facility

$105.00

Hospital Charge Code	3004168B
Hospital Revenue Code	301
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$15.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.75

MOLECULAR DIAGNOSTICS

Facility

$105.00

Hospital Charge Code	3004168C
Hospital Revenue Code	301
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$124.00
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) PPO	$26.77
Rate for Payer: Cigna Commercial	$52.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.53
Rate for Payer: Wellpoint Medicaid Managed Care	$2.78

MOLECULAR DIAGNOSTICS

Facility

$105.00

Hospital Charge Code	3004168C
Hospital Revenue Code	301
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$15.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.75

MOLECULAR DIAG SEPARATION (1)

Facility

$44.00

Service Code	HCPCS 83894
Hospital Charge Code	38473134
Hospital Revenue Code	301
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

MOLECULAR DIAG SEPARATION (1)

Facility

$44.00

Service Code	HCPCS 83894
Hospital Charge Code	38473134
Hospital Revenue Code	301
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$16.72
Rate for Payer: Aetna Medicare Advantage	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.22
Rate for Payer: Cigna Commercial	$22.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.06
Rate for Payer: Wellpoint Medicaid Managed Care	$1.17

MOLECULAR DIAG SEPARATION (5)

Facility

$44.00

Service Code	HCPCS 83894
Hospital Charge Code	38473146
Hospital Revenue Code	301
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$16.72
Rate for Payer: Aetna Medicare Advantage	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.22
Rate for Payer: Cigna Commercial	$22.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.06
Rate for Payer: Wellpoint Medicaid Managed Care	$1.17

MOLECULAR DIAG SEPARATION (5)

Facility

$44.00

Service Code	HCPCS 83894
Hospital Charge Code	38473146
Hospital Revenue Code	301
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

MOLECULAR DIAG SEPARAT W IDENT

Facility

$120.05

Hospital Charge Code	3036025A
Hospital Revenue Code	309
Min. Negotiated Rate	$18.01
Max. Negotiated Rate	$18.01
Rate for Payer: Qualcare PPO/HMO/WC	$18.01

MOLECULAR DIAG SEPARAT W IDENT

Facility

$120.05

Hospital Charge Code	3036025A
Hospital Revenue Code	309
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$45.62
Rate for Payer: Aetna Medicare Advantage	$36.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.61
Rate for Payer: Cigna Commercial	$60.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.02
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.01
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.89
Rate for Payer: Wellpoint Medicaid Managed Care	$3.18

MOLECULAR DX INTERPRETATION

Facility

$85.00

Service Code	HCPCS 83912
Hospital Charge Code	38479425
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 DX INTERPRETATION

Facility

$85.00

Service Code	HCPCS 83912
Hospital Charge Code	38479425
Hospital Revenue Code	301
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$12.75
Rate for Payer: Qualcare PPO/HMO/WC	$12.75

MOLECULAR DX LYSIS PRIOR TO NA

Facility

$94.60

Service Code	HCPCS 83907
Hospital Charge Code	38477114
Hospital Revenue Code	301
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$35.95
Rate for Payer: Aetna Medicare Advantage	$28.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.12
Rate for Payer: Cigna Commercial	$47.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.19
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.28
Rate for Payer: Wellpoint Medicaid Managed Care	$2.51

MOLECULAR DX LYSIS PRIOR TO NA

Facility

$94.60

Service Code	HCPCS 83907
Hospital Charge Code	38477114
Hospital Revenue Code	301
Min. Negotiated Rate	$14.19
Max. Negotiated Rate	$14.19
Rate for Payer: Qualcare PPO/HMO/WC	$14.19

MOLECULAR DX;MUTATION SCANNIG

Facility

$118.69

Service Code	HCPCS 83903
Hospital Charge Code	38477139
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

MOLECULAR DX;MUTATION SCANNIG

Facility

$118.69

Service Code	HCPCS 83903
Hospital Charge Code	38477139
Hospital Revenue Code	301
Min. Negotiated Rate	$17.80
Max. Negotiated Rate	$17.80
Rate for Payer: Qualcare PPO/HMO/WC	$17.80

MOLECULAR DX NUCLEIC ACID TRAN

Facility

$28.00

Service Code	HCPCS 83897
Hospital Charge Code	38477024
Hospital Revenue Code	301
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$4.20

MOLECULAR DX NUCLEIC ACID TRAN

Facility

$28.00

Service Code	HCPCS 83897
Hospital Charge Code	38477024
Hospital Revenue Code	301
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$10.64
Rate for Payer: Aetna Medicare Advantage	$8.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.14
Rate for Payer: Cigna Commercial	$14.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.67
Rate for Payer: Wellpoint Medicaid Managed Care	$0.74

MOLECULAR DX RNA STABILIZATION

Facility

$94.60

Service Code	HCPCS 83913
Hospital Charge Code	38477115
Hospital Revenue Code	301
Min. Negotiated Rate	$14.19
Max. Negotiated Rate	$14.19
Rate for Payer: Qualcare PPO/HMO/WC	$14.19

MOLECULAR DX RNA STABILIZATION

Facility

$94.60

Service Code	HCPCS 83913
Hospital Charge Code	38477115
Hospital Revenue Code	301
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$35.95
Rate for Payer: Aetna Medicare Advantage	$28.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.12
Rate for Payer: Cigna Commercial	$47.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.19
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.28
Rate for Payer: Wellpoint Medicaid Managed Care	$2.51

Know your out-of-pocket cost for care.

All Charges