Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MOLECULAR ISOLATION (1)

Facility

$478.00

Service Code	HCPCS 83890
Hospital Charge Code	38473131
Hospital Revenue Code	301
Min. Negotiated Rate	$71.70
Max. Negotiated Rate	$71.70
Rate for Payer: Qualcare PPO/HMO/WC	$71.70

MOLECULAR ISOLATION (1)

Facility

$478.00

Service Code	HCPCS 83890
Hospital Charge Code	38473131
Hospital Revenue Code	301
Min. Negotiated Rate	$11.52
Max. Negotiated Rate	$239.00
Rate for Payer: Aetna Commercial	$181.64
Rate for Payer: Aetna Medicare Advantage	$143.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.89
Rate for Payer: Cigna Commercial	$239.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$71.70
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.52
Rate for Payer: Wellpoint Medicaid Managed Care	$12.67

MOLECULAR ISOLATION (2)

Facility

$568.00

Service Code	HCPCS 83890
Hospital Charge Code	38473132
Hospital Revenue Code	301
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$284.00
Rate for Payer: Aetna Commercial	$215.84
Rate for Payer: Aetna Medicare Advantage	$170.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$144.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$144.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$144.84
Rate for Payer: Cigna Commercial	$284.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$85.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.69
Rate for Payer: Wellpoint Medicaid Managed Care	$15.05

MOLECULAR ISOLATION (2)

Facility

$568.00

Service Code	HCPCS 83890
Hospital Charge Code	38473132
Hospital Revenue Code	301
Min. Negotiated Rate	$85.20
Max. Negotiated Rate	$85.20
Rate for Payer: Qualcare PPO/HMO/WC	$85.20

MOLECULE ISOLATE NUCLEIC

Facility

$111.00

Hospital Charge Code	3004168A
Hospital Revenue Code	301
Min. Negotiated Rate	$16.65
Max. Negotiated Rate	$16.65
Rate for Payer: Qualcare PPO/HMO/WC	$16.65

MOLECULE ISOLATE NUCLEIC

Facility

$111.00

Hospital Charge Code	3004168A
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

MOLECULE NUCLEIC AMPLI

Facility

$121.00

Hospital Charge Code	3004168D
Hospital Revenue Code	301
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$45.98
Rate for Payer: Aetna Medicare Advantage	$36.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.86
Rate for Payer: Cigna Commercial	$60.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.15
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.92
Rate for Payer: Wellpoint Medicaid Managed Care	$3.21

MOLECULE NUCLEIC AMPLI

Facility

$121.00

Hospital Charge Code	3004168D
Hospital Revenue Code	301
Min. Negotiated Rate	$18.15
Max. Negotiated Rate	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$18.15

MOLEDULAR ISOLATION (3)

Facility

$568.00

Service Code	HCPCS 83890
Hospital Charge Code	38473133
Hospital Revenue Code	301
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$284.00
Rate for Payer: Aetna Commercial	$215.84
Rate for Payer: Aetna Medicare Advantage	$170.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$144.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$144.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$144.84
Rate for Payer: Cigna Commercial	$284.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$85.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.69
Rate for Payer: Wellpoint Medicaid Managed Care	$15.05

MOLEDULAR ISOLATION (3)

Facility

$568.00

Service Code	HCPCS 83890
Hospital Charge Code	38473133
Hospital Revenue Code	301
Min. Negotiated Rate	$85.20
Max. Negotiated Rate	$85.20
Rate for Payer: Qualcare PPO/HMO/WC	$85.20

MOLESKIN

Facility

$195.25

Hospital Charge Code	270300185
Hospital Revenue Code	270
Min. Negotiated Rate	$4.71
Max. Negotiated Rate	$97.62
Rate for Payer: Aetna Commercial	$74.19
Rate for Payer: Aetna Medicare Advantage	$58.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.79
Rate for Payer: Cigna Commercial	$97.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.58
Rate for Payer: Oxford Commercial	$39.05
Rate for Payer: Qualcare PPO/HMO/WC	$29.29
Rate for Payer: UnitedHealthcare Commercial	$39.05
Rate for Payer: UnitedHealthcare Community & State	$4.71
Rate for Payer: Wellpoint Medicaid Managed Care	$5.17

MOLESKIN

Facility

$195.25

Hospital Charge Code	270300185
Hospital Revenue Code	270
Min. Negotiated Rate	$29.29
Max. Negotiated Rate	$29.29
Rate for Payer: Qualcare PPO/HMO/WC	$29.29

MOLINDONE 25 MG TAB

Facility

$15.10

Hospital Charge Code	60628655
Hospital Revenue Code	250
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$2.27
Rate for Payer: Qualcare PPO/HMO/WC	$2.27

MOLINDONE 25 MG TAB

Facility

$15.10

Hospital Charge Code	60628655
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.55
Rate for Payer: Aetna Commercial	$5.74
Rate for Payer: Aetna Medicare Advantage	$4.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.85
Rate for Payer: Cigna Commercial	$7.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.53
Rate for Payer: Oxford Commercial	$3.02
Rate for Payer: Qualcare PPO/HMO/WC	$2.27
Rate for Payer: UnitedHealthcare Commercial	$3.02
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

MOLLELAST GAUZE 10X

Facility

$3.95

Hospital Charge Code	270636432
Hospital Revenue Code	272
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$1.98
Rate for Payer: Aetna Commercial	$1.50
Rate for Payer: Aetna Medicare Advantage	$1.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.01
Rate for Payer: Cigna Commercial	$1.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.19
Rate for Payer: Oxford Commercial	$0.79
Rate for Payer: Qualcare PPO/HMO/WC	$0.59
Rate for Payer: UnitedHealthcare Commercial	$0.79
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.10

MOLLELAST GAUZE 10X

Facility

$3.95

Hospital Charge Code	270636432
Hospital Revenue Code	272
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$0.59
Rate for Payer: Qualcare PPO/HMO/WC	$0.59

MOLLELAST GAUZE 6X

Facility

$3.35

Hospital Charge Code	270636431
Hospital Revenue Code	272
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$1.68
Rate for Payer: Aetna Commercial	$1.27
Rate for Payer: Aetna Medicare Advantage	$1.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.85
Rate for Payer: Cigna Commercial	$1.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.00
Rate for Payer: Oxford Commercial	$0.67
Rate for Payer: Qualcare PPO/HMO/WC	$0.50
Rate for Payer: UnitedHealthcare Commercial	$0.67
Rate for Payer: UnitedHealthcare Community & State	$0.08
Rate for Payer: Wellpoint Medicaid Managed Care	$0.09

MOLLELAST GAUZE 6X

Facility

$3.35

Hospital Charge Code	270636431
Hospital Revenue Code	272
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.50

MOM/15CC/UD

Facility

$3.00

Hospital Charge Code	60634629
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

MOM/15CC/UD

Facility

$3.00

Hospital Charge Code	60634629
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

MOM 15ML & CASCARA 2.5ML

Facility

$1.00

Hospital Charge Code	60635134
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.38
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.30
Rate for Payer: Oxford Commercial	$0.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.20
Rate for Payer: UnitedHealthcare Community & State	$0.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

MOM 15ML & CASCARA 2.5ML

Facility

$1.00

Hospital Charge Code	60635134
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

MOMA FLOW REVERSAL DEVICE

Facility

$8,000.00

Hospital Charge Code	270682752
Hospital Revenue Code	272
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

MOMA FLOW REVERSAL DEVICE

Facility

$8,000.00

Hospital Charge Code	270682752N
Hospital Revenue Code	272
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

MOMA FLOW REVERSAL DEVICE

Facility

$8,000.00

Hospital Charge Code	270682752N
Hospital Revenue Code	272
Min. Negotiated Rate	$192.80
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,400.00
Rate for Payer: Oxford Commercial	$1,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Commercial	$1,600.00
Rate for Payer: UnitedHealthcare Community & State	$192.80
Rate for Payer: Wellpoint Medicaid Managed Care	$212.00

Know your out-of-pocket cost for care.

All Charges