Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MS PANEL III

Facility

$390.00

Service Code	HCPCS 82784
Hospital Charge Code	39990130C
Hospital Revenue Code	301
Min. Negotiated Rate	$7.44
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$25.30
Rate for Payer: Aetna Medicare Advantage	$30.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.57
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$9.30
Rate for Payer: Clover Medicare Advantage	$8.84
Rate for Payer: EmblemHealth Commercial	$27.90
Rate for Payer: Humana Medicare Advantage	$9.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.30
Rate for Payer: Wellcare Medicare Advantage	$9.30
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

MS PANEL IV

Facility

$390.00

Service Code	HCPCS 82784
Hospital Charge Code	39990130D
Hospital Revenue Code	301
Min. Negotiated Rate	$7.44
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$25.30
Rate for Payer: Aetna Medicare Advantage	$30.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.57
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$9.30
Rate for Payer: Clover Medicare Advantage	$8.84
Rate for Payer: EmblemHealth Commercial	$27.90
Rate for Payer: Humana Medicare Advantage	$9.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.30
Rate for Payer: Wellcare Medicare Advantage	$9.30
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

MS PANEL IV

Facility

$390.00

Service Code	HCPCS 82784
Hospital Charge Code	39990130D
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MS PANEL V

Facility

$390.00

Service Code	HCPCS 83916
Hospital Charge Code	39990130E
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$74.50
Rate for Payer: Aetna Medicare Advantage	$88.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$27.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.87
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$27.39
Rate for Payer: Clover Medicare Advantage	$26.02
Rate for Payer: EmblemHealth Commercial	$82.17
Rate for Payer: Humana Medicare Advantage	$28.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$27.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$21.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.39
Rate for Payer: Wellcare Medicare Advantage	$27.39
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

MS PANEL V

Facility

$390.00

Service Code	HCPCS 83916
Hospital Charge Code	39990130E
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MS PROFILE I

Facility

$216.65

Service Code	HCPCS 82030
Hospital Charge Code	3037060A
Hospital Revenue Code	307
Min. Negotiated Rate	$5.74
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$70.18
Rate for Payer: Aetna Medicare Advantage	$83.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$72.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.13
Rate for Payer: Cigna Commercial	$108.33
Rate for Payer: Cigna Medicare Advantage	$25.80
Rate for Payer: Clover Medicare Advantage	$24.51
Rate for Payer: EmblemHealth Commercial	$77.40
Rate for Payer: Humana Medicare Advantage	$26.57
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$20.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.80
Rate for Payer: Wellcare Medicare Advantage	$25.80
Rate for Payer: Wellpoint Medicaid Managed Care	$5.74

MS PROFILE I

Facility

$216.65

Service Code	HCPCS 82030
Hospital Charge Code	3037060A
Hospital Revenue Code	307
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$32.50
Rate for Payer: Qualcare PPO/HMO/WC	$32.50

MS PROFILE II

Facility

$47.50

Service Code	HCPCS 82042
Hospital Charge Code	3037060B
Hospital Revenue Code	307
Min. Negotiated Rate	$7.12
Max. Negotiated Rate	$7.12
Rate for Payer: Qualcare PPO/HMO/WC	$7.12

MS PROFILE II

Facility

$47.50

Service Code	HCPCS 82042
Hospital Charge Code	3037060B
Hospital Revenue Code	307
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$21.16
Rate for Payer: Aetna Medicare Advantage	$25.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.08
Rate for Payer: Cigna Commercial	$23.75
Rate for Payer: Cigna Medicare Advantage	$7.78
Rate for Payer: Clover Medicare Advantage	$7.39
Rate for Payer: EmblemHealth Commercial	$23.34
Rate for Payer: Humana Medicare Advantage	$8.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.25
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.12
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.78
Rate for Payer: Wellcare Medicare Advantage	$7.78
Rate for Payer: Wellpoint Medicaid Managed Care	$1.26

MS PROFILE III

Facility

$81.25

Service Code	HCPCS 82784
Hospital Charge Code	3037060C
Hospital Revenue Code	301
Min. Negotiated Rate	$12.19
Max. Negotiated Rate	$12.19
Rate for Payer: Qualcare PPO/HMO/WC	$12.19

MS PROFILE III

Facility

$81.25

Service Code	HCPCS 82784
Hospital Charge Code	3037060C
Hospital Revenue Code	301
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$25.30
Rate for Payer: Aetna Medicare Advantage	$30.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.57
Rate for Payer: Cigna Commercial	$40.62
Rate for Payer: Cigna Medicare Advantage	$9.30
Rate for Payer: Clover Medicare Advantage	$8.84
Rate for Payer: EmblemHealth Commercial	$27.90
Rate for Payer: Humana Medicare Advantage	$9.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.19
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.30
Rate for Payer: Wellcare Medicare Advantage	$9.30
Rate for Payer: Wellpoint Medicaid Managed Care	$2.15

MS PROFILE IV

Facility

$81.25

Service Code	HCPCS 82784
Hospital Charge Code	3037060D
Hospital Revenue Code	301
Min. Negotiated Rate	$12.19
Max. Negotiated Rate	$12.19
Rate for Payer: Qualcare PPO/HMO/WC	$12.19

MS PROFILE IV

Facility

$81.25

Service Code	HCPCS 82784
Hospital Charge Code	3037060D
Hospital Revenue Code	301
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$25.30
Rate for Payer: Aetna Medicare Advantage	$30.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.57
Rate for Payer: Cigna Commercial	$40.62
Rate for Payer: Cigna Medicare Advantage	$9.30
Rate for Payer: Clover Medicare Advantage	$8.84
Rate for Payer: EmblemHealth Commercial	$27.90
Rate for Payer: Humana Medicare Advantage	$9.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.19
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.30
Rate for Payer: Wellcare Medicare Advantage	$9.30
Rate for Payer: Wellpoint Medicaid Managed Care	$2.15

MS PROFILE V

Facility

$181.65

Service Code	HCPCS 83916
Hospital Charge Code	3037060E
Hospital Revenue Code	301
Min. Negotiated Rate	$4.81
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$74.50
Rate for Payer: Aetna Medicare Advantage	$88.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$27.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.87
Rate for Payer: Cigna Commercial	$90.83
Rate for Payer: Cigna Medicare Advantage	$27.39
Rate for Payer: Clover Medicare Advantage	$26.02
Rate for Payer: EmblemHealth Commercial	$82.17
Rate for Payer: Humana Medicare Advantage	$28.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$27.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.49
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$21.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.39
Rate for Payer: Wellcare Medicare Advantage	$27.39
Rate for Payer: Wellpoint Medicaid Managed Care	$4.81

MS PROFILE V

Facility

$181.65

Service Code	HCPCS 83916
Hospital Charge Code	3037060E
Hospital Revenue Code	301
Min. Negotiated Rate	$27.25
Max. Negotiated Rate	$27.25
Rate for Payer: Qualcare PPO/HMO/WC	$27.25

MSTA/1EACH

Facility

$18.00

Hospital Charge Code	60633461
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$6.84
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.40
Rate for Payer: Oxford Commercial	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$3.60
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

MSTA/1EACH

Facility

$18.00

Hospital Charge Code	60633461
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

MTA3U0 22.5D

Facility

$725.00

Hospital Charge Code	270667855
Hospital Revenue Code	278
Min. Negotiated Rate	$108.75
Max. Negotiated Rate	$175.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$159.50
Rate for Payer: Qualcare PPO/HMO/WC	$108.75

MTA3U0 22.5D

Facility

$725.00

Hospital Charge Code	270667855
Hospital Revenue Code	278
Min. Negotiated Rate	$17.47
Max. Negotiated Rate	$362.50
Rate for Payer: Aetna Commercial	$275.50
Rate for Payer: Aetna Medicare Advantage	$217.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$145.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$184.88
Rate for Payer: Cigna Commercial	$362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$159.50
Rate for Payer: Qualcare PPO/HMO/WC	$108.75
Rate for Payer: UnitedHealthcare Community & State	$17.47
Rate for Payer: Wellpoint Medicaid Managed Care	$19.21

MTF-AUTOLOGUS PLATELET SYSTEM

Facility

$775.00

Hospital Charge Code	270339453
Hospital Revenue Code	272
Min. Negotiated Rate	$116.25
Max. Negotiated Rate	$116.25
Rate for Payer: Qualcare PPO/HMO/WC	$116.25

MTF-AUTOLOGUS PLATELET SYSTEM

Facility

$775.00

Hospital Charge Code	270339453
Hospital Revenue Code	272
Min. Negotiated Rate	$18.68
Max. Negotiated Rate	$387.50
Rate for Payer: Aetna Commercial	$294.50
Rate for Payer: Aetna Medicare Advantage	$232.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$197.62
Rate for Payer: Cigna Commercial	$387.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$232.50
Rate for Payer: Oxford Commercial	$155.00
Rate for Payer: Qualcare PPO/HMO/WC	$116.25
Rate for Payer: UnitedHealthcare Commercial	$155.00
Rate for Payer: UnitedHealthcare Community & State	$18.68
Rate for Payer: Wellpoint Medicaid Managed Care	$20.54

MTHFR

Facility

$300.00

Service Code	HCPCS 81291
Hospital Charge Code	3037000
Hospital Revenue Code	310
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$45.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00

MTHFR

Facility

$300.00

Service Code	HCPCS 81291
Hospital Charge Code	3037000
Hospital Revenue Code	310
Min. Negotiated Rate	$7.95
Max. Negotiated Rate	$235.86
Rate for Payer: Aetna Commercial	$177.72
Rate for Payer: Aetna Medicare Advantage	$211.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$235.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$235.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$65.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$235.86
Rate for Payer: Cigna Commercial	$150.00
Rate for Payer: Cigna Medicare Advantage	$65.34
Rate for Payer: Clover Medicare Advantage	$62.07
Rate for Payer: EmblemHealth Commercial	$196.02
Rate for Payer: Humana Medicare Advantage	$67.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$65.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$52.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$65.34
Rate for Payer: Wellcare Medicare Advantage	$65.34
Rate for Payer: Wellpoint Medicaid Managed Care	$7.95

MTHFR,DNA M

Facility

$389.40

Service Code	HCPCS 81291
Hospital Charge Code	39900022
Hospital Revenue Code	310
Min. Negotiated Rate	$10.32
Max. Negotiated Rate	$235.86
Rate for Payer: Aetna Commercial	$177.72
Rate for Payer: Aetna Medicare Advantage	$211.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$235.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$235.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$65.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$235.86
Rate for Payer: Cigna Commercial	$194.70
Rate for Payer: Cigna Medicare Advantage	$65.34
Rate for Payer: Clover Medicare Advantage	$62.07
Rate for Payer: EmblemHealth Commercial	$196.02
Rate for Payer: Humana Medicare Advantage	$67.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$65.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.82
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.41
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$52.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$65.34
Rate for Payer: Wellcare Medicare Advantage	$65.34
Rate for Payer: Wellpoint Medicaid Managed Care	$10.32

MTHFR,DNA M

Facility

$389.40

Service Code	HCPCS 81291
Hospital Charge Code	39900022
Hospital Revenue Code	310
Min. Negotiated Rate	$58.41
Max. Negotiated Rate	$58.41
Rate for Payer: Qualcare PPO/HMO/WC	$58.41

Know your out-of-pocket cost for care.

All Charges