Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MYCOBAC PCR,C/SM,NON-RESP II

Facility

$390.00

Service Code	HCPCS 87116
Hospital Charge Code	3990156B
Hospital Revenue Code	309
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$29.38
Rate for Payer: Aetna Medicare Advantage	$34.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.98
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$10.80
Rate for Payer: Clover Medicare Advantage	$10.26
Rate for Payer: EmblemHealth Commercial	$32.40
Rate for Payer: Humana Medicare Advantage	$11.12
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.80
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	$8.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.80
Rate for Payer: Wellcare Medicare Advantage	$10.80
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

MYCOBAC PCR,C/SM,NON-RESP IV

Facility

$390.00

Service Code	HCPCS 87556
Hospital Charge Code	3990156D
Hospital Revenue Code	306
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$113.37
Rate for Payer: Aetna Medicare Advantage	$135.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$150.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$150.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$41.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$150.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$41.68
Rate for Payer: Clover Medicare Advantage	$39.60
Rate for Payer: EmblemHealth Commercial	$125.04
Rate for Payer: Humana Medicare Advantage	$42.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$41.68
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	$33.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$41.68
Rate for Payer: Wellcare Medicare Advantage	$41.68
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

MYCOBAC PCR,C/SM,NON-RESP IV

Facility

$390.00

Service Code	HCPCS 87556
Hospital Charge Code	3990156D
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MYCOBACTERIA CULT,CSF I

Facility

$390.00

Service Code	HCPCS 87015
Hospital Charge Code	39990153A
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MYCOBACTERIA CULT,CSF I

Facility

$390.00

Service Code	HCPCS 87015
Hospital Charge Code	39990153A
Hospital Revenue Code	309
Min. Negotiated Rate	$5.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$18.17
Rate for Payer: Aetna Medicare Advantage	$21.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.11
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$6.68
Rate for Payer: Clover Medicare Advantage	$6.35
Rate for Payer: EmblemHealth Commercial	$20.04
Rate for Payer: Humana Medicare Advantage	$6.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.68
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	$5.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.68
Rate for Payer: Wellcare Medicare Advantage	$6.68
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

MYCOBACTERIA CULT,CSF II

Facility

$390.00

Service Code	HCPCS 87116
Hospital Charge Code	39990153B
Hospital Revenue Code	309
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$29.38
Rate for Payer: Aetna Medicare Advantage	$34.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.98
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$10.80
Rate for Payer: Clover Medicare Advantage	$10.26
Rate for Payer: EmblemHealth Commercial	$32.40
Rate for Payer: Humana Medicare Advantage	$11.12
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.80
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	$8.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.80
Rate for Payer: Wellcare Medicare Advantage	$10.80
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

MYCOBACTERIA CULT,CSF II

Facility

$390.00

Service Code	HCPCS 87116
Hospital Charge Code	39990153B
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MYCOBACTERIA CULT,CSF III

Facility

$390.00

Service Code	HCPCS 87206
Hospital Charge Code	39990153C
Hospital Revenue Code	309
Min. Negotiated Rate	$4.31
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$14.66
Rate for Payer: Aetna Medicare Advantage	$17.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.46
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.39
Rate for Payer: Clover Medicare Advantage	$5.12
Rate for Payer: EmblemHealth Commercial	$16.17
Rate for Payer: Humana Medicare Advantage	$5.55
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.39
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	$4.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.39
Rate for Payer: Wellcare Medicare Advantage	$5.39
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

MYCOBACTERIA CULT,CSF III

Facility

$390.00

Service Code	HCPCS 87206
Hospital Charge Code	39990153C
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MYCOBACTERIA CULT,GASTRIC I

Facility

$45.90

Service Code	HCPCS 87015
Hospital Charge Code	39990152A
Hospital Revenue Code	309
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$18.17
Rate for Payer: Aetna Medicare Advantage	$21.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.11
Rate for Payer: Cigna Commercial	$22.95
Rate for Payer: Cigna Medicare Advantage	$6.68
Rate for Payer: Clover Medicare Advantage	$6.35
Rate for Payer: EmblemHealth Commercial	$20.04
Rate for Payer: Humana Medicare Advantage	$6.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.77
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.88
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.68
Rate for Payer: Wellcare Medicare Advantage	$6.68
Rate for Payer: Wellpoint Medicaid Managed Care	$1.22

MYCOBACTERIA CULT,GASTRIC I

Facility

$45.90

Service Code	HCPCS 87015
Hospital Charge Code	39990152A
Hospital Revenue Code	309
Min. Negotiated Rate	$6.88
Max. Negotiated Rate	$6.88
Rate for Payer: Qualcare PPO/HMO/WC	$6.88

MYCOBACTERIA CULT,GASTRIC II

Facility

$73.70

Service Code	HCPCS 87116
Hospital Charge Code	39990152B
Hospital Revenue Code	309
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$11.05
Rate for Payer: Qualcare PPO/HMO/WC	$11.05

MYCOBACTERIA CULT,GASTRIC II

Facility

$73.70

Service Code	HCPCS 87116
Hospital Charge Code	39990152B
Hospital Revenue Code	309
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$29.38
Rate for Payer: Aetna Medicare Advantage	$34.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.98
Rate for Payer: Cigna Commercial	$36.85
Rate for Payer: Cigna Medicare Advantage	$10.80
Rate for Payer: Clover Medicare Advantage	$10.26
Rate for Payer: EmblemHealth Commercial	$32.40
Rate for Payer: Humana Medicare Advantage	$11.12
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.11
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$8.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.80
Rate for Payer: Wellcare Medicare Advantage	$10.80
Rate for Payer: Wellpoint Medicaid Managed Care	$1.95

MYCOBACTERIA CULT,GASTRIC III

Facility

$36.70

Service Code	HCPCS 87206
Hospital Charge Code	39990152C
Hospital Revenue Code	309
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$5.50
Rate for Payer: Qualcare PPO/HMO/WC	$5.50

MYCOBACTERIA CULT,GASTRIC III

Facility

$36.70

Service Code	HCPCS 87206
Hospital Charge Code	39990152C
Hospital Revenue Code	309
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$14.66
Rate for Payer: Aetna Medicare Advantage	$17.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.46
Rate for Payer: Cigna Commercial	$18.35
Rate for Payer: Cigna Medicare Advantage	$5.39
Rate for Payer: Clover Medicare Advantage	$5.12
Rate for Payer: EmblemHealth Commercial	$16.17
Rate for Payer: Humana Medicare Advantage	$5.55
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.01
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.39
Rate for Payer: Wellcare Medicare Advantage	$5.39
Rate for Payer: Wellpoint Medicaid Managed Care	$0.97

MYCOBACTERIA CULT + STAIN I

Facility

$667.59

Service Code	HCPCS 87015
Hospital Charge Code	39990151A
Hospital Revenue Code	309
Min. Negotiated Rate	$5.34
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$18.17
Rate for Payer: Aetna Medicare Advantage	$21.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.11
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$6.68
Rate for Payer: Clover Medicare Advantage	$6.35
Rate for Payer: EmblemHealth Commercial	$20.04
Rate for Payer: Humana Medicare Advantage	$6.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.68
Rate for Payer: Wellcare Medicare Advantage	$6.68
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

MYCOBACTERIA CULT + STAIN I

Facility

$667.59

Service Code	HCPCS 87015
Hospital Charge Code	39990151A
Hospital Revenue Code	309
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

MYCOBACTERIA CULT + STAIN II

Facility

$667.59

Service Code	HCPCS 87116
Hospital Charge Code	39990151B
Hospital Revenue Code	309
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

MYCOBACTERIA CULT + STAIN II

Facility

$667.59

Service Code	HCPCS 87116
Hospital Charge Code	39990151B
Hospital Revenue Code	309
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$29.38
Rate for Payer: Aetna Medicare Advantage	$34.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.98
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$10.80
Rate for Payer: Clover Medicare Advantage	$10.26
Rate for Payer: EmblemHealth Commercial	$32.40
Rate for Payer: Humana Medicare Advantage	$11.12
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$8.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.80
Rate for Payer: Wellcare Medicare Advantage	$10.80
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

MYCOBACTERIA CULT + STAIN III

Facility

$667.59

Service Code	HCPCS 87206
Hospital Charge Code	39990151C
Hospital Revenue Code	309
Min. Negotiated Rate	$4.31
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$14.66
Rate for Payer: Aetna Medicare Advantage	$17.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.46
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$5.39
Rate for Payer: Clover Medicare Advantage	$5.12
Rate for Payer: EmblemHealth Commercial	$16.17
Rate for Payer: Humana Medicare Advantage	$5.55
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.39
Rate for Payer: Wellcare Medicare Advantage	$5.39
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

MYCOBACTERIA CULT + STAIN III

Facility

$667.59

Service Code	HCPCS 87206
Hospital Charge Code	39990151C
Hospital Revenue Code	309
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

MYCOBACTERIA CULTURE

Facility

$390.00

Service Code	HCPCS 87116
Hospital Charge Code	401087116
Hospital Revenue Code	306
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$29.38
Rate for Payer: Aetna Medicare Advantage	$34.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.98
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$10.80
Rate for Payer: Clover Medicare Advantage	$10.26
Rate for Payer: EmblemHealth Commercial	$32.40
Rate for Payer: Humana Medicare Advantage	$11.12
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.80
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	$8.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.80
Rate for Payer: Wellcare Medicare Advantage	$10.80
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

MYCOBACTERIA CULTURE

Facility

$390.00

Service Code	HCPCS 87116
Hospital Charge Code	401087116
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MYCOBACTERIA ID

Facility

$235.00

Service Code	HCPCS 87118
Hospital Charge Code	38475101
Hospital Revenue Code	309
Min. Negotiated Rate	$6.23
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$39.74
Rate for Payer: Aetna Medicare Advantage	$47.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.74
Rate for Payer: Cigna Commercial	$117.50
Rate for Payer: Cigna Medicare Advantage	$14.61
Rate for Payer: Clover Medicare Advantage	$13.88
Rate for Payer: EmblemHealth Commercial	$43.83
Rate for Payer: Humana Medicare Advantage	$15.05
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.61
Rate for Payer: Wellcare Medicare Advantage	$14.61
Rate for Payer: Wellpoint Medicaid Managed Care	$6.23

MYCOBACTERIA ID

Facility

$235.00

Service Code	HCPCS 87118
Hospital Charge Code	38475101
Hospital Revenue Code	309
Min. Negotiated Rate	$35.25
Max. Negotiated Rate	$35.25
Rate for Payer: Qualcare PPO/HMO/WC	$35.25

Know your out-of-pocket cost for care.

All Charges