Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$15.43
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$35.61
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	$15.43
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.80
Rate for Payer: UnitedHealthcare Commercial	$114.00

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	$13.07
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$30.16
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	$13.07
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.08
Rate for Payer: UnitedHealthcare Commercial	$114.00

MOLECULAR DIAG AMPLIFICATION

Facility

$240.10

Hospital Charge Code	3036025D
Hospital Revenue Code	309
Min. Negotiated Rate	$31.21
Max. Negotiated Rate	$120.05
Rate for Payer: Aetna Commercial	$72.03
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	$31.21
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.02
Rate for Payer: UnitedHealthcare Commercial	$114.00

MOLECULAR DIAG AMPLIFICATION

Facility

$293.00

Service Code	HCPCS 83898
Hospital Charge Code	38479468
Hospital Revenue Code	301
Min. Negotiated Rate	$38.09
Max. Negotiated Rate	$146.50
Rate for Payer: Aetna Commercial	$87.90
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	$38.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.95
Rate for Payer: UnitedHealthcare Commercial	$114.00

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

$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 1

Facility

$293.00

Service Code	HCPCS 83898
Hospital Charge Code	38473138
Hospital Revenue Code	301
Min. Negotiated Rate	$38.09
Max. Negotiated Rate	$146.50
Rate for Payer: Aetna Commercial	$87.90
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	$38.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.95
Rate for Payer: UnitedHealthcare Commercial	$114.00

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 8

Facility

$293.00

Service Code	HCPCS 83898
Hospital Charge Code	38473149
Hospital Revenue Code	301
Min. Negotiated Rate	$38.09
Max. Negotiated Rate	$146.50
Rate for Payer: Aetna Commercial	$87.90
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	$38.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.95
Rate for Payer: UnitedHealthcare Commercial	$114.00

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	$14.43
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$33.30
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	$14.43
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.65
Rate for Payer: UnitedHealthcare Commercial	$114.00

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

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 INTERPRETATION

Facility

$85.00

Hospital Charge Code	38479455
Hospital Revenue Code	301
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$114.00
Rate for Payer: Cigna Commercial	$42.50
Rate for Payer: Aetna Commercial	$25.50
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: MagnaCare PPO/Direct Plus/Exchange/WC	$11.05
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.75
Rate for Payer: UnitedHealthcare Commercial	$114.00

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

Service Code	HCPCS 83912
Hospital Charge Code	38473145
Hospital Revenue Code	301
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$25.50
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	$11.05
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.75
Rate for Payer: UnitedHealthcare Commercial	$114.00

MOLECULAR DIAG INTERPRETATION2

Facility

$84.00

Service Code	HCPCS 83912
Hospital Charge Code	38473150
Hospital Revenue Code	301
Min. Negotiated Rate	$10.92
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$25.20
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	$10.92
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.60
Rate for Payer: UnitedHealthcare Commercial	$114.00

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	$14.43
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$33.30
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	$14.43
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.65
Rate for Payer: UnitedHealthcare Commercial	$114.00

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 DIAGNOSTIC - CYSTIC

Facility

$111.00

Hospital Charge Code	3036006A
Hospital Revenue Code	301
Min. Negotiated Rate	$14.43
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$33.30
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	$14.43
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.65
Rate for Payer: UnitedHealthcare Commercial	$114.00

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 DIAGNOSTICS

Facility

$105.00

Hospital Charge Code	3004168B
Hospital Revenue Code	301
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$31.50
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	$13.65
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.75
Rate for Payer: UnitedHealthcare Commercial	$114.00

Know your out-of-pocket cost for care.

All Charges