St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC CYSTOSCOPY,DIR VIS INT URETHROTOMY

Facility

$6,792.00

Service Code	CPT 52276
Hospital Charge Code	3615227601
Hospital Revenue Code	361
Min. Negotiated Rate	$296.71
Max. Negotiated Rate	$5,094.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,502.91
Rate for Payer: Aetna Government	$2,502.91
Rate for Payer: Affinity Essential Plan 1&2	$1,752.04
Rate for Payer: Affinity Essential Plan 3&4	$1,752.04
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,752.04
Rate for Payer: Brighton Health Commercial	$5,094.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2,502.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,092.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,628.64
Rate for Payer: Elderplan Medicare Advantage	$2,502.91
Rate for Payer: EmblemHealth Commercial	$2,502.91
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2,252.62
Rate for Payer: Fidelis Essential Plan Aliesa	$2,127.47
Rate for Payer: Fidelis Essential Plan QHP	$2,227.59
Rate for Payer: Fidelis Medicare Advantage	$2,502.91
Rate for Payer: Fidelis Qualified Health Plan	$2,227.59
Rate for Payer: Group Health Inc Commercial	$2,502.91
Rate for Payer: Group Health Inc Medicare	$2,502.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,502.91
Rate for Payer: Hamaspik Choice Inc Medicare	$959.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$296.71
Rate for Payer: Healthfirst Medicare Advantage	$2,127.47
Rate for Payer: Healthfirst QHP	$2,502.91
Rate for Payer: Humana Medicare	$2,552.97
Rate for Payer: Senior Whole Health Medicare Advantage	$2,502.91
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$2,502.91
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,502.91
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,377.76
Rate for Payer: Wellcare Medicare	$2,377.76

HC CYSTOSCOPY,DIR VIS INT URETHROTOMY

Facility

$6,792.00

Service Code	CPT 52276
Hospital Charge Code	3615227601
Hospital Revenue Code	361
Min. Negotiated Rate	$3,396.00
Max. Negotiated Rate	$3,396.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,396.00

HC CYSTOSCOPY,INSERT URETERAL STENT

Facility

$11,217.00

Service Code	CPT 52332
Hospital Charge Code	3615233201
Hospital Revenue Code	361
Min. Negotiated Rate	$5,608.50
Max. Negotiated Rate	$5,608.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,608.50

HC CYSTOSCOPY,INSERT URETERAL STENT

Facility

$11,217.00

Service Code	CPT 52332
Hospital Charge Code	3615233201
Hospital Revenue Code	361
Min. Negotiated Rate	$175.84
Max. Negotiated Rate	$8,412.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,214.02
Rate for Payer: Aetna Government	$4,214.02
Rate for Payer: Affinity Essential Plan 1&2	$2,949.81
Rate for Payer: Affinity Essential Plan 3&4	$2,949.81
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,949.81
Rate for Payer: Brighton Health Commercial	$8,412.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$4,214.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,092.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,628.64
Rate for Payer: Elderplan Medicare Advantage	$4,214.02
Rate for Payer: EmblemHealth Commercial	$4,214.02
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3,792.62
Rate for Payer: Fidelis Essential Plan Aliesa	$3,581.92
Rate for Payer: Fidelis Essential Plan QHP	$3,750.48
Rate for Payer: Fidelis Medicare Advantage	$4,214.02
Rate for Payer: Fidelis Qualified Health Plan	$3,750.48
Rate for Payer: Group Health Inc Commercial	$4,214.02
Rate for Payer: Group Health Inc Medicare	$4,214.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,214.02
Rate for Payer: Hamaspik Choice Inc Medicare	$1,655.31
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$175.84
Rate for Payer: Healthfirst Medicare Advantage	$3,581.92
Rate for Payer: Healthfirst QHP	$4,214.02
Rate for Payer: Humana Medicare	$4,298.30
Rate for Payer: Senior Whole Health Medicare Advantage	$4,214.02
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$4,214.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,214.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4,003.32
Rate for Payer: Wellcare Medicare	$4,003.32

HC CYSTOURETHROSCOPY

Facility

$1,875.00

Service Code	CPT 52000
Hospital Charge Code	3615200001
Hospital Revenue Code	361
Min. Negotiated Rate	$90.23
Max. Negotiated Rate	$3,092.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$815.53
Rate for Payer: Aetna Government	$815.53
Rate for Payer: Affinity Essential Plan 1&2	$570.87
Rate for Payer: Affinity Essential Plan 3&4	$570.87
Rate for Payer: Affinity Medicaid/CHP/HARP	$570.87
Rate for Payer: Brighton Health Commercial	$1,406.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$815.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,092.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,628.64
Rate for Payer: Elderplan Medicare Advantage	$815.53
Rate for Payer: EmblemHealth Commercial	$815.53
Rate for Payer: Fidelis CHP/HARP/Medicaid	$733.98
Rate for Payer: Fidelis Essential Plan Aliesa	$693.20
Rate for Payer: Fidelis Essential Plan QHP	$725.82
Rate for Payer: Fidelis Medicare Advantage	$815.53
Rate for Payer: Fidelis Qualified Health Plan	$725.82
Rate for Payer: Group Health Inc Commercial	$815.53
Rate for Payer: Group Health Inc Medicare	$815.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$815.53
Rate for Payer: Hamaspik Choice Inc Medicare	$315.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$90.23
Rate for Payer: Healthfirst Medicare Advantage	$693.20
Rate for Payer: Healthfirst QHP	$815.53
Rate for Payer: Humana Medicare	$831.84
Rate for Payer: Senior Whole Health Medicare Advantage	$815.53
Rate for Payer: United Healthcare Commercial	$1,188.00
Rate for Payer: United Healthcare Medicare Advantage	$815.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$815.53
Rate for Payer: Wellcare CHP/FHP/Medicaid	$774.75
Rate for Payer: Wellcare Medicare	$774.75

HC CYSTOURETHROSCOPY

Facility

$1,875.00

Service Code	CPT 52000
Hospital Charge Code	3615200001
Hospital Revenue Code	361
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$937.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$937.50

HC CYSTOURETHROSCOPY W/URETEROSCOPY/PYELOSCOPY

Facility

$9,142.00

Service Code	CPT 52351 TC
Hospital Charge Code	3615235101
Hospital Revenue Code	361
Min. Negotiated Rate	$369.05
Max. Negotiated Rate	$6,856.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$369.05
Rate for Payer: Aetna Government	$369.05
Rate for Payer: Brighton Health Commercial	$6,856.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,092.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,628.64
Rate for Payer: EmblemHealth Commercial	$4,571.00
Rate for Payer: Group Health Inc Commercial	$4,571.00
Rate for Payer: Group Health Inc Medicare	$3,199.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,571.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,655.31
Rate for Payer: United Healthcare Commercial	$1,468.00

HC CYSTOURETHROSCOPY W/URETEROSCOPY/PYELOSCOPY

Facility

$9,142.00

Service Code	CPT 52351 TC
Hospital Charge Code	3615235101
Hospital Revenue Code	361
Min. Negotiated Rate	$4,571.00
Max. Negotiated Rate	$4,571.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,571.00

HC CYTOGENETICS, 100-300 - BCR/ABL1, FISH

Facility

$125.00

Service Code	CPT 88275
Hospital Charge Code	3108827501
Hospital Revenue Code	310
Min. Negotiated Rate	$62.50
Max. Negotiated Rate	$62.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$62.50

HC CYTOGENETICS, 100-300 - BCR/ABL1, FISH

Facility

$125.00

Service Code	CPT 88275
Hospital Charge Code	3108827501
Hospital Revenue Code	310
Min. Negotiated Rate	$35.83
Max. Negotiated Rate	$115.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$68.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$51.19
Rate for Payer: Aetna Government	$51.19
Rate for Payer: Affinity Essential Plan 1&2	$35.83
Rate for Payer: Affinity Essential Plan 3&4	$35.83
Rate for Payer: Affinity Medicaid/CHP/HARP	$35.83
Rate for Payer: Brighton Health Commercial	$51.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$51.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$68.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$57.45
Rate for Payer: Elderplan Medicare Advantage	$51.19
Rate for Payer: EmblemHealth Commercial	$51.19
Rate for Payer: Fidelis CHP/HARP/Medicaid	$46.07
Rate for Payer: Fidelis Essential Plan Aliesa	$43.51
Rate for Payer: Fidelis Essential Plan QHP	$45.56
Rate for Payer: Fidelis Medicare Advantage	$51.19
Rate for Payer: Fidelis Qualified Health Plan	$45.56
Rate for Payer: Group Health Inc Commercial	$51.19
Rate for Payer: Group Health Inc Medicare	$51.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.19
Rate for Payer: Hamaspik Choice Inc Medicare	$51.19
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$51.19
Rate for Payer: Healthfirst Essential Plan	$115.18
Rate for Payer: Healthfirst Medicare Advantage	$51.19
Rate for Payer: Healthfirst QHP	$51.19
Rate for Payer: Humana Medicare	$52.21
Rate for Payer: Senior Whole Health Medicare Advantage	$51.19
Rate for Payer: United Healthcare Medicare Advantage	$51.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$51.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$51.19
Rate for Payer: Wellcare Medicare	$46.07

HC CYTOGENETICS, DNA PROBE - ALK, FISH

Facility

$125.00

Service Code	CPT 88271
Hospital Charge Code	3108827101
Hospital Revenue Code	310
Min. Negotiated Rate	$14.99
Max. Negotiated Rate	$68.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$68.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.42
Rate for Payer: Aetna Government	$21.42
Rate for Payer: Affinity Essential Plan 1&2	$14.99
Rate for Payer: Affinity Essential Plan 3&4	$14.99
Rate for Payer: Affinity Medicaid/CHP/HARP	$14.99
Rate for Payer: Brighton Health Commercial	$21.42
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$21.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$36.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.64
Rate for Payer: Elderplan Medicare Advantage	$21.42
Rate for Payer: EmblemHealth Commercial	$21.42
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19.28
Rate for Payer: Fidelis Essential Plan Aliesa	$18.21
Rate for Payer: Fidelis Essential Plan QHP	$19.06
Rate for Payer: Fidelis Medicare Advantage	$21.42
Rate for Payer: Fidelis Qualified Health Plan	$19.06
Rate for Payer: Group Health Inc Commercial	$21.42
Rate for Payer: Group Health Inc Medicare	$21.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.42
Rate for Payer: Hamaspik Choice Inc Medicare	$21.42
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21.42
Rate for Payer: Healthfirst Essential Plan	$48.20
Rate for Payer: Healthfirst Medicare Advantage	$21.42
Rate for Payer: Healthfirst QHP	$21.42
Rate for Payer: Humana Medicare	$21.85
Rate for Payer: Senior Whole Health Medicare Advantage	$21.42
Rate for Payer: United Healthcare Medicare Advantage	$21.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21.42
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21.42
Rate for Payer: Wellcare Medicare	$19.28

HC CYTOGENETICS, DNA PROBE - ALK, FISH

Facility

$125.00

Service Code	CPT 88271
Hospital Charge Code	3108827101
Hospital Revenue Code	310
Min. Negotiated Rate	$62.50
Max. Negotiated Rate	$62.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$62.50

HC CYTOGENETICS, DNA PROBE - CLL PROFILE, FISH

Facility

$125.00

Service Code	CPT 88271
Hospital Charge Code	3108827102
Hospital Revenue Code	310
Min. Negotiated Rate	$14.99
Max. Negotiated Rate	$68.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$68.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.42
Rate for Payer: Aetna Government	$21.42
Rate for Payer: Affinity Essential Plan 1&2	$14.99
Rate for Payer: Affinity Essential Plan 3&4	$14.99
Rate for Payer: Affinity Medicaid/CHP/HARP	$14.99
Rate for Payer: Brighton Health Commercial	$21.42
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$21.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$36.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.64
Rate for Payer: Elderplan Medicare Advantage	$21.42
Rate for Payer: EmblemHealth Commercial	$21.42
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19.28
Rate for Payer: Fidelis Essential Plan Aliesa	$18.21
Rate for Payer: Fidelis Essential Plan QHP	$19.06
Rate for Payer: Fidelis Medicare Advantage	$21.42
Rate for Payer: Fidelis Qualified Health Plan	$19.06
Rate for Payer: Group Health Inc Commercial	$21.42
Rate for Payer: Group Health Inc Medicare	$21.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.42
Rate for Payer: Hamaspik Choice Inc Medicare	$21.42
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21.42
Rate for Payer: Healthfirst Essential Plan	$48.20
Rate for Payer: Healthfirst Medicare Advantage	$21.42
Rate for Payer: Healthfirst QHP	$21.42
Rate for Payer: Humana Medicare	$21.85
Rate for Payer: Senior Whole Health Medicare Advantage	$21.42
Rate for Payer: United Healthcare Medicare Advantage	$21.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21.42
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21.42
Rate for Payer: Wellcare Medicare	$19.28

HC CYTOGENETICS, DNA PROBE - CLL PROFILE, FISH

Facility

$125.00

Service Code	CPT 88271
Hospital Charge Code	3108827102
Hospital Revenue Code	310
Min. Negotiated Rate	$62.50
Max. Negotiated Rate	$62.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$62.50

HC CYTOGENETICS & MOLECULAR CYTOGENETICS; INTERP & REPORT

Facility

$58.00

Service Code	CPT 88291
Hospital Charge Code	3118829101
Hospital Revenue Code	311
Min. Negotiated Rate	$19.57
Max. Negotiated Rate	$45.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$31.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.57
Rate for Payer: Aetna Government	$19.57
Rate for Payer: Brighton Health Commercial	$43.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$35.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$29.71
Rate for Payer: EmblemHealth Commercial	$37.78
Rate for Payer: Group Health Inc Commercial	$29.00
Rate for Payer: Group Health Inc Medicare	$20.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.00
Rate for Payer: Hamaspik Choice Inc Medicare	$29.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20.20
Rate for Payer: Healthfirst Essential Plan	$45.45
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20.20

HC CYTOGENETICS & MOLECULAR CYTOGENETICS; INTERP & REPORT

Facility

$58.00

Service Code	CPT 88291
Hospital Charge Code	3118829101
Hospital Revenue Code	311
Min. Negotiated Rate	$29.00
Max. Negotiated Rate	$29.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.00

HC CYTOGENOMIC ANALYSIS,CONSTIT CHROMO ABNORM, DGH MICROARRAY ANA

Facility

$3,000.00

Service Code	CPT 81229
Hospital Charge Code	3108122901
Hospital Revenue Code	310
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00

HC CYTOGENOMIC ANALYSIS,CONSTIT CHROMO ABNORM, DGH MICROARRAY ANA

Facility

$3,000.00

Service Code	CPT 81229
Hospital Charge Code	3108122901
Hospital Revenue Code	310
Min. Negotiated Rate	$812.00
Max. Negotiated Rate	$2,400.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,650.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,160.00
Rate for Payer: Aetna Government	$1,160.00
Rate for Payer: Affinity Essential Plan 1&2	$812.00
Rate for Payer: Affinity Essential Plan 3&4	$812.00
Rate for Payer: Affinity Medicaid/CHP/HARP	$812.00
Rate for Payer: Brighton Health Commercial	$1,160.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,160.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,400.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,040.00
Rate for Payer: Elderplan Medicare Advantage	$1,160.00
Rate for Payer: EmblemHealth Commercial	$1,160.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,044.00
Rate for Payer: Fidelis Essential Plan Aliesa	$986.00
Rate for Payer: Fidelis Essential Plan QHP	$1,032.40
Rate for Payer: Fidelis Medicare Advantage	$1,160.00
Rate for Payer: Fidelis Qualified Health Plan	$1,032.40
Rate for Payer: Group Health Inc Commercial	$1,160.00
Rate for Payer: Group Health Inc Medicare	$1,160.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,160.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,160.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,160.00
Rate for Payer: Healthfirst Medicare Advantage	$1,160.00
Rate for Payer: Healthfirst QHP	$1,160.00
Rate for Payer: Humana Medicare	$1,183.20
Rate for Payer: Senior Whole Health Medicare Advantage	$1,160.00
Rate for Payer: United Healthcare Medicare Advantage	$1,160.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,160.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,102.00
Rate for Payer: Wellcare Medicare	$1,044.00

HC CYTOLOGIC EXAM, TOUCH/SQUASH PREP - INITIAL SITE

Facility

$1,902.00

Service Code	CPT 88333 TC
Hospital Charge Code	3128833301
Hospital Revenue Code	312
Min. Negotiated Rate	$951.00
Max. Negotiated Rate	$951.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$951.00

HC CYTOLOGIC EXAM, TOUCH/SQUASH PREP - INITIAL SITE

Facility

$1,902.00

Service Code	CPT 88333 TC
Hospital Charge Code	3128833301
Hospital Revenue Code	312
Min. Negotiated Rate	$22.91
Max. Negotiated Rate	$1,426.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,046.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.91
Rate for Payer: Aetna Government	$22.91
Rate for Payer: Brighton Health Commercial	$1,426.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$42.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$35.58
Rate for Payer: EmblemHealth Commercial	$36.72
Rate for Payer: Group Health Inc Commercial	$951.00
Rate for Payer: Group Health Inc Medicare	$665.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$951.00
Rate for Payer: Hamaspik Choice Inc Medicare	$951.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$36.72

HC CYTOMEG, DNA, AMP PROBE - CYTOMEGALOVIRUS DNA PROBE, AMPLIFIED

Facility

$87.00

Service Code	CPT 87496
Hospital Charge Code	3068749601
Hospital Revenue Code	306
Min. Negotiated Rate	$43.50
Max. Negotiated Rate	$43.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.50

HC CYTOMEG, DNA, AMP PROBE - CYTOMEGALOVIRUS DNA PROBE, AMPLIFIED

Facility

$87.00

Service Code	CPT 87496
Hospital Charge Code	3068749601
Hospital Revenue Code	306
Min. Negotiated Rate	$23.62
Max. Negotiated Rate	$65.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$47.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.09
Rate for Payer: Aetna Government	$35.09
Rate for Payer: Affinity Essential Plan 1&2	$24.56
Rate for Payer: Affinity Essential Plan 3&4	$24.56
Rate for Payer: Affinity Medicaid/CHP/HARP	$24.56
Rate for Payer: Brighton Health Commercial	$65.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$35.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$59.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$50.20
Rate for Payer: Elderplan Medicare Advantage	$35.09
Rate for Payer: EmblemHealth Commercial	$35.09
Rate for Payer: Fidelis CHP/HARP/Medicaid	$31.58
Rate for Payer: Fidelis Essential Plan Aliesa	$29.83
Rate for Payer: Fidelis Essential Plan QHP	$31.23
Rate for Payer: Fidelis Medicare Advantage	$35.09
Rate for Payer: Fidelis Qualified Health Plan	$31.23
Rate for Payer: Group Health Inc Commercial	$35.09
Rate for Payer: Group Health Inc Medicare	$35.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.09
Rate for Payer: Hamaspik Choice Inc Medicare	$35.09
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23.62
Rate for Payer: Healthfirst Essential Plan	$53.15
Rate for Payer: Healthfirst Medicare Advantage	$35.09
Rate for Payer: Healthfirst QHP	$35.09
Rate for Payer: Humana Medicare	$35.79
Rate for Payer: Senior Whole Health Medicare Advantage	$35.09
Rate for Payer: United Healthcare Commercial	$44.45
Rate for Payer: United Healthcare Medicare Advantage	$35.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$35.09
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23.62
Rate for Payer: Wellcare Medicare	$31.58

HC CYTOMEG, DNA, QUANT - CMV DNA, QUANTITATIVE, PCR

Facility

$107.00

Service Code	CPT 87497
Hospital Charge Code	3068749701
Hospital Revenue Code	306
Min. Negotiated Rate	$28.85
Max. Negotiated Rate	$80.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$58.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$42.84
Rate for Payer: Aetna Government	$42.84
Rate for Payer: Affinity Essential Plan 1&2	$29.99
Rate for Payer: Affinity Essential Plan 3&4	$29.99
Rate for Payer: Affinity Medicaid/CHP/HARP	$29.99
Rate for Payer: Brighton Health Commercial	$80.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$42.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$72.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$61.28
Rate for Payer: Elderplan Medicare Advantage	$42.84
Rate for Payer: EmblemHealth Commercial	$42.84
Rate for Payer: Fidelis CHP/HARP/Medicaid	$38.56
Rate for Payer: Fidelis Essential Plan Aliesa	$36.41
Rate for Payer: Fidelis Essential Plan QHP	$38.13
Rate for Payer: Fidelis Medicare Advantage	$42.84
Rate for Payer: Fidelis Qualified Health Plan	$38.13
Rate for Payer: Group Health Inc Commercial	$42.84
Rate for Payer: Group Health Inc Medicare	$42.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.84
Rate for Payer: Hamaspik Choice Inc Medicare	$42.84
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$28.85
Rate for Payer: Healthfirst Essential Plan	$64.91
Rate for Payer: Healthfirst Medicare Advantage	$42.84
Rate for Payer: Healthfirst QHP	$42.84
Rate for Payer: Humana Medicare	$43.70
Rate for Payer: Senior Whole Health Medicare Advantage	$42.84
Rate for Payer: United Healthcare Commercial	$54.25
Rate for Payer: United Healthcare Medicare Advantage	$42.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$42.84
Rate for Payer: Wellcare CHP/FHP/Medicaid	$28.85
Rate for Payer: Wellcare Medicare	$38.56

HC CYTOMEG, DNA, QUANT - CMV DNA, QUANTITATIVE, PCR

Facility

$107.00

Service Code	CPT 87497
Hospital Charge Code	3068749701
Hospital Revenue Code	306
Min. Negotiated Rate	$53.50
Max. Negotiated Rate	$53.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.50

HC CYTOPATH CELL ENHANCE TECH - LAB CYTOPATH, CELL ENHANCE TECH

Facility

$149.00

Service Code	CPT 88112 TC
Hospital Charge Code	3118811201
Hospital Revenue Code	311
Min. Negotiated Rate	$74.50
Max. Negotiated Rate	$74.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.50

Know your out-of-pocket cost for care.

All Charges