St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS

Facility

$135.00

Service Code	CPT 99156
Hospital Charge Code	3709915601
Hospital Revenue Code	370
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.50

HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS

Facility

$135.00

Service Code	CPT 99156
Hospital Charge Code	3709915601
Hospital Revenue Code	370
Min. Negotiated Rate	$47.25
Max. Negotiated Rate	$108.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$74.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$65.47
Rate for Payer: Aetna Government	$65.47
Rate for Payer: Brighton Health Commercial	$101.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$108.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$91.80
Rate for Payer: EmblemHealth Commercial	$67.50
Rate for Payer: Group Health Inc Commercial	$67.50
Rate for Payer: Group Health Inc Medicare	$47.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.50
Rate for Payer: Hamaspik Choice Inc Medicare	$67.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$81.87

HC MOD SED SAME PHYS/QHP EACH ADDL 15 MINS

Facility

$42.00

Service Code	CPT 99153
Hospital Charge Code	3709915301
Hospital Revenue Code	370
Min. Negotiated Rate	$10.07
Max. Negotiated Rate	$33.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.07
Rate for Payer: Aetna Government	$10.07
Rate for Payer: Brighton Health Commercial	$31.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$33.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.56
Rate for Payer: EmblemHealth Commercial	$21.00
Rate for Payer: Group Health Inc Commercial	$21.00
Rate for Payer: Group Health Inc Medicare	$14.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.00
Rate for Payer: Hamaspik Choice Inc Medicare	$21.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$14.43

HC MOD SED SAME PHYS/QHP EACH ADDL 15 MINS

Facility

$42.00

Service Code	CPT 99153
Hospital Charge Code	3709915301
Hospital Revenue Code	370
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$21.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.00

HC MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS

Facility

$84.00

Service Code	CPT 99151
Hospital Charge Code	3709915101
Hospital Revenue Code	370
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$42.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.00

HC MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS

Facility

$84.00

Service Code	CPT 99151
Hospital Charge Code	3709915101
Hospital Revenue Code	370
Min. Negotiated Rate	$20.49
Max. Negotiated Rate	$67.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$46.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.49
Rate for Payer: Aetna Government	$20.49
Rate for Payer: Brighton Health Commercial	$63.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$67.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$57.12
Rate for Payer: EmblemHealth Commercial	$42.00
Rate for Payer: Group Health Inc Commercial	$42.00
Rate for Payer: Group Health Inc Medicare	$29.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.00
Rate for Payer: Hamaspik Choice Inc Medicare	$42.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$26.07

HC MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS

Facility

$84.00

Service Code	CPT 99152
Hospital Charge Code	3709915201
Hospital Revenue Code	370
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$42.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.00

HC MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS

Facility

$84.00

Service Code	CPT 99152
Hospital Charge Code	3709915201
Hospital Revenue Code	370
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$67.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$46.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.66
Rate for Payer: Aetna Government	$10.66
Rate for Payer: Brighton Health Commercial	$63.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$67.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$57.12
Rate for Payer: EmblemHealth Commercial	$42.00
Rate for Payer: Group Health Inc Commercial	$42.00
Rate for Payer: Group Health Inc Medicare	$29.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.00
Rate for Payer: Hamaspik Choice Inc Medicare	$42.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$13.57

HC MOG-IGG1 ANTIBODY CELL-BASED IMFLUOR ASSAY EACH

Facility

$117.00

Service Code	CPT 86362
Hospital Charge Code	3028636201
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$58.50

HC MOG-IGG1 ANTIBODY CELL-BASED IMFLUOR ASSAY EACH

Facility

$117.00

Service Code	CPT 86362
Hospital Charge Code	3028636201
Hospital Revenue Code	302
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$93.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$64.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.05
Rate for Payer: Aetna Government	$12.05
Rate for Payer: Affinity Essential Plan 1&2	$8.44
Rate for Payer: Affinity Essential Plan 3&4	$8.44
Rate for Payer: Affinity Medicaid/CHP/HARP	$8.44
Rate for Payer: Brighton Health Commercial	$87.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$93.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$79.56
Rate for Payer: Elderplan Medicare Advantage	$12.05
Rate for Payer: EmblemHealth Commercial	$12.05
Rate for Payer: Fidelis CHP/HARP/Medicaid	$10.85
Rate for Payer: Fidelis Essential Plan Aliesa	$10.24
Rate for Payer: Fidelis Essential Plan QHP	$10.72
Rate for Payer: Fidelis Medicare Advantage	$12.05
Rate for Payer: Fidelis Qualified Health Plan	$10.72
Rate for Payer: Group Health Inc Commercial	$12.05
Rate for Payer: Group Health Inc Medicare	$12.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.05
Rate for Payer: Hamaspik Choice Inc Medicare	$12.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$12.05
Rate for Payer: Healthfirst Medicare Advantage	$12.05
Rate for Payer: Healthfirst QHP	$12.05
Rate for Payer: Humana Medicare	$12.29
Rate for Payer: Senior Whole Health Medicare Advantage	$12.05
Rate for Payer: United Healthcare Commercial	$10.85
Rate for Payer: United Healthcare Medicare Advantage	$12.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$11.45
Rate for Payer: Wellcare Medicare	$10.85

HC MOLECULAR CYTOGENETICS; IN SITU HYBRIDIZATIO, 25-99 CELLS

Facility

$105.00

Service Code	CPT 88274
Hospital Charge Code	3118827401
Hospital Revenue Code	311
Min. Negotiated Rate	$29.67
Max. Negotiated Rate	$95.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$57.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$42.38
Rate for Payer: Aetna Government	$42.38
Rate for Payer: Affinity Essential Plan 1&2	$29.67
Rate for Payer: Affinity Essential Plan 3&4	$29.67
Rate for Payer: Affinity Medicaid/CHP/HARP	$29.67
Rate for Payer: Brighton Health Commercial	$42.38
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$42.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$59.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$49.80
Rate for Payer: Elderplan Medicare Advantage	$42.38
Rate for Payer: EmblemHealth Commercial	$42.38
Rate for Payer: Fidelis CHP/HARP/Medicaid	$38.14
Rate for Payer: Fidelis Essential Plan Aliesa	$36.02
Rate for Payer: Fidelis Essential Plan QHP	$37.72
Rate for Payer: Fidelis Medicare Advantage	$42.38
Rate for Payer: Fidelis Qualified Health Plan	$37.72
Rate for Payer: Group Health Inc Commercial	$42.38
Rate for Payer: Group Health Inc Medicare	$42.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.38
Rate for Payer: Hamaspik Choice Inc Medicare	$42.38
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$42.38
Rate for Payer: Healthfirst Essential Plan	$95.36
Rate for Payer: Healthfirst Medicare Advantage	$42.38
Rate for Payer: Healthfirst QHP	$42.38
Rate for Payer: Humana Medicare	$43.23
Rate for Payer: Senior Whole Health Medicare Advantage	$42.38
Rate for Payer: United Healthcare Medicare Advantage	$42.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$42.38
Rate for Payer: Wellcare CHP/FHP/Medicaid	$42.38
Rate for Payer: Wellcare Medicare	$38.14

HC MOLECULAR CYTOGENETICS; IN SITU HYBRIDIZATIO, 25-99 CELLS

Facility

$105.00

Service Code	CPT 88274
Hospital Charge Code	3118827401
Hospital Revenue Code	311
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.50

HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 2

Facility

$342.00

Service Code	CPT 81401
Hospital Charge Code	3108140101
Hospital Revenue Code	310
Min. Negotiated Rate	$95.90
Max. Negotiated Rate	$273.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$188.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$137.00
Rate for Payer: Aetna Government	$137.00
Rate for Payer: Affinity Essential Plan 1&2	$95.90
Rate for Payer: Affinity Essential Plan 3&4	$95.90
Rate for Payer: Affinity Medicaid/CHP/HARP	$95.90
Rate for Payer: Brighton Health Commercial	$137.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$137.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$273.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$232.56
Rate for Payer: Elderplan Medicare Advantage	$137.00
Rate for Payer: EmblemHealth Commercial	$137.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$123.30
Rate for Payer: Fidelis Essential Plan Aliesa	$116.45
Rate for Payer: Fidelis Essential Plan QHP	$121.93
Rate for Payer: Fidelis Medicare Advantage	$137.00
Rate for Payer: Fidelis Qualified Health Plan	$121.93
Rate for Payer: Group Health Inc Commercial	$137.00
Rate for Payer: Group Health Inc Medicare	$137.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$137.00
Rate for Payer: Hamaspik Choice Inc Medicare	$137.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$137.00
Rate for Payer: Healthfirst Medicare Advantage	$137.00
Rate for Payer: Healthfirst QHP	$137.00
Rate for Payer: Humana Medicare	$139.74
Rate for Payer: Senior Whole Health Medicare Advantage	$137.00
Rate for Payer: United Healthcare Medicare Advantage	$137.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$137.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$130.15
Rate for Payer: Wellcare Medicare	$123.30

HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 2

Facility

$342.00

Service Code	CPT 81401
Hospital Charge Code	3108140101
Hospital Revenue Code	310
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$171.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$171.00

HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 4

Facility

$463.00

Service Code	CPT 81403
Hospital Charge Code	3108140301
Hospital Revenue Code	310
Min. Negotiated Rate	$129.64
Max. Negotiated Rate	$370.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$254.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$185.20
Rate for Payer: Aetna Government	$185.20
Rate for Payer: Affinity Essential Plan 1&2	$129.64
Rate for Payer: Affinity Essential Plan 3&4	$129.64
Rate for Payer: Affinity Medicaid/CHP/HARP	$129.64
Rate for Payer: Brighton Health Commercial	$185.20
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$185.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$370.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$314.84
Rate for Payer: Elderplan Medicare Advantage	$185.20
Rate for Payer: EmblemHealth Commercial	$185.20
Rate for Payer: Fidelis CHP/HARP/Medicaid	$166.68
Rate for Payer: Fidelis Essential Plan Aliesa	$157.42
Rate for Payer: Fidelis Essential Plan QHP	$164.83
Rate for Payer: Fidelis Medicare Advantage	$185.20
Rate for Payer: Fidelis Qualified Health Plan	$164.83
Rate for Payer: Group Health Inc Commercial	$185.20
Rate for Payer: Group Health Inc Medicare	$185.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$185.20
Rate for Payer: Hamaspik Choice Inc Medicare	$185.20
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$185.20
Rate for Payer: Healthfirst Medicare Advantage	$185.20
Rate for Payer: Healthfirst QHP	$185.20
Rate for Payer: Humana Medicare	$188.90
Rate for Payer: Senior Whole Health Medicare Advantage	$185.20
Rate for Payer: United Healthcare Medicare Advantage	$185.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$185.20
Rate for Payer: Wellcare CHP/FHP/Medicaid	$175.94
Rate for Payer: Wellcare Medicare	$166.68

HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 4

Facility

$463.00

Service Code	CPT 81403
Hospital Charge Code	3108140301
Hospital Revenue Code	310
Min. Negotiated Rate	$231.50
Max. Negotiated Rate	$231.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$231.50

HC MOLECULAR PATHOLOGY PROCEDURE, LEVEL 5

Facility

$556.00

Service Code	CPT 81404
Hospital Charge Code	3108140401
Hospital Revenue Code	310
Min. Negotiated Rate	$192.38
Max. Negotiated Rate	$444.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$305.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$274.83
Rate for Payer: Aetna Government	$274.83
Rate for Payer: Affinity Essential Plan 1&2	$192.38
Rate for Payer: Affinity Essential Plan 3&4	$192.38
Rate for Payer: Affinity Medicaid/CHP/HARP	$192.38
Rate for Payer: Brighton Health Commercial	$274.83
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$274.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$444.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$378.08
Rate for Payer: Elderplan Medicare Advantage	$274.83
Rate for Payer: EmblemHealth Commercial	$274.83
Rate for Payer: Fidelis CHP/HARP/Medicaid	$247.35
Rate for Payer: Fidelis Essential Plan Aliesa	$233.61
Rate for Payer: Fidelis Essential Plan QHP	$244.60
Rate for Payer: Fidelis Medicare Advantage	$274.83
Rate for Payer: Fidelis Qualified Health Plan	$244.60
Rate for Payer: Group Health Inc Commercial	$274.83
Rate for Payer: Group Health Inc Medicare	$274.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$274.83
Rate for Payer: Hamaspik Choice Inc Medicare	$274.83
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$274.83
Rate for Payer: Healthfirst Medicare Advantage	$274.83
Rate for Payer: Healthfirst QHP	$274.83
Rate for Payer: Humana Medicare	$280.33
Rate for Payer: Senior Whole Health Medicare Advantage	$274.83
Rate for Payer: United Healthcare Medicare Advantage	$274.83
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$274.83
Rate for Payer: Wellcare CHP/FHP/Medicaid	$261.09
Rate for Payer: Wellcare Medicare	$247.35

HC MOLECULAR PATHOLOGY PROCEDURE, LEVEL 5

Facility

$556.00

Service Code	CPT 81404
Hospital Charge Code	3108140401
Hospital Revenue Code	310
Min. Negotiated Rate	$278.00
Max. Negotiated Rate	$278.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$278.00

HC MOLECULAR PATHOLOGY PROCEDURE, LEVEL 6

Facility

$637.00

Service Code	CPT 81405
Hospital Charge Code	3108140501
Hospital Revenue Code	310
Min. Negotiated Rate	$318.50
Max. Negotiated Rate	$318.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$318.50

HC MOLECULAR PATHOLOGY PROCEDURE, LEVEL 6

Facility

$637.00

Service Code	CPT 81405
Hospital Charge Code	3108140501
Hospital Revenue Code	310
Min. Negotiated Rate	$210.94
Max. Negotiated Rate	$509.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$350.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$301.35
Rate for Payer: Aetna Government	$301.35
Rate for Payer: Affinity Essential Plan 1&2	$210.94
Rate for Payer: Affinity Essential Plan 3&4	$210.94
Rate for Payer: Affinity Medicaid/CHP/HARP	$210.94
Rate for Payer: Brighton Health Commercial	$301.35
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$301.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$509.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$433.16
Rate for Payer: Elderplan Medicare Advantage	$301.35
Rate for Payer: EmblemHealth Commercial	$301.35
Rate for Payer: Fidelis CHP/HARP/Medicaid	$271.21
Rate for Payer: Fidelis Essential Plan Aliesa	$256.15
Rate for Payer: Fidelis Essential Plan QHP	$268.20
Rate for Payer: Fidelis Medicare Advantage	$301.35
Rate for Payer: Fidelis Qualified Health Plan	$268.20
Rate for Payer: Group Health Inc Commercial	$301.35
Rate for Payer: Group Health Inc Medicare	$301.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$301.35
Rate for Payer: Hamaspik Choice Inc Medicare	$301.35
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$301.35
Rate for Payer: Healthfirst Medicare Advantage	$301.35
Rate for Payer: Healthfirst QHP	$301.35
Rate for Payer: Humana Medicare	$307.38
Rate for Payer: Senior Whole Health Medicare Advantage	$301.35
Rate for Payer: United Healthcare Medicare Advantage	$301.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$301.35
Rate for Payer: Wellcare CHP/FHP/Medicaid	$286.28
Rate for Payer: Wellcare Medicare	$271.21

HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 7

Facility

$707.00

Service Code	CPT 81406
Hospital Charge Code	3108140601
Hospital Revenue Code	310
Min. Negotiated Rate	$353.50
Max. Negotiated Rate	$353.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$353.50

HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 7

Facility

$707.00

Service Code	CPT 81406
Hospital Charge Code	3108140601
Hospital Revenue Code	310
Min. Negotiated Rate	$198.02
Max. Negotiated Rate	$565.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$388.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$282.88
Rate for Payer: Aetna Government	$282.88
Rate for Payer: Affinity Essential Plan 1&2	$198.02
Rate for Payer: Affinity Essential Plan 3&4	$198.02
Rate for Payer: Affinity Medicaid/CHP/HARP	$198.02
Rate for Payer: Brighton Health Commercial	$282.88
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$282.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$565.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$480.76
Rate for Payer: Elderplan Medicare Advantage	$282.88
Rate for Payer: EmblemHealth Commercial	$282.88
Rate for Payer: Fidelis CHP/HARP/Medicaid	$254.59
Rate for Payer: Fidelis Essential Plan Aliesa	$240.45
Rate for Payer: Fidelis Essential Plan QHP	$251.76
Rate for Payer: Fidelis Medicare Advantage	$282.88
Rate for Payer: Fidelis Qualified Health Plan	$251.76
Rate for Payer: Group Health Inc Commercial	$282.88
Rate for Payer: Group Health Inc Medicare	$282.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$282.88
Rate for Payer: Hamaspik Choice Inc Medicare	$282.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$282.88
Rate for Payer: Healthfirst Medicare Advantage	$282.88
Rate for Payer: Healthfirst QHP	$282.88
Rate for Payer: Humana Medicare	$288.54
Rate for Payer: Senior Whole Health Medicare Advantage	$282.88
Rate for Payer: United Healthcare Medicare Advantage	$282.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$282.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$268.74
Rate for Payer: Wellcare Medicare	$254.59

HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 8

Facility

$848.00

Service Code	CPT 81407
Hospital Charge Code	3108140701
Hospital Revenue Code	310
Min. Negotiated Rate	$424.00
Max. Negotiated Rate	$424.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$424.00

HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 8

Facility

$848.00

Service Code	CPT 81407
Hospital Charge Code	3108140701
Hospital Revenue Code	310
Min. Negotiated Rate	$466.40
Max. Negotiated Rate	$863.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$466.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$846.27
Rate for Payer: Aetna Government	$846.27
Rate for Payer: Affinity Essential Plan 1&2	$592.39
Rate for Payer: Affinity Essential Plan 3&4	$592.39
Rate for Payer: Affinity Medicaid/CHP/HARP	$592.39
Rate for Payer: Brighton Health Commercial	$846.27
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$846.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$678.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$576.64
Rate for Payer: Elderplan Medicare Advantage	$846.27
Rate for Payer: EmblemHealth Commercial	$846.27
Rate for Payer: Fidelis CHP/HARP/Medicaid	$761.64
Rate for Payer: Fidelis Essential Plan Aliesa	$719.33
Rate for Payer: Fidelis Essential Plan QHP	$753.18
Rate for Payer: Fidelis Medicare Advantage	$846.27
Rate for Payer: Fidelis Qualified Health Plan	$753.18
Rate for Payer: Group Health Inc Commercial	$846.27
Rate for Payer: Group Health Inc Medicare	$846.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$846.27
Rate for Payer: Hamaspik Choice Inc Medicare	$846.27
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$846.27
Rate for Payer: Healthfirst Medicare Advantage	$846.27
Rate for Payer: Healthfirst QHP	$846.27
Rate for Payer: Humana Medicare	$863.20
Rate for Payer: Senior Whole Health Medicare Advantage	$846.27
Rate for Payer: United Healthcare Medicare Advantage	$846.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$846.27
Rate for Payer: Wellcare CHP/FHP/Medicaid	$803.96
Rate for Payer: Wellcare Medicare	$761.64

HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 9

Facility

$933.00

Service Code	CPT 81408
Hospital Charge Code	3108140801
Hospital Revenue Code	310
Min. Negotiated Rate	$513.15
Max. Negotiated Rate	$2,040.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$513.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,000.00
Rate for Payer: Aetna Government	$2,000.00
Rate for Payer: Affinity Essential Plan 1&2	$1,400.00
Rate for Payer: Affinity Essential Plan 3&4	$1,400.00
Rate for Payer: Affinity Medicaid/CHP/HARP	$1,400.00
Rate for Payer: Brighton Health Commercial	$2,000.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$2,000.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$746.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$634.44
Rate for Payer: Elderplan Medicare Advantage	$2,000.00
Rate for Payer: EmblemHealth Commercial	$2,000.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,800.00
Rate for Payer: Fidelis Essential Plan Aliesa	$1,700.00
Rate for Payer: Fidelis Essential Plan QHP	$1,780.00
Rate for Payer: Fidelis Medicare Advantage	$2,000.00
Rate for Payer: Fidelis Qualified Health Plan	$1,780.00
Rate for Payer: Group Health Inc Commercial	$2,000.00
Rate for Payer: Group Health Inc Medicare	$2,000.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,000.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,000.00
Rate for Payer: Healthfirst Medicare Advantage	$2,000.00
Rate for Payer: Healthfirst QHP	$2,000.00
Rate for Payer: Humana Medicare	$2,040.00
Rate for Payer: Senior Whole Health Medicare Advantage	$2,000.00
Rate for Payer: United Healthcare Medicare Advantage	$2,000.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,000.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,900.00
Rate for Payer: Wellcare Medicare	$1,800.00

Know your out-of-pocket cost for care.

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