St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC MED ASSTD TRMT, BUPRENORPHINE(INJ), WKLY

Facility

$258.00

Service Code	CPT G2069
Hospital Charge Code	900G206901
Hospital Revenue Code	900
Min. Negotiated Rate	$90.30
Max. Negotiated Rate	$1,783.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$141.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,783.91
Rate for Payer: Aetna Government	$1,783.91
Rate for Payer: Brighton Health Commercial	$193.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$206.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$175.44
Rate for Payer: EmblemHealth Commercial	$129.00
Rate for Payer: Group Health Inc Commercial	$129.00
Rate for Payer: Group Health Inc Medicare	$90.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.00
Rate for Payer: Hamaspik Choice Inc Medicare	$129.00
Rate for Payer: United Healthcare Commercial	$129.00

HC MED ASSTD TRMT, BUPRENORPHINE(INJ), WKLY

Facility

$258.00

Service Code	CPT G2069
Hospital Charge Code	900G206901
Hospital Revenue Code	900
Min. Negotiated Rate	$129.00
Max. Negotiated Rate	$129.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.00

HC MED ASSTD TRMT, BUPRENORPHINE(ORAL), WKLY

Facility

$82.00

Service Code	CPT G2068
Hospital Charge Code	900G206802
Hospital Revenue Code	900
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$41.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.00

HC MED ASSTD TRMT, BUPRENORPHINE(ORAL), WKLY

Facility

$82.00

Service Code	CPT G2068
Hospital Charge Code	900G206802
Hospital Revenue Code	900
Min. Negotiated Rate	$28.70
Max. Negotiated Rate	$772.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$45.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$284.13
Rate for Payer: Aetna Government	$284.13
Rate for Payer: Affinity Essential Plan 1&2	$772.64
Rate for Payer: Affinity Essential Plan 3&4	$772.64
Rate for Payer: Affinity Medicaid/CHP/HARP	$343.40
Rate for Payer: Amida Care Medicaid	$343.40
Rate for Payer: Brighton Health Commercial	$61.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$65.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$55.76
Rate for Payer: EmblemHealth Commercial	$41.00
Rate for Payer: EmblemHealth Essential Plan 1&2	$772.64
Rate for Payer: EmblemHealth Essential Plan 3&4	$343.40
Rate for Payer: Fidelis CHP/HARP/Medicaid	$343.40
Rate for Payer: Fidelis Essential Plan Aliesa	$772.64
Rate for Payer: Fidelis Essential Plan QHP	$772.64
Rate for Payer: Fidelis Qualified Health Plan	$360.56
Rate for Payer: Group Health Inc Commercial	$41.00
Rate for Payer: Group Health Inc Medicare	$28.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$343.40
Rate for Payer: Hamaspik Choice Inc Medicare	$343.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$343.40
Rate for Payer: Healthfirst Essential Plan	$772.64
Rate for Payer: Healthfirst QHP	$559.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$343.40
Rate for Payer: SOMOS Essential	$772.64
Rate for Payer: United Healthcare Commercial	$41.00
Rate for Payer: United Healthcare Essential Plan 1&2	$772.64
Rate for Payer: United Healthcare Essential Plan 3&4	$377.73
Rate for Payer: United Healthcare Medicaid	$343.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$343.40

HC MED LIST DOCD IN RCRD

Facility

$10.00

Service Code	CPT 1159F
Hospital Charge Code	9691159F01
Hospital Revenue Code	969
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$8.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$7.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.80
Rate for Payer: EmblemHealth Commercial	$5.00
Rate for Payer: Group Health Inc Commercial	$5.00
Rate for Payer: Group Health Inc Medicare	$3.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5.00

HC MED LIST DOCD IN RCRD

Facility

$10.00

Service Code	CPT 1159F
Hospital Charge Code	9691159F01
Hospital Revenue Code	969
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$5.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.00

HC MED NUTITION THERAPY RE-ASS, GROUP, EA 30 MIN

Facility

$45.00

Service Code	CPT G0271
Hospital Charge Code	942G027101
Hospital Revenue Code	942
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.50

HC MED NUTITION THERAPY RE-ASS, GROUP, EA 30 MIN

Facility

$45.00

Service Code	CPT G0271
Hospital Charge Code	942G027101
Hospital Revenue Code	942
Min. Negotiated Rate	$9.09
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.09
Rate for Payer: Aetna Government	$9.09
Rate for Payer: Affinity Essential Plan 1&2	$78.99
Rate for Payer: Affinity Essential Plan 3&4	$78.99
Rate for Payer: Affinity Medicaid/CHP/HARP	$35.11
Rate for Payer: Amida Care Medicaid	$35.11
Rate for Payer: Brighton Health Commercial	$33.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$36.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.60
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: EmblemHealth Essential Plan 1&2	$78.99
Rate for Payer: EmblemHealth Essential Plan 3&4	$35.11
Rate for Payer: Fidelis CHP/HARP/Medicaid	$35.11
Rate for Payer: Fidelis Essential Plan Aliesa	$78.99
Rate for Payer: Fidelis Essential Plan QHP	$78.99
Rate for Payer: Fidelis Qualified Health Plan	$36.86
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.11
Rate for Payer: Hamaspik Choice Inc Medicare	$35.11
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$35.11
Rate for Payer: Healthfirst Essential Plan	$78.99
Rate for Payer: Healthfirst QHP	$57.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$35.11
Rate for Payer: SOMOS Essential	$78.99
Rate for Payer: United Healthcare Commercial	$22.50
Rate for Payer: United Healthcare Essential Plan 1&2	$78.99
Rate for Payer: United Healthcare Essential Plan 3&4	$38.62
Rate for Payer: United Healthcare Medicaid	$35.11
Rate for Payer: Wellcare CHP/FHP/Medicaid	$35.11

HC MED NUTITION THERAPY RE-ASS, INDIVIDUAL, EA 15 MIN

Facility

$82.00

Service Code	CPT G0270
Hospital Charge Code	942G027001
Hospital Revenue Code	942
Min. Negotiated Rate	$16.52
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$45.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.52
Rate for Payer: Aetna Government	$16.52
Rate for Payer: Affinity Essential Plan 1&2	$96.18
Rate for Payer: Affinity Essential Plan 3&4	$96.18
Rate for Payer: Affinity Medicaid/CHP/HARP	$42.75
Rate for Payer: Amida Care Medicaid	$42.75
Rate for Payer: Brighton Health Commercial	$61.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$65.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$55.76
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: EmblemHealth Essential Plan 1&2	$96.18
Rate for Payer: EmblemHealth Essential Plan 3&4	$42.75
Rate for Payer: Fidelis CHP/HARP/Medicaid	$42.75
Rate for Payer: Fidelis Essential Plan Aliesa	$96.18
Rate for Payer: Fidelis Essential Plan QHP	$96.18
Rate for Payer: Fidelis Qualified Health Plan	$44.88
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.75
Rate for Payer: Hamaspik Choice Inc Medicare	$42.75
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$42.75
Rate for Payer: Healthfirst Essential Plan	$96.18
Rate for Payer: Healthfirst QHP	$69.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$42.75
Rate for Payer: SOMOS Essential	$96.18
Rate for Payer: United Healthcare Commercial	$41.00
Rate for Payer: United Healthcare Essential Plan 1&2	$96.18
Rate for Payer: United Healthcare Essential Plan 3&4	$47.02
Rate for Payer: United Healthcare Medicaid	$42.75
Rate for Payer: Wellcare CHP/FHP/Medicaid	$42.75

HC MED NUTITION THERAPY RE-ASS, INDIVIDUAL, EA 15 MIN

Facility

$82.00

Service Code	CPT G0270
Hospital Charge Code	942G027001
Hospital Revenue Code	942
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$41.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.00

HC MED NUTR THER, 1ST, INDIV, EA 15 MIN

Facility

$97.00

Service Code	CPT 97802
Hospital Charge Code	9429780201
Hospital Revenue Code	942
Min. Negotiated Rate	$27.89
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$53.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$27.89
Rate for Payer: Aetna Government	$27.89
Rate for Payer: Affinity Essential Plan 1&2	$96.18
Rate for Payer: Affinity Essential Plan 3&4	$96.18
Rate for Payer: Affinity Medicaid/CHP/HARP	$42.75
Rate for Payer: Amida Care Medicaid	$42.75
Rate for Payer: Brighton Health Commercial	$72.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$77.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$65.96
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: EmblemHealth Essential Plan 1&2	$96.18
Rate for Payer: EmblemHealth Essential Plan 3&4	$42.75
Rate for Payer: Fidelis CHP/HARP/Medicaid	$42.75
Rate for Payer: Fidelis Essential Plan Aliesa	$96.18
Rate for Payer: Fidelis Essential Plan QHP	$96.18
Rate for Payer: Fidelis Qualified Health Plan	$44.88
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.75
Rate for Payer: Hamaspik Choice Inc Medicare	$42.75
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$42.75
Rate for Payer: Healthfirst Essential Plan	$96.18
Rate for Payer: Healthfirst QHP	$69.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$42.75
Rate for Payer: SOMOS Essential	$96.18
Rate for Payer: United Healthcare Commercial	$48.50
Rate for Payer: United Healthcare Essential Plan 1&2	$96.18
Rate for Payer: United Healthcare Essential Plan 3&4	$47.02
Rate for Payer: United Healthcare Medicaid	$42.75
Rate for Payer: Wellcare CHP/FHP/Medicaid	$42.75

HC MED NUTR THER, 1ST, INDIV, EA 15 MIN

Facility

$97.00

Service Code	CPT 97802
Hospital Charge Code	9429780201
Hospital Revenue Code	942
Min. Negotiated Rate	$48.50
Max. Negotiated Rate	$48.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.50

HC MED NUTR THER, SUBSQ, INDIV, EA 15 MIN

Facility

$82.00

Service Code	CPT 97803
Hospital Charge Code	9429780301
Hospital Revenue Code	942
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$41.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.00

HC MED NUTR THER, SUBSQ, INDIV, EA 15 MIN

Facility

$82.00

Service Code	CPT 97803
Hospital Charge Code	9429780301
Hospital Revenue Code	942
Min. Negotiated Rate	$23.69
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$45.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$23.69
Rate for Payer: Aetna Government	$23.69
Rate for Payer: Affinity Essential Plan 1&2	$96.18
Rate for Payer: Affinity Essential Plan 3&4	$96.18
Rate for Payer: Affinity Medicaid/CHP/HARP	$42.75
Rate for Payer: Amida Care Medicaid	$42.75
Rate for Payer: Brighton Health Commercial	$61.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$65.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$55.76
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: EmblemHealth Essential Plan 1&2	$96.18
Rate for Payer: EmblemHealth Essential Plan 3&4	$42.75
Rate for Payer: Fidelis CHP/HARP/Medicaid	$42.75
Rate for Payer: Fidelis Essential Plan Aliesa	$96.18
Rate for Payer: Fidelis Essential Plan QHP	$96.18
Rate for Payer: Fidelis Qualified Health Plan	$44.88
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$42.75
Rate for Payer: Hamaspik Choice Inc Medicare	$42.75
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$42.75
Rate for Payer: Healthfirst Essential Plan	$96.18
Rate for Payer: Healthfirst QHP	$69.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$42.75
Rate for Payer: SOMOS Essential	$96.18
Rate for Payer: United Healthcare Commercial	$41.00
Rate for Payer: United Healthcare Essential Plan 1&2	$96.18
Rate for Payer: United Healthcare Essential Plan 3&4	$47.02
Rate for Payer: United Healthcare Medicaid	$42.75
Rate for Payer: Wellcare CHP/FHP/Medicaid	$42.75

HC MED SERV EVE/WKEND/HOLIDAY

Facility

$205.00

Service Code	CPT 99051
Hospital Charge Code	4569905101
Hospital Revenue Code	456
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$874.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$694.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.00
Rate for Payer: Aetna Government	$10.00
Rate for Payer: Affinity Essential Plan 1&2	$39.52
Rate for Payer: Affinity Essential Plan 3&4	$39.52
Rate for Payer: Affinity Medicaid/CHP/HARP	$17.57
Rate for Payer: Amida Care Medicaid	$17.57
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$792.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$673.89
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: EmblemHealth Essential Plan 1&2	$39.52
Rate for Payer: EmblemHealth Essential Plan 3&4	$17.57
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17.57
Rate for Payer: Fidelis Essential Plan Aliesa	$39.52
Rate for Payer: Fidelis Essential Plan QHP	$39.52
Rate for Payer: Fidelis Qualified Health Plan	$18.44
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.57
Rate for Payer: Hamaspik Choice Inc Medicare	$17.57
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17.57
Rate for Payer: Healthfirst Essential Plan	$39.52
Rate for Payer: Healthfirst QHP	$28.63
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17.57
Rate for Payer: SOMOS Essential	$39.52
Rate for Payer: United Healthcare Commercial	$50.00
Rate for Payer: United Healthcare Essential Plan 1&2	$39.52
Rate for Payer: United Healthcare Essential Plan 3&4	$19.32
Rate for Payer: United Healthcare Medicaid	$17.57
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17.57

HC MED SERV EVE/WKEND/HOLIDAY

Facility

$205.00

Service Code	CPT 99051
Hospital Charge Code	4569905101
Hospital Revenue Code	456
Min. Negotiated Rate	$102.50
Max. Negotiated Rate	$102.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$102.50

HC MEDS RECONCILE W/CURRENT MEDS

Facility

$10.00

Service Code	CPT 1111F
Hospital Charge Code	9691111F01
Hospital Revenue Code	969
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$8.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$7.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.80
Rate for Payer: EmblemHealth Commercial	$5.00
Rate for Payer: Group Health Inc Commercial	$5.00
Rate for Payer: Group Health Inc Medicare	$3.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5.00

HC MEDS RECONCILE W/CURRENT MEDS

Facility

$10.00

Service Code	CPT 1111F
Hospital Charge Code	9691111F01
Hospital Revenue Code	969
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$5.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.00

HC MENACWY CONJUGATE VACCINE GROUPS ACYW-135 IM USE

Facility

$329.00

Service Code	CPT 90734
Hospital Charge Code	6369073401
Hospital Revenue Code	636
Min. Negotiated Rate	$115.15
Max. Negotiated Rate	$213.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$180.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$137.33
Rate for Payer: Aetna Government	$137.33
Rate for Payer: Brighton Health Commercial	$197.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$164.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$189.18
Rate for Payer: EmblemHealth Commercial	$164.50
Rate for Payer: Group Health Inc Commercial	$164.50
Rate for Payer: Group Health Inc Medicare	$115.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$164.50
Rate for Payer: Hamaspik Choice Inc Medicare	$164.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$213.85

HC MENACWY CONJUGATE VACCINE GROUPS ACYW-135 IM USE

Facility

$329.00

Service Code	CPT 90734
Hospital Charge Code	6369073401
Hospital Revenue Code	636
Min. Negotiated Rate	$164.50
Max. Negotiated Rate	$164.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$164.50
Rate for Payer: Hamaspik Choice Inc Medicare	$164.50

HC MENACWY-TT CONJ VACC SEROGROUPS ACWY FOR IM USE

Facility

$67.00

Service Code	CPT 90619
Hospital Charge Code	6369061901
Hospital Revenue Code	636
Min. Negotiated Rate	$33.50
Max. Negotiated Rate	$33.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$33.50
Rate for Payer: Hamaspik Choice Inc Medicare	$33.50

HC MENACWY-TT CONJ VACC SEROGROUPS ACWY FOR IM USE

Facility

$67.00

Service Code	CPT 90619
Hospital Charge Code	6369061901
Hospital Revenue Code	636
Min. Negotiated Rate	$23.45
Max. Negotiated Rate	$144.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$36.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$144.13
Rate for Payer: Aetna Government	$144.13
Rate for Payer: Brighton Health Commercial	$40.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$33.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$38.52
Rate for Payer: EmblemHealth Commercial	$33.50
Rate for Payer: Group Health Inc Commercial	$33.50
Rate for Payer: Group Health Inc Medicare	$23.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$33.50
Rate for Payer: Hamaspik Choice Inc Medicare	$33.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$43.55

HC MENB-4C RECOMBNT PROT & OUTER MEMB VESIC VACC IM

Facility

$119.00

Service Code	CPT 90620
Hospital Charge Code	6369062001
Hospital Revenue Code	636
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$59.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$59.50
Rate for Payer: Hamaspik Choice Inc Medicare	$59.50

HC MENB-4C RECOMBNT PROT & OUTER MEMB VESIC VACC IM

Facility

$119.00

Service Code	CPT 90620
Hospital Charge Code	6369062001
Hospital Revenue Code	636
Min. Negotiated Rate	$41.65
Max. Negotiated Rate	$195.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$65.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$195.45
Rate for Payer: Aetna Government	$195.45
Rate for Payer: Brighton Health Commercial	$71.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$59.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$68.42
Rate for Payer: EmblemHealth Commercial	$59.50
Rate for Payer: Group Health Inc Commercial	$59.50
Rate for Payer: Group Health Inc Medicare	$41.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$59.50
Rate for Payer: Hamaspik Choice Inc Medicare	$59.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$77.35

HC METABOLIC PANEL,COMPREHENSIVE - BUNDLED CHARGE

Facility

$26.00

Service Code	CPT 80053
Hospital Charge Code	3018005301
Hospital Revenue Code	301
Min. Negotiated Rate	$13.00
Max. Negotiated Rate	$13.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.00

Know your out-of-pocket cost for care.

All Charges