St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

INVIZIA TEMP PIN

Facility

$360.00

Hospital Charge Code	64905968
Hospital Revenue Code	270
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$288.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$198.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$180.00
Rate for Payer: Aetna Government	$180.00
Rate for Payer: Brighton Health Commercial	$270.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$288.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$244.80
Rate for Payer: Group Health Inc Commercial	$180.00
Rate for Payer: Group Health Inc Medicare	$126.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$180.00
Rate for Payer: Hamaspik Choice Inc Medicare	$180.00

INVRTD COUPLINGPIN TO ROD 4-5/8MM

Facility

$298.20

Service Code	HCPCS C1713
Hospital Charge Code	40209404
Hospital Revenue Code	278
Min. Negotiated Rate	$104.37
Max. Negotiated Rate	$313.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$164.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$178.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$149.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$171.46
Rate for Payer: EmblemHealth Commercial	$149.10
Rate for Payer: Fidelis Medicare Advantage	$313.11
Rate for Payer: Group Health Inc Commercial	$149.10
Rate for Payer: Group Health Inc Medicare	$104.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$149.10
Rate for Payer: Hamaspik Choice Inc Medicare	$149.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$193.83

INVRTD COUPLINGPIN TO ROD 4-5/8MM

Facility

$298.20

Service Code	HCPCS C1713
Hospital Charge Code	40209404
Hospital Revenue Code	278
Min. Negotiated Rate	$149.10
Max. Negotiated Rate	$149.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$149.10
Rate for Payer: Hamaspik Choice Inc Medicare	$149.10

IOBAN-2 4 X 5 (CURTAIN)

Facility

$40.76

Hospital Charge Code	40200489
Hospital Revenue Code	270
Min. Negotiated Rate	$14.27
Max. Negotiated Rate	$32.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.38
Rate for Payer: Aetna Government	$20.38
Rate for Payer: Brighton Health Commercial	$30.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$27.72
Rate for Payer: Group Health Inc Commercial	$20.38
Rate for Payer: Group Health Inc Medicare	$14.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.38
Rate for Payer: Hamaspik Choice Inc Medicare	$20.38

IOBAN-2 6648EZ 23X 23

Facility

$16.84

Hospital Charge Code	40200491
Hospital Revenue Code	270
Min. Negotiated Rate	$5.89
Max. Negotiated Rate	$13.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.42
Rate for Payer: Aetna Government	$8.42
Rate for Payer: Brighton Health Commercial	$12.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.45
Rate for Payer: Group Health Inc Commercial	$8.42
Rate for Payer: Group Health Inc Medicare	$5.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.42
Rate for Payer: Hamaspik Choice Inc Medicare	$8.42

IOBAN-2 6651EZ 23X33

Facility

$23.28

Hospital Charge Code	40200492
Hospital Revenue Code	270
Min. Negotiated Rate	$8.15
Max. Negotiated Rate	$18.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.64
Rate for Payer: Aetna Government	$11.64
Rate for Payer: Brighton Health Commercial	$17.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.83
Rate for Payer: Group Health Inc Commercial	$11.64
Rate for Payer: Group Health Inc Medicare	$8.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.64
Rate for Payer: Hamaspik Choice Inc Medicare	$11.64

IODINE 1-123, 100 UCI CAP

Facility

$98.12

Service Code	HCPCS A9516
Hospital Charge Code	41656490
Hospital Revenue Code	343
Min. Negotiated Rate	$34.34
Max. Negotiated Rate	$149.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$53.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$149.74
Rate for Payer: Aetna Government	$149.74
Rate for Payer: Brighton Health Commercial	$73.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$78.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$66.72
Rate for Payer: Group Health Inc Commercial	$49.06
Rate for Payer: Group Health Inc Medicare	$34.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$49.06
Rate for Payer: Hamaspik Choice Inc Medicare	$49.06

IODINE 1-123, 100 UCI CAP

Facility

$98.12

Service Code	HCPCS A9516
Hospital Charge Code	41646490
Hospital Revenue Code	343
Min. Negotiated Rate	$34.34
Max. Negotiated Rate	$149.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$53.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$149.74
Rate for Payer: Aetna Government	$149.74
Rate for Payer: Brighton Health Commercial	$73.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$78.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$66.72
Rate for Payer: Group Health Inc Commercial	$49.06
Rate for Payer: Group Health Inc Medicare	$34.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$49.06
Rate for Payer: Hamaspik Choice Inc Medicare	$49.06

IODINE I-123, 200 UCI CAP

Facility

$65.62

Service Code	HCPCS A9516
Hospital Charge Code	41656491
Hospital Revenue Code	343
Min. Negotiated Rate	$22.97
Max. Negotiated Rate	$149.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$36.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$149.74
Rate for Payer: Aetna Government	$149.74
Rate for Payer: Brighton Health Commercial	$49.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$52.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$44.62
Rate for Payer: Group Health Inc Commercial	$32.81
Rate for Payer: Group Health Inc Medicare	$22.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.81
Rate for Payer: Hamaspik Choice Inc Medicare	$32.81

IODINE I-123, 200 UCI CAP

Facility

$65.62

Service Code	HCPCS A9516
Hospital Charge Code	41646491
Hospital Revenue Code	343
Min. Negotiated Rate	$22.97
Max. Negotiated Rate	$149.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$36.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$149.74
Rate for Payer: Aetna Government	$149.74
Rate for Payer: Brighton Health Commercial	$49.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$52.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$44.62
Rate for Payer: Group Health Inc Commercial	$32.81
Rate for Payer: Group Health Inc Medicare	$22.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.81
Rate for Payer: Hamaspik Choice Inc Medicare	$32.81

IODINE I-123 SOD IODIDE MIC

Professional

Both

$488.88

Service Code	HCPCS A9516
Min. Negotiated Rate	$366.66
Max. Negotiated Rate	$366.66
Rate for Payer: SOMOS CHP/HARP/Medicaid	$366.66
Rate for Payer: SOMOS Essential	$366.66

IODINE I-131 CAP 10MCI THERAPEUT

Facility

$18.21

Service Code	HCPCS A9517
Hospital Charge Code	41656574
Hospital Revenue Code	344
Min. Negotiated Rate	$9.10
Max. Negotiated Rate	$23.73
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.34
Rate for Payer: Aetna Government	$21.34
Rate for Payer: Affinity Essential Plan 1&2	$14.94
Rate for Payer: Affinity Essential Plan 3&4	$14.94
Rate for Payer: Affinity Medicaid/CHP/HARP	$14.94
Rate for Payer: Brighton Health Commercial	$21.34
Rate for Payer: Cash Price	$21.34
Rate for Payer: Cash Price	$21.34
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$21.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.38
Rate for Payer: Elderplan Medicare Advantage	$21.34
Rate for Payer: EmblemHealth Commercial	$21.34
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18.14
Rate for Payer: Fidelis Essential Plan Aliesa	$18.14
Rate for Payer: Fidelis Essential Plan QHP	$18.99
Rate for Payer: Fidelis Medicare Advantage	$21.34
Rate for Payer: Fidelis Qualified Health Plan	$18.99
Rate for Payer: Group Health Inc Commercial	$21.34
Rate for Payer: Group Health Inc Medicare	$21.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.10
Rate for Payer: Hamaspik Choice Inc Medicare	$21.34
Rate for Payer: Healthfirst Medicare Advantage	$18.14
Rate for Payer: Healthfirst QHP	$21.34
Rate for Payer: Humana Medicare	$21.77
Rate for Payer: Senior Whole Health Medicare Advantage	$21.34
Rate for Payer: United Healthcare Commercial	$23.73
Rate for Payer: United Healthcare Medicare Advantage	$21.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17.07
Rate for Payer: Wellcare Medicare	$20.27

IODINE I-131 CAP 10MCI THERAPEUT

Facility

$18.21

Service Code	HCPCS A9517
Hospital Charge Code	41646574
Hospital Revenue Code	344
Rate for Payer: Cash Price	$21.34

IODINE I-131 CAP 10MCI THERAPEUT

Facility

$18.21

Service Code	HCPCS A9517
Hospital Charge Code	41646574
Hospital Revenue Code	344
Min. Negotiated Rate	$9.10
Max. Negotiated Rate	$23.73
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.34
Rate for Payer: Aetna Government	$21.34
Rate for Payer: Affinity Essential Plan 1&2	$14.94
Rate for Payer: Affinity Essential Plan 3&4	$14.94
Rate for Payer: Affinity Medicaid/CHP/HARP	$14.94
Rate for Payer: Brighton Health Commercial	$21.34
Rate for Payer: Cash Price	$21.34
Rate for Payer: Cash Price	$21.34
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$21.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.38
Rate for Payer: Elderplan Medicare Advantage	$21.34
Rate for Payer: EmblemHealth Commercial	$21.34
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18.14
Rate for Payer: Fidelis Essential Plan Aliesa	$18.14
Rate for Payer: Fidelis Essential Plan QHP	$18.99
Rate for Payer: Fidelis Medicare Advantage	$21.34
Rate for Payer: Fidelis Qualified Health Plan	$18.99
Rate for Payer: Group Health Inc Commercial	$21.34
Rate for Payer: Group Health Inc Medicare	$21.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.10
Rate for Payer: Hamaspik Choice Inc Medicare	$21.34
Rate for Payer: Healthfirst Medicare Advantage	$18.14
Rate for Payer: Healthfirst QHP	$21.34
Rate for Payer: Humana Medicare	$21.77
Rate for Payer: Senior Whole Health Medicare Advantage	$21.34
Rate for Payer: United Healthcare Commercial	$23.73
Rate for Payer: United Healthcare Medicare Advantage	$21.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17.07
Rate for Payer: Wellcare Medicare	$20.27

IODINE I-131 CAP 10MCI THERAPEUT

Facility

$18.21

Service Code	HCPCS A9517
Hospital Charge Code	41656574
Hospital Revenue Code	344
Rate for Payer: Cash Price	$21.34

IODINE I-131 CAP 4MCI THERAPEUTIC

Facility

$45.53

Service Code	HCPCS A9517
Hospital Charge Code	41656573
Hospital Revenue Code	344
Min. Negotiated Rate	$14.94
Max. Negotiated Rate	$36.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.34
Rate for Payer: Aetna Government	$21.34
Rate for Payer: Affinity Essential Plan 1&2	$14.94
Rate for Payer: Affinity Essential Plan 3&4	$14.94
Rate for Payer: Affinity Medicaid/CHP/HARP	$14.94
Rate for Payer: Brighton Health Commercial	$21.34
Rate for Payer: Cash Price	$21.34
Rate for Payer: Cash Price	$21.34
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$21.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$36.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.96
Rate for Payer: Elderplan Medicare Advantage	$21.34
Rate for Payer: EmblemHealth Commercial	$21.34
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18.14
Rate for Payer: Fidelis Essential Plan Aliesa	$18.14
Rate for Payer: Fidelis Essential Plan QHP	$18.99
Rate for Payer: Fidelis Medicare Advantage	$21.34
Rate for Payer: Fidelis Qualified Health Plan	$18.99
Rate for Payer: Group Health Inc Commercial	$21.34
Rate for Payer: Group Health Inc Medicare	$21.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.76
Rate for Payer: Hamaspik Choice Inc Medicare	$21.34
Rate for Payer: Healthfirst Medicare Advantage	$18.14
Rate for Payer: Healthfirst QHP	$21.34
Rate for Payer: Humana Medicare	$21.77
Rate for Payer: Senior Whole Health Medicare Advantage	$21.34
Rate for Payer: United Healthcare Commercial	$23.73
Rate for Payer: United Healthcare Medicare Advantage	$21.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17.07
Rate for Payer: Wellcare Medicare	$20.27

IODINE I-131 CAP 4MCI THERAPEUTIC

Facility

$45.53

Service Code	HCPCS A9517
Hospital Charge Code	41646573
Hospital Revenue Code	344
Rate for Payer: Cash Price	$21.34

IODINE I-131 CAP 4MCI THERAPEUTIC

Facility

$45.53

Service Code	HCPCS A9517
Hospital Charge Code	41646573
Hospital Revenue Code	344
Min. Negotiated Rate	$14.94
Max. Negotiated Rate	$36.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.34
Rate for Payer: Aetna Government	$21.34
Rate for Payer: Affinity Essential Plan 1&2	$14.94
Rate for Payer: Affinity Essential Plan 3&4	$14.94
Rate for Payer: Affinity Medicaid/CHP/HARP	$14.94
Rate for Payer: Brighton Health Commercial	$21.34
Rate for Payer: Cash Price	$21.34
Rate for Payer: Cash Price	$21.34
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$21.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$36.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.96
Rate for Payer: Elderplan Medicare Advantage	$21.34
Rate for Payer: EmblemHealth Commercial	$21.34
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18.14
Rate for Payer: Fidelis Essential Plan Aliesa	$18.14
Rate for Payer: Fidelis Essential Plan QHP	$18.99
Rate for Payer: Fidelis Medicare Advantage	$21.34
Rate for Payer: Fidelis Qualified Health Plan	$18.99
Rate for Payer: Group Health Inc Commercial	$21.34
Rate for Payer: Group Health Inc Medicare	$21.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.76
Rate for Payer: Hamaspik Choice Inc Medicare	$21.34
Rate for Payer: Healthfirst Medicare Advantage	$18.14
Rate for Payer: Healthfirst QHP	$21.34
Rate for Payer: Humana Medicare	$21.77
Rate for Payer: Senior Whole Health Medicare Advantage	$21.34
Rate for Payer: United Healthcare Commercial	$23.73
Rate for Payer: United Healthcare Medicare Advantage	$21.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17.07
Rate for Payer: Wellcare Medicare	$20.27

IODINE I-131 CAP 4MCI THERAPEUTIC

Facility

$45.53

Service Code	HCPCS A9517
Hospital Charge Code	41656573
Hospital Revenue Code	344
Rate for Payer: Cash Price	$21.34

IODINE I-131 CAP 50MCI THERAPEUT

Facility

$3.64

Service Code	HCPCS A9517
Hospital Charge Code	41646575
Hospital Revenue Code	344
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$23.73
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.34
Rate for Payer: Aetna Government	$21.34
Rate for Payer: Affinity Essential Plan 1&2	$14.94
Rate for Payer: Affinity Essential Plan 3&4	$14.94
Rate for Payer: Affinity Medicaid/CHP/HARP	$14.94
Rate for Payer: Brighton Health Commercial	$21.34
Rate for Payer: Cash Price	$21.34
Rate for Payer: Cash Price	$21.34
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$21.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.48
Rate for Payer: Elderplan Medicare Advantage	$21.34
Rate for Payer: EmblemHealth Commercial	$21.34
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18.14
Rate for Payer: Fidelis Essential Plan Aliesa	$18.14
Rate for Payer: Fidelis Essential Plan QHP	$18.99
Rate for Payer: Fidelis Medicare Advantage	$21.34
Rate for Payer: Fidelis Qualified Health Plan	$18.99
Rate for Payer: Group Health Inc Commercial	$21.34
Rate for Payer: Group Health Inc Medicare	$21.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.82
Rate for Payer: Hamaspik Choice Inc Medicare	$21.34
Rate for Payer: Healthfirst Medicare Advantage	$18.14
Rate for Payer: Healthfirst QHP	$21.34
Rate for Payer: Humana Medicare	$21.77
Rate for Payer: Senior Whole Health Medicare Advantage	$21.34
Rate for Payer: United Healthcare Commercial	$23.73
Rate for Payer: United Healthcare Medicare Advantage	$21.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17.07
Rate for Payer: Wellcare Medicare	$20.27

IODINE I-131 CAP 50MCI THERAPEUT

Facility

$3.64

Service Code	HCPCS A9517
Hospital Charge Code	41646575
Hospital Revenue Code	344
Rate for Payer: Cash Price	$21.34

IODINE I-131 CAP 50MCI THERAPEUT

Facility

$3.64

Service Code	HCPCS A9517
Hospital Charge Code	41656575
Hospital Revenue Code	344
Rate for Payer: Cash Price	$21.34

IODINE I-131 CAP 50MCI THERAPEUT

Facility

$3.64

Service Code	HCPCS A9517
Hospital Charge Code	41656575
Hospital Revenue Code	344
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$23.73
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.34
Rate for Payer: Aetna Government	$21.34
Rate for Payer: Affinity Essential Plan 1&2	$14.94
Rate for Payer: Affinity Essential Plan 3&4	$14.94
Rate for Payer: Affinity Medicaid/CHP/HARP	$14.94
Rate for Payer: Brighton Health Commercial	$21.34
Rate for Payer: Cash Price	$21.34
Rate for Payer: Cash Price	$21.34
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$21.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.48
Rate for Payer: Elderplan Medicare Advantage	$21.34
Rate for Payer: EmblemHealth Commercial	$21.34
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18.14
Rate for Payer: Fidelis Essential Plan Aliesa	$18.14
Rate for Payer: Fidelis Essential Plan QHP	$18.99
Rate for Payer: Fidelis Medicare Advantage	$21.34
Rate for Payer: Fidelis Qualified Health Plan	$18.99
Rate for Payer: Group Health Inc Commercial	$21.34
Rate for Payer: Group Health Inc Medicare	$21.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.82
Rate for Payer: Hamaspik Choice Inc Medicare	$21.34
Rate for Payer: Healthfirst Medicare Advantage	$18.14
Rate for Payer: Healthfirst QHP	$21.34
Rate for Payer: Humana Medicare	$21.77
Rate for Payer: Senior Whole Health Medicare Advantage	$21.34
Rate for Payer: United Healthcare Commercial	$23.73
Rate for Payer: United Healthcare Medicare Advantage	$21.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21.34
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17.07
Rate for Payer: Wellcare Medicare	$20.27

IODINE, RANDOM URINE

Facility

$60.28

Service Code	HCPCS 83789
Hospital Charge Code	40609096
Hospital Revenue Code	300
Rate for Payer: Cash Price	$24.11

IODINE, RANDOM URINE

Facility

$60.28

Service Code	HCPCS 83789
Hospital Charge Code	40609096
Hospital Revenue Code	300
Min. Negotiated Rate	$16.88
Max. Negotiated Rate	$45.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$33.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.11
Rate for Payer: Aetna Government	$24.11
Rate for Payer: Affinity Essential Plan 1&2	$16.88
Rate for Payer: Affinity Essential Plan 3&4	$16.88
Rate for Payer: Affinity Medicaid/CHP/HARP	$16.88
Rate for Payer: Brighton Health Commercial	$45.21
Rate for Payer: Cash Price	$24.11
Rate for Payer: Cash Price	$24.11
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$24.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.29
Rate for Payer: Elderplan Medicare Advantage	$24.11
Rate for Payer: EmblemHealth Commercial	$24.11
Rate for Payer: Fidelis Essential Plan Aliesa	$20.49
Rate for Payer: Fidelis Essential Plan QHP	$21.46
Rate for Payer: Fidelis Medicare Advantage	$24.11
Rate for Payer: Fidelis Qualified Health Plan	$21.46
Rate for Payer: Group Health Inc Commercial	$24.11
Rate for Payer: Group Health Inc Medicare	$24.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.14
Rate for Payer: Hamaspik Choice Inc Medicare	$24.11
Rate for Payer: Healthfirst Medicare Advantage	$24.11
Rate for Payer: Healthfirst QHP	$24.11
Rate for Payer: Humana Medicare	$24.59
Rate for Payer: Senior Whole Health Medicare Advantage	$24.11
Rate for Payer: United Healthcare Commercial	$22.87
Rate for Payer: United Healthcare Medicare Advantage	$24.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$24.11
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19.29
Rate for Payer: Wellcare Medicare	$21.70

Know your out-of-pocket cost for care.

All Charges