|
RAD EXAM, CHEST, 4 OR MORE VIEWS
|
Facility
|
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 71048 TC
|
| Hospital Charge Code |
41103177
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$271.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$127.14
|
| Rate for Payer: Aetna Government |
$127.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$89.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$89.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$89.00
|
| Rate for Payer: Brighton Health Commercial |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$127.14
|
| Rate for Payer: EmblemHealth Commercial |
$89.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$108.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.15
|
| Rate for Payer: Group Health Inc Commercial |
$114.43
|
| Rate for Payer: Group Health Inc Medicare |
$114.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$114.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$127.14
|
| Rate for Payer: Healthfirst QHP |
$127.14
|
| Rate for Payer: Humana Medicare |
$129.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$101.71
|
| Rate for Payer: Wellcare Medicare |
$120.78
|
|
|
RAD EXAM, CHEST, 4 OR MORE VIEWS
|
Facility
|
IP
|
$339.45
|
|
|
Service Code
|
HCPCS 71048 TC
|
| Hospital Charge Code |
41103177
|
|
Hospital Revenue Code
|
324
|
| Rate for Payer: Cash Price |
$127.14
|
|
|
RADIAL COLUMN PLATE
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$400.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$400.00
|
|
|
RADIAL COLUMN PLATE
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$440.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$480.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$400.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$460.00
|
| Rate for Payer: EmblemHealth Commercial |
$400.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$840.00
|
| Rate for Payer: Group Health Inc Commercial |
$400.00
|
| Rate for Payer: Group Health Inc Medicare |
$280.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$400.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$400.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$520.00
|
|
|
RADIAL HEAD PROSTH
|
Facility
|
IP
|
$7,546.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40203565
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,773.00 |
| Max. Negotiated Rate |
$3,773.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,773.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,773.00
|
|
|
RADIAL HEAD PROSTH
|
Facility
|
OP
|
$7,546.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40203565
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$7,923.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,150.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$4,527.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,773.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,338.95
|
| Rate for Payer: EmblemHealth Commercial |
$3,773.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$7,923.30
|
| Rate for Payer: Group Health Inc Commercial |
$3,773.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,641.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,773.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,773.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,904.90
|
|
|
RADIAL HEAD PROSTHESIS MED 91MM
|
Facility
|
OP
|
$4,186.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40202042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$4,395.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,302.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$2,511.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,093.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,406.95
|
| Rate for Payer: EmblemHealth Commercial |
$2,093.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,395.30
|
| Rate for Payer: Group Health Inc Commercial |
$2,093.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,465.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,093.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,093.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,720.90
|
|
|
RADIAL HEAD PROSTHESIS MED 91MM
|
Facility
|
IP
|
$4,186.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40202042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,093.00 |
| Max. Negotiated Rate |
$2,093.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,093.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,093.00
|
|
|
RADIAL HEAD PROSTHESIS SM 11MM
|
Facility
|
IP
|
$4,186.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40202043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,093.00 |
| Max. Negotiated Rate |
$2,093.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,093.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,093.00
|
|
|
RADIAL HEAD PROSTHESIS SM 11MM
|
Facility
|
OP
|
$4,186.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40202043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$4,395.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,302.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$2,511.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,093.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,406.95
|
| Rate for Payer: EmblemHealth Commercial |
$2,093.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,395.30
|
| Rate for Payer: Group Health Inc Commercial |
$2,093.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,465.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,093.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,093.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,720.90
|
|
|
RADIAL HEAD RES
|
Facility
|
OP
|
$28.71
|
|
| Hospital Charge Code |
40000525
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$22.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.36
|
| Rate for Payer: Aetna Government |
$14.36
|
| Rate for Payer: Brighton Health Commercial |
$21.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.52
|
| Rate for Payer: Group Health Inc Commercial |
$14.36
|
| Rate for Payer: Group Health Inc Medicare |
$10.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.36
|
|
|
RADIAL JAW 3
|
Facility
|
OP
|
$610.00
|
|
| Hospital Charge Code |
40209773
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$213.50 |
| Max. Negotiated Rate |
$488.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$335.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$305.00
|
| Rate for Payer: Aetna Government |
$305.00
|
| Rate for Payer: Brighton Health Commercial |
$457.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$488.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$414.80
|
| Rate for Payer: Group Health Inc Commercial |
$305.00
|
| Rate for Payer: Group Health Inc Medicare |
$213.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$305.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$305.00
|
|
|
RADIAL JAW3 BIOPSY FRCPS W/NEEDLE
|
Facility
|
OP
|
$144.00
|
|
| Hospital Charge Code |
40209774
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$79.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$72.00
|
| Rate for Payer: Aetna Government |
$72.00
|
| Rate for Payer: Brighton Health Commercial |
$108.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$115.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$97.92
|
| Rate for Payer: Group Health Inc Commercial |
$72.00
|
| Rate for Payer: Group Health Inc Medicare |
$50.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.00
|
|
|
Radial styloidectomy (separate procedure)
|
Facility
|
OP
|
$3,818.01
|
|
|
Service Code
|
CPT 25230
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$3,818.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,620.20
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,620.20
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,620.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,743.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,743.15
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,181.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,331.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,743.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,331.40
|
| Rate for Payer: Group Health Inc Commercial |
$3,743.15
|
| Rate for Payer: Group Health Inc Medicare |
$3,743.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,743.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Humana Medicare |
$3,818.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,743.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,743.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,994.52
|
| Rate for Payer: Wellcare Medicare |
$3,555.99
|
|
|
RADIATION CARRIER
|
Facility
|
IP
|
$968.00
|
|
|
Service Code
|
HCPCS D5983
|
| Hospital Charge Code |
42301380
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,018.19
|
|
|
RADIATION CARRIER
|
Facility
|
OP
|
$968.00
|
|
|
Service Code
|
HCPCS D5983
|
| Hospital Charge Code |
42301380
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$484.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$532.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$712.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$712.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$712.73
|
| Rate for Payer: Brighton Health Commercial |
$726.00
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.19
|
| Rate for Payer: Group Health Inc Commercial |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$484.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Humana Medicare |
$1,038.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,018.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$967.28
|
|
|
RADIATION CONE LOCATOR
|
Facility
|
OP
|
$974.00
|
|
|
Service Code
|
HCPCS D5985
|
| Hospital Charge Code |
42301390
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$487.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$535.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$712.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$712.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$712.73
|
| Rate for Payer: Brighton Health Commercial |
$730.50
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.19
|
| Rate for Payer: Group Health Inc Commercial |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$487.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Humana Medicare |
$1,038.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,018.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$967.28
|
|
|
RADIATION CONE LOCATOR
|
Facility
|
IP
|
$974.00
|
|
|
Service Code
|
HCPCS D5985
|
| Hospital Charge Code |
42301390
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,018.19
|
|
|
RADIATION SHIELD
|
Facility
|
OP
|
$892.00
|
|
|
Service Code
|
HCPCS D5984
|
| Hospital Charge Code |
42301385
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$446.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$490.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$712.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$712.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$712.73
|
| Rate for Payer: Brighton Health Commercial |
$669.00
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.19
|
| Rate for Payer: Group Health Inc Commercial |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$446.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Humana Medicare |
$1,038.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,018.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$967.28
|
|
|
RADIATION SHIELD
|
Facility
|
IP
|
$892.00
|
|
|
Service Code
|
HCPCS D5984
|
| Hospital Charge Code |
42301385
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,018.19
|
|
|
RADIATION TX DELIVERY IMRT
|
Facility
|
OP
|
$1,452.82
|
|
|
Service Code
|
HCPCS G6015
|
| Hospital Charge Code |
66542976
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$279.92 |
| Max. Negotiated Rate |
$1,162.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$799.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$448.78
|
| Rate for Payer: Aetna Government |
$448.78
|
| Rate for Payer: Brighton Health Commercial |
$1,089.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,162.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$987.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$726.41
|
| Rate for Payer: Group Health Inc Medicare |
$508.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$726.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$726.41
|
|
|
Radical excision of bursa, synovia of wrist, or forearm tendon sheaths (eg, tenosynovitis, fungus, Tbc, or other granulomas, rheumatoid arthritis); flexors
|
Facility
|
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 25115
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,301.03 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,858.61
|
| Rate for Payer: Aetna Government |
$1,858.61
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,301.03
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,301.03
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,301.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,858.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,858.61
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,579.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,654.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,858.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,654.16
|
| Rate for Payer: Group Health Inc Commercial |
$1,858.61
|
| Rate for Payer: Group Health Inc Medicare |
$1,858.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,858.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,579.82
|
| Rate for Payer: Healthfirst QHP |
$1,858.61
|
| Rate for Payer: Humana Medicare |
$1,895.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,858.61
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,858.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,858.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,486.89
|
| Rate for Payer: Wellcare Medicare |
$1,765.68
|
|
|
RADICAL EXC-REAC INFLAMM LESION D
|
Facility
|
IP
|
$252.50
|
|
|
Service Code
|
HCPCS D7410
|
| Hospital Charge Code |
42301755
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,763.60
|
|
|
RADICAL EXC-REAC INFLAMM LESION D
|
Facility
|
OP
|
$252.50
|
|
|
Service Code
|
HCPCS D7410
|
| Hospital Charge Code |
42301755
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$126.25 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$138.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,763.60
|
| Rate for Payer: Aetna Government |
$1,763.60
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,234.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,234.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,234.52
|
| Rate for Payer: Brighton Health Commercial |
$189.38
|
| Rate for Payer: Cash Price |
$1,763.60
|
| Rate for Payer: Cash Price |
$1,763.60
|
| Rate for Payer: Cash Price |
$1,763.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,763.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,763.60
|
| Rate for Payer: EmblemHealth Commercial |
$1,763.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,499.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,569.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,763.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,569.60
|
| Rate for Payer: Group Health Inc Commercial |
$1,763.60
|
| Rate for Payer: Group Health Inc Medicare |
$1,763.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,763.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,499.06
|
| Rate for Payer: Healthfirst QHP |
$1,763.60
|
| Rate for Payer: Humana Medicare |
$1,798.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,763.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,763.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,763.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,410.88
|
| Rate for Payer: Wellcare Medicare |
$1,675.42
|
|
|
RADICAL MASTECTOMY
|
Facility
|
OP
|
$3,291.12
|
|
|
Service Code
|
HCPCS 19305
|
| Hospital Charge Code |
40010975
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,003.40 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,810.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,003.40
|
| Rate for Payer: Aetna Government |
$1,003.40
|
| Rate for Payer: Brighton Health Commercial |
$2,468.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,645.56
|
| Rate for Payer: Group Health Inc Medicare |
$1,151.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,645.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,645.56
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
