|
RADICAL NECK DISS
|
Facility
|
OP
|
$8,021.25
|
|
|
Service Code
|
HCPCS 31365
|
| Hospital Charge Code |
40109025
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,496.00 |
| Max. Negotiated Rate |
$6,015.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,411.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,766.84
|
| Rate for Payer: Aetna Government |
$2,766.84
|
| Rate for Payer: Brighton Health Commercial |
$6,015.94
|
| 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 |
$4,010.62
|
| Rate for Payer: Group Health Inc Medicare |
$2,807.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,010.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,010.62
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
RADICAL RESECTION OF MANDIBLE WIT
|
Facility
|
OP
|
$14,500.00
|
|
|
Service Code
|
HCPCS D7490
|
| Hospital Charge Code |
42301825
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,203.69 |
| Max. Negotiated Rate |
$10,875.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7,975.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,203.69
|
| Rate for Payer: Aetna Government |
$2,203.69
|
| Rate for Payer: Brighton Health Commercial |
$10,875.00
|
| 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: Group Health Inc Commercial |
$7,250.00
|
| Rate for Payer: Group Health Inc Medicare |
$5,075.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7,250.00
|
|
|
RADIOACTIVE CONTRAST AGENT CU-68
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS A9597
|
| Hospital Charge Code |
41202523
|
|
Hospital Revenue Code
|
343
|
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,000.00
|
| Rate for Payer: Aetna Government |
$1,000.00
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
RADIOACTIVE CONTRAST AGENT GA-68
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS A9598
|
| Hospital Charge Code |
41202525
|
|
Hospital Revenue Code
|
343
|
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,000.00
|
| Rate for Payer: Aetna Government |
$1,000.00
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$61,394.49
|
|
|
Service Code
|
MSDRG 849
|
| Min. Negotiated Rate |
$20,762.50 |
| Max. Negotiated Rate |
$61,394.49 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$39,684.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44,650.54
|
| Rate for Payer: Aetna Government |
$44,650.54
|
| Rate for Payer: Brighton Health Commercial |
$39,025.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$45,543.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$46,477.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$38,355.46
|
| Rate for Payer: Elderplan Medicare Advantage |
$42,418.01
|
| Rate for Payer: EmblemHealth Commercial |
$23,078.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$44,650.54
|
| Rate for Payer: Group Health Inc Commercial |
$44,650.54
|
| Rate for Payer: Group Health Inc Medicare |
$44,650.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44,650.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20,762.50
|
| Rate for Payer: Humana Medicare |
$61,394.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$44,650.54
|
| Rate for Payer: United Healthcare Commercial |
$53,523.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44,650.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44,650.54
|
| Rate for Payer: Wellcare Medicare |
$42,418.01
|
|
|
RAD PAD FEMORAL ACCESS WT5300A-Y
|
Facility
|
OP
|
$50.00
|
|
| Hospital Charge Code |
66523136
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.00
|
| Rate for Payer: Aetna Government |
$25.00
|
| Rate for Payer: Brighton Health Commercial |
$37.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$34.00
|
| Rate for Payer: Group Health Inc Commercial |
$25.00
|
| Rate for Payer: Group Health Inc Medicare |
$17.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.00
|
|
|
RAD PAD RADIAL ACCESS-WT5511A-Y
|
Facility
|
OP
|
$48.00
|
|
| Hospital Charge Code |
66526606
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$38.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.00
|
| Rate for Payer: Aetna Government |
$24.00
|
| Rate for Payer: Brighton Health Commercial |
$36.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$38.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.64
|
| Rate for Payer: Group Health Inc Commercial |
$24.00
|
| Rate for Payer: Group Health Inc Medicare |
$16.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.00
|
|
|
RAD TRMT DEL,> 1MEV, SIMPLE
|
Facility
|
IP
|
$371.65
|
|
|
Service Code
|
HCPCS 77402
|
| Hospital Charge Code |
66541322
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$138.67
|
|
|
RAD TRMT DEL,> 1MEV, SIMPLE
|
Facility
|
OP
|
$371.65
|
|
|
Service Code
|
HCPCS 77402
|
| Hospital Charge Code |
66541322
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$97.07 |
| Max. Negotiated Rate |
$297.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$204.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$138.67
|
| Rate for Payer: Aetna Government |
$138.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$97.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$97.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$97.07
|
| Rate for Payer: Brighton Health Commercial |
$278.74
|
| Rate for Payer: Cash Price |
$138.67
|
| Rate for Payer: Cash Price |
$138.67
|
| Rate for Payer: Cash Price |
$138.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$138.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$297.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$252.72
|
| Rate for Payer: Elderplan Medicare Advantage |
$138.67
|
| Rate for Payer: EmblemHealth Commercial |
$138.67
|
| 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 Medicare Advantage |
$138.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$138.67
|
| Rate for Payer: Group Health Inc Medicare |
$138.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$185.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$138.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$124.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$138.67
|
| Rate for Payer: Healthfirst QHP |
$138.67
|
| Rate for Payer: Humana Medicare |
$141.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$138.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$138.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$138.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$110.94
|
| Rate for Payer: Wellcare Medicare |
$131.74
|
|
|
RAD TRMT DELIVERY, > 1 MEV, COMPL
|
Facility
|
IP
|
$715.88
|
|
|
Service Code
|
HCPCS 77412
|
| Hospital Charge Code |
66541231
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$310.79
|
|
|
RAD TRMT DELIVERY, > 1 MEV, COMPL
|
Facility
|
OP
|
$715.88
|
|
|
Service Code
|
HCPCS 77412
|
| Hospital Charge Code |
66541232
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$217.55 |
| Max. Negotiated Rate |
$572.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$393.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$310.79
|
| Rate for Payer: Aetna Government |
$310.79
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$217.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$217.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$217.55
|
| Rate for Payer: Brighton Health Commercial |
$536.91
|
| Rate for Payer: Cash Price |
$310.79
|
| Rate for Payer: Cash Price |
$310.79
|
| Rate for Payer: Cash Price |
$310.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$310.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$572.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$486.80
|
| Rate for Payer: Elderplan Medicare Advantage |
$310.79
|
| Rate for Payer: EmblemHealth Commercial |
$310.79
|
| 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 Medicare Advantage |
$310.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$310.79
|
| Rate for Payer: Group Health Inc Medicare |
$310.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$357.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$310.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$279.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$310.79
|
| Rate for Payer: Healthfirst QHP |
$310.79
|
| Rate for Payer: Humana Medicare |
$317.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$310.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$310.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$310.79
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$248.63
|
| Rate for Payer: Wellcare Medicare |
$295.25
|
|
|
RAD TRMT DELIVERY, > 1 MEV, COMPL
|
Facility
|
IP
|
$715.88
|
|
|
Service Code
|
HCPCS 77412
|
| Hospital Charge Code |
66548538
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$310.79
|
|
|
RAD TRMT DELIVERY, > 1 MEV, COMPL
|
Facility
|
OP
|
$715.88
|
|
|
Service Code
|
HCPCS 77412
|
| Hospital Charge Code |
66548538
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$217.55 |
| Max. Negotiated Rate |
$572.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$393.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$310.79
|
| Rate for Payer: Aetna Government |
$310.79
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$217.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$217.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$217.55
|
| Rate for Payer: Brighton Health Commercial |
$536.91
|
| Rate for Payer: Cash Price |
$310.79
|
| Rate for Payer: Cash Price |
$310.79
|
| Rate for Payer: Cash Price |
$310.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$310.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$572.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$486.80
|
| Rate for Payer: Elderplan Medicare Advantage |
$310.79
|
| Rate for Payer: EmblemHealth Commercial |
$310.79
|
| 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 Medicare Advantage |
$310.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$310.79
|
| Rate for Payer: Group Health Inc Medicare |
$310.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$357.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$310.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$279.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$310.79
|
| Rate for Payer: Healthfirst QHP |
$310.79
|
| Rate for Payer: Humana Medicare |
$317.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$310.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$310.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$310.79
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$248.63
|
| Rate for Payer: Wellcare Medicare |
$295.25
|
|
|
RAD TRMT DELIVERY, > 1 MEV, COMPL
|
Facility
|
IP
|
$715.88
|
|
|
Service Code
|
HCPCS 77407
|
| Hospital Charge Code |
66541230
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$310.79
|
|
|
RAD TRMT DELIVERY, > 1 MEV, COMPL
|
Facility
|
OP
|
$715.88
|
|
|
Service Code
|
HCPCS 77407
|
| Hospital Charge Code |
66541230
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$217.55 |
| Max. Negotiated Rate |
$572.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$393.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$310.79
|
| Rate for Payer: Aetna Government |
$310.79
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$217.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$217.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$217.55
|
| Rate for Payer: Brighton Health Commercial |
$536.91
|
| Rate for Payer: Cash Price |
$310.79
|
| Rate for Payer: Cash Price |
$310.79
|
| Rate for Payer: Cash Price |
$310.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$310.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$572.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$486.80
|
| Rate for Payer: Elderplan Medicare Advantage |
$310.79
|
| Rate for Payer: EmblemHealth Commercial |
$310.79
|
| 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 Medicare Advantage |
$310.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$310.79
|
| Rate for Payer: Group Health Inc Medicare |
$310.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$357.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$310.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$279.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$310.79
|
| Rate for Payer: Healthfirst QHP |
$310.79
|
| Rate for Payer: Humana Medicare |
$317.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$310.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$310.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$310.79
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$248.63
|
| Rate for Payer: Wellcare Medicare |
$295.25
|
|
|
RAD TRMT DELIVERY, > 1 MEV, COMPL
|
Facility
|
IP
|
$715.88
|
|
|
Service Code
|
HCPCS 77412
|
| Hospital Charge Code |
66541232
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$310.79
|
|
|
RAD TRMT DELIVERY, > 1 MEV, COMPL
|
Facility
|
OP
|
$715.88
|
|
|
Service Code
|
HCPCS 77412
|
| Hospital Charge Code |
66541231
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$217.55 |
| Max. Negotiated Rate |
$572.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$393.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$310.79
|
| Rate for Payer: Aetna Government |
$310.79
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$217.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$217.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$217.55
|
| Rate for Payer: Brighton Health Commercial |
$536.91
|
| Rate for Payer: Cash Price |
$310.79
|
| Rate for Payer: Cash Price |
$310.79
|
| Rate for Payer: Cash Price |
$310.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$310.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$572.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$486.80
|
| Rate for Payer: Elderplan Medicare Advantage |
$310.79
|
| Rate for Payer: EmblemHealth Commercial |
$310.79
|
| 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 Medicare Advantage |
$310.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$310.79
|
| Rate for Payer: Group Health Inc Medicare |
$310.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$357.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$310.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$279.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$310.79
|
| Rate for Payer: Healthfirst QHP |
$310.79
|
| Rate for Payer: Humana Medicare |
$317.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$310.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$310.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$310.79
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$248.63
|
| Rate for Payer: Wellcare Medicare |
$295.25
|
|
|
RAD TRMT DELIVERY, > 1MEV, COMPLE
|
Facility
|
IP
|
$715.88
|
|
|
Service Code
|
HCPCS 77412
|
| Hospital Charge Code |
66541233
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$310.79
|
|
|
RAD TRMT DELIVERY, > 1MEV, COMPLE
|
Facility
|
OP
|
$715.88
|
|
|
Service Code
|
HCPCS 77412
|
| Hospital Charge Code |
66541233
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$217.55 |
| Max. Negotiated Rate |
$572.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$393.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$310.79
|
| Rate for Payer: Aetna Government |
$310.79
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$217.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$217.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$217.55
|
| Rate for Payer: Brighton Health Commercial |
$536.91
|
| Rate for Payer: Cash Price |
$310.79
|
| Rate for Payer: Cash Price |
$310.79
|
| Rate for Payer: Cash Price |
$310.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$310.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$572.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$486.80
|
| Rate for Payer: Elderplan Medicare Advantage |
$310.79
|
| Rate for Payer: EmblemHealth Commercial |
$310.79
|
| 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 Medicare Advantage |
$310.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$310.79
|
| Rate for Payer: Group Health Inc Medicare |
$310.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$357.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$310.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$279.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$310.79
|
| Rate for Payer: Healthfirst QHP |
$310.79
|
| Rate for Payer: Humana Medicare |
$317.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$310.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$310.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$310.79
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$248.63
|
| Rate for Payer: Wellcare Medicare |
$295.25
|
|
|
RAD TRMT DELIVERY, > 1 MEV, INTER
|
Facility
|
OP
|
$715.88
|
|
|
Service Code
|
HCPCS 77407
|
| Hospital Charge Code |
66541325
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$217.55 |
| Max. Negotiated Rate |
$572.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$393.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$310.79
|
| Rate for Payer: Aetna Government |
$310.79
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$217.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$217.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$217.55
|
| Rate for Payer: Brighton Health Commercial |
$536.91
|
| Rate for Payer: Cash Price |
$310.79
|
| Rate for Payer: Cash Price |
$310.79
|
| Rate for Payer: Cash Price |
$310.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$310.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$572.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$486.80
|
| Rate for Payer: Elderplan Medicare Advantage |
$310.79
|
| Rate for Payer: EmblemHealth Commercial |
$310.79
|
| 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 Medicare Advantage |
$310.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$310.79
|
| Rate for Payer: Group Health Inc Medicare |
$310.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$357.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$310.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$279.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$310.79
|
| Rate for Payer: Healthfirst QHP |
$310.79
|
| Rate for Payer: Humana Medicare |
$317.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$310.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$310.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$310.79
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$248.63
|
| Rate for Payer: Wellcare Medicare |
$295.25
|
|
|
RAD TRMT DELIVERY, > 1 MEV, INTER
|
Facility
|
OP
|
$715.88
|
|
|
Service Code
|
HCPCS 77407
|
| Hospital Charge Code |
66541229
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$217.55 |
| Max. Negotiated Rate |
$572.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$393.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$310.79
|
| Rate for Payer: Aetna Government |
$310.79
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$217.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$217.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$217.55
|
| Rate for Payer: Brighton Health Commercial |
$536.91
|
| Rate for Payer: Cash Price |
$310.79
|
| Rate for Payer: Cash Price |
$310.79
|
| Rate for Payer: Cash Price |
$310.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$310.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$572.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$486.80
|
| Rate for Payer: Elderplan Medicare Advantage |
$310.79
|
| Rate for Payer: EmblemHealth Commercial |
$310.79
|
| 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 Medicare Advantage |
$310.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$310.79
|
| Rate for Payer: Group Health Inc Medicare |
$310.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$357.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$310.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$279.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$310.79
|
| Rate for Payer: Healthfirst QHP |
$310.79
|
| Rate for Payer: Humana Medicare |
$317.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$310.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$310.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$310.79
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$248.63
|
| Rate for Payer: Wellcare Medicare |
$295.25
|
|
|
RAD TRMT DELIVERY, > 1 MEV, INTER
|
Facility
|
IP
|
$715.88
|
|
|
Service Code
|
HCPCS 77407
|
| Hospital Charge Code |
66541229
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$310.79
|
|
|
RAD TRMT DELIVERY, > 1 MEV, INTER
|
Facility
|
IP
|
$715.88
|
|
|
Service Code
|
HCPCS 77407
|
| Hospital Charge Code |
66541325
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$310.79
|
|
|
RAD TRMT DELIVERY. >1 MEV SIMPLE
|
Facility
|
IP
|
$371.65
|
|
|
Service Code
|
HCPCS 77402
|
| Hospital Charge Code |
66541228
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$138.67
|
|
|
RAD TRMT DELIVERY. >1 MEV SIMPLE
|
Facility
|
OP
|
$371.65
|
|
|
Service Code
|
HCPCS 77402
|
| Hospital Charge Code |
66541228
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$97.07 |
| Max. Negotiated Rate |
$297.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$204.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$138.67
|
| Rate for Payer: Aetna Government |
$138.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$97.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$97.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$97.07
|
| Rate for Payer: Brighton Health Commercial |
$278.74
|
| Rate for Payer: Cash Price |
$138.67
|
| Rate for Payer: Cash Price |
$138.67
|
| Rate for Payer: Cash Price |
$138.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$138.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$297.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$252.72
|
| Rate for Payer: Elderplan Medicare Advantage |
$138.67
|
| Rate for Payer: EmblemHealth Commercial |
$138.67
|
| 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 Medicare Advantage |
$138.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$138.67
|
| Rate for Payer: Group Health Inc Medicare |
$138.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$185.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$138.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$124.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$138.67
|
| Rate for Payer: Healthfirst QHP |
$138.67
|
| Rate for Payer: Humana Medicare |
$141.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$138.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$138.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$138.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$110.94
|
| Rate for Payer: Wellcare Medicare |
$131.74
|
|
