|
RSVPREF3 VAC RECOMB ADJUVANTED 120 MCG/0.5ML IM SUSR [191151]
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
NDC 58160084811
|
| Hospital Charge Code |
58160084811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$117.60 |
| Max. Negotiated Rate |
$268.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$184.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$168.00
|
| Rate for Payer: Aetna Government |
$168.00
|
| Rate for Payer: Brighton Health Commercial |
$252.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$268.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$228.48
|
| Rate for Payer: Group Health Inc Commercial |
$168.00
|
| Rate for Payer: Group Health Inc Medicare |
$117.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$168.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$168.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$218.40
|
|
|
RSV PRE-FUSION F A&B VAC RCMB 120 MCG/0.5ML IM SOLR [191337]
|
Facility
|
OP
|
$354.00
|
|
|
Service Code
|
NDC 00069034401
|
| Hospital Charge Code |
00069034401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$123.90 |
| Max. Negotiated Rate |
$283.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$194.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$177.00
|
| Rate for Payer: Aetna Government |
$177.00
|
| Rate for Payer: Brighton Health Commercial |
$265.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$283.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$240.72
|
| Rate for Payer: Group Health Inc Commercial |
$177.00
|
| Rate for Payer: Group Health Inc Medicare |
$123.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$177.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$177.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$230.10
|
|
|
RT 3+ TX CONVERGING PORTS
|
Facility
|
OP
|
$1,015.13
|
|
|
Service Code
|
HCPCS 77285 TC
|
| Hospital Charge Code |
66541240
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$279.92 |
| Max. Negotiated Rate |
$812.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$558.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$427.29
|
| Rate for Payer: Aetna Government |
$427.29
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$299.10
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$299.10
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$299.10
|
| Rate for Payer: Brighton Health Commercial |
$761.35
|
| Rate for Payer: Cash Price |
$427.29
|
| Rate for Payer: Cash Price |
$427.29
|
| Rate for Payer: Cash Price |
$427.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$427.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$812.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$690.29
|
| Rate for Payer: Elderplan Medicare Advantage |
$427.29
|
| Rate for Payer: EmblemHealth Commercial |
$427.29
|
| 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 |
$427.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$427.29
|
| Rate for Payer: Group Health Inc Medicare |
$427.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$507.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$427.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$384.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$427.29
|
| Rate for Payer: Healthfirst QHP |
$427.29
|
| Rate for Payer: Humana Medicare |
$435.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$427.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$427.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$427.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$341.83
|
| Rate for Payer: Wellcare Medicare |
$405.93
|
|
|
RT 3+ TX CONVERGING PORTS
|
Facility
|
IP
|
$1,015.13
|
|
|
Service Code
|
HCPCS 77285 TC
|
| Hospital Charge Code |
66541240
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$427.29
|
|
|
RT BASIC DOSIMETRY CALC
|
Facility
|
IP
|
$383.40
|
|
|
Service Code
|
HCPCS 77300 TC
|
| Hospital Charge Code |
66541258
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$156.91
|
|
|
RT BASIC DOSIMETRY CALC
|
Facility
|
OP
|
$383.40
|
|
|
Service Code
|
HCPCS 77300 TC
|
| Hospital Charge Code |
66541258
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$109.84 |
| Max. Negotiated Rate |
$306.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$210.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$156.91
|
| Rate for Payer: Aetna Government |
$156.91
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$109.84
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$109.84
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$109.84
|
| Rate for Payer: Brighton Health Commercial |
$287.55
|
| Rate for Payer: Cash Price |
$156.91
|
| Rate for Payer: Cash Price |
$156.91
|
| Rate for Payer: Cash Price |
$156.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$156.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$306.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$260.71
|
| Rate for Payer: Elderplan Medicare Advantage |
$156.91
|
| Rate for Payer: EmblemHealth Commercial |
$156.91
|
| 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 |
$156.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$156.91
|
| Rate for Payer: Group Health Inc Medicare |
$156.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$156.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$141.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$156.91
|
| Rate for Payer: Healthfirst QHP |
$156.91
|
| Rate for Payer: Humana Medicare |
$160.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$156.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$156.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$156.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$125.53
|
| Rate for Payer: Wellcare Medicare |
$149.06
|
|
|
RT BASIC DOSIMETRY CALC(1MIC/KG)
|
Facility
|
IP
|
$383.40
|
|
|
Service Code
|
HCPCS 77300 TC
|
| Hospital Charge Code |
66541328
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$156.91
|
|
|
RT BASIC DOSIMETRY CALC(1MIC/KG)
|
Facility
|
OP
|
$383.40
|
|
|
Service Code
|
HCPCS 77300 TC
|
| Hospital Charge Code |
66541328
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$109.84 |
| Max. Negotiated Rate |
$306.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$210.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$156.91
|
| Rate for Payer: Aetna Government |
$156.91
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$109.84
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$109.84
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$109.84
|
| Rate for Payer: Brighton Health Commercial |
$287.55
|
| Rate for Payer: Cash Price |
$156.91
|
| Rate for Payer: Cash Price |
$156.91
|
| Rate for Payer: Cash Price |
$156.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$156.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$306.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$260.71
|
| Rate for Payer: Elderplan Medicare Advantage |
$156.91
|
| Rate for Payer: EmblemHealth Commercial |
$156.91
|
| 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 |
$156.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$156.91
|
| Rate for Payer: Group Health Inc Medicare |
$156.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$156.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$141.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$156.91
|
| Rate for Payer: Healthfirst QHP |
$156.91
|
| Rate for Payer: Humana Medicare |
$160.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$156.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$156.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$156.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$125.53
|
| Rate for Payer: Wellcare Medicare |
$149.06
|
|
|
RT BEST IND IODINE 125 SEED
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS C2639
|
| Hospital Charge Code |
66541317
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: Cash Price |
$42.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.00
|
|
|
RT BEST IND IODINE 125 SEED
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS C2639
|
| Hospital Charge Code |
66541317
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$43.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$42.42
|
| Rate for Payer: Aetna Government |
$42.42
|
| Rate for Payer: Brighton Health Commercial |
$30.00
|
| Rate for Payer: Cash Price |
$42.42
|
| Rate for Payer: Cash Price |
$42.42
|
| Rate for Payer: Cash Price |
$42.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$42.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$42.42
|
| Rate for Payer: EmblemHealth Commercial |
$25.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$42.42
|
| Rate for Payer: Group Health Inc Commercial |
$42.42
|
| Rate for Payer: Group Health Inc Medicare |
$42.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.06
|
| Rate for Payer: Healthfirst QHP |
$42.42
|
| Rate for Payer: Humana Medicare |
$43.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$42.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.50
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$33.94
|
|
|
RT BIOPSY SKIN
|
Facility
|
OP
|
$356.37
|
|
|
Service Code
|
HCPCS 11103
|
| Hospital Charge Code |
66541303
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.78 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.78
|
| Rate for Payer: Aetna Government |
$19.78
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$178.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$178.18
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
RT BRACHYTHERAPY,NON STRAND I-125
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
HCPCS C2639
|
| Hospital Charge Code |
66541336
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Cash Price |
$42.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.00
|
|
|
RT BRACHYTHERAPY,NON STRAND I-125
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
HCPCS C2639
|
| Hospital Charge Code |
66541336
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$43.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$42.42
|
| Rate for Payer: Aetna Government |
$42.42
|
| Rate for Payer: Brighton Health Commercial |
$20.40
|
| Rate for Payer: Cash Price |
$42.42
|
| Rate for Payer: Cash Price |
$42.42
|
| Rate for Payer: Cash Price |
$42.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$42.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.55
|
| Rate for Payer: Elderplan Medicare Advantage |
$42.42
|
| Rate for Payer: EmblemHealth Commercial |
$17.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$42.42
|
| Rate for Payer: Group Health Inc Commercial |
$42.42
|
| Rate for Payer: Group Health Inc Medicare |
$42.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.06
|
| Rate for Payer: Healthfirst QHP |
$42.42
|
| Rate for Payer: Humana Medicare |
$43.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$42.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$33.94
|
|
|
RT BRACHYTHERAPY, STRANDED I-125
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS C2638
|
| Hospital Charge Code |
66541335
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: Cash Price |
$50.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.00
|
|
|
RT BRACHYTHERAPY, STRANDED I-125
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS C2638
|
| Hospital Charge Code |
66541335
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$51.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$50.71
|
| Rate for Payer: Aetna Government |
$50.71
|
| Rate for Payer: Brighton Health Commercial |
$30.00
|
| Rate for Payer: Cash Price |
$50.71
|
| Rate for Payer: Cash Price |
$50.71
|
| Rate for Payer: Cash Price |
$50.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$50.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$50.71
|
| Rate for Payer: EmblemHealth Commercial |
$25.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$50.71
|
| Rate for Payer: Group Health Inc Commercial |
$50.71
|
| Rate for Payer: Group Health Inc Medicare |
$50.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43.10
|
| Rate for Payer: Healthfirst QHP |
$50.71
|
| Rate for Payer: Humana Medicare |
$51.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$50.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.50
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$40.57
|
|
|
RT COMPUTER GENERATED 3D SIM
|
Facility
|
IP
|
$3,771.83
|
|
|
Service Code
|
HCPCS 77295 TC
|
| Hospital Charge Code |
66541242
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$1,602.37
|
|
|
RT COMPUTER GENERATED 3D SIM
|
Facility
|
OP
|
$3,771.83
|
|
|
Service Code
|
HCPCS 77295 TC
|
| Hospital Charge Code |
66541242
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$279.92 |
| Max. Negotiated Rate |
$3,017.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,074.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,602.37
|
| Rate for Payer: Aetna Government |
$1,602.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,121.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,121.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,121.66
|
| Rate for Payer: Brighton Health Commercial |
$2,828.87
|
| Rate for Payer: Cash Price |
$1,602.37
|
| Rate for Payer: Cash Price |
$1,602.37
|
| Rate for Payer: Cash Price |
$1,602.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,602.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,017.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,564.84
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,602.37
|
| Rate for Payer: EmblemHealth Commercial |
$1,602.37
|
| 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 |
$1,602.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,602.37
|
| Rate for Payer: Group Health Inc Medicare |
$1,602.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,885.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,602.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,442.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,602.37
|
| Rate for Payer: Healthfirst QHP |
$1,602.37
|
| Rate for Payer: Humana Medicare |
$1,634.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,602.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,602.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,602.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,281.90
|
| Rate for Payer: Wellcare Medicare |
$1,522.25
|
|
|
RT CONT PHYSICS CONSULT/QA
|
Facility
|
IP
|
$383.40
|
|
|
Service Code
|
HCPCS 77336
|
| Hospital Charge Code |
66541261
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$156.91
|
|
|
RT CONT PHYSICS CONSULT/QA
|
Facility
|
OP
|
$383.40
|
|
|
Service Code
|
HCPCS 77336
|
| Hospital Charge Code |
66541261
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$109.84 |
| Max. Negotiated Rate |
$306.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$210.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$156.91
|
| Rate for Payer: Aetna Government |
$156.91
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$109.84
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$109.84
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$109.84
|
| Rate for Payer: Brighton Health Commercial |
$287.55
|
| Rate for Payer: Cash Price |
$156.91
|
| Rate for Payer: Cash Price |
$156.91
|
| Rate for Payer: Cash Price |
$156.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$156.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$306.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$260.71
|
| Rate for Payer: Elderplan Medicare Advantage |
$156.91
|
| Rate for Payer: EmblemHealth Commercial |
$156.91
|
| 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 |
$156.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$156.91
|
| Rate for Payer: Group Health Inc Medicare |
$156.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$156.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$141.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$156.91
|
| Rate for Payer: Healthfirst QHP |
$156.91
|
| Rate for Payer: Humana Medicare |
$160.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$156.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$156.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$156.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$125.53
|
| Rate for Payer: Wellcare Medicare |
$149.06
|
|
|
RT CRITICAL CARE 30-74 MINS
|
Facility
|
IP
|
$2,019.15
|
|
|
Service Code
|
HCPCS 99291
|
| Hospital Charge Code |
66541206
|
|
Hospital Revenue Code
|
983
|
| Rate for Payer: Cash Price |
$1,026.18
|
|
|
RT CRITICAL CARE 30-74 MINS
|
Facility
|
OP
|
$2,019.15
|
|
|
Service Code
|
HCPCS 99291
|
| Hospital Charge Code |
66541206
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$718.33 |
| Max. Negotiated Rate |
$1,615.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,110.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,026.18
|
| Rate for Payer: Aetna Government |
$1,026.18
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$718.33
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$718.33
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$718.33
|
| Rate for Payer: Brighton Health Commercial |
$1,514.36
|
| Rate for Payer: Cash Price |
$1,026.18
|
| Rate for Payer: Cash Price |
$1,026.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,026.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,615.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,373.02
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,026.18
|
| Rate for Payer: EmblemHealth Commercial |
$1,026.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$872.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$913.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,026.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$913.30
|
| Rate for Payer: Group Health Inc Commercial |
$1,026.18
|
| Rate for Payer: Group Health Inc Medicare |
$1,026.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,009.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,026.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$872.25
|
| Rate for Payer: Healthfirst QHP |
$1,026.18
|
| Rate for Payer: Humana Medicare |
$1,046.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,026.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,026.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,026.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$820.94
|
| Rate for Payer: Wellcare Medicare |
$974.87
|
|
|
RT CT GUID FOR PLACEMENT RT FIELD
|
Facility
|
OP
|
$577.03
|
|
|
Service Code
|
HCPCS 77014 TC
|
| Hospital Charge Code |
66548228
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$77.61 |
| Max. Negotiated Rate |
$461.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$317.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$77.61
|
| Rate for Payer: Aetna Government |
$77.61
|
| Rate for Payer: Brighton Health Commercial |
$432.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$461.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$392.38
|
| Rate for Payer: Group Health Inc Commercial |
$288.52
|
| Rate for Payer: Group Health Inc Medicare |
$201.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$288.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$288.52
|
|
|
RT CT GUID FOR PLACEMENT RT FIELD
|
Facility
|
OP
|
$577.03
|
|
|
Service Code
|
HCPCS 76370
|
| Hospital Charge Code |
66528228
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$201.96 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$317.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$288.52
|
| Rate for Payer: Aetna Government |
$288.52
|
| Rate for Payer: Brighton Health Commercial |
$432.77
|
| 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 |
$288.52
|
| Rate for Payer: Group Health Inc Medicare |
$201.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$288.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$288.52
|
|
|
RT DEL 2AREA/3PORT/STX 5MEV
|
Facility
|
IP
|
$715.88
|
|
|
Service Code
|
HCPCS 77407
|
| Hospital Charge Code |
66541324
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$310.79
|
|
|
RT DEL 2AREA/3PORT/STX 5MEV
|
Facility
|
OP
|
$715.88
|
|
|
Service Code
|
HCPCS 77407
|
| Hospital Charge Code |
66541324
|
|
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
|
|
