|
RT DEL 3ARCSTB UP TO 5 MEV
|
Facility
|
OP
|
$715.88
|
|
|
Service Code
|
HCPCS 77412
|
| Hospital Charge Code |
66541326
|
|
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
|
|
|
RT DEL 3ARCSTB UP TO 5 MEV
|
Facility
|
IP
|
$715.88
|
|
|
Service Code
|
HCPCS 77412
|
| Hospital Charge Code |
66541326
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$310.79
|
|
|
RT DEL S/AREA/PORT PAR 5MEV
|
Facility
|
OP
|
$371.65
|
|
|
Service Code
|
HCPCS 77402
|
| Hospital Charge Code |
66541321
|
|
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
|
|
|
RT DEL S/AREA/PORT PAR 5MEV
|
Facility
|
IP
|
$371.65
|
|
|
Service Code
|
HCPCS 77402
|
| Hospital Charge Code |
66541321
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$138.67
|
|
|
RT DEL SUP AND/OR ORTHO VOLT
|
Facility
|
IP
|
$371.65
|
|
|
Service Code
|
HCPCS 77401
|
| Hospital Charge Code |
66541320
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$138.67
|
|
|
RT DEL SUP AND/OR ORTHO VOLT
|
Facility
|
OP
|
$371.65
|
|
|
Service Code
|
HCPCS 77401
|
| Hospital Charge Code |
66541320
|
|
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
|
|
|
RT DISCHARGE MGMT >30 MINS
|
Facility
|
OP
|
$379.37
|
|
|
Service Code
|
HCPCS 99239
|
| Hospital Charge Code |
66541295
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$79.96 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$79.96
|
| Rate for Payer: Aetna Government |
$79.96
|
| Rate for Payer: Brighton Health Commercial |
$284.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$303.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$257.97
|
| Rate for Payer: Group Health Inc Commercial |
$189.68
|
| Rate for Payer: Group Health Inc Medicare |
$132.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$189.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$189.68
|
|
|
RT DISCHARGE MGMT<30 MINS
|
Facility
|
OP
|
$276.60
|
|
|
Service Code
|
HCPCS 99238
|
| Hospital Charge Code |
66541294
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$54.01 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$54.01
|
| Rate for Payer: Aetna Government |
$54.01
|
| Rate for Payer: Brighton Health Commercial |
$207.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$221.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$188.09
|
| Rate for Payer: Group Health Inc Commercial |
$138.30
|
| Rate for Payer: Group Health Inc Medicare |
$96.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$138.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$138.30
|
|
|
RT FILM DUPLICATION (PER FILM)
|
Facility
|
OP
|
$113.17
|
|
| Hospital Charge Code |
66541305
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.61 |
| Max. Negotiated Rate |
$90.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$62.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$56.58
|
| Rate for Payer: Aetna Government |
$56.58
|
| Rate for Payer: Brighton Health Commercial |
$84.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$90.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$76.96
|
| Rate for Payer: Group Health Inc Commercial |
$56.58
|
| Rate for Payer: Group Health Inc Medicare |
$39.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.58
|
|
|
RT HDR BRACHY>12 CHANNEL RADIONU
|
Facility
|
OP
|
$2,563.70
|
|
| Hospital Charge Code |
66541415
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$279.92 |
| Max. Negotiated Rate |
$2,050.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,410.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,281.85
|
| Rate for Payer: Aetna Government |
$1,281.85
|
| Rate for Payer: Brighton Health Commercial |
$1,922.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,050.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,743.32
|
| 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 |
$1,281.85
|
| Rate for Payer: Group Health Inc Medicare |
$897.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,281.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,281.85
|
|
|
RT HDR BRACHY 1CHANNEL RADIONU
|
Facility
|
IP
|
$2,242.85
|
|
|
Service Code
|
HCPCS 77770 TC
|
| Hospital Charge Code |
66541412
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$829.13
|
|
|
RT HDR BRACHY 1CHANNEL RADIONU
|
Facility
|
OP
|
$2,242.85
|
|
|
Service Code
|
HCPCS 77770 TC
|
| Hospital Charge Code |
66541412
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$279.92 |
| Max. Negotiated Rate |
$1,794.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,233.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$829.13
|
| Rate for Payer: Aetna Government |
$829.13
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$580.39
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$580.39
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$580.39
|
| Rate for Payer: Brighton Health Commercial |
$1,682.14
|
| Rate for Payer: Cash Price |
$829.13
|
| Rate for Payer: Cash Price |
$829.13
|
| Rate for Payer: Cash Price |
$829.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$829.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,794.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,525.14
|
| Rate for Payer: Elderplan Medicare Advantage |
$829.13
|
| Rate for Payer: EmblemHealth Commercial |
$829.13
|
| 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 |
$829.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$829.13
|
| Rate for Payer: Group Health Inc Medicare |
$829.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,121.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$829.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$746.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$829.13
|
| Rate for Payer: Healthfirst QHP |
$829.13
|
| Rate for Payer: Humana Medicare |
$845.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$829.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$829.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$829.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$663.30
|
| Rate for Payer: Wellcare Medicare |
$787.67
|
|
|
RT HDR BRACHY 2-12 CHANNELRADIONU
|
Facility
|
IP
|
$2,242.85
|
|
|
Service Code
|
HCPCS 77771 TC
|
| Hospital Charge Code |
66541413
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$829.13
|
|
|
RT HDR BRACHY 2-12 CHANNELRADIONU
|
Facility
|
OP
|
$2,242.85
|
|
|
Service Code
|
HCPCS 77771 TC
|
| Hospital Charge Code |
66541413
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$279.92 |
| Max. Negotiated Rate |
$1,794.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,233.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$829.13
|
| Rate for Payer: Aetna Government |
$829.13
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$580.39
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$580.39
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$580.39
|
| Rate for Payer: Brighton Health Commercial |
$1,682.14
|
| Rate for Payer: Cash Price |
$829.13
|
| Rate for Payer: Cash Price |
$829.13
|
| Rate for Payer: Cash Price |
$829.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$829.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,794.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,525.14
|
| Rate for Payer: Elderplan Medicare Advantage |
$829.13
|
| Rate for Payer: EmblemHealth Commercial |
$829.13
|
| 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 |
$829.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$829.13
|
| Rate for Payer: Group Health Inc Medicare |
$829.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,121.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$829.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$746.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$829.13
|
| Rate for Payer: Healthfirst QHP |
$829.13
|
| Rate for Payer: Humana Medicare |
$845.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$829.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$829.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$829.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$663.30
|
| Rate for Payer: Wellcare Medicare |
$787.67
|
|
|
RT HDR OVER 12 POSITION CATH
|
Facility
|
IP
|
$2,242.85
|
|
|
Service Code
|
HCPCS 77772 TC
|
| Hospital Charge Code |
66541257
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$829.13
|
|
|
RT HDR OVER 12 POSITION CATH
|
Facility
|
OP
|
$2,242.85
|
|
|
Service Code
|
HCPCS 77772 TC
|
| Hospital Charge Code |
66541257
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$279.92 |
| Max. Negotiated Rate |
$1,794.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,233.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$829.13
|
| Rate for Payer: Aetna Government |
$829.13
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$580.39
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$580.39
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$580.39
|
| Rate for Payer: Brighton Health Commercial |
$1,682.14
|
| Rate for Payer: Cash Price |
$829.13
|
| Rate for Payer: Cash Price |
$829.13
|
| Rate for Payer: Cash Price |
$829.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$829.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,794.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,525.14
|
| Rate for Payer: Elderplan Medicare Advantage |
$829.13
|
| Rate for Payer: EmblemHealth Commercial |
$829.13
|
| 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 |
$829.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$829.13
|
| Rate for Payer: Group Health Inc Medicare |
$829.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,121.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$829.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$746.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$829.13
|
| Rate for Payer: Healthfirst QHP |
$829.13
|
| Rate for Payer: Humana Medicare |
$845.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$829.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$829.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$829.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$663.30
|
| Rate for Payer: Wellcare Medicare |
$787.67
|
|
|
RT HEMIBODY
|
Facility
|
IP
|
$1,631.98
|
|
|
Service Code
|
HCPCS 77470 TC
|
| Hospital Charge Code |
66541276
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$680.74
|
|
|
RT HEMIBODY
|
Facility
|
OP
|
$1,631.98
|
|
|
Service Code
|
HCPCS 77470 TC
|
| Hospital Charge Code |
66541276
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$279.92 |
| Max. Negotiated Rate |
$1,305.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$897.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$680.74
|
| Rate for Payer: Aetna Government |
$680.74
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$476.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$476.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$476.52
|
| Rate for Payer: Brighton Health Commercial |
$1,223.98
|
| Rate for Payer: Cash Price |
$680.74
|
| Rate for Payer: Cash Price |
$680.74
|
| Rate for Payer: Cash Price |
$680.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$680.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,305.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,109.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$680.74
|
| Rate for Payer: EmblemHealth Commercial |
$680.74
|
| 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 |
$680.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$680.74
|
| Rate for Payer: Group Health Inc Medicare |
$680.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$815.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$680.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$612.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$680.74
|
| Rate for Payer: Healthfirst QHP |
$680.74
|
| Rate for Payer: Humana Medicare |
$694.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$680.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$680.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$680.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$544.59
|
| Rate for Payer: Wellcare Medicare |
$646.70
|
|
|
RT IC APP COMPLEX
|
Facility
|
OP
|
$2,242.85
|
|
|
Service Code
|
HCPCS 77763 TC
|
| Hospital Charge Code |
66541247
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$580.39 |
| Max. Negotiated Rate |
$1,233.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,233.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$829.13
|
| Rate for Payer: Aetna Government |
$829.13
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$580.39
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$580.39
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$580.39
|
| Rate for Payer: Brighton Health Commercial |
$829.13
|
| Rate for Payer: Cash Price |
$829.13
|
| Rate for Payer: Cash Price |
$829.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$829.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$710.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$601.12
|
| Rate for Payer: Elderplan Medicare Advantage |
$829.13
|
| Rate for Payer: EmblemHealth Commercial |
$580.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$704.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$704.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$737.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$829.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$737.93
|
| Rate for Payer: Group Health Inc Commercial |
$746.22
|
| Rate for Payer: Group Health Inc Medicare |
$746.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,121.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$829.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$746.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$829.13
|
| Rate for Payer: Healthfirst QHP |
$829.13
|
| Rate for Payer: Humana Medicare |
$845.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$829.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$829.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$829.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$663.30
|
| Rate for Payer: Wellcare Medicare |
$787.67
|
|
|
RT IC APP COMPLEX
|
Facility
|
IP
|
$2,242.85
|
|
|
Service Code
|
HCPCS 77763 TC
|
| Hospital Charge Code |
66541247
|
|
Hospital Revenue Code
|
342
|
| Rate for Payer: Cash Price |
$829.13
|
|
|
RT IC APP INTER
|
Facility
|
IP
|
$1,631.98
|
|
|
Service Code
|
HCPCS 77762 TC
|
| Hospital Charge Code |
66541246
|
|
Hospital Revenue Code
|
342
|
| Rate for Payer: Cash Price |
$680.74
|
|
|
RT IC APP INTER
|
Facility
|
OP
|
$1,631.98
|
|
|
Service Code
|
HCPCS 77762 TC
|
| Hospital Charge Code |
66541246
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$476.52 |
| Max. Negotiated Rate |
$897.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$897.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$680.74
|
| Rate for Payer: Aetna Government |
$680.74
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$476.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$476.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$476.52
|
| Rate for Payer: Brighton Health Commercial |
$680.74
|
| Rate for Payer: Cash Price |
$680.74
|
| Rate for Payer: Cash Price |
$680.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$680.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$710.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$601.12
|
| Rate for Payer: Elderplan Medicare Advantage |
$680.74
|
| Rate for Payer: EmblemHealth Commercial |
$476.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$578.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$578.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$605.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$680.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$605.86
|
| Rate for Payer: Group Health Inc Commercial |
$612.67
|
| Rate for Payer: Group Health Inc Medicare |
$612.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$815.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$680.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$612.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$680.74
|
| Rate for Payer: Healthfirst QHP |
$680.74
|
| Rate for Payer: Humana Medicare |
$694.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$680.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$680.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$680.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$544.59
|
| Rate for Payer: Wellcare Medicare |
$646.70
|
|
|
RT IMRT DVH
|
Facility
|
IP
|
$3,771.83
|
|
|
Service Code
|
HCPCS 77301 TC
|
| Hospital Charge Code |
66541269
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$1,602.37
|
|
|
RT IMRT DVH
|
Facility
|
OP
|
$3,771.83
|
|
|
Service Code
|
HCPCS 77301 TC
|
| Hospital Charge Code |
66541269
|
|
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 IMRT TREATMENT PLAN
|
Facility
|
IP
|
$3,771.83
|
|
|
Service Code
|
HCPCS 77301 TC
|
| Hospital Charge Code |
66541226
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$1,602.37
|
|
