|
RT PER ORAL
|
Facility
|
OP
|
$1,631.98
|
|
|
Service Code
|
HCPCS 77470 TC
|
| Hospital Charge Code |
66541277
|
|
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 RADIOELEMENTS BRACHY ANY TP EA
|
Facility
|
IP
|
$2,550.00
|
|
|
Service Code
|
HCPCS C1719
|
| Hospital Charge Code |
66541318
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$1,275.00 |
| Rate for Payer: Cash Price |
$422.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,275.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,275.00
|
|
|
RT RADIOELEMENTS BRACHY ANY TP EA
|
Facility
|
OP
|
$2,550.00
|
|
|
Service Code
|
HCPCS C1719
|
| Hospital Charge Code |
66541318
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$338.30 |
| Max. Negotiated Rate |
$1,657.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,402.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$422.88
|
| Rate for Payer: Aetna Government |
$422.88
|
| Rate for Payer: Brighton Health Commercial |
$1,530.00
|
| Rate for Payer: Cash Price |
$422.88
|
| Rate for Payer: Cash Price |
$422.88
|
| Rate for Payer: Cash Price |
$422.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$422.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,275.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,466.25
|
| Rate for Payer: Elderplan Medicare Advantage |
$422.88
|
| Rate for Payer: EmblemHealth Commercial |
$1,275.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$422.88
|
| Rate for Payer: Group Health Inc Commercial |
$422.88
|
| Rate for Payer: Group Health Inc Medicare |
$422.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,275.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,275.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$359.45
|
| Rate for Payer: Healthfirst QHP |
$422.88
|
| Rate for Payer: Humana Medicare |
$431.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$422.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$422.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,657.50
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$338.30
|
|
|
RT RADIOPHARM
|
Facility
|
IP
|
$719.03
|
|
|
Service Code
|
HCPCS 79101 TC
|
| Hospital Charge Code |
66541282
|
|
Hospital Revenue Code
|
340
|
| Rate for Payer: Cash Price |
$287.70
|
|
|
RT RADIOPHARM
|
Facility
|
OP
|
$719.03
|
|
|
Service Code
|
HCPCS 79101 TC
|
| Hospital Charge Code |
66541282
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$179.30 |
| Max. Negotiated Rate |
$448.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$395.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$287.70
|
| Rate for Payer: Aetna Government |
$287.70
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$201.39
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$201.39
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$201.39
|
| Rate for Payer: Brighton Health Commercial |
$287.70
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$287.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$448.55
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$379.54
|
| Rate for Payer: Elderplan Medicare Advantage |
$287.70
|
| Rate for Payer: EmblemHealth Commercial |
$201.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$244.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$244.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$256.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$287.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$256.05
|
| Rate for Payer: Group Health Inc Commercial |
$258.93
|
| Rate for Payer: Group Health Inc Medicare |
$258.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$359.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$287.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$258.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$287.70
|
| Rate for Payer: Healthfirst QHP |
$287.70
|
| Rate for Payer: Humana Medicare |
$293.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$287.70
|
| Rate for Payer: United Healthcare Commercial |
$179.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$287.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$287.70
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$230.16
|
| Rate for Payer: Wellcare Medicare |
$273.32
|
|
|
RT RADIOPH RX, BY IV ADMIN
|
Facility
|
OP
|
$719.03
|
|
|
Service Code
|
HCPCS 79101 TC
|
| Hospital Charge Code |
66541331
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$179.30 |
| Max. Negotiated Rate |
$448.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$395.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$287.70
|
| Rate for Payer: Aetna Government |
$287.70
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$201.39
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$201.39
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$201.39
|
| Rate for Payer: Brighton Health Commercial |
$287.70
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$287.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$448.55
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$379.54
|
| Rate for Payer: Elderplan Medicare Advantage |
$287.70
|
| Rate for Payer: EmblemHealth Commercial |
$201.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$244.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$244.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$256.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$287.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$256.05
|
| Rate for Payer: Group Health Inc Commercial |
$258.93
|
| Rate for Payer: Group Health Inc Medicare |
$258.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$359.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$287.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$258.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$287.70
|
| Rate for Payer: Healthfirst QHP |
$287.70
|
| Rate for Payer: Humana Medicare |
$293.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$287.70
|
| Rate for Payer: United Healthcare Commercial |
$179.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$287.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$287.70
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$230.16
|
| Rate for Payer: Wellcare Medicare |
$273.32
|
|
|
RT RADIOPH RX, BY IV ADMIN
|
Facility
|
IP
|
$719.03
|
|
|
Service Code
|
HCPCS 79101 TC
|
| Hospital Charge Code |
66541331
|
|
Hospital Revenue Code
|
342
|
| Rate for Payer: Cash Price |
$287.70
|
|
|
RT RAIOPHARMACEUTICAL THERAPY
|
Facility
|
IP
|
$719.03
|
|
|
Service Code
|
HCPCS 79101 TC
|
| Hospital Charge Code |
66540131
|
|
Hospital Revenue Code
|
342
|
| Rate for Payer: Cash Price |
$287.70
|
|
|
RT RAIOPHARMACEUTICAL THERAPY
|
Facility
|
OP
|
$719.03
|
|
|
Service Code
|
HCPCS 79101 TC
|
| Hospital Charge Code |
66540131
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$179.30 |
| Max. Negotiated Rate |
$448.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$395.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$287.70
|
| Rate for Payer: Aetna Government |
$287.70
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$201.39
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$201.39
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$201.39
|
| Rate for Payer: Brighton Health Commercial |
$287.70
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$287.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$448.55
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$379.54
|
| Rate for Payer: Elderplan Medicare Advantage |
$287.70
|
| Rate for Payer: EmblemHealth Commercial |
$201.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$244.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$244.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$256.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$287.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$256.05
|
| Rate for Payer: Group Health Inc Commercial |
$258.93
|
| Rate for Payer: Group Health Inc Medicare |
$258.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$359.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$287.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$258.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$287.70
|
| Rate for Payer: Healthfirst QHP |
$287.70
|
| Rate for Payer: Humana Medicare |
$293.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$287.70
|
| Rate for Payer: United Healthcare Commercial |
$179.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$287.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$287.70
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$230.16
|
| Rate for Payer: Wellcare Medicare |
$273.32
|
|
|
RT SAMARIUM
|
Facility
|
IP
|
$2,161.80
|
|
|
Service Code
|
HCPCS A9604
|
| Hospital Charge Code |
66541238
|
|
Hospital Revenue Code
|
344
|
| Rate for Payer: Cash Price |
$17,259.85
|
|
|
RT SAMARIUM
|
Facility
|
OP
|
$2,161.80
|
|
|
Service Code
|
HCPCS A9604
|
| Hospital Charge Code |
66541238
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$1,080.90 |
| Max. Negotiated Rate |
$17,605.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,188.99
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17,259.85
|
| Rate for Payer: Aetna Government |
$17,259.85
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12,081.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12,081.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12,081.90
|
| Rate for Payer: Brighton Health Commercial |
$17,259.85
|
| Rate for Payer: Cash Price |
$17,259.85
|
| Rate for Payer: Cash Price |
$17,259.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17,259.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,729.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,470.02
|
| Rate for Payer: Elderplan Medicare Advantage |
$17,259.85
|
| Rate for Payer: EmblemHealth Commercial |
$17,259.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14,670.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14,670.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15,361.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$17,259.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15,361.27
|
| Rate for Payer: Group Health Inc Commercial |
$17,259.85
|
| Rate for Payer: Group Health Inc Medicare |
$17,259.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,080.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17,259.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14,670.88
|
| Rate for Payer: Healthfirst QHP |
$17,259.85
|
| Rate for Payer: Humana Medicare |
$17,605.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17,259.85
|
| Rate for Payer: United Healthcare Commercial |
$17,259.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,259.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17,259.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13,807.88
|
| Rate for Payer: Wellcare Medicare |
$16,396.86
|
|
|
RT SIMPLE BLOCK OR BOLUS
|
Facility
|
OP
|
$383.40
|
|
|
Service Code
|
HCPCS 77332 TC
|
| Hospital Charge Code |
66541235
|
|
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 SIMPLE BLOCK OR BOLUS
|
Facility
|
IP
|
$383.40
|
|
|
Service Code
|
HCPCS 77332 TC
|
| Hospital Charge Code |
66541235
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$156.91
|
|
|
RT SIMPLE,SINGLE OR PARALLEL
|
Facility
|
IP
|
$383.40
|
|
|
Service Code
|
HCPCS 77280 TC
|
| Hospital Charge Code |
66541239
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$156.91
|
|
|
RT SIMPLE,SINGLE OR PARALLEL
|
Facility
|
OP
|
$383.40
|
|
|
Service Code
|
HCPCS 77280 TC
|
| Hospital Charge Code |
66541239
|
|
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 SP EB PORT PL HEM/TOT BDY
|
Facility
|
IP
|
$1,015.13
|
|
|
Service Code
|
HCPCS 77321 TC
|
| Hospital Charge Code |
66541270
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$427.29
|
|
|
RT SP EB PORT PL HEM/TOT BDY
|
Facility
|
OP
|
$1,015.13
|
|
|
Service Code
|
HCPCS 77321 TC
|
| Hospital Charge Code |
66541270
|
|
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 SPECIAL PHYSICS CONSULT
|
Facility
|
OP
|
$383.40
|
|
|
Service Code
|
HCPCS 77370
|
| Hospital Charge Code |
66541260
|
|
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 SPECIAL PHYSICS CONSULT
|
Facility
|
IP
|
$383.40
|
|
|
Service Code
|
HCPCS 77370
|
| Hospital Charge Code |
66541260
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$156.91
|
|
|
RT SPECIAL TOTAL BODY IRRADIATION
|
Facility
|
OP
|
$1,631.98
|
|
|
Service Code
|
HCPCS 77470 TC
|
| Hospital Charge Code |
66541278
|
|
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 SPECIAL TOTAL BODY IRRADIATION
|
Facility
|
IP
|
$1,631.98
|
|
|
Service Code
|
HCPCS 77470 TC
|
| Hospital Charge Code |
66541278
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$680.74
|
|
|
RT SPECIAL TREATMENT PROCEDURE
|
Facility
|
OP
|
$1,631.98
|
|
|
Service Code
|
HCPCS 77470 TC
|
| Hospital Charge Code |
66541329
|
|
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 SPECIAL TREATMENT PROCEDURE
|
Facility
|
IP
|
$1,631.98
|
|
|
Service Code
|
HCPCS 77470 TC
|
| Hospital Charge Code |
66541329
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$680.74
|
|
|
RT SPEC TELETHERPY PORT PL
|
Facility
|
IP
|
$1,015.13
|
|
|
Service Code
|
HCPCS 77321 TC
|
| Hospital Charge Code |
66541224
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$427.29
|
|
|
RT SPEC TELETHERPY PORT PL
|
Facility
|
OP
|
$1,015.13
|
|
|
Service Code
|
HCPCS 77321 TC
|
| Hospital Charge Code |
66541224
|
|
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
|
|
