|
RT TREATM MGMT 5 OR MORE
|
Facility
|
OP
|
$740.78
|
|
|
Service Code
|
HCPCS 77427
|
| Hospital Charge Code |
66541272
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$232.13 |
| Max. Negotiated Rate |
$555.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$407.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$232.13
|
| Rate for Payer: Aetna Government |
$232.13
|
| Rate for Payer: Brighton Health Commercial |
$555.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$356.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$301.32
|
| Rate for Payer: Group Health Inc Commercial |
$370.39
|
| Rate for Payer: Group Health Inc Medicare |
$259.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$370.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$370.39
|
|
|
RT TREATM MGMT SRS BODY
|
Facility
|
OP
|
$1,859.78
|
|
| Hospital Charge Code |
66541411
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$279.92 |
| Max. Negotiated Rate |
$1,487.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,022.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$929.89
|
| Rate for Payer: Aetna Government |
$929.89
|
| Rate for Payer: Brighton Health Commercial |
$1,394.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,487.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,264.65
|
| 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 |
$929.89
|
| Rate for Payer: Group Health Inc Medicare |
$650.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$929.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$929.89
|
|
|
RT TREATMT DEVICES CMPLX
|
Facility
|
OP
|
$1,015.13
|
|
|
Service Code
|
HCPCS 77334 TC
|
| Hospital Charge Code |
66541237
|
|
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 TREATMT DEVICES CMPLX
|
Facility
|
IP
|
$1,015.13
|
|
|
Service Code
|
HCPCS 77334 TC
|
| Hospital Charge Code |
66541237
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$427.29
|
|
|
RT UNLISTED PROCEDURE,CLI BARCHY
|
Facility
|
IP
|
$371.65
|
|
|
Service Code
|
HCPCS 77799 TC
|
| Hospital Charge Code |
66541253
|
|
Hospital Revenue Code
|
342
|
| Rate for Payer: Cash Price |
$138.67
|
|
|
RT UNLISTED PROCEDURE,CLI BARCHY
|
Facility
|
OP
|
$371.65
|
|
|
Service Code
|
HCPCS 77799 TC
|
| Hospital Charge Code |
66541253
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$97.07 |
| Max. Negotiated Rate |
$710.41 |
| 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 |
$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 |
$710.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$601.12
|
| Rate for Payer: Elderplan Medicare Advantage |
$138.67
|
| Rate for Payer: EmblemHealth Commercial |
$97.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$117.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$117.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$123.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$138.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$123.42
|
| Rate for Payer: Group Health Inc Commercial |
$124.80
|
| Rate for Payer: Group Health Inc Medicare |
$124.80
|
| 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 UNLISTED PROCEDURE TP
|
Facility
|
IP
|
$383.40
|
|
|
Service Code
|
HCPCS 77299 TC
|
| Hospital Charge Code |
66541225
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$156.91
|
|
|
RT UNLISTED PROCEDURE TP
|
Facility
|
OP
|
$383.40
|
|
|
Service Code
|
HCPCS 77299 TC
|
| Hospital Charge Code |
66541225
|
|
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 UNLISTED PROC. FEMALE GEN SYS
|
Facility
|
IP
|
$502.93
|
|
|
Service Code
|
HCPCS 58999
|
| Hospital Charge Code |
66549954
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$230.44
|
|
|
RT UNLISTED PROC. FEMALE GEN SYS
|
Facility
|
OP
|
$502.93
|
|
|
Service Code
|
HCPCS 58999
|
| Hospital Charge Code |
66549954
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$161.31 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$230.44
|
| Rate for Payer: Aetna Government |
$230.44
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$161.31
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$161.31
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$161.31
|
| Rate for Payer: Brighton Health Commercial |
$377.20
|
| Rate for Payer: Cash Price |
$230.44
|
| Rate for Payer: Cash Price |
$230.44
|
| Rate for Payer: Cash Price |
$230.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$230.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$230.44
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$195.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$205.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$230.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$205.09
|
| Rate for Payer: Group Health Inc Commercial |
$230.44
|
| Rate for Payer: Group Health Inc Medicare |
$230.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$230.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$195.87
|
| Rate for Payer: Healthfirst QHP |
$230.44
|
| Rate for Payer: Humana Medicare |
$235.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$230.44
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$230.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$230.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$184.35
|
| Rate for Payer: Wellcare Medicare |
$218.92
|
|
|
RT UNLIST SIM PROC
|
Facility
|
IP
|
$383.40
|
|
|
Service Code
|
HCPCS 77299 TC
|
| Hospital Charge Code |
66541243
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$156.91
|
|
|
RT UNLIST SIM PROC
|
Facility
|
OP
|
$383.40
|
|
|
Service Code
|
HCPCS 77299 TC
|
| Hospital Charge Code |
66541243
|
|
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 UNLIST SP PHY PROC/DEVICE
|
Facility
|
IP
|
$383.40
|
|
|
Service Code
|
HCPCS 77399 TC
|
| Hospital Charge Code |
66541262
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$156.91
|
|
|
RT UNLIST SP PHY PROC/DEVICE
|
Facility
|
OP
|
$383.40
|
|
|
Service Code
|
HCPCS 77399 TC
|
| Hospital Charge Code |
66541262
|
|
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 US GUIDE INTRSTTL RADLMNT APP
|
Facility
|
OP
|
$1,250.92
|
|
|
Service Code
|
HCPCS 76965 TC
|
| Hospital Charge Code |
66541309
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$18.83 |
| Max. Negotiated Rate |
$1,000.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$688.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.83
|
| Rate for Payer: Aetna Government |
$18.83
|
| Rate for Payer: Brighton Health Commercial |
$938.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,000.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$850.63
|
| 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 |
$625.46
|
| Rate for Payer: Group Health Inc Medicare |
$437.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$625.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$625.46
|
|
|
RT US PLAN
|
Facility
|
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76873 TC
|
| Hospital Charge Code |
66541304
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$77.02 |
| Max. Negotiated Rate |
$192.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$127.14
|
| Rate for Payer: Aetna Government |
$127.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$89.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$89.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$89.00
|
| Rate for Payer: Brighton Health Commercial |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$192.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$163.05
|
| Rate for Payer: Elderplan Medicare Advantage |
$127.14
|
| Rate for Payer: EmblemHealth Commercial |
$89.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$108.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.15
|
| Rate for Payer: Group Health Inc Commercial |
$114.43
|
| Rate for Payer: Group Health Inc Medicare |
$114.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$114.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$127.14
|
| Rate for Payer: Healthfirst QHP |
$127.14
|
| Rate for Payer: Humana Medicare |
$129.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.14
|
| Rate for Payer: United Healthcare Commercial |
$77.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$101.71
|
| Rate for Payer: Wellcare Medicare |
$120.78
|
|
|
RT US PLAN
|
Facility
|
IP
|
$339.45
|
|
|
Service Code
|
HCPCS 76873 TC
|
| Hospital Charge Code |
66541304
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$127.14
|
|
|
RT VENIPUNCTURE
|
Facility
|
IP
|
$9.71
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
66541216
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$8.83
|
|
|
RT VENIPUNCTURE
|
Facility
|
OP
|
$9.71
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
66541216
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$926.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.57
|
| Rate for Payer: Aetna Government |
$8.57
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$20.84
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$20.84
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.26
|
| Rate for Payer: Amida Care Medicaid |
$9.26
|
| Rate for Payer: Brighton Health Commercial |
$7.28
|
| Rate for Payer: Cash Price |
$8.83
|
| Rate for Payer: Cash Price |
$8.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.87
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.57
|
| Rate for Payer: EmblemHealth Commercial |
$8.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$926.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.72
|
| Rate for Payer: Group Health Inc Commercial |
$8.57
|
| Rate for Payer: Group Health Inc Medicare |
$8.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.26
|
| Rate for Payer: Healthfirst Essential Plan |
$20.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.28
|
| Rate for Payer: Healthfirst QHP |
$9.26
|
| Rate for Payer: Humana Medicare |
$8.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.26
|
| Rate for Payer: SOMOS Essential |
$20.84
|
| Rate for Payer: United Healthcare Commercial |
$2.70
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$20.84
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$10.19
|
| Rate for Payer: United Healthcare Medicaid |
$9.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.86
|
| Rate for Payer: Wellcare Medicare |
$7.71
|
|
|
RT WHEN PRESCRIBED BY MD
|
Facility
|
IP
|
$383.40
|
|
|
Service Code
|
HCPCS 77331 TC
|
| Hospital Charge Code |
66541259
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$156.91
|
|
|
RT WHEN PRESCRIBED BY MD
|
Facility
|
OP
|
$383.40
|
|
|
Service Code
|
HCPCS 77331 TC
|
| Hospital Charge Code |
66541259
|
|
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
|
|
|
RUBBER PANTS
|
Facility
|
OP
|
$9.57
|
|
| Hospital Charge Code |
40205620
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$7.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.78
|
| Rate for Payer: Aetna Government |
$4.78
|
| Rate for Payer: Brighton Health Commercial |
$7.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.51
|
| Rate for Payer: Group Health Inc Commercial |
$4.78
|
| Rate for Payer: Group Health Inc Medicare |
$3.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.78
|
|
|
RUBELLA ANTIBODIES, IGG
|
Facility
|
IP
|
$35.98
|
|
|
Service Code
|
HCPCS 86762
|
| Hospital Charge Code |
40729377
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$14.39
|
|
|
RUBELLA ANTIBODIES, IGG
|
Facility
|
OP
|
$35.98
|
|
|
Service Code
|
HCPCS 86762
|
| Hospital Charge Code |
40729377
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$26.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.39
|
| Rate for Payer: Aetna Government |
$14.39
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.07
|
| Rate for Payer: Brighton Health Commercial |
$26.98
|
| Rate for Payer: Cash Price |
$14.39
|
| Rate for Payer: Cash Price |
$14.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.35
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.39
|
| Rate for Payer: EmblemHealth Commercial |
$14.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.81
|
| Rate for Payer: Group Health Inc Commercial |
$14.39
|
| Rate for Payer: Group Health Inc Medicare |
$14.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.39
|
| Rate for Payer: Healthfirst QHP |
$14.39
|
| Rate for Payer: Humana Medicare |
$14.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.39
|
| Rate for Payer: United Healthcare Commercial |
$18.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.51
|
| Rate for Payer: Wellcare Medicare |
$12.95
|
|
|
RUBELLA ANTIBODIES, IGM
|
Facility
|
OP
|
$35.98
|
|
|
Service Code
|
HCPCS 86762
|
| Hospital Charge Code |
40729378
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$26.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.39
|
| Rate for Payer: Aetna Government |
$14.39
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.07
|
| Rate for Payer: Brighton Health Commercial |
$26.98
|
| Rate for Payer: Cash Price |
$14.39
|
| Rate for Payer: Cash Price |
$14.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.35
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.39
|
| Rate for Payer: EmblemHealth Commercial |
$14.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.81
|
| Rate for Payer: Group Health Inc Commercial |
$14.39
|
| Rate for Payer: Group Health Inc Medicare |
$14.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.39
|
| Rate for Payer: Healthfirst QHP |
$14.39
|
| Rate for Payer: Humana Medicare |
$14.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.39
|
| Rate for Payer: United Healthcare Commercial |
$18.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.51
|
| Rate for Payer: Wellcare Medicare |
$12.95
|
|
