|
RT LUPRON/7.5MG
|
Facility
OP
|
$971.30
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
66541319
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$145.04 |
| Max. Negotiated Rate |
$631.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$534.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$181.30
|
| Rate for Payer: Aetna Government |
$181.30
|
| Rate for Payer: Cash Price |
$181.30
|
| Rate for Payer: Cash Price |
$181.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$181.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$485.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$558.50
|
| Rate for Payer: Elderplan Medicare Advantage |
$181.30
|
| Rate for Payer: EmblemHealth Commercial |
$181.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$181.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$181.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$190.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$181.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$190.37
|
| Rate for Payer: Group Health Inc Commercial |
$181.30
|
| Rate for Payer: Group Health Inc Medicare |
$181.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$485.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$485.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$154.11
|
| Rate for Payer: Healthfirst QHP |
$181.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$181.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$196.80
|
| Rate for Payer: SOMOS Essential |
$196.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$631.34
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$145.04
|
| Rate for Payer: Wellcare Medicare |
$172.24
|
|
|
RT MULTI BLCK,STENTS,BITE BLCK
|
Facility
OP
|
$383.40
|
|
|
Service Code
|
HCPCS 77333 TC
|
| Hospital Charge Code |
66541236
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$121.12 |
| Max. Negotiated Rate |
$306.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$210.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$191.70
|
| Rate for Payer: Aetna Government |
$191.70
|
| Rate for Payer: Cash Price |
$156.91
|
| Rate for Payer: Cash Price |
$156.91
|
| Rate for Payer: Cash Price |
$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: 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 |
$191.70
|
| Rate for Payer: Group Health Inc Medicare |
$134.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$191.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$121.12
|
|
|
RT OPT CONSULT, LEVEL 1
|
Facility
OP
|
$358.63
|
|
|
Service Code
|
HCPCS 99241
|
| Hospital Charge Code |
66541201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.02 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$197.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.02
|
| Rate for Payer: Aetna Government |
$24.02
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| 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 |
$179.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$179.32
|
|
|
RT OPT CONSULT, LEVEL 2
|
Facility
OP
|
$395.39
|
|
|
Service Code
|
HCPCS 99242
|
| Hospital Charge Code |
66541202
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$50.34 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$217.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$50.34
|
| Rate for Payer: Aetna Government |
$50.34
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| 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 |
$197.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$197.70
|
|
|
RT OPT CONSULT, LEVEL 3
|
Facility
OP
|
$479.51
|
|
|
Service Code
|
HCPCS 99243
|
| Hospital Charge Code |
66541203
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.38 |
| Max. Negotiated Rate |
$263.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$263.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.38
|
| Rate for Payer: Aetna Government |
$70.38
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| 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 |
$239.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$239.76
|
|
|
RT OPT CONSULT,LEVEL 4
|
Facility
OP
|
$528.33
|
|
|
Service Code
|
HCPCS 99244
|
| Hospital Charge Code |
66541204
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$113.18 |
| Max. Negotiated Rate |
$290.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$290.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$113.18
|
| Rate for Payer: Aetna Government |
$113.18
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| 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 |
$264.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$264.16
|
|
|
RT OPT CONSULT,LEVEL 5
|
Facility
OP
|
$559.74
|
|
|
Service Code
|
HCPCS 99245
|
| Hospital Charge Code |
66541205
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$139.91 |
| Max. Negotiated Rate |
$307.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$307.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$139.91
|
| Rate for Payer: Aetna Government |
$139.91
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| 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 |
$279.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$279.87
|
|
|
RT OUTPT CONSULT 60 ON DAY OF SIM
|
Facility
OP
|
$528.33
|
|
|
Service Code
|
HCPCS 99244 25
|
| Hospital Charge Code |
66549893
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$173.89 |
| Max. Negotiated Rate |
$290.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$290.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$264.16
|
| Rate for Payer: Aetna Government |
$264.16
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| 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 |
$264.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$264.16
|
|
|
RT PELVIC UNDER ANESTHESIA
|
Facility
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 57410
|
| Hospital Charge Code |
66541252
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$116.76 |
| Max. Negotiated Rate |
$3,783.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,615.39
|
| 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 |
$3,615.39
|
| Rate for Payer: EmblemHealth Commercial |
$3,615.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$116.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,073.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,217.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,615.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,217.70
|
| Rate for Payer: Group Health Inc Commercial |
$3,615.39
|
| Rate for Payer: Group Health Inc Medicare |
$3,615.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,783.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,615.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$129.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,073.08
|
| Rate for Payer: Healthfirst QHP |
$3,615.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,615.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,892.31
|
| Rate for Payer: Wellcare Medicare |
$3,434.62
|
|
|
RT PER ORAL
|
Facility
OP
|
$1,631.98
|
|
|
Service Code
|
HCPCS 77470 TC
|
| Hospital Charge Code |
66541277
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$40.58 |
| Max. Negotiated Rate |
$1,305.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$897.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$815.99
|
| Rate for Payer: Aetna Government |
$815.99
|
| Rate for Payer: Cash Price |
$680.74
|
| Rate for Payer: Cash Price |
$680.74
|
| Rate for Payer: Cash Price |
$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: 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 |
$815.99
|
| Rate for Payer: Group Health Inc Medicare |
$571.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$815.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$815.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.58
|
|
|
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: 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: 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: Senior Whole Health 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 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 RADIOPHARM
|
Facility
OP
|
$719.03
|
|
|
Service Code
|
HCPCS 79101 TC
|
| Hospital Charge Code |
66541282
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$59.81 |
| Max. Negotiated Rate |
$575.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$395.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$359.52
|
| Rate for Payer: Aetna Government |
$359.52
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$575.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$488.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$59.81
|
| Rate for Payer: Group Health Inc Commercial |
$359.52
|
| Rate for Payer: Group Health Inc Medicare |
$251.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$359.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$359.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$66.46
|
|
|
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 |
$59.81 |
| Max. Negotiated Rate |
$575.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$395.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$359.52
|
| Rate for Payer: Aetna Government |
$359.52
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$575.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$488.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$59.81
|
| Rate for Payer: Group Health Inc Commercial |
$359.52
|
| Rate for Payer: Group Health Inc Medicare |
$251.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$359.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$359.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$66.46
|
|
|
RT RAIOPHARMACEUTICAL THERAPY
|
Facility
OP
|
$719.03
|
|
|
Service Code
|
HCPCS 79101 TC
|
| Hospital Charge Code |
66540131
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$59.81 |
| Max. Negotiated Rate |
$575.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$395.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$359.52
|
| Rate for Payer: Aetna Government |
$359.52
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$575.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$488.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$59.81
|
| Rate for Payer: Group Health Inc Commercial |
$359.52
|
| Rate for Payer: Group Health Inc Medicare |
$251.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$359.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$359.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$66.46
|
|
|
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 |
$17,259.85 |
| 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: 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: Senior Whole Health 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 |
$18.03 |
| Max. Negotiated Rate |
$306.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$210.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$191.70
|
| Rate for Payer: Aetna Government |
$191.70
|
| Rate for Payer: Cash Price |
$156.91
|
| Rate for Payer: Cash Price |
$156.91
|
| Rate for Payer: Cash Price |
$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: 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 |
$191.70
|
| Rate for Payer: Group Health Inc Medicare |
$134.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$191.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.03
|
|
|
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 |
$134.19 |
| Max. Negotiated Rate |
$306.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$210.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$191.70
|
| Rate for Payer: Aetna Government |
$191.70
|
| Rate for Payer: Cash Price |
$156.91
|
| Rate for Payer: Cash Price |
$156.91
|
| Rate for Payer: Cash Price |
$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: 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 |
$191.70
|
| Rate for Payer: Group Health Inc Medicare |
$134.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$191.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$285.41
|
|
|
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 |
$54.17 |
| Max. Negotiated Rate |
$812.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$558.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$507.56
|
| Rate for Payer: Aetna Government |
$507.56
|
| Rate for Payer: Cash Price |
$427.29
|
| Rate for Payer: Cash Price |
$427.29
|
| Rate for Payer: Cash Price |
$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: 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 |
$507.56
|
| Rate for Payer: Group Health Inc Medicare |
$355.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$507.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$507.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.17
|
|
|
RT SPECIAL PHYSICS CONSULT
|
Facility
OP
|
$383.40
|
|
|
Service Code
|
HCPCS 77370
|
| Hospital Charge Code |
66541260
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$125.53 |
| 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: 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: Senior Whole Health 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 TOTAL BODY IRRADIATION
|
Facility
OP
|
$1,631.98
|
|
|
Service Code
|
HCPCS 77470 TC
|
| Hospital Charge Code |
66541278
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$40.58 |
| Max. Negotiated Rate |
$1,305.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$897.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$815.99
|
| Rate for Payer: Aetna Government |
$815.99
|
| Rate for Payer: Cash Price |
$680.74
|
| Rate for Payer: Cash Price |
$680.74
|
| Rate for Payer: Cash Price |
$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: 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 |
$815.99
|
| Rate for Payer: Group Health Inc Medicare |
$571.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$815.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$815.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.58
|
|
|
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 |
$40.58 |
| Max. Negotiated Rate |
$1,305.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$897.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$815.99
|
| Rate for Payer: Aetna Government |
$815.99
|
| Rate for Payer: Cash Price |
$680.74
|
| Rate for Payer: Cash Price |
$680.74
|
| Rate for Payer: Cash Price |
$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: 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 |
$815.99
|
| Rate for Payer: Group Health Inc Medicare |
$571.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$815.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$815.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.58
|
|
|
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 |
$54.17 |
| Max. Negotiated Rate |
$812.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$558.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$507.56
|
| Rate for Payer: Aetna Government |
$507.56
|
| Rate for Payer: Cash Price |
$427.29
|
| Rate for Payer: Cash Price |
$427.29
|
| Rate for Payer: Cash Price |
$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: 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 |
$507.56
|
| Rate for Payer: Group Health Inc Medicare |
$355.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$507.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$507.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.17
|
|
|
RT SPEC TRTM PRO PHYSICIST
|
Facility
OP
|
$1,631.98
|
|
|
Service Code
|
HCPCS 77470 TC
|
| Hospital Charge Code |
66541223
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$40.58 |
| Max. Negotiated Rate |
$1,305.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$897.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$815.99
|
| Rate for Payer: Aetna Government |
$815.99
|
| Rate for Payer: Cash Price |
$680.74
|
| Rate for Payer: Cash Price |
$680.74
|
| Rate for Payer: Cash Price |
$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: 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 |
$815.99
|
| Rate for Payer: Group Health Inc Medicare |
$571.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$815.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$815.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.58
|
|
|
RT SPEC TRTM PROV MGMT
|
Facility
OP
|
$1,631.98
|
|
|
Service Code
|
HCPCS 77470 TC
|
| Hospital Charge Code |
66541274
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$40.58 |
| Max. Negotiated Rate |
$1,305.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$897.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$815.99
|
| Rate for Payer: Aetna Government |
$815.99
|
| Rate for Payer: Cash Price |
$680.74
|
| Rate for Payer: Cash Price |
$680.74
|
| Rate for Payer: Cash Price |
$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: 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 |
$815.99
|
| Rate for Payer: Group Health Inc Medicare |
$571.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$815.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$815.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.58
|
|
