|
RT SRS TREATM MGMT CARNIALLESIONS
|
Facility
OP
|
$1,119.30
|
|
| Hospital Charge Code |
66541410
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$279.92 |
| Max. Negotiated Rate |
$895.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$615.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$559.65
|
| Rate for Payer: Aetna Government |
$559.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$895.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$761.12
|
| 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 |
$559.65
|
| Rate for Payer: Group Health Inc Medicare |
$391.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$559.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$559.65
|
|
|
RT STRONTIUM
|
Facility
OP
|
$1,329.45
|
|
|
Service Code
|
HCPCS A9600
|
| Hospital Charge Code |
66541281
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$664.72 |
| Max. Negotiated Rate |
$4,156.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$731.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,156.57
|
| Rate for Payer: Aetna Government |
$4,156.57
|
| Rate for Payer: Brighton Health Commercial |
$4,156.57
|
| Rate for Payer: Cash Price |
$4,156.57
|
| Rate for Payer: Cash Price |
$4,156.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,156.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,063.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$904.03
|
| Rate for Payer: Elderplan Medicare Advantage |
$4,156.57
|
| Rate for Payer: EmblemHealth Commercial |
$4,156.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,533.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,533.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,699.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,156.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,699.35
|
| Rate for Payer: Group Health Inc Commercial |
$4,156.57
|
| Rate for Payer: Group Health Inc Medicare |
$4,156.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$664.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,156.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,533.09
|
| Rate for Payer: Healthfirst QHP |
$4,156.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,156.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,156.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,325.26
|
| Rate for Payer: Wellcare Medicare |
$3,948.74
|
|
|
RT SUBS IHC,EXPANDED FOCUSED
|
Facility
OP
|
$222.76
|
|
|
Service Code
|
HCPCS 99232
|
| Hospital Charge Code |
66541292
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$53.57 |
| Max. Negotiated Rate |
$178.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$122.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$53.57
|
| Rate for Payer: Aetna Government |
$53.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$178.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$151.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$82.94
|
| Rate for Payer: Group Health Inc Commercial |
$111.38
|
| Rate for Payer: Group Health Inc Medicare |
$77.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$111.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$92.15
|
|
|
RT SUBS IHC, HIGH COMPLEXTY
|
Facility
OP
|
$317.95
|
|
|
Service Code
|
HCPCS 99233
|
| Hospital Charge Code |
66541293
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$77.48 |
| Max. Negotiated Rate |
$254.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$174.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$77.48
|
| Rate for Payer: Aetna Government |
$77.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$254.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$216.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$124.70
|
| Rate for Payer: Group Health Inc Commercial |
$158.98
|
| Rate for Payer: Group Health Inc Medicare |
$111.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$158.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$158.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$138.56
|
|
|
RT SUBS IHC, PROBLEM FOCUSED
|
Facility
OP
|
$135.70
|
|
|
Service Code
|
HCPCS 99231
|
| Hospital Charge Code |
66541291
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$29.44 |
| Max. Negotiated Rate |
$108.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$74.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29.44
|
| Rate for Payer: Aetna Government |
$29.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$108.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$92.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$52.92
|
| Rate for Payer: Group Health Inc Commercial |
$67.85
|
| Rate for Payer: Group Health Inc Medicare |
$47.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$58.80
|
|
|
RT SUPERV, HNDL, LOAD -RAD SOURCE
|
Facility
OP
|
$258.40
|
|
|
Service Code
|
HCPCS 77790
|
| Hospital Charge Code |
66541330
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$206.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$142.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.63
|
| Rate for Payer: Aetna Government |
$19.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$206.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$175.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.89
|
| Rate for Payer: Group Health Inc Commercial |
$129.20
|
| Rate for Payer: Group Health Inc Medicare |
$90.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$129.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$129.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.10
|
|
|
RT SUPERVISION HAND/LOAD
|
Facility
OP
|
$258.40
|
|
|
Service Code
|
HCPCS 77790
|
| Hospital Charge Code |
66541251
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$206.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$142.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.63
|
| Rate for Payer: Aetna Government |
$19.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$206.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$175.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.89
|
| Rate for Payer: Group Health Inc Commercial |
$129.20
|
| Rate for Payer: Group Health Inc Medicare |
$90.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$129.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$129.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.10
|
|
|
RT SURFACE APPL RAD SOURCE
|
Facility
OP
|
$371.65
|
|
|
Service Code
|
HCPCS 77789 TC
|
| Hospital Charge Code |
66541244
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$80.14 |
| Max. Negotiated Rate |
$297.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$204.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$185.82
|
| Rate for Payer: Aetna Government |
$185.82
|
| Rate for Payer: Cash Price |
$138.67
|
| Rate for Payer: Cash Price |
$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: Fidelis CHP/HARP/Medicaid |
$80.14
|
| Rate for Payer: Group Health Inc Commercial |
$185.82
|
| Rate for Payer: Group Health Inc Medicare |
$130.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$185.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$185.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$89.05
|
|
|
RT TANGENTIAL PORTS 3+
|
Facility
OP
|
$1,015.13
|
|
|
Service Code
|
HCPCS 77290 TC
|
| Hospital Charge Code |
66541241
|
|
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 |
$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 |
$456.22
|
|
|
RT THERAPEUTIC RADIO. TRTMNT PLAN
|
Facility
OP
|
$298.20
|
|
|
Service Code
|
HCPCS 77261
|
| Hospital Charge Code |
66540133
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$74.12 |
| Max. Negotiated Rate |
$164.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$164.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$94.55
|
| Rate for Payer: Aetna Government |
$94.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$142.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$120.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$74.12
|
| Rate for Payer: Group Health Inc Commercial |
$149.10
|
| Rate for Payer: Group Health Inc Medicare |
$104.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$149.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$149.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$82.35
|
|
|
RT THERAPY RAD PORT FILM
|
Facility
OP
|
$103.48
|
|
|
Service Code
|
HCPCS 77417
|
| Hospital Charge Code |
66541234
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$14.55 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.55
|
| Rate for Payer: Aetna Government |
$14.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$82.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$70.37
|
| 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 Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$51.74
|
| Rate for Payer: Group Health Inc Medicare |
$36.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.21
|
|
|
RT TOTAL BODY IRRADIATION
|
Facility
OP
|
$1,631.98
|
|
|
Service Code
|
HCPCS 77470 TC
|
| Hospital Charge Code |
66541275
|
|
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 TREATMENT PLAN COMPLEX
|
Facility
OP
|
$681.65
|
|
|
Service Code
|
HCPCS 77263
|
| Hospital Charge Code |
66541222
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$178.97 |
| Max. Negotiated Rate |
$374.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$374.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$207.09
|
| Rate for Payer: Aetna Government |
$207.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$317.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$268.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$178.97
|
| Rate for Payer: Group Health Inc Commercial |
$340.82
|
| Rate for Payer: Group Health Inc Medicare |
$238.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$340.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$340.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$198.86
|
|
|
RT TREATMENT PLANNING, COMPLEX
|
Facility
OP
|
$4,328.59
|
|
|
Service Code
|
HCPCS 77263
|
| Hospital Charge Code |
66541327
|
|
Hospital Revenue Code
|
973
|
| Min. Negotiated Rate |
$178.97 |
| Max. Negotiated Rate |
$2,380.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,380.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$207.09
|
| Rate for Payer: Aetna Government |
$207.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$317.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$268.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$178.97
|
| Rate for Payer: Group Health Inc Commercial |
$2,164.30
|
| Rate for Payer: Group Health Inc Medicare |
$1,515.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,164.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,164.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$198.86
|
|
|
RT TREATMENT PLAN SIMPLE
|
Facility
OP
|
$298.20
|
|
|
Service Code
|
HCPCS 77261
|
| Hospital Charge Code |
66541220
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$74.12 |
| Max. Negotiated Rate |
$164.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$164.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$94.55
|
| Rate for Payer: Aetna Government |
$94.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$142.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$120.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$74.12
|
| Rate for Payer: Group Health Inc Commercial |
$149.10
|
| Rate for Payer: Group Health Inc Medicare |
$104.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$149.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$149.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$82.35
|
|
|
RT TREATMENT PL INTERMEDIATE
|
Facility
OP
|
$448.32
|
|
|
Service Code
|
HCPCS 77262
|
| Hospital Charge Code |
66541221
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$113.81 |
| Max. Negotiated Rate |
$246.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$246.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$141.60
|
| Rate for Payer: Aetna Government |
$141.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$214.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$181.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$113.81
|
| Rate for Payer: Group Health Inc Commercial |
$224.16
|
| Rate for Payer: Group Health Inc Medicare |
$156.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$224.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$224.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$126.46
|
|
|
RT TREATM MGMT 1 OR 2 FRACT
|
Facility
OP
|
$740.78
|
|
|
Service Code
|
HCPCS 77431
|
| Hospital Charge Code |
66541273
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$113.98 |
| Max. Negotiated Rate |
$407.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$407.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$127.73
|
| Rate for Payer: Aetna Government |
$127.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$195.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$165.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$113.98
|
| 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
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$126.64
|
|
|
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 |
$202.98 |
| Max. Negotiated Rate |
$407.43 |
| 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: Cigna HMO/Network Benefit Plan/Open Access |
$356.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$301.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$202.98
|
| 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
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$225.53
|
|
|
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: 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 |
$80.05 |
| 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 |
$80.05
|
|
|
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 |
$130.08 |
| Max. Negotiated Rate |
$297.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$204.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$185.82
|
| Rate for Payer: Aetna Government |
$185.82
|
| Rate for Payer: Cash Price |
$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: Group Health Inc Commercial |
$185.82
|
| Rate for Payer: Group Health Inc Medicare |
$130.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$185.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$185.82
|
|
|
RT UNLISTED PROCEDURE TP
|
Facility
OP
|
$383.40
|
|
|
Service Code
|
HCPCS 77299 TC
|
| Hospital Charge Code |
66541225
|
|
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: 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
|
|
|
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 |
$184.35 |
| 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: 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: Senior Whole Health 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
OP
|
$383.40
|
|
|
Service Code
|
HCPCS 77299 TC
|
| Hospital Charge Code |
66541243
|
|
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: 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
|
|
|
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 |
$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: 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
|
|
