|
RT IMRT TREATMENT PLAN
|
Facility
|
OP
|
$3,771.83
|
|
|
Service Code
|
HCPCS 77301 TC
|
| Hospital Charge Code |
66541226
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$279.92 |
| Max. Negotiated Rate |
$3,017.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,074.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,602.37
|
| Rate for Payer: Aetna Government |
$1,602.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,121.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,121.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,121.66
|
| Rate for Payer: Brighton Health Commercial |
$2,828.87
|
| Rate for Payer: Cash Price |
$1,602.37
|
| Rate for Payer: Cash Price |
$1,602.37
|
| Rate for Payer: Cash Price |
$1,602.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,602.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,017.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,564.84
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,602.37
|
| Rate for Payer: EmblemHealth Commercial |
$1,602.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,602.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,602.37
|
| Rate for Payer: Group Health Inc Medicare |
$1,602.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,885.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,602.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,442.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,602.37
|
| Rate for Payer: Healthfirst QHP |
$1,602.37
|
| Rate for Payer: Humana Medicare |
$1,634.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,602.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,602.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,602.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,281.90
|
| Rate for Payer: Wellcare Medicare |
$1,522.25
|
|
|
RT INCISION & DRAINAGE
|
Facility
|
OP
|
$967.73
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
30305086
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$461.12
|
| Rate for Payer: Aetna Government |
$461.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$322.78
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$322.78
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$322.78
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$461.12
|
| 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 |
$461.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$391.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$461.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.40
|
| 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 |
$483.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$391.95
|
| Rate for Payer: Healthfirst QHP |
$461.12
|
| Rate for Payer: Humana Medicare |
$470.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$461.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$461.12
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$461.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$461.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$368.90
|
| Rate for Payer: Wellcare Medicare |
$438.06
|
|
|
RT INCISION & DRAINAGE
|
Facility
|
IP
|
$967.73
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
30103208
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$461.12
|
|
|
RT INCISION & DRAINAGE
|
Facility
|
OP
|
$967.73
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
66541302
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$461.12
|
| Rate for Payer: Aetna Government |
$461.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$322.78
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$322.78
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$322.78
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$461.12
|
| 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 |
$461.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$391.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$461.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.40
|
| 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 |
$483.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$391.95
|
| Rate for Payer: Healthfirst QHP |
$461.12
|
| Rate for Payer: Humana Medicare |
$470.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$461.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$461.12
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$461.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$461.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$368.90
|
| Rate for Payer: Wellcare Medicare |
$438.06
|
|
|
RT INCISION & DRAINAGE
|
Facility
|
IP
|
$967.73
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
30305086
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$461.12
|
|
|
RT INCISION & DRAINAGE
|
Facility
|
OP
|
$967.73
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
30103208
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$461.12
|
| Rate for Payer: Aetna Government |
$461.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$322.78
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$322.78
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$322.78
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$461.12
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$461.12
|
| 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 |
$461.12
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$391.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$461.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.40
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$483.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$461.12
|
| Rate for Payer: Humana Medicare |
$470.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$461.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$461.12
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$461.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$461.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$368.90
|
| Rate for Payer: Wellcare Medicare |
$438.06
|
|
|
RT INCISION & DRAINAGE
|
Facility
|
IP
|
$967.73
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
66541302
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$461.12
|
|
|
RT INFUSION OF RADIOELEMENT SOLUT
|
Facility
|
OP
|
$715.88
|
|
|
Service Code
|
HCPCS 77750 TC
|
| Hospital Charge Code |
66540132
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$217.55 |
| Max. Negotiated Rate |
$393.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$393.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$310.79
|
| Rate for Payer: Aetna Government |
$310.79
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$217.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$217.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$217.55
|
| Rate for Payer: Brighton Health Commercial |
$310.79
|
| Rate for Payer: Cash Price |
$310.79
|
| Rate for Payer: Cash Price |
$310.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$310.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$321.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$271.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$310.79
|
| Rate for Payer: EmblemHealth Commercial |
$217.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$264.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$264.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$276.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$310.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$276.60
|
| Rate for Payer: Group Health Inc Commercial |
$279.71
|
| Rate for Payer: Group Health Inc Medicare |
$279.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$357.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$310.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$279.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$310.79
|
| Rate for Payer: Healthfirst QHP |
$310.79
|
| Rate for Payer: Humana Medicare |
$317.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$310.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$310.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$310.79
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$248.63
|
| Rate for Payer: Wellcare Medicare |
$295.25
|
|
|
RT INFUSION OF RADIOELEMENT SOLUT
|
Facility
|
IP
|
$715.88
|
|
|
Service Code
|
HCPCS 77750 TC
|
| Hospital Charge Code |
66540132
|
|
Hospital Revenue Code
|
342
|
| Rate for Payer: Cash Price |
$310.79
|
|
|
RT INITIAL IHC,COMPLEX
|
Facility
|
OP
|
$628.20
|
|
|
Service Code
|
HCPCS 99223
|
| Hospital Charge Code |
66541290
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$151.33 |
| Max. Negotiated Rate |
$502.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$345.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$151.33
|
| Rate for Payer: Aetna Government |
$151.33
|
| Rate for Payer: Brighton Health Commercial |
$471.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$502.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$427.18
|
| Rate for Payer: Group Health Inc Commercial |
$314.10
|
| Rate for Payer: Group Health Inc Medicare |
$219.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$314.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$314.10
|
|
|
RT INITIAL IHC,COMPREHENSIVE
|
Facility
|
OP
|
$450.91
|
|
|
Service Code
|
HCPCS 99222
|
| Hospital Charge Code |
66541289
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$102.50 |
| Max. Negotiated Rate |
$360.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$248.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$102.50
|
| Rate for Payer: Aetna Government |
$102.50
|
| Rate for Payer: Brighton Health Commercial |
$338.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$360.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$306.62
|
| Rate for Payer: Group Health Inc Commercial |
$225.46
|
| Rate for Payer: Group Health Inc Medicare |
$157.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$225.46
|
|
|
RT INITIAL IHC,DETAILED
|
Facility
|
OP
|
$271.78
|
|
|
Service Code
|
HCPCS 99221
|
| Hospital Charge Code |
66541288
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$76.47 |
| Max. Negotiated Rate |
$217.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$149.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$76.47
|
| Rate for Payer: Aetna Government |
$76.47
|
| Rate for Payer: Brighton Health Commercial |
$203.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.81
|
| Rate for Payer: Group Health Inc Commercial |
$135.89
|
| Rate for Payer: Group Health Inc Medicare |
$95.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$135.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$135.89
|
|
|
RT INPT CONSULT 40
|
Facility
|
OP
|
$294.20
|
|
|
Service Code
|
HCPCS 99252
|
| Hospital Charge Code |
66541208
|
|
Hospital Revenue Code
|
657
|
| Min. Negotiated Rate |
$54.97 |
| Max. Negotiated Rate |
$235.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$161.81
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$54.97
|
| Rate for Payer: Aetna Government |
$54.97
|
| Rate for Payer: Brighton Health Commercial |
$220.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$235.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$200.06
|
| Rate for Payer: Group Health Inc Commercial |
$147.10
|
| Rate for Payer: Group Health Inc Medicare |
$102.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$147.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.10
|
|
|
RT INPT CONSULT 55
|
Facility
|
OP
|
$358.63
|
|
|
Service Code
|
HCPCS 99253
|
| Hospital Charge Code |
66541209
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$84.39 |
| Max. Negotiated Rate |
$286.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$197.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$84.39
|
| Rate for Payer: Aetna Government |
$84.39
|
| Rate for Payer: Brighton Health Commercial |
$268.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$286.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$243.87
|
| Rate for Payer: Group Health Inc Commercial |
$179.32
|
| Rate for Payer: Group Health Inc Medicare |
$125.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$179.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$179.32
|
| Rate for Payer: United Healthcare Commercial |
$179.32
|
|
|
RT INPT CONSULT 80 ON DAY OF SIM
|
Facility
|
OP
|
$462.23
|
|
|
Service Code
|
HCPCS 99254 25
|
| Hospital Charge Code |
66549892
|
|
Hospital Revenue Code
|
657
|
| Min. Negotiated Rate |
$122.72 |
| Max. Negotiated Rate |
$369.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$254.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$122.72
|
| Rate for Payer: Aetna Government |
$122.72
|
| Rate for Payer: Brighton Health Commercial |
$346.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$369.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$314.32
|
| Rate for Payer: Group Health Inc Commercial |
$231.12
|
| Rate for Payer: Group Health Inc Medicare |
$161.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$231.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.12
|
|
|
RT INPT CONSULT COMPREHENSIVE
|
Facility
|
OP
|
$572.53
|
|
|
Service Code
|
HCPCS 99254
|
| Hospital Charge Code |
66541210
|
|
Hospital Revenue Code
|
988
|
| Min. Negotiated Rate |
$122.72 |
| Max. Negotiated Rate |
$458.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$314.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$122.72
|
| Rate for Payer: Aetna Government |
$122.72
|
| Rate for Payer: Brighton Health Commercial |
$429.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$458.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$389.32
|
| Rate for Payer: Group Health Inc Commercial |
$286.26
|
| Rate for Payer: Group Health Inc Medicare |
$200.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$286.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$286.26
|
|
|
RT INPT CONSULT,HIGH COMPLEXITY
|
Facility
|
OP
|
$788.70
|
|
|
Service Code
|
HCPCS 99255
|
| Hospital Charge Code |
66541211
|
|
Hospital Revenue Code
|
988
|
| Min. Negotiated Rate |
$148.06 |
| Max. Negotiated Rate |
$630.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$433.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$148.06
|
| Rate for Payer: Aetna Government |
$148.06
|
| Rate for Payer: Brighton Health Commercial |
$591.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$630.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$536.32
|
| Rate for Payer: Group Health Inc Commercial |
$394.35
|
| Rate for Payer: Group Health Inc Medicare |
$276.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$394.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$394.35
|
|
|
RT INPT CONSULT, PROBLEM FOCUSED
|
Facility
|
OP
|
$358.63
|
|
|
Service Code
|
HCPCS 99251
|
| Hospital Charge Code |
66541207
|
|
Hospital Revenue Code
|
988
|
| Min. Negotiated Rate |
$35.92 |
| Max. Negotiated Rate |
$286.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$197.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.92
|
| Rate for Payer: Aetna Government |
$35.92
|
| Rate for Payer: Brighton Health Commercial |
$268.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$286.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$243.87
|
| Rate for Payer: Group Health Inc Commercial |
$179.32
|
| Rate for Payer: Group Health Inc Medicare |
$125.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$179.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$179.32
|
|
|
RT INTERSTITIAL COMPLEX
|
Facility
|
OP
|
$2,242.85
|
|
|
Service Code
|
HCPCS 77778 TC
|
| Hospital Charge Code |
66541250
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$580.39 |
| Max. Negotiated Rate |
$2,260.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,233.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$829.13
|
| Rate for Payer: Aetna Government |
$829.13
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$580.39
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$580.39
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$580.39
|
| Rate for Payer: Brighton Health Commercial |
$829.13
|
| Rate for Payer: Cash Price |
$829.13
|
| Rate for Payer: Cash Price |
$829.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$829.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,260.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,912.77
|
| Rate for Payer: Elderplan Medicare Advantage |
$829.13
|
| Rate for Payer: EmblemHealth Commercial |
$580.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$704.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$704.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$737.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$829.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$737.93
|
| Rate for Payer: Group Health Inc Commercial |
$746.22
|
| Rate for Payer: Group Health Inc Medicare |
$746.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,121.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$829.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$746.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$829.13
|
| Rate for Payer: Healthfirst QHP |
$829.13
|
| Rate for Payer: Humana Medicare |
$845.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$829.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$829.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$829.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$663.30
|
| Rate for Payer: Wellcare Medicare |
$787.67
|
|
|
RT INTERSTITIAL COMPLEX
|
Facility
|
IP
|
$2,242.85
|
|
|
Service Code
|
HCPCS 77778 TC
|
| Hospital Charge Code |
66541250
|
|
Hospital Revenue Code
|
342
|
| Rate for Payer: Cash Price |
$829.13
|
|
|
RT INTERSTITIAL INTER
|
Facility
|
OP
|
$371.65
|
|
|
Service Code
|
HCPCS 77799 TC
|
| Hospital Charge Code |
66541249
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$97.07 |
| Max. Negotiated Rate |
$297.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$204.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$138.67
|
| Rate for Payer: Aetna Government |
$138.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$97.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$97.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$97.07
|
| Rate for Payer: Brighton Health Commercial |
$278.74
|
| Rate for Payer: Cash Price |
$138.67
|
| Rate for Payer: Cash Price |
$138.67
|
| Rate for Payer: Cash Price |
$138.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$138.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$297.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$252.72
|
| Rate for Payer: Elderplan Medicare Advantage |
$138.67
|
| Rate for Payer: EmblemHealth Commercial |
$138.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$138.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$138.67
|
| Rate for Payer: Group Health Inc Medicare |
$138.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$185.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$138.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$124.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$138.67
|
| Rate for Payer: Healthfirst QHP |
$138.67
|
| Rate for Payer: Humana Medicare |
$141.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$138.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$138.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$138.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$110.94
|
| Rate for Payer: Wellcare Medicare |
$131.74
|
|
|
RT INTERSTITIAL INTER
|
Facility
|
IP
|
$371.65
|
|
|
Service Code
|
HCPCS 77799 TC
|
| Hospital Charge Code |
66541249
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$138.67
|
|
|
RT INTERSTITIAL SIMPLE
|
Facility
|
IP
|
$371.65
|
|
|
Service Code
|
HCPCS 77799 TC
|
| Hospital Charge Code |
66541248
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$138.67
|
|
|
RT INTERSTITIAL SIMPLE
|
Facility
|
OP
|
$371.65
|
|
|
Service Code
|
HCPCS 77799 TC
|
| Hospital Charge Code |
66541248
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$97.07 |
| Max. Negotiated Rate |
$297.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$204.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$138.67
|
| Rate for Payer: Aetna Government |
$138.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$97.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$97.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$97.07
|
| Rate for Payer: Brighton Health Commercial |
$278.74
|
| Rate for Payer: Cash Price |
$138.67
|
| Rate for Payer: Cash Price |
$138.67
|
| Rate for Payer: Cash Price |
$138.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$138.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$297.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$252.72
|
| Rate for Payer: Elderplan Medicare Advantage |
$138.67
|
| Rate for Payer: EmblemHealth Commercial |
$138.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$138.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$138.67
|
| Rate for Payer: Group Health Inc Medicare |
$138.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$185.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$138.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$124.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$138.67
|
| Rate for Payer: Healthfirst QHP |
$138.67
|
| Rate for Payer: Humana Medicare |
$141.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$138.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$138.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$138.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$110.94
|
| Rate for Payer: Wellcare Medicare |
$131.74
|
|
|
RT INTRACAVITRY APPL SIMPLE
|
Facility
|
OP
|
$1,631.98
|
|
|
Service Code
|
HCPCS 77761 TC
|
| Hospital Charge Code |
66541245
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$476.52 |
| Max. Negotiated Rate |
$897.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$897.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$680.74
|
| Rate for Payer: Aetna Government |
$680.74
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$476.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$476.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$476.52
|
| Rate for Payer: Brighton Health Commercial |
$680.74
|
| Rate for Payer: Cash Price |
$680.74
|
| Rate for Payer: Cash Price |
$680.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$680.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$710.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$601.12
|
| Rate for Payer: Elderplan Medicare Advantage |
$680.74
|
| Rate for Payer: EmblemHealth Commercial |
$476.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$578.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$578.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$605.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$680.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$605.86
|
| Rate for Payer: Group Health Inc Commercial |
$612.67
|
| Rate for Payer: Group Health Inc Medicare |
$612.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$815.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$680.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$612.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$680.74
|
| Rate for Payer: Healthfirst QHP |
$680.74
|
| Rate for Payer: Humana Medicare |
$694.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$680.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$680.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$680.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$544.59
|
| Rate for Payer: Wellcare Medicare |
$646.70
|
|
