|
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
|
|
|
RT INTRAOPERATIVE CONE
|
Facility
|
OP
|
$1,631.98
|
|
|
Service Code
|
HCPCS 77470 TC
|
| Hospital Charge Code |
66541279
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$279.92 |
| Max. Negotiated Rate |
$1,305.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$897.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$680.74
|
| Rate for Payer: Aetna Government |
$680.74
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$476.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$476.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$476.52
|
| Rate for Payer: Brighton Health Commercial |
$1,223.98
|
| Rate for Payer: Cash Price |
$680.74
|
| Rate for Payer: Cash Price |
$680.74
|
| Rate for Payer: Cash Price |
$680.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$680.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,305.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,109.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$680.74
|
| Rate for Payer: EmblemHealth Commercial |
$680.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$680.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$680.74
|
| Rate for Payer: Group Health Inc Medicare |
$680.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$815.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$680.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$612.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$680.74
|
| Rate for Payer: Healthfirst QHP |
$680.74
|
| Rate for Payer: Humana Medicare |
$694.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$680.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$680.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$680.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$544.59
|
| Rate for Payer: Wellcare Medicare |
$646.70
|
|
|
RT INTRAOPERATIVE CONE
|
Facility
|
IP
|
$1,631.98
|
|
|
Service Code
|
HCPCS 77470 TC
|
| Hospital Charge Code |
66541279
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$680.74
|
|
|
RT IODINE I-123 SOD IODIDE MIC
|
Facility
|
OP
|
$68.48
|
|
|
Service Code
|
HCPCS A9516
|
| Hospital Charge Code |
66548587
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$23.97 |
| Max. Negotiated Rate |
$149.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$37.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$149.74
|
| Rate for Payer: Aetna Government |
$149.74
|
| Rate for Payer: Brighton Health Commercial |
$51.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$54.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$46.57
|
| Rate for Payer: Group Health Inc Commercial |
$34.24
|
| Rate for Payer: Group Health Inc Medicare |
$23.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.24
|
|
|
RT IR192HD
|
Facility
|
OP
|
$77.36
|
|
|
Service Code
|
HCPCS C1717
|
| Hospital Charge Code |
66541315
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38.68 |
| Max. Negotiated Rate |
$429.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$42.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$421.14
|
| Rate for Payer: Aetna Government |
$421.14
|
| Rate for Payer: Brighton Health Commercial |
$46.42
|
| Rate for Payer: Cash Price |
$421.14
|
| Rate for Payer: Cash Price |
$421.14
|
| Rate for Payer: Cash Price |
$421.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$421.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$38.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$44.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$421.14
|
| Rate for Payer: EmblemHealth Commercial |
$38.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$421.14
|
| Rate for Payer: Group Health Inc Commercial |
$421.14
|
| Rate for Payer: Group Health Inc Medicare |
$421.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$357.97
|
| Rate for Payer: Healthfirst QHP |
$421.14
|
| Rate for Payer: Humana Medicare |
$429.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$421.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$421.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$336.91
|
|
|
RT IR192HD
|
Facility
|
IP
|
$77.36
|
|
|
Service Code
|
HCPCS C1717
|
| Hospital Charge Code |
66541315
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38.68 |
| Max. Negotiated Rate |
$38.68 |
| Rate for Payer: Cash Price |
$421.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.68
|
|
|
RT IR192NHD
|
Facility
|
OP
|
$77.36
|
|
|
Service Code
|
HCPCS C1717
|
| Hospital Charge Code |
66541316
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38.68 |
| Max. Negotiated Rate |
$429.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$42.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$421.14
|
| Rate for Payer: Aetna Government |
$421.14
|
| Rate for Payer: Brighton Health Commercial |
$46.42
|
| Rate for Payer: Cash Price |
$421.14
|
| Rate for Payer: Cash Price |
$421.14
|
| Rate for Payer: Cash Price |
$421.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$421.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$38.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$44.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$421.14
|
| Rate for Payer: EmblemHealth Commercial |
$38.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$421.14
|
| Rate for Payer: Group Health Inc Commercial |
$421.14
|
| Rate for Payer: Group Health Inc Medicare |
$421.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$357.97
|
| Rate for Payer: Healthfirst QHP |
$421.14
|
| Rate for Payer: Humana Medicare |
$429.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$421.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$421.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$336.91
|
|
|
RT IR192NHD
|
Facility
|
IP
|
$77.36
|
|
|
Service Code
|
HCPCS C1717
|
| Hospital Charge Code |
66541316
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38.68 |
| Max. Negotiated Rate |
$38.68 |
| Rate for Payer: Cash Price |
$421.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.68
|
|
|
RT LARYNGOSCOPY
|
Facility
|
IP
|
$458.00
|
|
|
Service Code
|
HCPCS 31575
|
| Hospital Charge Code |
30305592
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$229.07
|
|
|
RT LARYNGOSCOPY
|
Facility
|
OP
|
$458.00
|
|
|
Service Code
|
HCPCS 31575
|
| Hospital Charge Code |
30305592
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$160.35 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$229.07
|
| Rate for Payer: Aetna Government |
$229.07
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$160.35
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$160.35
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$160.35
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$229.07
|
| Rate for Payer: Cash Price |
$229.07
|
| Rate for Payer: Cash Price |
$229.07
|
| Rate for Payer: Cash Price |
$229.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$229.07
|
| 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 |
$229.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$194.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$203.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$229.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$203.87
|
| 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 |
$229.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$229.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$194.71
|
| Rate for Payer: Healthfirst QHP |
$229.07
|
| Rate for Payer: Humana Medicare |
$233.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$229.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$229.07
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$229.07
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$183.26
|
| Rate for Payer: Wellcare Medicare |
$217.62
|
|
|
RT LARYNGOSCOPY
|
Facility
|
IP
|
$458.00
|
|
|
Service Code
|
HCPCS 31575
|
| Hospital Charge Code |
66541311
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$229.07
|
|
|
RT LARYNGOSCOPY
|
Facility
|
OP
|
$458.00
|
|
|
Service Code
|
HCPCS 31575
|
| Hospital Charge Code |
66541311
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$160.35 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$229.07
|
| Rate for Payer: Aetna Government |
$229.07
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$160.35
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$160.35
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$160.35
|
| Rate for Payer: Brighton Health Commercial |
$343.50
|
| Rate for Payer: Cash Price |
$229.07
|
| Rate for Payer: Cash Price |
$229.07
|
| Rate for Payer: Cash Price |
$229.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$229.07
|
| 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 |
$229.07
|
| Rate for Payer: EmblemHealth Commercial |
$745.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$194.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$203.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$229.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$203.87
|
| Rate for Payer: Group Health Inc Commercial |
$229.07
|
| Rate for Payer: Group Health Inc Medicare |
$229.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$229.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$229.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$194.71
|
| Rate for Payer: Healthfirst QHP |
$229.07
|
| Rate for Payer: Humana Medicare |
$233.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$229.07
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$229.07
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$183.26
|
| Rate for Payer: Wellcare Medicare |
$217.62
|
|
|
RT LUPRON/7.5MG
|
Facility
|
OP
|
$971.30
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
66541319
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$126.91 |
| 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: Affinity Essential Plan 1&2 |
$126.91
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$126.91
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$126.91
|
| Rate for Payer: Brighton Health Commercial |
$582.78
|
| 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 Medicare Advantage |
$154.11
|
| Rate for Payer: Healthfirst QHP |
$181.30
|
| Rate for Payer: Humana Medicare |
$184.93
|
| 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: United Healthcare Commercial |
$188.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.30
|
| 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 LUPRON/7.5MG
|
Facility
|
IP
|
$971.30
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
66541319
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$485.65 |
| Max. Negotiated Rate |
$485.65 |
| Rate for Payer: Cash Price |
$181.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$485.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$485.65
|
|
|
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 |
$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 MULTI BLCK,STENTS,BITE BLCK
|
Facility
|
IP
|
$383.40
|
|
|
Service Code
|
HCPCS 77333 TC
|
| Hospital Charge Code |
66541236
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$156.91
|
|
|
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
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
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
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
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
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
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
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
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
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
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 |
$135.64 |
| Max. Negotiated Rate |
$290.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$290.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$135.64
|
| Rate for Payer: Aetna Government |
$135.64
|
| 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
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
RT PELVIC UNDER ANESTHESIA
|
Facility
|
IP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 57410
|
| Hospital Charge Code |
66541252
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$3,615.39
|
|
|
RT PELVIC UNDER ANESTHESIA
|
Facility
|
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 57410
|
| Hospital Charge Code |
66541252
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$5,674.60 |
| 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: Affinity Essential Plan 1&2 |
$2,530.77
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,530.77
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,530.77
|
| Rate for Payer: Brighton Health Commercial |
$5,674.60
|
| 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 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 Medicare Advantage |
$3,073.08
|
| Rate for Payer: Healthfirst QHP |
$3,615.39
|
| Rate for Payer: Humana Medicare |
$3,687.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare 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
|
IP
|
$1,631.98
|
|
|
Service Code
|
HCPCS 77470 TC
|
| Hospital Charge Code |
66541277
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$680.74
|
|
