|
CHG GASTROINTESTINAL PROTEIN LOSS
|
Professional
|
Both
|
$58.94
|
|
|
Service Code
|
HCPCS 78282 26
|
| Min. Negotiated Rate |
$11.23 |
| Max. Negotiated Rate |
$36.09 |
| Rate for Payer: Cash Price |
$16.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.03
|
| Rate for Payer: Healthfirst Commercial |
$16.04
|
| Rate for Payer: Healthfirst Essential Plan |
$36.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.24
|
| Rate for Payer: Healthfirst QHP |
$16.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$13.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.03
|
| Rate for Payer: SOMOS Essential |
$12.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.04
|
|
|
CHG GI ENDOSCOPIC US S&I
|
Professional
|
Both
|
$164.15
|
|
|
Service Code
|
HCPCS 76975 26
|
| Min. Negotiated Rate |
$30.61 |
| Max. Negotiated Rate |
$98.39 |
| Rate for Payer: Cash Price |
$44.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$43.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.80
|
| Rate for Payer: Healthfirst Commercial |
$43.73
|
| Rate for Payer: Healthfirst Essential Plan |
$98.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.54
|
| Rate for Payer: Healthfirst QHP |
$43.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$43.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.80
|
| Rate for Payer: SOMOS Essential |
$32.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.73
|
|
|
CHG GLUC BLD GLUC MNTR DEV CLEARED FDA SPEC HOME USE
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS 82962
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$7.38 |
| Rate for Payer: Cash Price |
$3.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.46
|
| Rate for Payer: Healthfirst Commercial |
$3.28
|
| Rate for Payer: Healthfirst Essential Plan |
$7.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.12
|
| Rate for Payer: Healthfirst QHP |
$3.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.31
|
| Rate for Payer: SOMOS Essential |
$1.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.28
|
|
|
CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP
|
Professional
|
Both
|
$9.82
|
|
|
Service Code
|
HCPCS 82947
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$8.84 |
| Rate for Payer: Cash Price |
$3.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.95
|
| Rate for Payer: Healthfirst Commercial |
$3.93
|
| Rate for Payer: Healthfirst Essential Plan |
$8.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.73
|
| Rate for Payer: Healthfirst QHP |
$3.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.57
|
| Rate for Payer: SOMOS Essential |
$1.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.93
|
|
|
CHG GSTRC EMPTNG IMAG STD W/SM BWL COL TRNST MLT DAY
|
Professional
|
Both
|
$1,584.59
|
|
|
Service Code
|
HCPCS 78266 TC
|
| Min. Negotiated Rate |
$285.17 |
| Max. Negotiated Rate |
$916.63 |
| Rate for Payer: Cash Price |
$426.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$407.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$366.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$366.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$387.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$407.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$387.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$407.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$407.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$305.54
|
| Rate for Payer: Healthfirst Commercial |
$407.39
|
| Rate for Payer: Healthfirst Essential Plan |
$916.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$387.02
|
| Rate for Payer: Healthfirst QHP |
$407.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$285.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$407.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$346.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$285.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$407.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$305.54
|
| Rate for Payer: SOMOS Essential |
$305.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$407.39
|
|
|
CHG GSTRC EMPTNG IMAG STD W/SM BWL COL TRNST MLT DAY
|
Professional
|
Both
|
$192.22
|
|
|
Service Code
|
HCPCS 78266 26
|
| Min. Negotiated Rate |
$36.47 |
| Max. Negotiated Rate |
$117.22 |
| Rate for Payer: Cash Price |
$52.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$46.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$46.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.08
|
| Rate for Payer: Healthfirst Commercial |
$52.10
|
| Rate for Payer: Healthfirst Essential Plan |
$117.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.49
|
| Rate for Payer: Healthfirst QHP |
$52.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.08
|
| Rate for Payer: SOMOS Essential |
$39.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.10
|
|
|
CHG GSTRC EMPTNG IMAG STD W/SM BWL COL TRNST MLT DAY
|
Professional
|
Both
|
$1,776.81
|
|
|
Service Code
|
HCPCS 78266
|
| Min. Negotiated Rate |
$321.64 |
| Max. Negotiated Rate |
$1,033.85 |
| Rate for Payer: Cash Price |
$479.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$459.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$413.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$413.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$436.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$459.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$436.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$459.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$459.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$344.62
|
| Rate for Payer: Healthfirst Commercial |
$459.49
|
| Rate for Payer: Healthfirst Essential Plan |
$1,033.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$436.52
|
| Rate for Payer: Healthfirst QHP |
$459.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$321.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$459.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$390.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$321.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$459.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$344.62
|
| Rate for Payer: SOMOS Essential |
$344.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$459.49
|
|
|
CHG HDR RDNCL NTRSTL/INTRCAV BRACHYTX >12 CHANNELS
|
Professional
|
Both
|
$2,664.20
|
|
|
Service Code
|
HCPCS 77772 TC
|
| Min. Negotiated Rate |
$516.81 |
| Max. Negotiated Rate |
$1,661.17 |
| Rate for Payer: Cash Price |
$740.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$738.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$664.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$664.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$701.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$738.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$701.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$738.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$738.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$553.73
|
| Rate for Payer: Healthfirst Commercial |
$738.30
|
| Rate for Payer: Healthfirst Essential Plan |
$1,661.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$701.38
|
| Rate for Payer: Healthfirst QHP |
$738.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$516.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$738.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$627.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$516.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$738.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$553.73
|
| Rate for Payer: SOMOS Essential |
$553.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$738.30
|
|
|
CHG HDR RDNCL NTRSTL/INTRCAV BRACHYTX >12 CHANNELS
|
Professional
|
Both
|
$1,131.83
|
|
|
Service Code
|
HCPCS 77772 26
|
| Min. Negotiated Rate |
$218.81 |
| Max. Negotiated Rate |
$703.30 |
| Rate for Payer: Cash Price |
$311.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$312.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$281.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$281.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$296.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$312.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$296.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$312.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$312.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$234.44
|
| Rate for Payer: Healthfirst Commercial |
$312.58
|
| Rate for Payer: Healthfirst Essential Plan |
$703.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$296.95
|
| Rate for Payer: Healthfirst QHP |
$312.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$218.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$312.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$265.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$218.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$312.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$234.44
|
| Rate for Payer: SOMOS Essential |
$234.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$312.58
|
|
|
CHG HDR RDNCL NTRSTL/INTRCAV BRACHYTX >12 CHANNELS
|
Professional
|
Both
|
$3,796.03
|
|
|
Service Code
|
HCPCS 77772
|
| Min. Negotiated Rate |
$735.62 |
| Max. Negotiated Rate |
$2,364.48 |
| Rate for Payer: Cash Price |
$1,051.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,050.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$945.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$945.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$998.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,050.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$998.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,050.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,050.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$788.16
|
| Rate for Payer: Healthfirst Commercial |
$1,050.88
|
| Rate for Payer: Healthfirst Essential Plan |
$2,364.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$998.34
|
| Rate for Payer: Healthfirst QHP |
$1,050.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$735.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,050.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$893.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$735.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,050.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$788.16
|
| Rate for Payer: SOMOS Essential |
$788.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,050.88
|
|
|
CHG HDR RDNCL NTRSTL/INTRCAV BRACHYTX 1 CHANNEL
|
Professional
|
Both
|
$411.32
|
|
|
Service Code
|
HCPCS 77770 26
|
| Min. Negotiated Rate |
$79.39 |
| Max. Negotiated Rate |
$255.19 |
| Rate for Payer: Cash Price |
$113.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$113.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$102.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$102.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$107.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$113.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$107.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$113.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$113.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$85.06
|
| Rate for Payer: Healthfirst Commercial |
$113.42
|
| Rate for Payer: Healthfirst Essential Plan |
$255.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$107.75
|
| Rate for Payer: Healthfirst QHP |
$113.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$79.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$113.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$96.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$79.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$113.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$85.06
|
| Rate for Payer: SOMOS Essential |
$85.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$113.42
|
|
|
CHG HDR RDNCL NTRSTL/INTRCAV BRACHYTX 1 CHANNEL
|
Professional
|
Both
|
$1,054.55
|
|
|
Service Code
|
HCPCS 77770 TC
|
| Min. Negotiated Rate |
$201.60 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Cash Price |
$292.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$288.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$259.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$259.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$273.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$288.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$273.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$288.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$288.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$216.00
|
| Rate for Payer: Healthfirst Commercial |
$288.00
|
| Rate for Payer: Healthfirst Essential Plan |
$648.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$273.60
|
| Rate for Payer: Healthfirst QHP |
$288.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$201.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$288.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$244.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$201.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$288.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$216.00
|
| Rate for Payer: SOMOS Essential |
$216.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$288.00
|
|
|
CHG HDR RDNCL NTRSTL/INTRCAV BRACHYTX 1 CHANNEL
|
Professional
|
Both
|
$1,465.87
|
|
|
Service Code
|
HCPCS 77770
|
| Min. Negotiated Rate |
$280.99 |
| Max. Negotiated Rate |
$903.20 |
| Rate for Payer: Cash Price |
$405.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$401.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$361.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$361.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$381.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$401.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$381.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$401.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$401.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$301.06
|
| Rate for Payer: Healthfirst Commercial |
$401.42
|
| Rate for Payer: Healthfirst Essential Plan |
$903.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$381.35
|
| Rate for Payer: Healthfirst QHP |
$401.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$280.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$401.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$341.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$280.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$401.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$301.06
|
| Rate for Payer: SOMOS Essential |
$301.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$401.42
|
|
|
CHG HDR RDNCL NTRSTL/INTRCAV BRACHYTX 2-12 CHANNEL
|
Professional
|
Both
|
$1,740.87
|
|
|
Service Code
|
HCPCS 77771 TC
|
| Min. Negotiated Rate |
$336.68 |
| Max. Negotiated Rate |
$1,082.18 |
| Rate for Payer: Cash Price |
$483.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$480.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$432.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$432.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$456.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$480.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$456.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$480.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$480.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$360.73
|
| Rate for Payer: Healthfirst Commercial |
$480.97
|
| Rate for Payer: Healthfirst Essential Plan |
$1,082.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$456.92
|
| Rate for Payer: Healthfirst QHP |
$480.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$336.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$480.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$408.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$336.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$480.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$360.73
|
| Rate for Payer: SOMOS Essential |
$360.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$480.97
|
|
|
CHG HDR RDNCL NTRSTL/INTRCAV BRACHYTX 2-12 CHANNEL
|
Professional
|
Both
|
$2,547.93
|
|
|
Service Code
|
HCPCS 77771
|
| Min. Negotiated Rate |
$492.02 |
| Max. Negotiated Rate |
$1,581.50 |
| Rate for Payer: Cash Price |
$703.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$702.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$632.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$632.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$667.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$702.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$667.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$702.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$702.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$527.17
|
| Rate for Payer: Healthfirst Commercial |
$702.89
|
| Rate for Payer: Healthfirst Essential Plan |
$1,581.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$667.75
|
| Rate for Payer: Healthfirst QHP |
$702.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$492.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$702.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$597.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$492.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$702.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$527.17
|
| Rate for Payer: SOMOS Essential |
$527.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$702.89
|
|
|
CHG HDR RDNCL NTRSTL/INTRCAV BRACHYTX 2-12 CHANNEL
|
Professional
|
Both
|
$807.07
|
|
|
Service Code
|
HCPCS 77771 26
|
| Min. Negotiated Rate |
$155.34 |
| Max. Negotiated Rate |
$499.32 |
| Rate for Payer: Cash Price |
$220.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$221.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$199.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$199.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$210.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$221.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$210.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$221.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$221.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$166.44
|
| Rate for Payer: Healthfirst Commercial |
$221.92
|
| Rate for Payer: Healthfirst Essential Plan |
$499.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$210.82
|
| Rate for Payer: Healthfirst QHP |
$221.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$155.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$221.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$188.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$155.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$221.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$166.44
|
| Rate for Payer: SOMOS Essential |
$166.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$221.92
|
|
|
CHG HDR RDNCL SKN SURF BRACHYTX LES <2CM/1 CHAN
|
Professional
|
Both
|
$1,060.47
|
|
|
Service Code
|
HCPCS 77767
|
| Min. Negotiated Rate |
$202.41 |
| Max. Negotiated Rate |
$650.59 |
| Rate for Payer: Cash Price |
$292.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$289.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$260.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$260.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$274.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$289.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$274.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$289.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$289.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$216.86
|
| Rate for Payer: Healthfirst Commercial |
$289.15
|
| Rate for Payer: Healthfirst Essential Plan |
$650.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$274.69
|
| Rate for Payer: Healthfirst QHP |
$289.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$202.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$289.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$245.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$202.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$289.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$216.86
|
| Rate for Payer: SOMOS Essential |
$216.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$289.15
|
|
|
CHG HDR RDNCL SKN SURF BRACHYTX LES <2CM/1 CHAN
|
Professional
|
Both
|
$838.95
|
|
|
Service Code
|
HCPCS 77767 TC
|
| Min. Negotiated Rate |
$159.59 |
| Max. Negotiated Rate |
$512.98 |
| Rate for Payer: Cash Price |
$231.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$227.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$205.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$205.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$216.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$227.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$216.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$227.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$227.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$170.99
|
| Rate for Payer: Healthfirst Commercial |
$227.99
|
| Rate for Payer: Healthfirst Essential Plan |
$512.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$216.59
|
| Rate for Payer: Healthfirst QHP |
$227.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$159.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$227.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$193.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$159.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$227.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$170.99
|
| Rate for Payer: SOMOS Essential |
$170.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$227.99
|
|
|
CHG HDR RDNCL SKN SURF BRACHYTX LES <2CM/1 CHAN
|
Professional
|
Both
|
$221.52
|
|
|
Service Code
|
HCPCS 77767 26
|
| Min. Negotiated Rate |
$42.81 |
| Max. Negotiated Rate |
$137.61 |
| Rate for Payer: Cash Price |
$60.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$61.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$55.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$55.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$58.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$61.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$58.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$61.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.87
|
| Rate for Payer: Healthfirst Commercial |
$61.16
|
| Rate for Payer: Healthfirst Essential Plan |
$137.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$58.10
|
| Rate for Payer: Healthfirst QHP |
$61.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$42.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$61.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$51.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$42.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$61.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$45.87
|
| Rate for Payer: SOMOS Essential |
$45.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$61.16
|
|
|
CHG HDR RDNCL SK SRF BRCHYTX LES >2CM&2CHAN/MLT LES
|
Professional
|
Both
|
$1,256.85
|
|
|
Service Code
|
HCPCS 77768 TC
|
| Min. Negotiated Rate |
$241.04 |
| Max. Negotiated Rate |
$774.79 |
| Rate for Payer: Cash Price |
$347.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$344.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$309.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$309.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$327.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$344.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$327.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$344.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$344.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$258.26
|
| Rate for Payer: Healthfirst Commercial |
$344.35
|
| Rate for Payer: Healthfirst Essential Plan |
$774.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$327.13
|
| Rate for Payer: Healthfirst QHP |
$344.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$241.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$344.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$292.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$241.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$344.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$258.26
|
| Rate for Payer: SOMOS Essential |
$258.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$344.35
|
|
|
CHG HDR RDNCL SK SRF BRCHYTX LES >2CM&2CHAN/MLT LES
|
Professional
|
Both
|
$1,553.55
|
|
|
Service Code
|
HCPCS 77768
|
| Min. Negotiated Rate |
$297.89 |
| Max. Negotiated Rate |
$957.51 |
| Rate for Payer: Cash Price |
$428.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$425.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$383.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$383.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$404.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$425.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$404.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$425.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$425.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$319.17
|
| Rate for Payer: Healthfirst Commercial |
$425.56
|
| Rate for Payer: Healthfirst Essential Plan |
$957.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$404.28
|
| Rate for Payer: Healthfirst QHP |
$425.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$297.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$425.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$361.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$297.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$425.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$319.17
|
| Rate for Payer: SOMOS Essential |
$319.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$425.56
|
|
|
CHG HDR RDNCL SK SRF BRCHYTX LES >2CM&2CHAN/MLT LES
|
Professional
|
Both
|
$296.70
|
|
|
Service Code
|
HCPCS 77768 26
|
| Min. Negotiated Rate |
$56.85 |
| Max. Negotiated Rate |
$182.72 |
| Rate for Payer: Cash Price |
$81.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$81.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$73.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$77.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.91
|
| Rate for Payer: Healthfirst Commercial |
$81.21
|
| Rate for Payer: Healthfirst Essential Plan |
$182.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$77.15
|
| Rate for Payer: Healthfirst QHP |
$81.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$56.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$81.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$69.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$56.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$60.91
|
| Rate for Payer: SOMOS Essential |
$60.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.21
|
|
|
CHG HEMOGLOBIN FRACTJ/QUANTJ ELECTROPHORESIS
|
Professional
|
Both
|
$69.20
|
|
|
Service Code
|
HCPCS 83020 26
|
| Min. Negotiated Rate |
$7.68 |
| Max. Negotiated Rate |
$43.18 |
| Rate for Payer: Cash Price |
$19.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.39
|
| Rate for Payer: Healthfirst Commercial |
$19.19
|
| Rate for Payer: Healthfirst Essential Plan |
$43.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.23
|
| Rate for Payer: Healthfirst QHP |
$19.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.68
|
| Rate for Payer: SOMOS Essential |
$7.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.19
|
|
|
CHG HEMOGLOBIN GLYCOSYLATED A1C
|
Professional
|
Both
|
$24.27
|
|
|
Service Code
|
HCPCS 83036
|
| Min. Negotiated Rate |
$3.88 |
| Max. Negotiated Rate |
$21.85 |
| Rate for Payer: Cash Price |
$9.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.28
|
| Rate for Payer: Healthfirst Commercial |
$9.71
|
| Rate for Payer: Healthfirst Essential Plan |
$21.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.22
|
| Rate for Payer: Healthfirst QHP |
$9.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.88
|
| Rate for Payer: SOMOS Essential |
$3.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.71
|
|
|
CHG HEPATC VNGRPH WDG/FR HEMODYN EVAL RS&I
|
Professional
|
Both
|
$209.23
|
|
|
Service Code
|
HCPCS 75889 26
|
| Min. Negotiated Rate |
$39.21 |
| Max. Negotiated Rate |
$126.05 |
| Rate for Payer: Cash Price |
$56.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$56.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$50.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$50.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$53.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$56.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$53.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.02
|
| Rate for Payer: Healthfirst Commercial |
$56.02
|
| Rate for Payer: Healthfirst Essential Plan |
$126.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$53.22
|
| Rate for Payer: Healthfirst QHP |
$56.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$39.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$56.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$47.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$39.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$56.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$42.02
|
| Rate for Payer: SOMOS Essential |
$42.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56.02
|
|
