|
CHG HEPATC VNGRPH WDG/FR HEMODYN EVAL RS&I
|
Professional
|
Both
|
$315.98
|
|
|
Service Code
|
HCPCS 75889 TC
|
| Min. Negotiated Rate |
$59.28 |
| Max. Negotiated Rate |
$190.55 |
| Rate for Payer: Cash Price |
$85.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$84.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$76.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$76.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$80.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$84.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$80.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$84.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$84.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$63.52
|
| Rate for Payer: Healthfirst Commercial |
$84.69
|
| Rate for Payer: Healthfirst Essential Plan |
$190.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$80.46
|
| Rate for Payer: Healthfirst QHP |
$84.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$59.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$84.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$71.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$59.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$84.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$63.52
|
| Rate for Payer: SOMOS Essential |
$63.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$84.69
|
|
|
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
|
|
|
CHG HEPATC VNGRPH WDG/FR W/O HEMODYN EVAL RS&I
|
Professional
|
Both
|
$209.37
|
|
|
Service Code
|
HCPCS 75891 26
|
| Min. Negotiated Rate |
$39.33 |
| Max. Negotiated Rate |
$126.41 |
| Rate for Payer: Cash Price |
$56.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$56.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$50.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$50.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$53.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$56.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$53.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.13
|
| Rate for Payer: Healthfirst Commercial |
$56.18
|
| Rate for Payer: Healthfirst Essential Plan |
$126.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$53.37
|
| Rate for Payer: Healthfirst QHP |
$56.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$39.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$56.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$47.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$39.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$56.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$42.13
|
| Rate for Payer: SOMOS Essential |
$42.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56.18
|
|
|
CHG HEPATC VNGRPH WDG/FR W/O HEMODYN EVAL RS&I
|
Professional
|
Both
|
$317.42
|
|
|
Service Code
|
HCPCS 75891 TC
|
| Min. Negotiated Rate |
$59.56 |
| Max. Negotiated Rate |
$191.43 |
| Rate for Payer: Cash Price |
$86.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$85.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$76.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$76.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$80.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$85.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$80.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$63.81
|
| Rate for Payer: Healthfirst Commercial |
$85.08
|
| Rate for Payer: Healthfirst Essential Plan |
$191.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$80.83
|
| Rate for Payer: Healthfirst QHP |
$85.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$59.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$85.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$72.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$59.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$85.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$63.81
|
| Rate for Payer: SOMOS Essential |
$63.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$85.08
|
|
|
CHG HEPATC VNGRPH WDG/FR W/O HEMODYN EVAL RS&I
|
Professional
|
Both
|
$526.79
|
|
|
Service Code
|
HCPCS 75891
|
| Min. Negotiated Rate |
$98.88 |
| Max. Negotiated Rate |
$317.83 |
| Rate for Payer: Cash Price |
$143.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$141.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$127.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$127.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$134.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$141.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$134.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$141.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$141.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$105.94
|
| Rate for Payer: Healthfirst Commercial |
$141.26
|
| Rate for Payer: Healthfirst Essential Plan |
$317.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$134.20
|
| Rate for Payer: Healthfirst QHP |
$141.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$98.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$141.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$120.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$98.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$141.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$105.94
|
| Rate for Payer: SOMOS Essential |
$105.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$141.26
|
|
|
CHG HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER
|
Professional
|
Both
|
$1,160.95
|
|
|
Service Code
|
HCPCS 78226 TC
|
| Min. Negotiated Rate |
$209.05 |
| Max. Negotiated Rate |
$671.94 |
| Rate for Payer: Cash Price |
$310.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$298.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$268.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$268.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$283.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$298.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$283.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$298.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$298.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$223.98
|
| Rate for Payer: Healthfirst Commercial |
$298.64
|
| Rate for Payer: Healthfirst Essential Plan |
$671.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$283.71
|
| Rate for Payer: Healthfirst QHP |
$298.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$209.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$298.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$253.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$209.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$298.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$223.98
|
| Rate for Payer: SOMOS Essential |
$223.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$298.64
|
|
|
CHG HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER
|
Professional
|
Both
|
$1,300.50
|
|
|
Service Code
|
HCPCS 78226
|
| Min. Negotiated Rate |
$235.42 |
| Max. Negotiated Rate |
$756.70 |
| Rate for Payer: Cash Price |
$348.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$336.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$302.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$302.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$319.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$336.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$319.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$336.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$336.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$252.23
|
| Rate for Payer: Healthfirst Commercial |
$336.31
|
| Rate for Payer: Healthfirst Essential Plan |
$756.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$319.49
|
| Rate for Payer: Healthfirst QHP |
$336.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$235.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$336.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$285.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$235.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$336.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$252.23
|
| Rate for Payer: SOMOS Essential |
$252.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$336.31
|
|
|
CHG HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER
|
Professional
|
Both
|
$139.58
|
|
|
Service Code
|
HCPCS 78226 26
|
| Min. Negotiated Rate |
$26.37 |
| Max. Negotiated Rate |
$84.76 |
| Rate for Payer: Cash Price |
$38.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.25
|
| Rate for Payer: Healthfirst Commercial |
$37.67
|
| Rate for Payer: Healthfirst Essential Plan |
$84.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.79
|
| Rate for Payer: Healthfirst QHP |
$37.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.25
|
| Rate for Payer: SOMOS Essential |
$28.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.67
|
|
|
CHG HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ
|
Professional
|
Both
|
$168.25
|
|
|
Service Code
|
HCPCS 78227 26
|
| Min. Negotiated Rate |
$31.86 |
| Max. Negotiated Rate |
$102.40 |
| Rate for Payer: Cash Price |
$45.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$45.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$45.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.13
|
| Rate for Payer: Healthfirst Commercial |
$45.51
|
| Rate for Payer: Healthfirst Essential Plan |
$102.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43.23
|
| Rate for Payer: Healthfirst QHP |
$45.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$45.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$38.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$34.13
|
| Rate for Payer: SOMOS Essential |
$34.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.51
|
|
|
CHG HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ
|
Professional
|
Both
|
$1,581.72
|
|
|
Service Code
|
HCPCS 78227 TC
|
| Min. Negotiated Rate |
$284.36 |
| Max. Negotiated Rate |
$914.02 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$406.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$365.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$365.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$385.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$406.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$385.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$406.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$406.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$304.67
|
| Rate for Payer: Healthfirst Commercial |
$406.23
|
| Rate for Payer: Healthfirst Essential Plan |
$914.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$385.92
|
| Rate for Payer: Healthfirst QHP |
$406.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$284.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$406.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$345.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$284.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$406.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$304.67
|
| Rate for Payer: SOMOS Essential |
$304.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$406.23
|
|
|
CHG HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ
|
Professional
|
Both
|
$1,749.93
|
|
|
Service Code
|
HCPCS 78227
|
| Min. Negotiated Rate |
$316.22 |
| Max. Negotiated Rate |
$1,016.41 |
| Rate for Payer: Cash Price |
$467.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$451.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$406.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$406.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$429.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$451.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$429.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$451.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$451.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$338.81
|
| Rate for Payer: Healthfirst Commercial |
$451.74
|
| Rate for Payer: Healthfirst Essential Plan |
$1,016.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$429.15
|
| Rate for Payer: Healthfirst QHP |
$451.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$316.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$451.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$383.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$316.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$451.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$338.81
|
| Rate for Payer: SOMOS Essential |
$338.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$451.74
|
|
|
CHG HGB GLYCOSYLATED DEVICE CLEARED FDA HOME USE
|
Professional
|
Both
|
$38.84
|
|
|
Service Code
|
HCPCS 83037
|
| 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 HYPERTHERMIA EXTERNAL GENERATED DEEP
|
Professional
|
Both
|
$438.48
|
|
|
Service Code
|
HCPCS 77605 26
|
| Min. Negotiated Rate |
$80.66 |
| Max. Negotiated Rate |
$259.27 |
| Rate for Payer: Cash Price |
$117.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$115.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$103.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$103.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$109.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$115.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$109.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$115.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$115.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$86.42
|
| Rate for Payer: Healthfirst Commercial |
$115.23
|
| Rate for Payer: Healthfirst Essential Plan |
$259.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$109.47
|
| Rate for Payer: Healthfirst QHP |
$115.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$80.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$115.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$97.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$80.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$115.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$86.42
|
| Rate for Payer: SOMOS Essential |
$86.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$115.23
|
|
|
CHG HYPERTHERMIA EXTERNAL GENERATED DEEP
|
Professional
|
Both
|
$3,722.29
|
|
|
Service Code
|
HCPCS 77605 TC
|
| Min. Negotiated Rate |
$686.22 |
| Max. Negotiated Rate |
$2,205.70 |
| Rate for Payer: Cash Price |
$998.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$980.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$882.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$882.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$931.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$980.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$931.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$980.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$980.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$735.23
|
| Rate for Payer: Healthfirst Commercial |
$980.31
|
| Rate for Payer: Healthfirst Essential Plan |
$2,205.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$931.29
|
| Rate for Payer: Healthfirst QHP |
$980.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$686.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$980.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$833.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$686.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$980.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$735.23
|
| Rate for Payer: SOMOS Essential |
$735.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$980.31
|
|
|
CHG HYPERTHERMIA EXTERNAL GENERATED DEEP
|
Professional
|
Both
|
$4,160.77
|
|
|
Service Code
|
HCPCS 77605
|
| Min. Negotiated Rate |
$766.88 |
| Max. Negotiated Rate |
$2,464.97 |
| Rate for Payer: Cash Price |
$1,115.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,095.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$985.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$985.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,040.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,095.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,040.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,095.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,095.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$821.65
|
| Rate for Payer: Healthfirst Commercial |
$1,095.54
|
| Rate for Payer: Healthfirst Essential Plan |
$2,464.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,040.76
|
| Rate for Payer: Healthfirst QHP |
$1,095.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$766.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,095.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$931.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$766.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,095.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$821.65
|
| Rate for Payer: SOMOS Essential |
$821.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,095.54
|
|
|
CHG HYPERTHERMIA EXTERNAL GENERATED SUPERFICIAL
|
Professional
|
Both
|
$286.86
|
|
|
Service Code
|
HCPCS 77600 26
|
| Min. Negotiated Rate |
$54.95 |
| Max. Negotiated Rate |
$176.62 |
| Rate for Payer: Cash Price |
$78.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$78.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$70.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$70.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$74.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$78.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$74.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$78.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$78.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$58.88
|
| Rate for Payer: Healthfirst Commercial |
$78.50
|
| Rate for Payer: Healthfirst Essential Plan |
$176.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$74.58
|
| Rate for Payer: Healthfirst QHP |
$78.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$54.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$78.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$66.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$54.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$78.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$58.88
|
| Rate for Payer: SOMOS Essential |
$58.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$78.50
|
|
|
CHG HYPERTHERMIA EXTERNAL GENERATED SUPERFICIAL
|
Professional
|
Both
|
$1,981.49
|
|
|
Service Code
|
HCPCS 77600 TC
|
| Min. Negotiated Rate |
$386.25 |
| Max. Negotiated Rate |
$1,241.53 |
| Rate for Payer: Cash Price |
$560.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$551.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$496.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$496.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$524.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$551.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$524.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$551.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$551.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$413.84
|
| Rate for Payer: Healthfirst Commercial |
$551.79
|
| Rate for Payer: Healthfirst Essential Plan |
$1,241.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$524.20
|
| Rate for Payer: Healthfirst QHP |
$551.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$386.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$551.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$469.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$386.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$551.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$413.84
|
| Rate for Payer: SOMOS Essential |
$413.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$551.79
|
|
|
CHG HYPERTHERMIA EXTERNAL GENERATED SUPERFICIAL
|
Professional
|
Both
|
$2,268.35
|
|
|
Service Code
|
HCPCS 77600
|
| Min. Negotiated Rate |
$441.20 |
| Max. Negotiated Rate |
$1,418.13 |
| Rate for Payer: Cash Price |
$639.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$630.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$567.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$567.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$598.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$630.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$598.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$630.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$630.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$472.71
|
| Rate for Payer: Healthfirst Commercial |
$630.28
|
| Rate for Payer: Healthfirst Essential Plan |
$1,418.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$598.77
|
| Rate for Payer: Healthfirst QHP |
$630.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$441.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$630.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$535.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$441.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$630.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$472.71
|
| Rate for Payer: SOMOS Essential |
$472.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$630.28
|
|
|
CHG HYPERTHERMIA INTERSTIAL PROBE 5/> APPLICATORS
|
Professional
|
Both
|
$388.92
|
|
|
Service Code
|
HCPCS 77615 26
|
| Min. Negotiated Rate |
$75.12 |
| Max. Negotiated Rate |
$241.45 |
| Rate for Payer: Cash Price |
$107.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$107.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$96.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$96.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$101.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$101.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$107.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.48
|
| Rate for Payer: Healthfirst Commercial |
$107.31
|
| Rate for Payer: Healthfirst Essential Plan |
$241.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$101.94
|
| Rate for Payer: Healthfirst QHP |
$107.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$75.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$107.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$91.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$75.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$107.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$80.48
|
| Rate for Payer: SOMOS Essential |
$80.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$107.31
|
|
|
CHG HYPERTHERMIA INTERSTIAL PROBE 5/> APPLICATORS
|
Professional
|
Both
|
$4,250.44
|
|
|
Service Code
|
HCPCS 77615 TC
|
| Min. Negotiated Rate |
$789.45 |
| Max. Negotiated Rate |
$2,537.53 |
| Rate for Payer: Cash Price |
$1,156.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,127.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,015.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,015.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,071.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,127.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,071.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,127.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,127.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$845.84
|
| Rate for Payer: Healthfirst Commercial |
$1,127.79
|
| Rate for Payer: Healthfirst Essential Plan |
$2,537.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,071.40
|
| Rate for Payer: Healthfirst QHP |
$1,127.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$789.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,127.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$958.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$789.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,127.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$845.84
|
| Rate for Payer: SOMOS Essential |
$845.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,127.79
|
|
|
CHG HYPERTHERMIA INTERSTIAL PROBE 5/> APPLICATORS
|
Professional
|
Both
|
$4,639.36
|
|
|
Service Code
|
HCPCS 77615
|
| Min. Negotiated Rate |
$864.56 |
| Max. Negotiated Rate |
$2,778.95 |
| Rate for Payer: Cash Price |
$1,263.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,235.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,111.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,111.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,173.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,235.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,173.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,235.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,235.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$926.32
|
| Rate for Payer: Healthfirst Commercial |
$1,235.09
|
| Rate for Payer: Healthfirst Essential Plan |
$2,778.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,173.34
|
| Rate for Payer: Healthfirst QHP |
$1,235.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$864.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,235.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,049.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$864.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,235.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$926.32
|
| Rate for Payer: SOMOS Essential |
$926.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,235.09
|
|
|
CHG HYPERTHERMIA INTERSTITIAL PROBE 5/< APPLICATORS
|
Professional
|
Both
|
$274.19
|
|
|
Service Code
|
HCPCS 77610 26
|
| Min. Negotiated Rate |
$53.32 |
| Max. Negotiated Rate |
$171.38 |
| Rate for Payer: Cash Price |
$76.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$76.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$68.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$68.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$72.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$76.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$72.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.13
|
| Rate for Payer: Healthfirst Commercial |
$76.17
|
| Rate for Payer: Healthfirst Essential Plan |
$171.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$72.36
|
| Rate for Payer: Healthfirst QHP |
$76.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$53.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$76.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$64.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$53.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$76.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$57.13
|
| Rate for Payer: SOMOS Essential |
$57.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$76.17
|
|
|
CHG HYPERTHERMIA INTERSTITIAL PROBE 5/< APPLICATORS
|
Professional
|
Both
|
$2,684.40
|
|
|
Service Code
|
HCPCS 77610 TC
|
| Min. Negotiated Rate |
$493.58 |
| Max. Negotiated Rate |
$1,586.50 |
| Rate for Payer: Cash Price |
$727.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$705.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$634.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$634.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$669.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$705.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$669.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$705.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$705.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$528.83
|
| Rate for Payer: Healthfirst Commercial |
$705.11
|
| Rate for Payer: Healthfirst Essential Plan |
$1,586.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$669.85
|
| Rate for Payer: Healthfirst QHP |
$705.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$493.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$705.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$599.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$493.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$705.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$528.83
|
| Rate for Payer: SOMOS Essential |
$528.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$705.11
|
|
|
CHG HYPERTHERMIA INTERSTITIAL PROBE 5/< APPLICATORS
|
Professional
|
Both
|
$2,958.62
|
|
|
Service Code
|
HCPCS 77610
|
| Min. Negotiated Rate |
$546.90 |
| Max. Negotiated Rate |
$1,757.88 |
| Rate for Payer: Cash Price |
$804.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$781.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$703.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$703.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$742.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$781.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$742.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$781.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$781.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$585.96
|
| Rate for Payer: Healthfirst Commercial |
$781.28
|
| Rate for Payer: Healthfirst Essential Plan |
$1,757.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$742.22
|
| Rate for Payer: Healthfirst QHP |
$781.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$546.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$781.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$664.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$546.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$781.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$585.96
|
| Rate for Payer: SOMOS Essential |
$585.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$781.28
|
|
|
CHG HYPERTHERMIA INTRACAVITARY PROBES
|
Professional
|
Both
|
$2,408.42
|
|
|
Service Code
|
HCPCS 77620 TC
|
| Min. Negotiated Rate |
$447.38 |
| Max. Negotiated Rate |
$1,438.02 |
| Rate for Payer: Cash Price |
$655.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$639.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$575.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$575.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$607.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$639.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$607.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$639.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$639.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$479.34
|
| Rate for Payer: Healthfirst Commercial |
$639.12
|
| Rate for Payer: Healthfirst Essential Plan |
$1,438.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$607.16
|
| Rate for Payer: Healthfirst QHP |
$639.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$447.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$639.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$543.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$447.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$639.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$479.34
|
| Rate for Payer: SOMOS Essential |
$479.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$639.12
|
|
