|
CHG IMMUNOFLUORESCENCE PR SPEC EA ADD SINGL ANTB STN
|
Professional
|
Both
|
$379.37
|
|
|
Service Code
|
HCPCS 88350 TC
|
| Min. Negotiated Rate |
$67.28 |
| Max. Negotiated Rate |
$216.25 |
| Rate for Payer: Cash Price |
$101.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$96.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$86.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$86.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$91.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$96.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$91.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$96.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$96.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.08
|
| Rate for Payer: Healthfirst Commercial |
$96.11
|
| Rate for Payer: Healthfirst Essential Plan |
$216.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$91.30
|
| Rate for Payer: Healthfirst QHP |
$96.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$67.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$96.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$81.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$67.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$96.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$72.08
|
| Rate for Payer: SOMOS Essential |
$72.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$96.11
|
|
|
CHG IMMUNOFLUORESCENCE PR SPEC EA ADD SINGL ANTB STN
|
Professional
|
Both
|
$490.49
|
|
|
Service Code
|
HCPCS 88350
|
| Min. Negotiated Rate |
$88.45 |
| Max. Negotiated Rate |
$284.31 |
| Rate for Payer: Cash Price |
$132.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$126.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$113.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$113.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$120.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$126.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$120.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$94.77
|
| Rate for Payer: Healthfirst Commercial |
$126.36
|
| Rate for Payer: Healthfirst Essential Plan |
$284.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$120.04
|
| Rate for Payer: Healthfirst QHP |
$126.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$88.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$126.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$107.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$88.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$126.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$94.77
|
| Rate for Payer: SOMOS Essential |
$94.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$126.36
|
|
|
CHG IN SITU HYBRIDIZATION EA ADDL PROBE STAIN
|
Professional
|
Both
|
$444.05
|
|
|
Service Code
|
HCPCS 88364 TC
|
| Min. Negotiated Rate |
$78.69 |
| Max. Negotiated Rate |
$252.92 |
| Rate for Payer: Cash Price |
$118.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$112.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$101.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$101.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$106.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$112.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$106.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$112.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$84.31
|
| Rate for Payer: Healthfirst Commercial |
$112.41
|
| Rate for Payer: Healthfirst Essential Plan |
$252.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$106.79
|
| Rate for Payer: Healthfirst QHP |
$112.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$78.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$112.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$95.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$78.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$112.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$84.31
|
| Rate for Payer: SOMOS Essential |
$84.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$112.41
|
|
|
CHG IN SITU HYBRIDIZATION EA ADDL PROBE STAIN
|
Professional
|
Both
|
$130.66
|
|
|
Service Code
|
HCPCS 88364 26
|
| Min. Negotiated Rate |
$24.65 |
| Max. Negotiated Rate |
$79.22 |
| Rate for Payer: Cash Price |
$35.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.41
|
| Rate for Payer: Healthfirst Commercial |
$35.21
|
| Rate for Payer: Healthfirst Essential Plan |
$79.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.45
|
| Rate for Payer: Healthfirst QHP |
$35.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.41
|
| Rate for Payer: SOMOS Essential |
$26.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.21
|
|
|
CHG IN SITU HYBRIDIZATION EA ADDL PROBE STAIN
|
Professional
|
Both
|
$574.70
|
|
|
Service Code
|
HCPCS 88364
|
| Min. Negotiated Rate |
$103.33 |
| Max. Negotiated Rate |
$332.14 |
| Rate for Payer: Cash Price |
$154.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$132.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$132.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$147.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$110.72
|
| Rate for Payer: Healthfirst Commercial |
$147.62
|
| Rate for Payer: Healthfirst Essential Plan |
$332.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$140.24
|
| Rate for Payer: Healthfirst QHP |
$147.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$103.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$147.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$125.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$103.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$110.72
|
| Rate for Payer: SOMOS Essential |
$110.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.62
|
|
|
CHG IN SITU HYBRIDIZATION EA MULTIPLEX PROBE STAIN
|
Professional
|
Both
|
$1,176.81
|
|
|
Service Code
|
HCPCS 88366
|
| Min. Negotiated Rate |
$215.47 |
| Max. Negotiated Rate |
$692.57 |
| Rate for Payer: Cash Price |
$315.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$307.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$277.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$277.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$292.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$307.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$292.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$307.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$307.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$230.86
|
| Rate for Payer: Healthfirst Commercial |
$307.81
|
| Rate for Payer: Healthfirst Essential Plan |
$692.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$292.42
|
| Rate for Payer: Healthfirst QHP |
$307.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$215.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$307.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$261.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$215.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$307.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$230.86
|
| Rate for Payer: SOMOS Essential |
$230.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$307.81
|
|
|
CHG IN SITU HYBRIDIZATION EA MULTIPLEX PROBE STAIN
|
Professional
|
Both
|
$238.42
|
|
|
Service Code
|
HCPCS 88366 26
|
| Min. Negotiated Rate |
$45.17 |
| Max. Negotiated Rate |
$145.19 |
| Rate for Payer: Cash Price |
$64.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$64.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$58.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$61.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$64.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$61.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.40
|
| Rate for Payer: Healthfirst Commercial |
$64.53
|
| Rate for Payer: Healthfirst Essential Plan |
$145.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.30
|
| Rate for Payer: Healthfirst QHP |
$64.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$64.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$54.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$64.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$48.40
|
| Rate for Payer: SOMOS Essential |
$48.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$64.53
|
|
|
CHG IN SITU HYBRIDIZATION EA MULTIPLEX PROBE STAIN
|
Professional
|
Both
|
$938.42
|
|
|
Service Code
|
HCPCS 88366 TC
|
| Min. Negotiated Rate |
$170.30 |
| Max. Negotiated Rate |
$547.40 |
| Rate for Payer: Cash Price |
$250.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$243.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$218.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$218.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$231.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$243.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$231.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$243.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$243.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$182.47
|
| Rate for Payer: Healthfirst Commercial |
$243.29
|
| Rate for Payer: Healthfirst Essential Plan |
$547.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$231.13
|
| Rate for Payer: Healthfirst QHP |
$243.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$170.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$243.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$206.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$170.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$243.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$182.47
|
| Rate for Payer: SOMOS Essential |
$182.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$243.29
|
|
|
CHG INTERSTITIAL RADIATION SOURCE APPLIC COMPLEX
|
Professional
|
Both
|
$1,972.78
|
|
|
Service Code
|
HCPCS 77778 TC
|
| Min. Negotiated Rate |
$385.96 |
| Max. Negotiated Rate |
$1,240.58 |
| Rate for Payer: Cash Price |
$551.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$551.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$496.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$496.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$523.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$551.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$523.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$551.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$551.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$413.53
|
| Rate for Payer: Healthfirst Commercial |
$551.37
|
| Rate for Payer: Healthfirst Essential Plan |
$1,240.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$523.80
|
| Rate for Payer: Healthfirst QHP |
$551.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$385.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$551.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$468.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$385.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$551.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$413.53
|
| Rate for Payer: SOMOS Essential |
$413.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$551.37
|
|
|
CHG INTERSTITIAL RADIATION SOURCE APPLIC COMPLEX
|
Professional
|
Both
|
$1,850.80
|
|
|
Service Code
|
HCPCS 77778 26
|
| Min. Negotiated Rate |
$358.32 |
| Max. Negotiated Rate |
$1,151.73 |
| Rate for Payer: Cash Price |
$508.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$511.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$460.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$460.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$486.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$511.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$486.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$511.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$511.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$383.91
|
| Rate for Payer: Healthfirst Commercial |
$511.88
|
| Rate for Payer: Healthfirst Essential Plan |
$1,151.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$486.29
|
| Rate for Payer: Healthfirst QHP |
$511.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$358.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$511.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$435.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$358.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$511.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$383.91
|
| Rate for Payer: SOMOS Essential |
$383.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$511.88
|
|
|
CHG INTERSTITIAL RADIATION SOURCE APPLIC COMPLEX
|
Professional
|
Both
|
$3,823.54
|
|
|
Service Code
|
HCPCS 77778
|
| Min. Negotiated Rate |
$744.27 |
| Max. Negotiated Rate |
$2,392.31 |
| Rate for Payer: Cash Price |
$1,059.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,063.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$956.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$956.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,010.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,063.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,010.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,063.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,063.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$797.44
|
| Rate for Payer: Healthfirst Commercial |
$1,063.25
|
| Rate for Payer: Healthfirst Essential Plan |
$2,392.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,010.09
|
| Rate for Payer: Healthfirst QHP |
$1,063.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$744.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,063.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$903.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$744.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,063.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$797.44
|
| Rate for Payer: SOMOS Essential |
$797.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,063.25
|
|
|
CHG INTESTINE IMAGING
|
Professional
|
Both
|
$1,321.74
|
|
|
Service Code
|
HCPCS 78290
|
| Min. Negotiated Rate |
$239.67 |
| Max. Negotiated Rate |
$770.38 |
| Rate for Payer: Cash Price |
$353.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$342.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$308.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$308.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$325.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$342.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$325.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$342.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$342.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$256.79
|
| Rate for Payer: Healthfirst Commercial |
$342.39
|
| Rate for Payer: Healthfirst Essential Plan |
$770.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$325.27
|
| Rate for Payer: Healthfirst QHP |
$342.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$239.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$342.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$291.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$239.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$342.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$256.79
|
| Rate for Payer: SOMOS Essential |
$256.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$342.39
|
|
|
CHG INTESTINE IMAGING
|
Professional
|
Both
|
$129.19
|
|
|
Service Code
|
HCPCS 78290 26
|
| Min. Negotiated Rate |
$23.95 |
| Max. Negotiated Rate |
$76.97 |
| Rate for Payer: Cash Price |
$34.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.66
|
| Rate for Payer: Healthfirst Commercial |
$34.21
|
| Rate for Payer: Healthfirst Essential Plan |
$76.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.50
|
| Rate for Payer: Healthfirst QHP |
$34.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.66
|
| Rate for Payer: SOMOS Essential |
$25.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.21
|
|
|
CHG INTESTINE IMAGING
|
Professional
|
Both
|
$1,192.56
|
|
|
Service Code
|
HCPCS 78290 TC
|
| Min. Negotiated Rate |
$215.73 |
| Max. Negotiated Rate |
$693.40 |
| Rate for Payer: Cash Price |
$318.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$308.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$277.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$277.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$292.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$308.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$292.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$308.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$308.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$231.13
|
| Rate for Payer: Healthfirst Commercial |
$308.18
|
| Rate for Payer: Healthfirst Essential Plan |
$693.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$292.77
|
| Rate for Payer: Healthfirst QHP |
$308.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$215.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$308.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$261.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$215.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$308.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$231.13
|
| Rate for Payer: SOMOS Essential |
$231.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$308.18
|
|
|
CHG INTRACAVITARY RADIATION SOURCE APPLIC COMPLEX
|
Professional
|
Both
|
$1,395.59
|
|
|
Service Code
|
HCPCS 77763 TC
|
| Min. Negotiated Rate |
$277.33 |
| Max. Negotiated Rate |
$891.43 |
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$396.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$356.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$356.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$376.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$396.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$376.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$396.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$396.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$297.14
|
| Rate for Payer: Healthfirst Commercial |
$396.19
|
| Rate for Payer: Healthfirst Essential Plan |
$891.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$376.38
|
| Rate for Payer: Healthfirst QHP |
$396.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$277.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$396.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$336.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$277.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$396.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$297.14
|
| Rate for Payer: SOMOS Essential |
$297.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$396.19
|
|
|
CHG INTRACAVITARY RADIATION SOURCE APPLIC COMPLEX
|
Professional
|
Both
|
$3,225.74
|
|
|
Service Code
|
HCPCS 77763
|
| Min. Negotiated Rate |
$631.94 |
| Max. Negotiated Rate |
$2,031.23 |
| Rate for Payer: Cash Price |
$895.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$902.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$812.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$812.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$857.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$902.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$857.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$902.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$902.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$677.08
|
| Rate for Payer: Healthfirst Commercial |
$902.77
|
| Rate for Payer: Healthfirst Essential Plan |
$2,031.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$857.63
|
| Rate for Payer: Healthfirst QHP |
$902.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$631.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$902.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$767.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$631.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$902.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$677.08
|
| Rate for Payer: SOMOS Essential |
$677.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$902.77
|
|
|
CHG INTRACAVITARY RADIATION SOURCE APPLIC COMPLEX
|
Professional
|
Both
|
$1,830.15
|
|
|
Service Code
|
HCPCS 77763 26
|
| Min. Negotiated Rate |
$354.61 |
| Max. Negotiated Rate |
$1,139.81 |
| Rate for Payer: Cash Price |
$502.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$506.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$455.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$455.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$481.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$506.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$481.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$506.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$506.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$379.94
|
| Rate for Payer: Healthfirst Commercial |
$506.58
|
| Rate for Payer: Healthfirst Essential Plan |
$1,139.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$481.25
|
| Rate for Payer: Healthfirst QHP |
$506.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$354.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$506.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$430.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$354.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$506.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$379.94
|
| Rate for Payer: SOMOS Essential |
$379.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$506.58
|
|
|
CHG INTRACAVITARY RADIATION SOURCE APPLIC INTERMED
|
Professional
|
Both
|
$1,078.18
|
|
|
Service Code
|
HCPCS 77762 TC
|
| Min. Negotiated Rate |
$210.23 |
| Max. Negotiated Rate |
$675.74 |
| Rate for Payer: Cash Price |
$301.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$300.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$270.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$270.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$285.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$300.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$285.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$300.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$300.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$225.25
|
| Rate for Payer: Healthfirst Commercial |
$300.33
|
| Rate for Payer: Healthfirst Essential Plan |
$675.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$285.31
|
| Rate for Payer: Healthfirst QHP |
$300.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$210.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$300.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$255.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$210.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$300.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$225.25
|
| Rate for Payer: SOMOS Essential |
$225.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$300.33
|
|
|
CHG INTRACAVITARY RADIATION SOURCE APPLIC INTERMED
|
Professional
|
Both
|
$1,215.62
|
|
|
Service Code
|
HCPCS 77762 26
|
| Min. Negotiated Rate |
$234.98 |
| Max. Negotiated Rate |
$755.30 |
| Rate for Payer: Cash Price |
$334.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$335.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$302.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$302.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$318.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$335.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$318.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$335.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$335.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$251.77
|
| Rate for Payer: Healthfirst Commercial |
$335.69
|
| Rate for Payer: Healthfirst Essential Plan |
$755.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$318.91
|
| Rate for Payer: Healthfirst QHP |
$335.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$234.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$335.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$285.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$234.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$335.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$251.77
|
| Rate for Payer: SOMOS Essential |
$251.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$335.69
|
|
|
CHG INTRACAVITARY RADIATION SOURCE APPLIC INTERMED
|
Professional
|
Both
|
$2,293.76
|
|
|
Service Code
|
HCPCS 77762
|
| Min. Negotiated Rate |
$445.21 |
| Max. Negotiated Rate |
$1,431.05 |
| Rate for Payer: Cash Price |
$635.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$636.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$572.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$572.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$604.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$636.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$604.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$636.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$636.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$477.01
|
| Rate for Payer: Healthfirst Commercial |
$636.02
|
| Rate for Payer: Healthfirst Essential Plan |
$1,431.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$604.22
|
| Rate for Payer: Healthfirst QHP |
$636.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$445.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$636.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$540.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$445.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$636.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$477.01
|
| Rate for Payer: SOMOS Essential |
$477.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$636.02
|
|
|
CHG INTRACAVITARY RADIATION SOURCE APPLIC SIMPLE
|
Professional
|
Both
|
$937.72
|
|
|
Service Code
|
HCPCS 77761 TC
|
| Min. Negotiated Rate |
$182.63 |
| Max. Negotiated Rate |
$587.02 |
| Rate for Payer: Cash Price |
$262.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$260.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$234.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$234.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$247.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$260.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$247.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$260.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$260.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$195.68
|
| Rate for Payer: Healthfirst Commercial |
$260.90
|
| Rate for Payer: Healthfirst Essential Plan |
$587.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$247.85
|
| Rate for Payer: Healthfirst QHP |
$260.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$182.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$260.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$221.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$182.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$260.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$195.68
|
| Rate for Payer: SOMOS Essential |
$195.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$260.90
|
|
|
CHG INTRACAVITARY RADIATION SOURCE APPLIC SIMPLE
|
Professional
|
Both
|
$1,755.36
|
|
|
Service Code
|
HCPCS 77761
|
| Min. Negotiated Rate |
$340.00 |
| Max. Negotiated Rate |
$1,092.85 |
| Rate for Payer: Cash Price |
$485.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$485.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$437.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$437.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$461.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$485.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$461.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$485.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$485.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$364.28
|
| Rate for Payer: Healthfirst Commercial |
$485.71
|
| Rate for Payer: Healthfirst Essential Plan |
$1,092.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$461.42
|
| Rate for Payer: Healthfirst QHP |
$485.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$340.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$485.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$412.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$340.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$485.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$364.28
|
| Rate for Payer: SOMOS Essential |
$364.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$485.71
|
|
|
CHG INTRACAVITARY RADIATION SOURCE APPLIC SIMPLE
|
Professional
|
Both
|
$817.67
|
|
|
Service Code
|
HCPCS 77761 26
|
| Min. Negotiated Rate |
$157.37 |
| Max. Negotiated Rate |
$505.82 |
| Rate for Payer: Cash Price |
$223.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$224.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$202.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$202.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$213.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$224.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$213.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$224.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$224.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$168.61
|
| Rate for Payer: Healthfirst Commercial |
$224.81
|
| Rate for Payer: Healthfirst Essential Plan |
$505.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$213.57
|
| Rate for Payer: Healthfirst QHP |
$224.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$157.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$224.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$191.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$157.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$224.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$168.61
|
| Rate for Payer: SOMOS Essential |
$168.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$224.81
|
|
|
CHG INTRALUMINAL DILATION STRICTURES&/OBSTRCJS RS&I
|
Professional
|
Both
|
$108.78
|
|
|
Service Code
|
HCPCS 74360 26
|
| Min. Negotiated Rate |
$20.73 |
| Max. Negotiated Rate |
$66.62 |
| Rate for Payer: Cash Price |
$30.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$28.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.21
|
| Rate for Payer: Healthfirst Commercial |
$29.61
|
| Rate for Payer: Healthfirst Essential Plan |
$66.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.13
|
| Rate for Payer: Healthfirst QHP |
$29.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$25.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.21
|
| Rate for Payer: SOMOS Essential |
$22.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.61
|
|
|
CHG INTRAOPERATIVE RADIATION TREATMENT MANAGEMENT
|
Professional
|
Both
|
$1,314.95
|
|
|
Service Code
|
HCPCS 77469
|
| Min. Negotiated Rate |
$254.53 |
| Max. Negotiated Rate |
$818.12 |
| Rate for Payer: Cash Price |
$359.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$363.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$327.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$327.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$345.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$363.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$345.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$363.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$363.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$272.71
|
| Rate for Payer: Healthfirst Commercial |
$363.61
|
| Rate for Payer: Healthfirst Essential Plan |
$818.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$345.43
|
| Rate for Payer: Healthfirst QHP |
$363.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$254.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$363.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$309.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$254.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$363.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$272.71
|
| Rate for Payer: SOMOS Essential |
$272.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$363.61
|
|
