|
CHG RP LOCLZJ TUM SPECT 1 AREA/ACQUISJ 1 DAY IMG
|
Professional
|
Both
|
$1,320.52
|
|
|
Service Code
|
HCPCS 78803 TC
|
| Min. Negotiated Rate |
$235.94 |
| Max. Negotiated Rate |
$758.38 |
| Rate for Payer: Cash Price |
$352.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$337.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$303.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$303.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$320.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$337.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$320.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$337.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$337.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$252.79
|
| Rate for Payer: Healthfirst Commercial |
$337.06
|
| Rate for Payer: Healthfirst Essential Plan |
$758.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$320.21
|
| Rate for Payer: Healthfirst QHP |
$337.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$235.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$337.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$286.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$235.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$337.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$252.79
|
| Rate for Payer: SOMOS Essential |
$252.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$337.06
|
|
|
CHG RP LOCLZJ TUM SPECT 1 AREA/ACQUISJ 1 DAY IMG
|
Professional
|
Both
|
$197.79
|
|
|
Service Code
|
HCPCS 78803 26
|
| Min. Negotiated Rate |
$37.53 |
| Max. Negotiated Rate |
$120.62 |
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$53.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$48.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$48.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$53.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.21
|
| Rate for Payer: Healthfirst Commercial |
$53.61
|
| Rate for Payer: Healthfirst Essential Plan |
$120.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.93
|
| Rate for Payer: Healthfirst QHP |
$53.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$53.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$45.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$53.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.21
|
| Rate for Payer: SOMOS Essential |
$40.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.61
|
|
|
CHG RP LOCLZJ TUM SPECT 1 AREA/ACQUISJ 1 DAY IMG
|
Professional
|
Both
|
$1,518.27
|
|
|
Service Code
|
HCPCS 78803
|
| Min. Negotiated Rate |
$273.47 |
| Max. Negotiated Rate |
$879.01 |
| Rate for Payer: Cash Price |
$406.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$390.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$351.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$351.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$371.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$390.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$371.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$390.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$390.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$293.00
|
| Rate for Payer: Healthfirst Commercial |
$390.67
|
| Rate for Payer: Healthfirst Essential Plan |
$879.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$371.14
|
| Rate for Payer: Healthfirst QHP |
$390.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$273.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$390.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$332.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$273.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$390.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$293.00
|
| Rate for Payer: SOMOS Essential |
$293.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$390.67
|
|
|
CHG RP LOCLZJ TUM SPECT 2 AREA/SEP ACQUISJ IMG
|
Professional
|
Both
|
$2,833.08
|
|
|
Service Code
|
HCPCS 78831
|
| Min. Negotiated Rate |
$511.74 |
| Max. Negotiated Rate |
$1,644.88 |
| Rate for Payer: Cash Price |
$763.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$731.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$657.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$657.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$694.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$731.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$694.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$731.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$731.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$548.29
|
| Rate for Payer: Healthfirst Commercial |
$731.06
|
| Rate for Payer: Healthfirst Essential Plan |
$1,644.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$694.51
|
| Rate for Payer: Healthfirst QHP |
$731.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$511.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$731.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$621.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$511.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$731.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$548.29
|
| Rate for Payer: SOMOS Essential |
$548.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$731.06
|
|
|
CHG RP LOCLZJ TUM SPECT 2 AREA/SEP ACQUISJ IMG
|
Professional
|
Both
|
$334.64
|
|
|
Service Code
|
HCPCS 78831 26
|
| Min. Negotiated Rate |
$63.22 |
| Max. Negotiated Rate |
$203.20 |
| Rate for Payer: Cash Price |
$92.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$90.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$81.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$81.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$85.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$90.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$85.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$90.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67.73
|
| Rate for Payer: Healthfirst Commercial |
$90.31
|
| Rate for Payer: Healthfirst Essential Plan |
$203.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$85.79
|
| Rate for Payer: Healthfirst QHP |
$90.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$63.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$90.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$76.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$63.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$90.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$67.73
|
| Rate for Payer: SOMOS Essential |
$67.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$90.31
|
|
|
CHG RP LOCLZJ TUM SPECT 2 AREA/SEP ACQUISJ IMG
|
Professional
|
Both
|
$2,498.41
|
|
|
Service Code
|
HCPCS 78831 TC
|
| Min. Negotiated Rate |
$448.52 |
| Max. Negotiated Rate |
$1,441.69 |
| Rate for Payer: Cash Price |
$670.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$640.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$576.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$576.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$608.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$640.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$608.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$640.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$640.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$480.56
|
| Rate for Payer: Healthfirst Commercial |
$640.75
|
| Rate for Payer: Healthfirst Essential Plan |
$1,441.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$608.71
|
| Rate for Payer: Healthfirst QHP |
$640.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$448.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$640.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$544.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$448.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$640.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$480.56
|
| Rate for Payer: SOMOS Essential |
$480.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$640.75
|
|
|
CHG RP LOCLZJ TUM SPECT CT 2AREA/SEP ACQUISJ IMG
|
Professional
|
Both
|
$3,241.60
|
|
|
Service Code
|
HCPCS 78832 TC
|
| Min. Negotiated Rate |
$577.14 |
| Max. Negotiated Rate |
$1,855.10 |
| Rate for Payer: Cash Price |
$859.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$824.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$742.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$742.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$783.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$824.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$783.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$824.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$824.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$618.37
|
| Rate for Payer: Healthfirst Commercial |
$824.49
|
| Rate for Payer: Healthfirst Essential Plan |
$1,855.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$783.27
|
| Rate for Payer: Healthfirst QHP |
$824.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$577.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$824.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$700.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$577.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$824.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$618.37
|
| Rate for Payer: SOMOS Essential |
$618.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$824.49
|
|
|
CHG RP LOCLZJ TUM SPECT CT 2AREA/SEP ACQUISJ IMG
|
Professional
|
Both
|
$3,629.36
|
|
|
Service Code
|
HCPCS 78832
|
| Min. Negotiated Rate |
$649.66 |
| Max. Negotiated Rate |
$2,088.20 |
| Rate for Payer: Cash Price |
$964.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$928.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$835.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$835.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$881.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$928.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$881.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$928.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$928.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$696.07
|
| Rate for Payer: Healthfirst Commercial |
$928.09
|
| Rate for Payer: Healthfirst Essential Plan |
$2,088.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$881.69
|
| Rate for Payer: Healthfirst QHP |
$928.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$649.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$928.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$788.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$649.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$928.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$696.07
|
| Rate for Payer: SOMOS Essential |
$696.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$928.09
|
|
|
CHG RP LOCLZJ TUM SPECT CT 2AREA/SEP ACQUISJ IMG
|
Professional
|
Both
|
$387.77
|
|
|
Service Code
|
HCPCS 78832 26
|
| Min. Negotiated Rate |
$72.52 |
| Max. Negotiated Rate |
$233.10 |
| Rate for Payer: Cash Price |
$104.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$103.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$93.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$93.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$98.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$103.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$98.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$103.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$77.70
|
| Rate for Payer: Healthfirst Commercial |
$103.60
|
| Rate for Payer: Healthfirst Essential Plan |
$233.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$98.42
|
| Rate for Payer: Healthfirst QHP |
$103.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$72.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$103.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$88.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$72.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$103.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$77.70
|
| Rate for Payer: SOMOS Essential |
$77.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$103.60
|
|
|
CHG RP LOCLZJ TUM SPECT W/CT 1 AREA/ACQUISJ 1DAY IMG
|
Professional
|
Both
|
$267.72
|
|
|
Service Code
|
HCPCS 78830 26
|
| Min. Negotiated Rate |
$50.32 |
| Max. Negotiated Rate |
$161.75 |
| Rate for Payer: Cash Price |
$72.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$71.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$64.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$64.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$68.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$71.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$68.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$71.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$71.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$53.92
|
| Rate for Payer: Healthfirst Commercial |
$71.89
|
| Rate for Payer: Healthfirst Essential Plan |
$161.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$68.30
|
| Rate for Payer: Healthfirst QHP |
$71.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$50.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$71.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$61.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$50.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$71.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$53.92
|
| Rate for Payer: SOMOS Essential |
$53.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$71.89
|
|
|
CHG RP LOCLZJ TUM SPECT W/CT 1 AREA/ACQUISJ 1DAY IMG
|
Professional
|
Both
|
$1,645.11
|
|
|
Service Code
|
HCPCS 78830 TC
|
| Min. Negotiated Rate |
$293.17 |
| Max. Negotiated Rate |
$942.32 |
| Rate for Payer: Cash Price |
$436.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$418.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$376.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$376.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$397.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$418.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$397.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$418.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$418.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$314.11
|
| Rate for Payer: Healthfirst Commercial |
$418.81
|
| Rate for Payer: Healthfirst Essential Plan |
$942.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$397.87
|
| Rate for Payer: Healthfirst QHP |
$418.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$293.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$418.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$355.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$293.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$418.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$314.11
|
| Rate for Payer: SOMOS Essential |
$314.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$418.81
|
|
|
CHG RP LOCLZJ TUM SPECT W/CT 1 AREA/ACQUISJ 1DAY IMG
|
Professional
|
Both
|
$1,912.82
|
|
|
Service Code
|
HCPCS 78830
|
| Min. Negotiated Rate |
$343.48 |
| Max. Negotiated Rate |
$1,104.05 |
| Rate for Payer: Cash Price |
$508.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$490.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$441.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$441.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$466.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$490.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$466.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$490.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$490.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$368.02
|
| Rate for Payer: Healthfirst Commercial |
$490.69
|
| Rate for Payer: Healthfirst Essential Plan |
$1,104.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$466.16
|
| Rate for Payer: Healthfirst QHP |
$490.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$343.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$490.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$417.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$343.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$490.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$368.02
|
| Rate for Payer: SOMOS Essential |
$368.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$490.69
|
|
|
CHG RP THERAPY INRACAVITARY ADMINISTRATION
|
Professional
|
Both
|
$229.71
|
|
|
Service Code
|
HCPCS 79200 TC
|
| Min. Negotiated Rate |
$43.41 |
| Max. Negotiated Rate |
$139.54 |
| Rate for Payer: Cash Price |
$62.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$55.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$55.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$58.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$58.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$62.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$46.52
|
| Rate for Payer: Healthfirst Commercial |
$62.02
|
| Rate for Payer: Healthfirst Essential Plan |
$139.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$58.92
|
| Rate for Payer: Healthfirst QHP |
$62.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$43.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$62.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$52.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$43.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$46.52
|
| Rate for Payer: SOMOS Essential |
$46.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.02
|
|
|
CHG RP THERAPY INRACAVITARY ADMINISTRATION
|
Professional
|
Both
|
$302.16
|
|
|
Service Code
|
HCPCS 79200 26
|
| Min. Negotiated Rate |
$57.82 |
| Max. Negotiated Rate |
$185.85 |
| Rate for Payer: Cash Price |
$82.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$82.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$74.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$74.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$78.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$82.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$78.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$82.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$61.95
|
| Rate for Payer: Healthfirst Commercial |
$82.60
|
| Rate for Payer: Healthfirst Essential Plan |
$185.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$78.47
|
| Rate for Payer: Healthfirst QHP |
$82.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$57.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$82.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$70.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$57.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$82.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$61.95
|
| Rate for Payer: SOMOS Essential |
$61.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$82.60
|
|
|
CHG RP THERAPY INRACAVITARY ADMINISTRATION
|
Professional
|
Both
|
$531.86
|
|
|
Service Code
|
HCPCS 79200
|
| Min. Negotiated Rate |
$101.23 |
| Max. Negotiated Rate |
$325.39 |
| Rate for Payer: Cash Price |
$145.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$144.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$130.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$130.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$137.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$144.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$137.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$144.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$144.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$108.47
|
| Rate for Payer: Healthfirst Commercial |
$144.62
|
| Rate for Payer: Healthfirst Essential Plan |
$325.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$137.39
|
| Rate for Payer: Healthfirst QHP |
$144.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$101.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$144.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$122.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$101.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$144.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$108.47
|
| Rate for Payer: SOMOS Essential |
$108.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$144.62
|
|
|
CHG RP THERAPY INTERSTITIAL RADIOACTIVE COLLOID ADMN
|
Professional
|
Both
|
$243.25
|
|
|
Service Code
|
HCPCS 79300 26
|
| Min. Negotiated Rate |
$46.52 |
| Max. Negotiated Rate |
$149.51 |
| Rate for Payer: Cash Price |
$66.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$66.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$59.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$59.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$63.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$66.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$63.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$66.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$66.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$49.84
|
| Rate for Payer: Healthfirst Commercial |
$66.45
|
| Rate for Payer: Healthfirst Essential Plan |
$149.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$63.13
|
| Rate for Payer: Healthfirst QHP |
$66.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$46.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$66.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$56.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$46.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$66.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$49.84
|
| Rate for Payer: SOMOS Essential |
$49.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$66.45
|
|
|
CHG RP THERAPY INTRA-ARTERIAL PARTICULATE ADMN
|
Professional
|
Both
|
$439.53
|
|
|
Service Code
|
HCPCS 79445 26
|
| Min. Negotiated Rate |
$83.82 |
| Max. Negotiated Rate |
$269.42 |
| Rate for Payer: Cash Price |
$118.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$119.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$107.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$107.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$119.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$119.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$119.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$89.81
|
| Rate for Payer: Healthfirst Commercial |
$119.74
|
| Rate for Payer: Healthfirst Essential Plan |
$269.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$113.75
|
| Rate for Payer: Healthfirst QHP |
$119.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$83.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$119.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$101.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$83.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$119.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$89.81
|
| Rate for Payer: SOMOS Essential |
$89.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$119.74
|
|
|
CHG RP THERAPY INTRA-ARTICULAR ADMINISTRATION
|
Professional
|
Both
|
$475.83
|
|
|
Service Code
|
HCPCS 79440
|
| Min. Negotiated Rate |
$90.47 |
| Max. Negotiated Rate |
$290.81 |
| Rate for Payer: Cash Price |
$130.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$129.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$116.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$116.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$122.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$129.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$122.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$129.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$129.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$96.94
|
| Rate for Payer: Healthfirst Commercial |
$129.25
|
| Rate for Payer: Healthfirst Essential Plan |
$290.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$122.79
|
| Rate for Payer: Healthfirst QHP |
$129.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$90.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$129.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$109.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$90.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$129.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$96.94
|
| Rate for Payer: SOMOS Essential |
$96.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$129.25
|
|
|
CHG RP THERAPY INTRA-ARTICULAR ADMINISTRATION
|
Professional
|
Both
|
$173.67
|
|
|
Service Code
|
HCPCS 79440 TC
|
| Min. Negotiated Rate |
$32.66 |
| Max. Negotiated Rate |
$104.96 |
| Rate for Payer: Cash Price |
$47.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$44.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$44.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.99
|
| Rate for Payer: Healthfirst Commercial |
$46.65
|
| Rate for Payer: Healthfirst Essential Plan |
$104.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.32
|
| Rate for Payer: Healthfirst QHP |
$46.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$46.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$34.99
|
| Rate for Payer: SOMOS Essential |
$34.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.65
|
|
|
CHG RP THERAPY INTRA-ARTICULAR ADMINISTRATION
|
Professional
|
Both
|
$302.16
|
|
|
Service Code
|
HCPCS 79440 26
|
| Min. Negotiated Rate |
$57.82 |
| Max. Negotiated Rate |
$185.85 |
| Rate for Payer: Cash Price |
$82.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$82.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$74.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$74.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$78.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$82.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$78.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$82.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$61.95
|
| Rate for Payer: Healthfirst Commercial |
$82.60
|
| Rate for Payer: Healthfirst Essential Plan |
$185.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$78.47
|
| Rate for Payer: Healthfirst QHP |
$82.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$57.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$82.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$70.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$57.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$82.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$61.95
|
| Rate for Payer: SOMOS Essential |
$61.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$82.60
|
|
|
CHG RP THERAPY INTRAVENOUS ADMINISTRATION
|
Professional
|
Both
|
$605.05
|
|
|
Service Code
|
HCPCS 79101
|
| Min. Negotiated Rate |
$113.76 |
| Max. Negotiated Rate |
$365.67 |
| Rate for Payer: Cash Price |
$164.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$162.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$146.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$146.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$154.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$162.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$154.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$162.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$162.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$121.89
|
| Rate for Payer: Healthfirst Commercial |
$162.52
|
| Rate for Payer: Healthfirst Essential Plan |
$365.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$154.39
|
| Rate for Payer: Healthfirst QHP |
$162.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$113.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$162.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$138.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$113.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$162.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$121.89
|
| Rate for Payer: SOMOS Essential |
$121.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$162.52
|
|
|
CHG RP THERAPY INTRAVENOUS ADMINISTRATION
|
Professional
|
Both
|
$232.61
|
|
|
Service Code
|
HCPCS 79101 TC
|
| Min. Negotiated Rate |
$44.06 |
| Max. Negotiated Rate |
$141.64 |
| Rate for Payer: Cash Price |
$63.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$56.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$56.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$59.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$59.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$62.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.21
|
| Rate for Payer: Healthfirst Commercial |
$62.95
|
| Rate for Payer: Healthfirst Essential Plan |
$141.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$59.80
|
| Rate for Payer: Healthfirst QHP |
$62.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$44.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$62.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$53.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$44.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.21
|
| Rate for Payer: SOMOS Essential |
$47.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.95
|
|
|
CHG RP THERAPY INTRAVENOUS ADMINISTRATION
|
Professional
|
Both
|
$372.44
|
|
|
Service Code
|
HCPCS 79101 26
|
| Min. Negotiated Rate |
$69.69 |
| Max. Negotiated Rate |
$224.01 |
| Rate for Payer: Cash Price |
$101.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$99.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$89.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$89.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$94.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$99.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$94.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$99.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$99.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$74.67
|
| Rate for Payer: Healthfirst Commercial |
$99.56
|
| Rate for Payer: Healthfirst Essential Plan |
$224.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$94.58
|
| Rate for Payer: Healthfirst QHP |
$99.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$69.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$99.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$84.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$69.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$99.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$74.67
|
| Rate for Payer: SOMOS Essential |
$74.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$99.56
|
|
|
CHG RP THERAPY ORAL ADMINISTRATION
|
Professional
|
Both
|
$556.26
|
|
|
Service Code
|
HCPCS 79005
|
| Min. Negotiated Rate |
$105.72 |
| Max. Negotiated Rate |
$339.82 |
| Rate for Payer: Cash Price |
$151.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$151.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$135.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$135.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$143.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$151.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$143.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$151.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$151.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$113.27
|
| Rate for Payer: Healthfirst Commercial |
$151.03
|
| Rate for Payer: Healthfirst Essential Plan |
$339.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$143.48
|
| Rate for Payer: Healthfirst QHP |
$151.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$105.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$151.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$128.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$105.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$151.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$113.27
|
| Rate for Payer: SOMOS Essential |
$113.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$151.03
|
|
|
CHG RP THERAPY ORAL ADMINISTRATION
|
Professional
|
Both
|
$222.53
|
|
|
Service Code
|
HCPCS 79005 TC
|
| Min. Negotiated Rate |
$42.43 |
| Max. Negotiated Rate |
$136.40 |
| Rate for Payer: Cash Price |
$60.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$60.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$54.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$54.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$57.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$60.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$57.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.47
|
| Rate for Payer: Healthfirst Commercial |
$60.62
|
| Rate for Payer: Healthfirst Essential Plan |
$136.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$57.59
|
| Rate for Payer: Healthfirst QHP |
$60.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$42.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$60.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$51.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$42.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$60.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$45.47
|
| Rate for Payer: SOMOS Essential |
$45.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$60.62
|
|
