|
CHG SIALOGRAPHY RS&I
|
Professional
|
Both
|
$507.19
|
|
|
Service Code
|
HCPCS 70390
|
| Min. Negotiated Rate |
$91.43 |
| Max. Negotiated Rate |
$293.89 |
| Rate for Payer: Cash Price |
$135.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$130.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$117.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$117.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$124.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$130.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$124.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$97.97
|
| Rate for Payer: Healthfirst Commercial |
$130.62
|
| Rate for Payer: Healthfirst Essential Plan |
$293.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$124.09
|
| Rate for Payer: Healthfirst QHP |
$130.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$91.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$130.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$111.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$91.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$130.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$97.97
|
| Rate for Payer: SOMOS Essential |
$97.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.62
|
|
|
CHG SIALOGRAPHY RS&I
|
Professional
|
Both
|
$73.19
|
|
|
Service Code
|
HCPCS 70390 26
|
| Min. Negotiated Rate |
$13.83 |
| Max. Negotiated Rate |
$44.46 |
| Rate for Payer: Cash Price |
$19.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.82
|
| Rate for Payer: Healthfirst Commercial |
$19.76
|
| Rate for Payer: Healthfirst Essential Plan |
$44.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.77
|
| Rate for Payer: Healthfirst QHP |
$19.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$14.82
|
| Rate for Payer: SOMOS Essential |
$14.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.76
|
|
|
CHG SIALOGRAPHY RS&I
|
Professional
|
Both
|
$434.00
|
|
|
Service Code
|
HCPCS 70390 TC
|
| Min. Negotiated Rate |
$77.60 |
| Max. Negotiated Rate |
$249.44 |
| Rate for Payer: Cash Price |
$115.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$110.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$99.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$99.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$105.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$110.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$105.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$110.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$110.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$83.14
|
| Rate for Payer: Healthfirst Commercial |
$110.86
|
| Rate for Payer: Healthfirst Essential Plan |
$249.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$105.32
|
| Rate for Payer: Healthfirst QHP |
$110.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$77.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$110.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$94.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$77.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$110.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$83.14
|
| Rate for Payer: SOMOS Essential |
$83.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$110.86
|
|
|
CHG SKIN TEST COCCIDIOIDOMYCOSIS
|
Professional
|
Both
|
$336.25
|
|
|
Service Code
|
HCPCS 86490
|
| Rate for Payer: Cash Price |
$90.21
|
|
|
CHG SKIN TEST HISTOPLASMOSIS
|
Professional
|
Both
|
$32.94
|
|
|
Service Code
|
HCPCS 86510
|
| Min. Negotiated Rate |
$6.41 |
| Max. Negotiated Rate |
$20.61 |
| Rate for Payer: Cash Price |
$9.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.87
|
| Rate for Payer: Healthfirst Commercial |
$9.16
|
| Rate for Payer: Healthfirst Essential Plan |
$20.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.70
|
| Rate for Payer: Healthfirst QHP |
$9.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.87
|
| Rate for Payer: SOMOS Essential |
$6.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.16
|
|
|
CHG SKIN TEST TUBERCULOSIS INTRADERMAL
|
Professional
|
Both
|
$44.42
|
|
|
Service Code
|
HCPCS 86580
|
| Min. Negotiated Rate |
$8.31 |
| Max. Negotiated Rate |
$26.71 |
| Rate for Payer: Cash Price |
$12.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.90
|
| Rate for Payer: Healthfirst Commercial |
$11.87
|
| Rate for Payer: Healthfirst Essential Plan |
$26.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.28
|
| Rate for Payer: Healthfirst QHP |
$11.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$11.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$10.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.90
|
| Rate for Payer: SOMOS Essential |
$8.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.87
|
|
|
CHG SMR PRIM SRC SPEC STAIN BODIES/PARASITS
|
Professional
|
Both
|
$69.20
|
|
|
Service Code
|
HCPCS 87207 26
|
| Min. Negotiated Rate |
$7.68 |
| Max. Negotiated Rate |
$43.18 |
| Rate for Payer: Cash Price |
$19.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.39
|
| Rate for Payer: Healthfirst Commercial |
$19.19
|
| Rate for Payer: Healthfirst Essential Plan |
$43.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.23
|
| Rate for Payer: Healthfirst QHP |
$19.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.68
|
| Rate for Payer: SOMOS Essential |
$7.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.19
|
|
|
CHG SPEC DOSIM ONLY PRESCRIBED TREATING PHYS
|
Professional
|
Both
|
$184.59
|
|
|
Service Code
|
HCPCS 77331 26
|
| Min. Negotiated Rate |
$35.75 |
| Max. Negotiated Rate |
$114.91 |
| Rate for Payer: Cash Price |
$50.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$51.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$45.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$45.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$48.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$51.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$48.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.30
|
| Rate for Payer: Healthfirst Commercial |
$51.07
|
| Rate for Payer: Healthfirst Essential Plan |
$114.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$48.52
|
| Rate for Payer: Healthfirst QHP |
$51.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$35.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$51.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$43.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$35.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$51.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$38.30
|
| Rate for Payer: SOMOS Essential |
$38.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$51.07
|
|
|
CHG SPEC DOSIM ONLY PRESCRIBED TREATING PHYS
|
Professional
|
Both
|
$267.82
|
|
|
Service Code
|
HCPCS 77331
|
| Min. Negotiated Rate |
$51.67 |
| Max. Negotiated Rate |
$166.09 |
| Rate for Payer: Cash Price |
$73.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$73.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$66.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$66.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$70.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$73.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$70.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$55.37
|
| Rate for Payer: Healthfirst Commercial |
$73.82
|
| Rate for Payer: Healthfirst Essential Plan |
$166.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$70.13
|
| Rate for Payer: Healthfirst QHP |
$73.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$51.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$73.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$62.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$51.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$73.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$55.37
|
| Rate for Payer: SOMOS Essential |
$55.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$73.82
|
|
|
CHG SPEC DOSIM ONLY PRESCRIBED TREATING PHYS
|
Professional
|
Both
|
$83.23
|
|
|
Service Code
|
HCPCS 77331 TC
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$51.16 |
| Rate for Payer: Cash Price |
$23.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.05
|
| Rate for Payer: Healthfirst Commercial |
$22.74
|
| Rate for Payer: Healthfirst Essential Plan |
$51.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.60
|
| Rate for Payer: Healthfirst QHP |
$22.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$15.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$22.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$19.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$17.05
|
| Rate for Payer: SOMOS Essential |
$17.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.74
|
|
|
CHG SPECIAL TREATMENT PROCEDURE
|
Professional
|
Both
|
$142.03
|
|
|
Service Code
|
HCPCS 77470 TC
|
| Min. Negotiated Rate |
$32.11 |
| Max. Negotiated Rate |
$103.21 |
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$45.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$45.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.40
|
| Rate for Payer: Healthfirst Commercial |
$45.87
|
| Rate for Payer: Healthfirst Essential Plan |
$103.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43.58
|
| Rate for Payer: Healthfirst QHP |
$45.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$45.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$38.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$34.40
|
| Rate for Payer: SOMOS Essential |
$34.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.87
|
|
|
CHG SPECIAL TREATMENT PROCEDURE
|
Professional
|
Both
|
$432.57
|
|
|
Service Code
|
HCPCS 77470 26
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$266.29 |
| Rate for Payer: Cash Price |
$118.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$118.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$106.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$106.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$112.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$118.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$112.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$118.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$118.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.76
|
| Rate for Payer: Healthfirst Commercial |
$118.35
|
| Rate for Payer: Healthfirst Essential Plan |
$266.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$112.43
|
| Rate for Payer: Healthfirst QHP |
$118.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$82.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$118.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$100.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$82.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$118.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$88.76
|
| Rate for Payer: SOMOS Essential |
$88.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$118.35
|
|
|
CHG SPECIAL TREATMENT PROCEDURE
|
Professional
|
Both
|
$574.60
|
|
|
Service Code
|
HCPCS 77470
|
| Min. Negotiated Rate |
$114.95 |
| Max. Negotiated Rate |
$369.50 |
| Rate for Payer: Cash Price |
$160.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$164.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$147.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$147.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$156.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$164.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$156.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$164.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$164.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$123.17
|
| Rate for Payer: Healthfirst Commercial |
$164.22
|
| Rate for Payer: Healthfirst Essential Plan |
$369.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$156.01
|
| Rate for Payer: Healthfirst QHP |
$164.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$114.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$164.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$139.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$114.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$164.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$123.17
|
| Rate for Payer: SOMOS Essential |
$123.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$164.22
|
|
|
CHG SPEC MEDICAL RADJ PHYSICS CONSLTJ
|
Professional
|
Both
|
$614.74
|
|
|
Service Code
|
HCPCS 77370
|
| Min. Negotiated Rate |
$124.84 |
| Max. Negotiated Rate |
$401.29 |
| Rate for Payer: Cash Price |
$174.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$178.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$160.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$160.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$169.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$178.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$169.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$178.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$178.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$133.76
|
| Rate for Payer: Healthfirst Commercial |
$178.35
|
| Rate for Payer: Healthfirst Essential Plan |
$401.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$169.43
|
| Rate for Payer: Healthfirst QHP |
$178.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$124.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$178.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$151.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$124.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$178.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$133.76
|
| Rate for Payer: SOMOS Essential |
$133.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$178.35
|
|
|
CHG SPEC TELETHX PORT PLN PARTS HEMIBDY TOT BDY
|
Professional
|
Both
|
$391.41
|
|
|
Service Code
|
HCPCS 77321
|
| Min. Negotiated Rate |
$75.61 |
| Max. Negotiated Rate |
$243.02 |
| Rate for Payer: Cash Price |
$108.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$108.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$97.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$97.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$102.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$108.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$102.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$108.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$108.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$81.01
|
| Rate for Payer: Healthfirst Commercial |
$108.01
|
| Rate for Payer: Healthfirst Essential Plan |
$243.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$102.61
|
| Rate for Payer: Healthfirst QHP |
$108.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$75.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$108.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$91.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$75.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$108.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$81.01
|
| Rate for Payer: SOMOS Essential |
$81.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$108.01
|
|
|
CHG SPEC TELETHX PORT PLN PARTS HEMIBDY TOT BDY
|
Professional
|
Both
|
$201.81
|
|
|
Service Code
|
HCPCS 77321 26
|
| Min. Negotiated Rate |
$38.77 |
| Max. Negotiated Rate |
$124.61 |
| Rate for Payer: Cash Price |
$55.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$55.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$49.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$49.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$52.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$55.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$52.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.53
|
| Rate for Payer: Healthfirst Commercial |
$55.38
|
| Rate for Payer: Healthfirst Essential Plan |
$124.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$52.61
|
| Rate for Payer: Healthfirst QHP |
$55.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$38.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$55.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$47.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$38.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$55.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$41.53
|
| Rate for Payer: SOMOS Essential |
$41.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.38
|
|
|
CHG SPEC TELETHX PORT PLN PARTS HEMIBDY TOT BDY
|
Professional
|
Both
|
$189.60
|
|
|
Service Code
|
HCPCS 77321 TC
|
| Min. Negotiated Rate |
$36.84 |
| Max. Negotiated Rate |
$118.42 |
| Rate for Payer: Cash Price |
$52.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.47
|
| Rate for Payer: Healthfirst Commercial |
$52.63
|
| Rate for Payer: Healthfirst Essential Plan |
$118.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.00
|
| Rate for Payer: Healthfirst QHP |
$52.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.47
|
| Rate for Payer: SOMOS Essential |
$39.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.63
|
|
|
CHG SPLEEN IMAGING ONLY W/WO VASCULAR FLOW
|
Professional
|
Both
|
$617.58
|
|
|
Service Code
|
HCPCS 78185 TC
|
| Min. Negotiated Rate |
$112.31 |
| Max. Negotiated Rate |
$361.01 |
| Rate for Payer: Cash Price |
$164.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$160.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$144.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$144.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$152.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$160.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$152.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$160.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$160.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$120.34
|
| Rate for Payer: Healthfirst Commercial |
$160.45
|
| Rate for Payer: Healthfirst Essential Plan |
$361.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$152.43
|
| Rate for Payer: Healthfirst QHP |
$160.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$112.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$160.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$136.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$112.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$160.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$120.34
|
| Rate for Payer: SOMOS Essential |
$120.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$160.45
|
|
|
CHG SPLEEN IMAGING ONLY W/WO VASCULAR FLOW
|
Professional
|
Both
|
$62.90
|
|
|
Service Code
|
HCPCS 78185 26
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$38.50 |
| Rate for Payer: Cash Price |
$16.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.83
|
| Rate for Payer: Healthfirst Commercial |
$17.11
|
| Rate for Payer: Healthfirst Essential Plan |
$38.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.25
|
| Rate for Payer: Healthfirst QHP |
$17.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$17.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$14.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.83
|
| Rate for Payer: SOMOS Essential |
$12.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.11
|
|
|
CHG SPLEEN IMAGING ONLY W/WO VASCULAR FLOW
|
Professional
|
Both
|
$680.47
|
|
|
Service Code
|
HCPCS 78185
|
| Min. Negotiated Rate |
$124.30 |
| Max. Negotiated Rate |
$399.53 |
| Rate for Payer: Cash Price |
$181.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$177.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$159.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$159.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$168.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$177.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$168.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$177.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$177.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$133.18
|
| Rate for Payer: Healthfirst Commercial |
$177.57
|
| Rate for Payer: Healthfirst Essential Plan |
$399.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$168.69
|
| Rate for Payer: Healthfirst QHP |
$177.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$124.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$177.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$150.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$124.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$177.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$133.18
|
| Rate for Payer: SOMOS Essential |
$133.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$177.57
|
|
|
CHG SPLENOPORTOGRAPY RS&I
|
Professional
|
Both
|
$197.47
|
|
|
Service Code
|
HCPCS 75810 26
|
| Min. Negotiated Rate |
$37.25 |
| Max. Negotiated Rate |
$119.75 |
| Rate for Payer: Cash Price |
$53.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$53.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$53.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.91
|
| Rate for Payer: Healthfirst Commercial |
$53.22
|
| Rate for Payer: Healthfirst Essential Plan |
$119.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.56
|
| Rate for Payer: Healthfirst QHP |
$53.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$53.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$45.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$53.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.91
|
| Rate for Payer: SOMOS Essential |
$39.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.22
|
|
|
CHG STEREOTACTIC BODY RADIATION DELIVERY
|
Professional
|
Both
|
$4,352.43
|
|
|
Service Code
|
HCPCS 77373
|
| Min. Negotiated Rate |
$801.82 |
| Max. Negotiated Rate |
$2,577.26 |
| Rate for Payer: Cash Price |
$1,178.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,145.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,030.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,030.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,088.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,145.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,088.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,145.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,145.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$859.09
|
| Rate for Payer: Healthfirst Commercial |
$1,145.45
|
| Rate for Payer: Healthfirst Essential Plan |
$2,577.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,088.18
|
| Rate for Payer: Healthfirst QHP |
$1,145.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$801.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,145.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$973.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$801.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,145.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$859.09
|
| Rate for Payer: SOMOS Essential |
$859.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,145.45
|
|
|
CHG STEREOTACTIC BODY RADIATION MANAGEMENT
|
Professional
|
Both
|
$2,642.75
|
|
|
Service Code
|
HCPCS 77435
|
| Min. Negotiated Rate |
$507.28 |
| Max. Negotiated Rate |
$1,630.53 |
| Rate for Payer: Cash Price |
$722.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$724.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$652.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$652.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$688.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$724.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$688.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$724.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$724.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$543.51
|
| Rate for Payer: Healthfirst Commercial |
$724.68
|
| Rate for Payer: Healthfirst Essential Plan |
$1,630.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$688.45
|
| Rate for Payer: Healthfirst QHP |
$724.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$507.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$724.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$615.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$507.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$724.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$543.51
|
| Rate for Payer: SOMOS Essential |
$543.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$724.68
|
|
|
CHG STERETCTC RADIATION TX MANAGEMENT CRANIAL LESION
|
Professional
|
Both
|
$1,748.39
|
|
|
Service Code
|
HCPCS 77432
|
| Min. Negotiated Rate |
$335.89 |
| Max. Negotiated Rate |
$1,079.66 |
| Rate for Payer: Cash Price |
$477.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$479.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$431.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$431.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$455.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$479.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$455.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$479.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$479.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$359.89
|
| Rate for Payer: Healthfirst Commercial |
$479.85
|
| Rate for Payer: Healthfirst Essential Plan |
$1,079.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$455.86
|
| Rate for Payer: Healthfirst QHP |
$479.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$335.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$479.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$407.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$335.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$479.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$359.89
|
| Rate for Payer: SOMOS Essential |
$359.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$479.85
|
|
|
CHG SUPERVISION HANDLING LOADING RADIATION SOURCE
|
Professional
|
Both
|
$77.35
|
|
|
Service Code
|
HCPCS 77790
|
| Min. Negotiated Rate |
$15.81 |
| Max. Negotiated Rate |
$50.80 |
| Rate for Payer: Cash Price |
$21.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.93
|
| Rate for Payer: Healthfirst Commercial |
$22.58
|
| Rate for Payer: Healthfirst Essential Plan |
$50.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.45
|
| Rate for Payer: Healthfirst QHP |
$22.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$15.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$22.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$19.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$16.93
|
| Rate for Payer: SOMOS Essential |
$16.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.58
|
|
