|
CHG SURFACE APPLIC LOW DOSE RATE RADIONUCLIDE SOURCE
|
Professional
|
Both
|
$311.68
|
|
|
Service Code
|
HCPCS 77789 TC
|
| Min. Negotiated Rate |
$60.09 |
| Max. Negotiated Rate |
$193.16 |
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$85.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$77.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$77.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$81.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$85.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$81.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.39
|
| Rate for Payer: Healthfirst Commercial |
$85.85
|
| Rate for Payer: Healthfirst Essential Plan |
$193.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$81.56
|
| Rate for Payer: Healthfirst QHP |
$85.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$60.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$85.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$72.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$60.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$85.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$64.39
|
| Rate for Payer: SOMOS Essential |
$64.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$85.85
|
|
|
CHG SURFACE APPLIC LOW DOSE RATE RADIONUCLIDE SOURCE
|
Professional
|
Both
|
$551.64
|
|
|
Service Code
|
HCPCS 77789
|
| Min. Negotiated Rate |
$106.44 |
| Max. Negotiated Rate |
$342.11 |
| Rate for Payer: Cash Price |
$153.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$152.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$136.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$136.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$144.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$152.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$144.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$152.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$152.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$114.04
|
| Rate for Payer: Healthfirst Commercial |
$152.05
|
| Rate for Payer: Healthfirst Essential Plan |
$342.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$144.45
|
| Rate for Payer: Healthfirst QHP |
$152.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$106.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$152.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$129.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$106.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$152.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$114.04
|
| Rate for Payer: SOMOS Essential |
$114.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$152.05
|
|
|
CHG SURFACE APPLIC LOW DOSE RATE RADIONUCLIDE SOURCE
|
Professional
|
Both
|
$239.96
|
|
|
Service Code
|
HCPCS 77789 26
|
| Min. Negotiated Rate |
$46.34 |
| Max. Negotiated Rate |
$148.95 |
| Rate for Payer: Cash Price |
$66.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$66.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$59.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$59.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$66.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$66.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$66.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$49.65
|
| Rate for Payer: Healthfirst Commercial |
$66.20
|
| Rate for Payer: Healthfirst Essential Plan |
$148.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.89
|
| Rate for Payer: Healthfirst QHP |
$66.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$46.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$66.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$56.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$46.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$66.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$49.65
|
| Rate for Payer: SOMOS Essential |
$49.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$66.20
|
|
|
CHG TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON
|
Professional
|
Both
|
$155.00
|
|
|
Service Code
|
HCPCS 86480
|
| Min. Negotiated Rate |
$24.79 |
| Max. Negotiated Rate |
$139.46 |
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$61.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$55.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$55.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$58.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$61.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$58.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$61.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$46.48
|
| Rate for Payer: Healthfirst Commercial |
$61.98
|
| Rate for Payer: Healthfirst Essential Plan |
$139.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$58.88
|
| Rate for Payer: Healthfirst QHP |
$61.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$43.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$61.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$52.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$43.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$61.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.79
|
| Rate for Payer: SOMOS Essential |
$24.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$61.98
|
|
|
CHG TBS DXA/OTHER IMG CALCULATION W/I&R FX RISK
|
Professional
|
Both
|
$174.13
|
|
|
Service Code
|
HCPCS 77089
|
| Min. Negotiated Rate |
$32.48 |
| Max. Negotiated Rate |
$104.40 |
| Rate for Payer: Cash Price |
$47.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$44.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$44.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.80
|
| Rate for Payer: Healthfirst Commercial |
$46.40
|
| Rate for Payer: Healthfirst Essential Plan |
$104.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.08
|
| Rate for Payer: Healthfirst QHP |
$46.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$46.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$34.80
|
| Rate for Payer: SOMOS Essential |
$34.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.40
|
|
|
CHG TBS INTERPRETATION & REPORT FX RISK BY OTHER QHP
|
Professional
|
Both
|
$39.27
|
|
|
Service Code
|
HCPCS 77092
|
| Min. Negotiated Rate |
$7.43 |
| Max. Negotiated Rate |
$23.87 |
| Rate for Payer: Cash Price |
$10.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.96
|
| Rate for Payer: Healthfirst Commercial |
$10.61
|
| Rate for Payer: Healthfirst Essential Plan |
$23.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.08
|
| Rate for Payer: Healthfirst QHP |
$10.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$7.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$10.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$9.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.96
|
| Rate for Payer: SOMOS Essential |
$7.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.61
|
|
|
CHG TBS TECHL PREP&TRANSMIS DATA ALYS PFRMD ELSEWHR
|
Professional
|
Both
|
$12.81
|
|
|
Service Code
|
HCPCS 77090
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$8.37 |
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.79
|
| Rate for Payer: Healthfirst Commercial |
$3.72
|
| Rate for Payer: Healthfirst Essential Plan |
$8.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.53
|
| Rate for Payer: Healthfirst QHP |
$3.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2.79
|
| Rate for Payer: SOMOS Essential |
$2.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.72
|
|
|
CHG TBS TECHNICAL CALCULATION ONLY
|
Professional
|
Both
|
$122.05
|
|
|
Service Code
|
HCPCS 77091
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$72.14 |
| Rate for Payer: Cash Price |
$33.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.05
|
| Rate for Payer: Healthfirst Commercial |
$32.06
|
| Rate for Payer: Healthfirst Essential Plan |
$72.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.46
|
| Rate for Payer: Healthfirst QHP |
$32.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.05
|
| Rate for Payer: SOMOS Essential |
$24.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.06
|
|
|
CHG TELETHX ISODOSE PLN CPLX W/BASIC DOSIMETRY
|
Professional
|
Both
|
$613.13
|
|
|
Service Code
|
HCPCS 77307 26
|
| Min. Negotiated Rate |
$118.76 |
| Max. Negotiated Rate |
$381.74 |
| Rate for Payer: Cash Price |
$167.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$169.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$152.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$152.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$161.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$169.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$161.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$127.25
|
| Rate for Payer: Healthfirst Commercial |
$169.66
|
| Rate for Payer: Healthfirst Essential Plan |
$381.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$161.18
|
| Rate for Payer: Healthfirst QHP |
$169.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$118.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$169.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$144.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$118.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$169.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$127.25
|
| Rate for Payer: SOMOS Essential |
$127.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$169.66
|
|
|
CHG TELETHX ISODOSE PLN CPLX W/BASIC DOSIMETRY
|
Professional
|
Both
|
$1,194.76
|
|
|
Service Code
|
HCPCS 77307
|
| Min. Negotiated Rate |
$231.89 |
| Max. Negotiated Rate |
$745.36 |
| Rate for Payer: Cash Price |
$329.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$331.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$298.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$298.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$314.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$331.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$314.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$331.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$331.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$248.45
|
| Rate for Payer: Healthfirst Commercial |
$331.27
|
| Rate for Payer: Healthfirst Essential Plan |
$745.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$314.71
|
| Rate for Payer: Healthfirst QHP |
$331.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$231.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$331.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$281.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$231.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$331.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$248.45
|
| Rate for Payer: SOMOS Essential |
$248.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$331.27
|
|
|
CHG TELETHX ISODOSE PLN CPLX W/BASIC DOSIMETRY
|
Professional
|
Both
|
$581.63
|
|
|
Service Code
|
HCPCS 77307 TC
|
| Min. Negotiated Rate |
$113.13 |
| Max. Negotiated Rate |
$363.64 |
| Rate for Payer: Cash Price |
$161.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$161.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$145.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$145.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$153.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$161.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$153.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$161.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$161.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$121.22
|
| Rate for Payer: Healthfirst Commercial |
$161.62
|
| Rate for Payer: Healthfirst Essential Plan |
$363.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$153.54
|
| Rate for Payer: Healthfirst QHP |
$161.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$113.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$161.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$137.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$113.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$161.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$121.22
|
| Rate for Payer: SOMOS Essential |
$121.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$161.62
|
|
|
CHG TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION
|
Professional
|
Both
|
$618.42
|
|
|
Service Code
|
HCPCS 77306
|
| Min. Negotiated Rate |
$119.12 |
| Max. Negotiated Rate |
$382.88 |
| Rate for Payer: Cash Price |
$170.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$170.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$153.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$153.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$161.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$170.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$161.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$170.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$170.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$127.63
|
| Rate for Payer: Healthfirst Commercial |
$170.17
|
| Rate for Payer: Healthfirst Essential Plan |
$382.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$161.66
|
| Rate for Payer: Healthfirst QHP |
$170.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$119.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$170.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$144.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$119.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$170.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$127.63
|
| Rate for Payer: SOMOS Essential |
$127.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$170.17
|
|
|
CHG TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION
|
Professional
|
Both
|
$296.70
|
|
|
Service Code
|
HCPCS 77306 26
|
| Min. Negotiated Rate |
$56.85 |
| Max. Negotiated Rate |
$182.72 |
| Rate for Payer: Cash Price |
$81.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$81.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$73.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$77.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.91
|
| Rate for Payer: Healthfirst Commercial |
$81.21
|
| Rate for Payer: Healthfirst Essential Plan |
$182.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$77.15
|
| Rate for Payer: Healthfirst QHP |
$81.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$56.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$81.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$69.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$56.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$60.91
|
| Rate for Payer: SOMOS Essential |
$60.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.21
|
|
|
CHG TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION
|
Professional
|
Both
|
$321.72
|
|
|
Service Code
|
HCPCS 77306 TC
|
| Min. Negotiated Rate |
$62.27 |
| Max. Negotiated Rate |
$200.16 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$88.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$80.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$80.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$88.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$84.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$88.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$66.72
|
| Rate for Payer: Healthfirst Commercial |
$88.96
|
| Rate for Payer: Healthfirst Essential Plan |
$200.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$84.51
|
| Rate for Payer: Healthfirst QHP |
$88.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$62.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$88.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$75.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$62.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$88.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$66.72
|
| Rate for Payer: SOMOS Essential |
$66.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$88.96
|
|
|
CHG TEMPOROMANDBLE JT ARTHROGRAPHY RS&I
|
Professional
|
Both
|
$107.35
|
|
|
Service Code
|
HCPCS 70332 26
|
| Min. Negotiated Rate |
$19.75 |
| Max. Negotiated Rate |
$63.49 |
| Rate for Payer: Cash Price |
$28.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.16
|
| Rate for Payer: Healthfirst Commercial |
$28.22
|
| Rate for Payer: Healthfirst Essential Plan |
$63.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.81
|
| Rate for Payer: Healthfirst QHP |
$28.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.16
|
| Rate for Payer: SOMOS Essential |
$21.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.22
|
|
|
CHG TEMPOROMANDBLE JT ARTHROGRAPHY RS&I
|
Professional
|
Both
|
$255.75
|
|
|
Service Code
|
HCPCS 70332 TC
|
| Min. Negotiated Rate |
$45.53 |
| Max. Negotiated Rate |
$146.36 |
| Rate for Payer: Cash Price |
$67.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$65.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$58.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$61.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$65.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$61.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.79
|
| Rate for Payer: Healthfirst Commercial |
$65.05
|
| Rate for Payer: Healthfirst Essential Plan |
$146.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.80
|
| Rate for Payer: Healthfirst QHP |
$65.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$65.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$55.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$65.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$48.79
|
| Rate for Payer: SOMOS Essential |
$48.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.05
|
|
|
CHG TEMPOROMANDBLE JT ARTHROGRAPHY RS&I
|
Professional
|
Both
|
$363.06
|
|
|
Service Code
|
HCPCS 70332
|
| Min. Negotiated Rate |
$65.29 |
| Max. Negotiated Rate |
$209.86 |
| Rate for Payer: Cash Price |
$95.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$93.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$83.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$83.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$88.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$93.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$88.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.95
|
| Rate for Payer: Healthfirst Commercial |
$93.27
|
| Rate for Payer: Healthfirst Essential Plan |
$209.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$88.61
|
| Rate for Payer: Healthfirst QHP |
$93.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$65.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$93.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$79.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$65.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$93.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.95
|
| Rate for Payer: SOMOS Essential |
$69.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$93.27
|
|
|
CHG TESTICULAR IMAGING WITH VASCULAR FLOW
|
Professional
|
Both
|
$721.07
|
|
|
Service Code
|
HCPCS 78761 TC
|
| Min. Negotiated Rate |
$131.88 |
| Max. Negotiated Rate |
$423.90 |
| Rate for Payer: Cash Price |
$193.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$188.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$169.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$169.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$178.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$188.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$178.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$188.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$188.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$141.30
|
| Rate for Payer: Healthfirst Commercial |
$188.40
|
| Rate for Payer: Healthfirst Essential Plan |
$423.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$178.98
|
| Rate for Payer: Healthfirst QHP |
$188.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$131.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$188.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$160.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$131.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$188.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$141.30
|
| Rate for Payer: SOMOS Essential |
$141.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$188.40
|
|
|
CHG TESTICULAR IMAGING WITH VASCULAR FLOW
|
Professional
|
Both
|
$137.24
|
|
|
Service Code
|
HCPCS 78761 26
|
| Min. Negotiated Rate |
$25.91 |
| Max. Negotiated Rate |
$83.30 |
| Rate for Payer: Cash Price |
$37.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.77
|
| Rate for Payer: Healthfirst Commercial |
$37.02
|
| Rate for Payer: Healthfirst Essential Plan |
$83.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.17
|
| Rate for Payer: Healthfirst QHP |
$37.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$31.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.77
|
| Rate for Payer: SOMOS Essential |
$27.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.02
|
|
|
CHG TESTICULAR IMAGING WITH VASCULAR FLOW
|
Professional
|
Both
|
$858.31
|
|
|
Service Code
|
HCPCS 78761
|
| Min. Negotiated Rate |
$157.79 |
| Max. Negotiated Rate |
$507.19 |
| Rate for Payer: Cash Price |
$230.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$225.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$202.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$202.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$214.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$225.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$214.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$225.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$169.06
|
| Rate for Payer: Healthfirst Commercial |
$225.42
|
| Rate for Payer: Healthfirst Essential Plan |
$507.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$214.15
|
| Rate for Payer: Healthfirst QHP |
$225.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$157.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$225.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$191.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$157.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$225.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$169.06
|
| Rate for Payer: SOMOS Essential |
$169.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$225.42
|
|
|
CHG THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ
|
Professional
|
Both
|
$402.40
|
|
|
Service Code
|
HCPCS 74283 26
|
| Min. Negotiated Rate |
$76.95 |
| Max. Negotiated Rate |
$247.34 |
| Rate for Payer: Cash Price |
$109.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$109.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$98.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$98.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$104.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$109.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$104.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$109.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$82.45
|
| Rate for Payer: Healthfirst Commercial |
$109.93
|
| Rate for Payer: Healthfirst Essential Plan |
$247.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$104.43
|
| Rate for Payer: Healthfirst QHP |
$109.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$76.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$109.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$93.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$76.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$109.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$82.45
|
| Rate for Payer: SOMOS Essential |
$82.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$109.93
|
|
|
CHG THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ
|
Professional
|
Both
|
$1,085.07
|
|
|
Service Code
|
HCPCS 74283
|
| Min. Negotiated Rate |
$207.26 |
| Max. Negotiated Rate |
$666.18 |
| Rate for Payer: Cash Price |
$293.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$296.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$266.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$266.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$281.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$296.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$281.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$296.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$296.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$222.06
|
| Rate for Payer: Healthfirst Commercial |
$296.08
|
| Rate for Payer: Healthfirst Essential Plan |
$666.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$281.28
|
| Rate for Payer: Healthfirst QHP |
$296.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$207.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$296.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$251.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$207.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$296.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$222.06
|
| Rate for Payer: SOMOS Essential |
$222.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$296.08
|
|
|
CHG THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ
|
Professional
|
Both
|
$682.68
|
|
|
Service Code
|
HCPCS 74283 TC
|
| Min. Negotiated Rate |
$130.31 |
| Max. Negotiated Rate |
$418.86 |
| Rate for Payer: Cash Price |
$184.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$186.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$167.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$167.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$176.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$186.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$176.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$186.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$186.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$139.62
|
| Rate for Payer: Healthfirst Commercial |
$186.16
|
| Rate for Payer: Healthfirst Essential Plan |
$418.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$176.85
|
| Rate for Payer: Healthfirst QHP |
$186.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$130.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$186.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$158.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$130.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$186.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$139.62
|
| Rate for Payer: SOMOS Essential |
$139.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$186.16
|
|
|
CHG THERAPEUTIC RADIOLOGY PORT IMAGES(S)
|
Professional
|
Both
|
$60.24
|
|
|
Service Code
|
HCPCS 77417
|
| Min. Negotiated Rate |
$13.64 |
| Max. Negotiated Rate |
$43.83 |
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.61
|
| Rate for Payer: Healthfirst Commercial |
$19.48
|
| Rate for Payer: Healthfirst Essential Plan |
$43.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.51
|
| Rate for Payer: Healthfirst QHP |
$19.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$14.61
|
| Rate for Payer: SOMOS Essential |
$14.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.48
|
|
|
CHG THERAPEUTIC RADIOLOGY TX PLANNING COMPLEX
|
Professional
|
Both
|
$696.01
|
|
|
Service Code
|
HCPCS 77263
|
| Min. Negotiated Rate |
$132.84 |
| Max. Negotiated Rate |
$426.98 |
| Rate for Payer: Cash Price |
$188.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$189.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$170.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$170.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$180.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$189.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$180.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$189.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$189.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$142.33
|
| Rate for Payer: Healthfirst Commercial |
$189.77
|
| Rate for Payer: Healthfirst Essential Plan |
$426.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$180.28
|
| Rate for Payer: Healthfirst QHP |
$189.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$132.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$189.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$161.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$132.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$189.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$142.33
|
| Rate for Payer: SOMOS Essential |
$142.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$189.77
|
|
