|
CHG THERAPEUTIC RADIOLOGY TX PLANNING INTERMEDIATE
|
Professional
|
Both
|
$442.61
|
|
|
Service Code
|
HCPCS 77262
|
| Min. Negotiated Rate |
$85.10 |
| Max. Negotiated Rate |
$273.53 |
| Rate for Payer: Cash Price |
$121.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$121.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$109.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$109.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$115.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$121.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$115.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$121.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$121.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$91.18
|
| Rate for Payer: Healthfirst Commercial |
$121.57
|
| Rate for Payer: Healthfirst Essential Plan |
$273.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$115.49
|
| Rate for Payer: Healthfirst QHP |
$121.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$85.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$121.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$103.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$85.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$121.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$91.18
|
| Rate for Payer: SOMOS Essential |
$91.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$121.57
|
|
|
CHG THERAPEUTIC RADIOLOGY TX PLANNING SIMPLE
|
Professional
|
Both
|
$288.23
|
|
|
Service Code
|
HCPCS 77261
|
| Min. Negotiated Rate |
$54.59 |
| Max. Negotiated Rate |
$175.48 |
| Rate for Payer: Cash Price |
$79.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$77.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$70.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$70.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$74.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$77.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$74.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$58.49
|
| Rate for Payer: Healthfirst Commercial |
$77.99
|
| Rate for Payer: Healthfirst Essential Plan |
$175.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$74.09
|
| Rate for Payer: Healthfirst QHP |
$77.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$54.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$77.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$66.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$54.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$77.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$58.49
|
| Rate for Payer: SOMOS Essential |
$58.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$77.99
|
|
|
CHG THER RAD SIMULAJ-AIDED FIELD SETTING COMPLEX
|
Professional
|
Both
|
$332.43
|
|
|
Service Code
|
HCPCS 77290 26
|
| Min. Negotiated Rate |
$63.58 |
| Max. Negotiated Rate |
$204.37 |
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$90.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$81.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$81.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$86.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$90.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$86.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$90.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$68.12
|
| Rate for Payer: Healthfirst Commercial |
$90.83
|
| Rate for Payer: Healthfirst Essential Plan |
$204.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$86.29
|
| Rate for Payer: Healthfirst QHP |
$90.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$63.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$90.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$77.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$63.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$90.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$68.12
|
| Rate for Payer: SOMOS Essential |
$68.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$90.83
|
|
|
CHG THER RAD SIMULAJ-AIDED FIELD SETTING COMPLEX
|
Professional
|
Both
|
$1,596.77
|
|
|
Service Code
|
HCPCS 77290 TC
|
| Min. Negotiated Rate |
$292.30 |
| Max. Negotiated Rate |
$939.53 |
| Rate for Payer: Cash Price |
$432.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$417.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$375.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$375.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$396.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$417.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$396.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$417.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$417.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$313.18
|
| Rate for Payer: Healthfirst Commercial |
$417.57
|
| Rate for Payer: Healthfirst Essential Plan |
$939.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$396.69
|
| Rate for Payer: Healthfirst QHP |
$417.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$292.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$417.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$354.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$292.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$417.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$313.18
|
| Rate for Payer: SOMOS Essential |
$313.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$417.57
|
|
|
CHG THER RAD SIMULAJ-AIDED FIELD SETTING COMPLEX
|
Professional
|
Both
|
$1,929.20
|
|
|
Service Code
|
HCPCS 77290
|
| Min. Negotiated Rate |
$355.88 |
| Max. Negotiated Rate |
$1,143.90 |
| Rate for Payer: Cash Price |
$523.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$508.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$457.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$457.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$482.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$508.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$482.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$508.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$508.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$381.30
|
| Rate for Payer: Healthfirst Commercial |
$508.40
|
| Rate for Payer: Healthfirst Essential Plan |
$1,143.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$482.98
|
| Rate for Payer: Healthfirst QHP |
$508.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$355.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$508.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$432.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$355.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$508.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$381.30
|
| Rate for Payer: SOMOS Essential |
$381.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$508.40
|
|
|
CHG THER RAD SIMULAJ-AIDED FIELD SETTING INTERMED
|
Professional
|
Both
|
$1,658.58
|
|
|
Service Code
|
HCPCS 77285 TC
|
| Min. Negotiated Rate |
$316.60 |
| Max. Negotiated Rate |
$1,017.63 |
| Rate for Payer: Cash Price |
$453.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$452.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$407.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$407.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$429.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$452.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$429.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$452.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$452.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$339.21
|
| Rate for Payer: Healthfirst Commercial |
$452.28
|
| Rate for Payer: Healthfirst Essential Plan |
$1,017.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$429.67
|
| Rate for Payer: Healthfirst QHP |
$452.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$316.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$452.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$384.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$316.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$452.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$339.21
|
| Rate for Payer: SOMOS Essential |
$339.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$452.28
|
|
|
CHG THER RAD SIMULAJ-AIDED FIELD SETTING INTERMED
|
Professional
|
Both
|
$228.69
|
|
|
Service Code
|
HCPCS 77285 26
|
| Min. Negotiated Rate |
$43.62 |
| Max. Negotiated Rate |
$140.22 |
| Rate for Payer: Cash Price |
$62.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$56.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$56.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$59.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$59.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$62.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$46.74
|
| Rate for Payer: Healthfirst Commercial |
$62.32
|
| Rate for Payer: Healthfirst Essential Plan |
$140.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$59.20
|
| Rate for Payer: Healthfirst QHP |
$62.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$43.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$62.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$52.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$43.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$46.74
|
| Rate for Payer: SOMOS Essential |
$46.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.32
|
|
|
CHG THER RAD SIMULAJ-AIDED FIELD SETTING INTERMED
|
Professional
|
Both
|
$1,887.31
|
|
|
Service Code
|
HCPCS 77285
|
| Min. Negotiated Rate |
$360.22 |
| Max. Negotiated Rate |
$1,157.85 |
| Rate for Payer: Cash Price |
$516.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$514.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$463.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$463.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$488.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$514.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$488.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$514.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$514.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$385.95
|
| Rate for Payer: Healthfirst Commercial |
$514.60
|
| Rate for Payer: Healthfirst Essential Plan |
$1,157.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$488.87
|
| Rate for Payer: Healthfirst QHP |
$514.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$360.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$514.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$437.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$360.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$514.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$385.95
|
| Rate for Payer: SOMOS Essential |
$385.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$514.60
|
|
|
CHG THER RAD SIMULAJ-AIDED FIELD SETTING SIMPLE
|
Professional
|
Both
|
$154.67
|
|
|
Service Code
|
HCPCS 77280 26
|
| Min. Negotiated Rate |
$29.05 |
| Max. Negotiated Rate |
$93.38 |
| Rate for Payer: Cash Price |
$41.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$41.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$39.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.12
|
| Rate for Payer: Healthfirst Commercial |
$41.50
|
| Rate for Payer: Healthfirst Essential Plan |
$93.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.42
|
| Rate for Payer: Healthfirst QHP |
$41.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$41.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$35.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31.12
|
| Rate for Payer: SOMOS Essential |
$31.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.50
|
|
|
CHG THER RAD SIMULAJ-AIDED FIELD SETTING SIMPLE
|
Professional
|
Both
|
$998.94
|
|
|
Service Code
|
HCPCS 77280 TC
|
| Min. Negotiated Rate |
$188.08 |
| Max. Negotiated Rate |
$604.53 |
| Rate for Payer: Cash Price |
$273.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$268.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$241.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$241.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$255.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$268.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$255.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$268.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$268.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$201.51
|
| Rate for Payer: Healthfirst Commercial |
$268.68
|
| Rate for Payer: Healthfirst Essential Plan |
$604.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$255.25
|
| Rate for Payer: Healthfirst QHP |
$268.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$188.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$268.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$228.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$188.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$268.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$201.51
|
| Rate for Payer: SOMOS Essential |
$201.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$268.68
|
|
|
CHG THER RAD SIMULAJ-AIDED FIELD SETTING SIMPLE
|
Professional
|
Both
|
$1,153.60
|
|
|
Service Code
|
HCPCS 77280
|
| Min. Negotiated Rate |
$217.12 |
| Max. Negotiated Rate |
$697.88 |
| Rate for Payer: Cash Price |
$315.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$310.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$310.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$310.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$310.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$232.63
|
| Rate for Payer: Healthfirst Commercial |
$310.17
|
| Rate for Payer: Healthfirst Essential Plan |
$697.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$294.66
|
| Rate for Payer: Healthfirst QHP |
$310.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$217.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$310.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$263.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$217.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$310.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$232.63
|
| Rate for Payer: SOMOS Essential |
$232.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$310.17
|
|
|
CHG THYROID CARCINOMA METASTASES IMG ADDL STUDY
|
Professional
|
Both
|
$979.55
|
|
|
Service Code
|
HCPCS 78016 TC
|
| Min. Negotiated Rate |
$176.60 |
| Max. Negotiated Rate |
$567.65 |
| Rate for Payer: Cash Price |
$261.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$252.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$227.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$227.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$239.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$252.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$239.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$252.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$252.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$189.22
|
| Rate for Payer: Healthfirst Commercial |
$252.29
|
| Rate for Payer: Healthfirst Essential Plan |
$567.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$239.68
|
| Rate for Payer: Healthfirst QHP |
$252.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$176.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$252.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$214.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$176.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$252.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$189.22
|
| Rate for Payer: SOMOS Essential |
$189.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$252.29
|
|
|
CHG THYROID CARCINOMA METASTASES IMG ADDL STUDY
|
Professional
|
Both
|
$125.58
|
|
|
Service Code
|
HCPCS 78016 26
|
| Min. Negotiated Rate |
$24.01 |
| Max. Negotiated Rate |
$77.17 |
| Rate for Payer: Cash Price |
$34.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.73
|
| Rate for Payer: Healthfirst Commercial |
$34.30
|
| Rate for Payer: Healthfirst Essential Plan |
$77.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.59
|
| Rate for Payer: Healthfirst QHP |
$34.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.73
|
| Rate for Payer: SOMOS Essential |
$25.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.30
|
|
|
CHG THYROID CARCINOMA METASTASES IMG ADDL STUDY
|
Professional
|
Both
|
$1,105.09
|
|
|
Service Code
|
HCPCS 78016
|
| Min. Negotiated Rate |
$200.61 |
| Max. Negotiated Rate |
$644.83 |
| Rate for Payer: Cash Price |
$295.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$286.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$257.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$257.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$272.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$286.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$272.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$286.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$286.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$214.94
|
| Rate for Payer: Healthfirst Commercial |
$286.59
|
| Rate for Payer: Healthfirst Essential Plan |
$644.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$272.26
|
| Rate for Payer: Healthfirst QHP |
$286.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$200.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$286.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$243.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$200.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$286.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$214.94
|
| Rate for Payer: SOMOS Essential |
$214.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$286.59
|
|
|
CHG THYROID CARCINOMA METASTASES IMG LMTD AREA
|
Professional
|
Both
|
$130.80
|
|
|
Service Code
|
HCPCS 78015 26
|
| Min. Negotiated Rate |
$24.25 |
| Max. Negotiated Rate |
$77.94 |
| Rate for Payer: Cash Price |
$34.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.98
|
| Rate for Payer: Healthfirst Commercial |
$34.64
|
| Rate for Payer: Healthfirst Essential Plan |
$77.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.91
|
| Rate for Payer: Healthfirst QHP |
$34.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.98
|
| Rate for Payer: SOMOS Essential |
$25.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.64
|
|
|
CHG THYROID CARCINOMA METASTASES IMG LMTD AREA
|
Professional
|
Both
|
$928.06
|
|
|
Service Code
|
HCPCS 78015
|
| Min. Negotiated Rate |
$169.44 |
| Max. Negotiated Rate |
$544.63 |
| Rate for Payer: Cash Price |
$248.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$242.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$217.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$217.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$229.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$242.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$229.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$242.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$242.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$181.54
|
| Rate for Payer: Healthfirst Commercial |
$242.06
|
| Rate for Payer: Healthfirst Essential Plan |
$544.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$229.96
|
| Rate for Payer: Healthfirst QHP |
$242.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$169.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$242.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$205.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$169.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$242.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$181.54
|
| Rate for Payer: SOMOS Essential |
$181.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$242.06
|
|
|
CHG THYROID CARCINOMA METASTASES IMG LMTD AREA
|
Professional
|
Both
|
$797.27
|
|
|
Service Code
|
HCPCS 78015 TC
|
| Min. Negotiated Rate |
$145.19 |
| Max. Negotiated Rate |
$466.69 |
| Rate for Payer: Cash Price |
$213.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$207.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$186.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$186.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$197.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$207.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$197.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$207.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$207.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$155.56
|
| Rate for Payer: Healthfirst Commercial |
$207.42
|
| Rate for Payer: Healthfirst Essential Plan |
$466.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$197.05
|
| Rate for Payer: Healthfirst QHP |
$207.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$145.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$207.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$176.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$145.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$207.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$155.56
|
| Rate for Payer: SOMOS Essential |
$155.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$207.42
|
|
|
CHG THYROID CARCINOMA METASTASES IMG WHOLE BODY
|
Professional
|
Both
|
$156.03
|
|
|
Service Code
|
HCPCS 78018 26
|
| Min. Negotiated Rate |
$29.10 |
| Max. Negotiated Rate |
$93.53 |
| Rate for Payer: Cash Price |
$41.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$41.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$39.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.18
|
| Rate for Payer: Healthfirst Commercial |
$41.57
|
| Rate for Payer: Healthfirst Essential Plan |
$93.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.49
|
| Rate for Payer: Healthfirst QHP |
$41.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$41.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$35.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31.18
|
| Rate for Payer: SOMOS Essential |
$31.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.57
|
|
|
CHG THYROID CARCINOMA METASTASES IMG WHOLE BODY
|
Professional
|
Both
|
$1,089.06
|
|
|
Service Code
|
HCPCS 78018 TC
|
| Min. Negotiated Rate |
$197.09 |
| Max. Negotiated Rate |
$633.51 |
| Rate for Payer: Cash Price |
$291.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$281.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$253.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$253.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$267.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$281.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$267.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$281.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$281.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$211.17
|
| Rate for Payer: Healthfirst Commercial |
$281.56
|
| Rate for Payer: Healthfirst Essential Plan |
$633.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$267.48
|
| Rate for Payer: Healthfirst QHP |
$281.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$197.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$281.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$239.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$197.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$281.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$211.17
|
| Rate for Payer: SOMOS Essential |
$211.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$281.56
|
|
|
CHG THYROID CARCINOMA METASTASES IMG WHOLE BODY
|
Professional
|
Both
|
$1,245.09
|
|
|
Service Code
|
HCPCS 78018
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$727.04 |
| Rate for Payer: Cash Price |
$332.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$323.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$290.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$290.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$306.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$323.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$306.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$323.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$323.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$242.35
|
| Rate for Payer: Healthfirst Commercial |
$323.13
|
| Rate for Payer: Healthfirst Essential Plan |
$727.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$306.97
|
| Rate for Payer: Healthfirst QHP |
$323.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$226.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$323.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$274.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$226.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$323.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$242.35
|
| Rate for Payer: SOMOS Essential |
$242.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$323.13
|
|
|
CHG THYROID CARCINOMA METASTASES UPTAKE
|
Professional
|
Both
|
$103.64
|
|
|
Service Code
|
HCPCS 78020 26
|
| Min. Negotiated Rate |
$19.68 |
| Max. Negotiated Rate |
$63.27 |
| Rate for Payer: Cash Price |
$28.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.09
|
| Rate for Payer: Healthfirst Commercial |
$28.12
|
| Rate for Payer: Healthfirst Essential Plan |
$63.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.71
|
| Rate for Payer: Healthfirst QHP |
$28.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.09
|
| Rate for Payer: SOMOS Essential |
$21.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.12
|
|
|
CHG THYROID CARCINOMA METASTASES UPTAKE
|
Professional
|
Both
|
$331.91
|
|
|
Service Code
|
HCPCS 78020
|
| Min. Negotiated Rate |
$63.20 |
| Max. Negotiated Rate |
$203.15 |
| Rate for Payer: Cash Price |
$90.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$90.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$81.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$81.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$85.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$90.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$85.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$90.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67.72
|
| Rate for Payer: Healthfirst Commercial |
$90.29
|
| Rate for Payer: Healthfirst Essential Plan |
$203.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$85.78
|
| Rate for Payer: Healthfirst QHP |
$90.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$63.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$90.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$76.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$63.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$90.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$67.72
|
| Rate for Payer: SOMOS Essential |
$67.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$90.29
|
|
|
CHG THYROID CARCINOMA METASTASES UPTAKE
|
Professional
|
Both
|
$228.27
|
|
|
Service Code
|
HCPCS 78020 TC
|
| Min. Negotiated Rate |
$43.53 |
| Max. Negotiated Rate |
$139.91 |
| Rate for Payer: Cash Price |
$62.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$55.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$55.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$59.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$59.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$62.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$46.63
|
| Rate for Payer: Healthfirst Commercial |
$62.18
|
| Rate for Payer: Healthfirst Essential Plan |
$139.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$59.07
|
| Rate for Payer: Healthfirst QHP |
$62.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$43.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$62.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$52.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$43.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$46.63
|
| Rate for Payer: SOMOS Essential |
$46.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.18
|
|
|
CHG THYROID IMAGING WITH VASCULAR FLOW
|
Professional
|
Both
|
$70.49
|
|
|
Service Code
|
HCPCS 78013 26
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$41.94 |
| Rate for Payer: Cash Price |
$18.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.98
|
| Rate for Payer: Healthfirst Commercial |
$18.64
|
| Rate for Payer: Healthfirst Essential Plan |
$41.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.71
|
| Rate for Payer: Healthfirst QHP |
$18.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$18.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$15.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$13.98
|
| Rate for Payer: SOMOS Essential |
$13.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.64
|
|
|
CHG THYROID IMAGING WITH VASCULAR FLOW
|
Professional
|
Both
|
$768.57
|
|
|
Service Code
|
HCPCS 78013
|
| Min. Negotiated Rate |
$137.05 |
| Max. Negotiated Rate |
$440.50 |
| Rate for Payer: Cash Price |
$201.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$195.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$176.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$176.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$185.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$195.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$185.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$195.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$146.84
|
| Rate for Payer: Healthfirst Commercial |
$195.78
|
| Rate for Payer: Healthfirst Essential Plan |
$440.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$185.99
|
| Rate for Payer: Healthfirst QHP |
$195.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$137.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$195.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$166.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$137.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$195.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$146.84
|
| Rate for Payer: SOMOS Essential |
$146.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$195.78
|
|
