|
CHG BASIC RADIATION DOSIMETRY CALCULATION
|
Professional
|
$278.22
|
|
|
Service Code
|
HCPCS 77300
|
| Min. Negotiated Rate |
$26.92 |
| Max. Negotiated Rate |
$208.66 |
| Rate for Payer: Cash Price |
$75.99
|
| Rate for Payer: Cash Price |
$75.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$71.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$71.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$75.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$79.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$75.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$79.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$59.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$75.52
|
| Rate for Payer: Healthfirst QHP |
$79.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$55.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$79.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$67.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$55.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$79.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$208.66
|
| Rate for Payer: SOMOS Essential |
$208.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$79.49
|
|
|
CHG BASIC RADIATION DOSIMETRY CALCULATION
|
Professional
|
$143.61
|
|
|
Service Code
|
HCPCS 77300 TC
|
| Min. Negotiated Rate |
$26.92 |
| Max. Negotiated Rate |
$208.66 |
| Rate for Payer: Cash Price |
$39.92
|
| Rate for Payer: Cash Price |
$39.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.98
|
| Rate for Payer: Healthfirst QHP |
$41.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$41.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$107.71
|
| Rate for Payer: SOMOS Essential |
$107.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.03
|
|
|
CHG BASIC RADIATION DOSIMETRY CALCULATION
|
Professional
|
$134.61
|
|
|
Service Code
|
HCPCS 77300 26
|
| Min. Negotiated Rate |
$26.92 |
| Max. Negotiated Rate |
$208.66 |
| Rate for Payer: Cash Price |
$36.07
|
| Rate for Payer: Cash Price |
$36.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.54
|
| Rate for Payer: Healthfirst QHP |
$38.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$100.96
|
| Rate for Payer: SOMOS Essential |
$100.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.46
|
|
|
CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER
|
Professional
|
$11.00
|
|
|
Service Code
|
HCPCS 82270
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$8.25 |
| Rate for Payer: Cash Price |
$4.38
|
| Rate for Payer: Cash Price |
$4.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.16
|
| Rate for Payer: Healthfirst QHP |
$4.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.25
|
| Rate for Payer: SOMOS Essential |
$8.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.38
|
|
|
CHG BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES
|
Professional
|
$21.28
|
|
|
Service Code
|
HCPCS 82271
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$15.96 |
| Rate for Payer: Cash Price |
$5.32
|
| Rate for Payer: Cash Price |
$5.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.05
|
| Rate for Payer: Healthfirst QHP |
$5.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$5.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$4.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.96
|
| Rate for Payer: SOMOS Essential |
$15.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.32
|
|
|
CHG BLOOD SMEAR PERIPHERAL INTERP PHYS W/WRIT REPORT
|
Professional
|
$98.95
|
|
|
Service Code
|
HCPCS 85060
|
| Min. Negotiated Rate |
$19.79 |
| Max. Negotiated Rate |
$74.21 |
| Rate for Payer: Cash Price |
$26.21
|
| Rate for Payer: Cash Price |
$26.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.86
|
| Rate for Payer: Healthfirst QHP |
$28.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$74.21
|
| Rate for Payer: SOMOS Essential |
$74.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.27
|
|
|
CHG BONE AGE STUDIES
|
Professional
|
$111.20
|
|
|
Service Code
|
HCPCS 77072
|
| Min. Negotiated Rate |
$7.32 |
| Max. Negotiated Rate |
$83.40 |
| Rate for Payer: Cash Price |
$30.27
|
| Rate for Payer: Cash Price |
$30.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.18
|
| Rate for Payer: Healthfirst QHP |
$31.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$31.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$83.40
|
| Rate for Payer: SOMOS Essential |
$83.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.77
|
|
|
CHG BONE AGE STUDIES
|
Professional
|
$74.62
|
|
|
Service Code
|
HCPCS 77072 TC
|
| Min. Negotiated Rate |
$7.32 |
| Max. Negotiated Rate |
$83.40 |
| Rate for Payer: Cash Price |
$20.27
|
| Rate for Payer: Cash Price |
$20.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$19.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$20.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20.25
|
| Rate for Payer: Healthfirst QHP |
$21.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$21.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$18.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$14.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$55.96
|
| Rate for Payer: SOMOS Essential |
$55.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.32
|
|
|
CHG BONE AGE STUDIES
|
Professional
|
$36.61
|
|
|
Service Code
|
HCPCS 77072 26
|
| Min. Negotiated Rate |
$7.32 |
| Max. Negotiated Rate |
$83.40 |
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.94
|
| Rate for Payer: Healthfirst QHP |
$10.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$7.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$10.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.46
|
| Rate for Payer: SOMOS Essential |
$27.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.46
|
|
|
CHG BONE &/JOINT IMAGING 3 PHASE STUDY
|
Professional
|
$189.00
|
|
|
Service Code
|
HCPCS 78315 26
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$1,035.12 |
| Rate for Payer: Cash Price |
$52.06
|
| Rate for Payer: Cash Price |
$52.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$48.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$48.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$51.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$54.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$51.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$51.30
|
| Rate for Payer: Healthfirst QHP |
$54.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$54.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$45.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$54.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$141.75
|
| Rate for Payer: SOMOS Essential |
$141.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.00
|
|
|
CHG BONE &/JOINT IMAGING 3 PHASE STUDY
|
Professional
|
$1,191.12
|
|
|
Service Code
|
HCPCS 78315 TC
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$1,035.12 |
| Rate for Payer: Cash Price |
$319.28
|
| Rate for Payer: Cash Price |
$319.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$306.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$306.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$323.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$340.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$323.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$340.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$340.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$255.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$323.30
|
| Rate for Payer: Healthfirst QHP |
$340.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$238.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$340.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$289.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$238.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$340.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$893.34
|
| Rate for Payer: SOMOS Essential |
$893.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$340.32
|
|
|
CHG BONE &/JOINT IMAGING 3 PHASE STUDY
|
Professional
|
$1,380.16
|
|
|
Service Code
|
HCPCS 78315
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$1,035.12 |
| Rate for Payer: Cash Price |
$371.34
|
| Rate for Payer: Cash Price |
$371.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$354.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$354.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$374.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$394.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$374.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$394.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$394.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$295.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$374.61
|
| Rate for Payer: Healthfirst QHP |
$394.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$276.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$394.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$335.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$276.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$394.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,035.12
|
| Rate for Payer: SOMOS Essential |
$1,035.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$394.33
|
|
|
CHG BONE &/JOINT IMAGING LIMITED AREA
|
Professional
|
$791.49
|
|
|
Service Code
|
HCPCS 78300 TC
|
| Min. Negotiated Rate |
$24.04 |
| Max. Negotiated Rate |
$683.79 |
| Rate for Payer: Cash Price |
$210.52
|
| Rate for Payer: Cash Price |
$210.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$203.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$203.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$214.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$226.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$214.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$226.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$226.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$169.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$214.83
|
| Rate for Payer: Healthfirst QHP |
$226.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$158.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$226.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$192.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$158.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$226.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$593.62
|
| Rate for Payer: SOMOS Essential |
$593.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$226.14
|
|
|
CHG BONE &/JOINT IMAGING LIMITED AREA
|
Professional
|
$120.23
|
|
|
Service Code
|
HCPCS 78300 26
|
| Min. Negotiated Rate |
$24.04 |
| Max. Negotiated Rate |
$683.79 |
| Rate for Payer: Cash Price |
$31.75
|
| Rate for Payer: Cash Price |
$31.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.63
|
| Rate for Payer: Healthfirst QHP |
$34.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$90.17
|
| Rate for Payer: SOMOS Essential |
$90.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.35
|
|
|
CHG BONE &/JOINT IMAGING LIMITED AREA
|
Professional
|
$911.72
|
|
|
Service Code
|
HCPCS 78300
|
| Min. Negotiated Rate |
$24.04 |
| Max. Negotiated Rate |
$683.79 |
| Rate for Payer: Cash Price |
$242.27
|
| Rate for Payer: Cash Price |
$242.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$234.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$234.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$247.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$260.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$247.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$260.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$260.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$195.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$247.47
|
| Rate for Payer: Healthfirst QHP |
$260.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$182.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$260.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$221.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$182.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$260.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$683.79
|
| Rate for Payer: SOMOS Essential |
$683.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$260.49
|
|
|
CHG BONE &/JOINT IMAGING MULTIPLE AREAS
|
Professional
|
$156.59
|
|
|
Service Code
|
HCPCS 78305 26
|
| Min. Negotiated Rate |
$31.32 |
| Max. Negotiated Rate |
$828.58 |
| Rate for Payer: Cash Price |
$42.06
|
| Rate for Payer: Cash Price |
$42.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$44.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42.50
|
| Rate for Payer: Healthfirst QHP |
$44.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$44.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$38.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$44.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$117.44
|
| Rate for Payer: SOMOS Essential |
$117.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44.74
|
|
|
CHG BONE &/JOINT IMAGING MULTIPLE AREAS
|
Professional
|
$948.19
|
|
|
Service Code
|
HCPCS 78305 TC
|
| Min. Negotiated Rate |
$31.32 |
| Max. Negotiated Rate |
$828.58 |
| Rate for Payer: Cash Price |
$250.05
|
| Rate for Payer: Cash Price |
$250.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$243.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$243.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$257.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$270.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$257.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$270.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$270.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$203.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$257.36
|
| Rate for Payer: Healthfirst QHP |
$270.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$189.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$270.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$230.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$189.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$270.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$711.14
|
| Rate for Payer: SOMOS Essential |
$711.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$270.91
|
|
|
CHG BONE &/JOINT IMAGING MULTIPLE AREAS
|
Professional
|
$1,104.78
|
|
|
Service Code
|
HCPCS 78305
|
| Min. Negotiated Rate |
$31.32 |
| Max. Negotiated Rate |
$828.58 |
| Rate for Payer: Cash Price |
$292.11
|
| Rate for Payer: Cash Price |
$292.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$284.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$284.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$299.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$315.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$299.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$315.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$315.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$236.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$299.87
|
| Rate for Payer: Healthfirst QHP |
$315.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$220.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$315.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$268.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$220.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$315.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$828.58
|
| Rate for Payer: SOMOS Essential |
$828.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$315.65
|
|
|
CHG BONE &/JOINT IMAGING WHOLE BODY
|
Professional
|
$1,180.41
|
|
|
Service Code
|
HCPCS 78306
|
| Min. Negotiated Rate |
$32.07 |
| Max. Negotiated Rate |
$885.31 |
| Rate for Payer: Cash Price |
$315.55
|
| Rate for Payer: Cash Price |
$315.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$303.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$303.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$320.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$337.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$320.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$337.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$337.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$252.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$320.40
|
| Rate for Payer: Healthfirst QHP |
$337.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$236.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$337.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$286.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$236.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$337.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$885.31
|
| Rate for Payer: SOMOS Essential |
$885.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$337.26
|
|
|
CHG BONE &/JOINT IMAGING WHOLE BODY
|
Professional
|
$160.34
|
|
|
Service Code
|
HCPCS 78306 26
|
| Min. Negotiated Rate |
$32.07 |
| Max. Negotiated Rate |
$885.31 |
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$45.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43.52
|
| Rate for Payer: Healthfirst QHP |
$45.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$45.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$38.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$120.26
|
| Rate for Payer: SOMOS Essential |
$120.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.81
|
|
|
CHG BONE &/JOINT IMAGING WHOLE BODY
|
Professional
|
$1,020.08
|
|
|
Service Code
|
HCPCS 78306 TC
|
| Min. Negotiated Rate |
$32.07 |
| Max. Negotiated Rate |
$885.31 |
| Rate for Payer: Cash Price |
$272.05
|
| Rate for Payer: Cash Price |
$272.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$262.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$262.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$276.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$291.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$276.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$291.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$291.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$218.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$276.88
|
| Rate for Payer: Healthfirst QHP |
$291.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$204.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$291.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$247.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$204.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$291.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$765.06
|
| Rate for Payer: SOMOS Essential |
$765.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$291.45
|
|
|
CHG BONE LENGTH STUDIES
|
Professional
|
$193.13
|
|
|
Service Code
|
HCPCS 77073
|
| Min. Negotiated Rate |
$10.77 |
| Max. Negotiated Rate |
$144.85 |
| Rate for Payer: Cash Price |
$52.99
|
| Rate for Payer: Cash Price |
$52.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$49.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$49.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$52.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$55.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$52.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$52.42
|
| Rate for Payer: Healthfirst QHP |
$55.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$38.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$55.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$46.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$38.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$55.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$144.85
|
| Rate for Payer: SOMOS Essential |
$144.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.18
|
|
|
CHG BONE LENGTH STUDIES
|
Professional
|
$53.87
|
|
|
Service Code
|
HCPCS 77073 26
|
| Min. Negotiated Rate |
$10.77 |
| Max. Negotiated Rate |
$144.85 |
| Rate for Payer: Cash Price |
$14.64
|
| Rate for Payer: Cash Price |
$14.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.62
|
| Rate for Payer: Healthfirst QHP |
$15.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$10.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$15.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$13.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.40
|
| Rate for Payer: SOMOS Essential |
$40.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.39
|
|
|
CHG BONE LENGTH STUDIES
|
Professional
|
$139.30
|
|
|
Service Code
|
HCPCS 77073 TC
|
| Min. Negotiated Rate |
$10.77 |
| Max. Negotiated Rate |
$144.85 |
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$39.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.81
|
| Rate for Payer: Healthfirst QHP |
$39.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$39.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$104.48
|
| Rate for Payer: SOMOS Essential |
$104.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.80
|
|
|
CHG BONE MARROW BLOOD SUPPLY
|
Professional
|
$1,304.17
|
|
|
Service Code
|
HCPCS 77084
|
| Min. Negotiated Rate |
$61.42 |
| Max. Negotiated Rate |
$978.13 |
| Rate for Payer: Cash Price |
$379.77
|
| Rate for Payer: Cash Price |
$379.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$364.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$364.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$385.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$405.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$385.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$405.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$405.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$304.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$385.21
|
| Rate for Payer: Healthfirst QHP |
$405.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$283.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$405.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$344.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$283.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$405.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$978.13
|
| Rate for Payer: SOMOS Essential |
$978.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$405.48
|
|
