|
CHG BONE MARROW BLOOD SUPPLY
|
Professional
|
$997.08
|
|
|
Service Code
|
HCPCS 77084 TC
|
| Min. Negotiated Rate |
$61.42 |
| Max. Negotiated Rate |
$978.13 |
| Rate for Payer: Cash Price |
$296.58
|
| Rate for Payer: Cash Price |
$296.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$285.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$285.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$301.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$317.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$301.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$317.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$317.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$238.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$301.84
|
| Rate for Payer: Healthfirst QHP |
$317.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$222.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$317.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$270.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$222.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$317.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$747.81
|
| Rate for Payer: SOMOS Essential |
$747.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$317.73
|
|
|
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
|
|
|
CHG BONE MARROW IMAGING LIMITED AREA
|
Professional
|
$597.45
|
|
|
Service Code
|
HCPCS 78102 TC
|
| Min. Negotiated Rate |
$19.76 |
| Max. Negotiated Rate |
$522.20 |
| Rate for Payer: Cash Price |
$161.25
|
| Rate for Payer: Cash Price |
$161.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$153.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$153.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$170.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$170.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$170.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$128.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$162.16
|
| Rate for Payer: Healthfirst QHP |
$170.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$119.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$170.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$145.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$119.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$170.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$448.09
|
| Rate for Payer: SOMOS Essential |
$448.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$170.70
|
|
|
CHG BONE MARROW IMAGING LIMITED AREA
|
Professional
|
$98.81
|
|
|
Service Code
|
HCPCS 78102 26
|
| Min. Negotiated Rate |
$19.76 |
| Max. Negotiated Rate |
$522.20 |
| Rate for Payer: Cash Price |
$26.72
|
| Rate for Payer: Cash Price |
$26.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.82
|
| Rate for Payer: Healthfirst QHP |
$28.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$74.11
|
| Rate for Payer: SOMOS Essential |
$74.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.23
|
|
|
CHG BONE MARROW IMAGING LIMITED AREA
|
Professional
|
$696.26
|
|
|
Service Code
|
HCPCS 78102
|
| Min. Negotiated Rate |
$19.76 |
| Max. Negotiated Rate |
$522.20 |
| Rate for Payer: Cash Price |
$187.97
|
| Rate for Payer: Cash Price |
$187.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$179.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$179.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$188.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$198.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$188.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$198.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$198.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$149.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$188.98
|
| Rate for Payer: Healthfirst QHP |
$198.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$139.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$198.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$169.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$139.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$198.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$522.20
|
| Rate for Payer: SOMOS Essential |
$522.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$198.93
|
|
|
CHG BONE MARROW IMAGING MULTIPLE AREAS
|
Professional
|
$113.93
|
|
|
Service Code
|
HCPCS 78103 26
|
| Min. Negotiated Rate |
$22.78 |
| Max. Negotiated Rate |
$557.24 |
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.92
|
| Rate for Payer: Healthfirst QHP |
$32.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$85.45
|
| Rate for Payer: SOMOS Essential |
$85.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.55
|
|
|
CHG BONE MARROW IMAGING MULTIPLE AREAS
|
Professional
|
$629.06
|
|
|
Service Code
|
HCPCS 78103 TC
|
| Min. Negotiated Rate |
$22.78 |
| Max. Negotiated Rate |
$557.24 |
| Rate for Payer: Cash Price |
$167.93
|
| Rate for Payer: Cash Price |
$167.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$161.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$161.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$170.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$179.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$170.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$179.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$179.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$134.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$170.74
|
| Rate for Payer: Healthfirst QHP |
$179.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$125.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$179.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$152.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$125.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$179.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$471.80
|
| Rate for Payer: SOMOS Essential |
$471.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$179.73
|
|
|
CHG BONE MARROW IMAGING MULTIPLE AREAS
|
Professional
|
$742.98
|
|
|
Service Code
|
HCPCS 78103
|
| Min. Negotiated Rate |
$22.78 |
| Max. Negotiated Rate |
$557.24 |
| Rate for Payer: Cash Price |
$199.42
|
| Rate for Payer: Cash Price |
$199.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$191.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$191.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$201.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$212.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$201.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$212.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$212.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$159.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$201.67
|
| Rate for Payer: Healthfirst QHP |
$212.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$148.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$212.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$180.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$148.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$212.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$557.24
|
| Rate for Payer: SOMOS Essential |
$557.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$212.28
|
|
|
CHG BONE MARROW IMAGING WHOLE BODY
|
Professional
|
$856.21
|
|
|
Service Code
|
HCPCS 78104 TC
|
| Min. Negotiated Rate |
$29.70 |
| Max. Negotiated Rate |
$753.53 |
| Rate for Payer: Cash Price |
$229.46
|
| Rate for Payer: Cash Price |
$229.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$220.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$220.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$232.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$244.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$232.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$244.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$244.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$183.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$232.40
|
| Rate for Payer: Healthfirst QHP |
$244.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$171.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$244.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$207.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$171.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$244.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$642.16
|
| Rate for Payer: SOMOS Essential |
$642.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$244.63
|
|
|
CHG BONE MARROW IMAGING WHOLE BODY
|
Professional
|
$148.51
|
|
|
Service Code
|
HCPCS 78104 26
|
| Min. Negotiated Rate |
$29.70 |
| Max. Negotiated Rate |
$753.53 |
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$42.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$40.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.31
|
| Rate for Payer: Healthfirst QHP |
$42.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$42.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$36.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$42.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$111.38
|
| Rate for Payer: SOMOS Essential |
$111.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.43
|
|
|
CHG BONE MARROW IMAGING WHOLE BODY
|
Professional
|
$1,004.71
|
|
|
Service Code
|
HCPCS 78104
|
| Min. Negotiated Rate |
$29.70 |
| Max. Negotiated Rate |
$753.53 |
| Rate for Payer: Cash Price |
$269.06
|
| Rate for Payer: Cash Price |
$269.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$258.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$258.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$272.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$287.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$272.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$287.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$287.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$215.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$272.71
|
| Rate for Payer: Healthfirst QHP |
$287.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$200.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$287.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$244.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$200.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$287.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$753.53
|
| Rate for Payer: SOMOS Essential |
$753.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$287.06
|
|
|
CHG BONE MARROW SMEAR INTERPRETATION
|
Professional
|
$190.51
|
|
|
Service Code
|
HCPCS 85097
|
| Min. Negotiated Rate |
$38.10 |
| Max. Negotiated Rate |
$142.88 |
| Rate for Payer: Cash Price |
$52.41
|
| Rate for Payer: Cash Price |
$52.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$48.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$48.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$51.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$54.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$51.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$51.71
|
| Rate for Payer: Healthfirst QHP |
$54.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$38.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$54.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$46.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$38.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$54.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$142.88
|
| Rate for Payer: SOMOS Essential |
$142.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.43
|
|
|
CHG BRACHYTX ISODOSE PLN CPLX W/DOSIMETRY CAL
|
Professional
|
$611.66
|
|
|
Service Code
|
HCPCS 77318 26
|
| Min. Negotiated Rate |
$122.33 |
| Max. Negotiated Rate |
$1,448.72 |
| Rate for Payer: Cash Price |
$167.58
|
| Rate for Payer: Cash Price |
$167.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$157.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$157.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$166.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$174.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$166.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$174.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$131.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$166.02
|
| Rate for Payer: Healthfirst QHP |
$174.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$122.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$174.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$148.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$122.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$174.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$458.74
|
| Rate for Payer: SOMOS Essential |
$458.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$174.76
|
|
|
CHG BRACHYTX ISODOSE PLN CPLX W/DOSIMETRY CAL
|
Professional
|
$1,319.96
|
|
|
Service Code
|
HCPCS 77318 TC
|
| Min. Negotiated Rate |
$122.33 |
| Max. Negotiated Rate |
$1,448.72 |
| Rate for Payer: Cash Price |
$365.95
|
| Rate for Payer: Cash Price |
$365.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$339.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$339.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$358.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$377.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$358.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$377.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$377.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$282.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$358.27
|
| Rate for Payer: Healthfirst QHP |
$377.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$263.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$377.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$320.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$263.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$377.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$989.97
|
| Rate for Payer: SOMOS Essential |
$989.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$377.13
|
|
|
CHG BRACHYTX ISODOSE PLN CPLX W/DOSIMETRY CAL
|
Professional
|
$1,931.62
|
|
|
Service Code
|
HCPCS 77318
|
| Min. Negotiated Rate |
$122.33 |
| Max. Negotiated Rate |
$1,448.72 |
| Rate for Payer: Cash Price |
$533.53
|
| Rate for Payer: Cash Price |
$533.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$496.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$496.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$524.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$551.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$524.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$551.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$551.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$413.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$524.30
|
| Rate for Payer: Healthfirst QHP |
$551.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$386.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$551.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$469.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$386.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$551.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,448.72
|
| Rate for Payer: SOMOS Essential |
$1,448.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$551.89
|
|
|
CHG BRACHYTX ISODOSE PLN INTERMED W/DOSIMETRY CAL
|
Professional
|
$387.66
|
|
|
Service Code
|
HCPCS 77317 26
|
| Min. Negotiated Rate |
$77.53 |
| Max. Negotiated Rate |
$1,023.26 |
| Rate for Payer: Cash Price |
$106.54
|
| Rate for Payer: Cash Price |
$106.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$99.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$99.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$105.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$110.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$105.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$110.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$110.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$83.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$105.22
|
| Rate for Payer: Healthfirst QHP |
$110.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$77.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$110.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$94.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$77.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$110.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$290.74
|
| Rate for Payer: SOMOS Essential |
$290.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$110.76
|
|
|
CHG BRACHYTX ISODOSE PLN INTERMED W/DOSIMETRY CAL
|
Professional
|
$1,364.34
|
|
|
Service Code
|
HCPCS 77317
|
| Min. Negotiated Rate |
$77.53 |
| Max. Negotiated Rate |
$1,023.26 |
| Rate for Payer: Cash Price |
$377.10
|
| Rate for Payer: Cash Price |
$377.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$350.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$350.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$370.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$389.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$370.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$389.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$389.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$292.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$370.32
|
| Rate for Payer: Healthfirst QHP |
$389.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$272.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$389.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$331.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$272.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$389.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,023.26
|
| Rate for Payer: SOMOS Essential |
$1,023.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$389.81
|
|
|
CHG BRACHYTX ISODOSE PLN INTERMED W/DOSIMETRY CAL
|
Professional
|
$976.68
|
|
|
Service Code
|
HCPCS 77317 TC
|
| Min. Negotiated Rate |
$77.53 |
| Max. Negotiated Rate |
$1,023.26 |
| Rate for Payer: Cash Price |
$270.55
|
| Rate for Payer: Cash Price |
$270.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$251.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$251.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$265.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$279.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$265.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$279.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$279.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$209.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$265.10
|
| Rate for Payer: Healthfirst QHP |
$279.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$195.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$279.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$237.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$195.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$279.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$732.51
|
| Rate for Payer: SOMOS Essential |
$732.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$279.05
|
|
|
CHG BRACHYTX ISODOSE PLN SMPL W/DOSIMETRY CAL
|
Professional
|
$739.76
|
|
|
Service Code
|
HCPCS 77316 TC
|
| Min. Negotiated Rate |
$59.34 |
| Max. Negotiated Rate |
$777.34 |
| Rate for Payer: Cash Price |
$205.49
|
| Rate for Payer: Cash Price |
$205.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$190.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$190.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$200.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$211.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$200.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$211.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$211.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$158.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$200.79
|
| Rate for Payer: Healthfirst QHP |
$211.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$147.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$211.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$179.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$147.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$211.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$554.82
|
| Rate for Payer: SOMOS Essential |
$554.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$211.36
|
|
|
CHG BRACHYTX ISODOSE PLN SMPL W/DOSIMETRY CAL
|
Professional
|
$296.70
|
|
|
Service Code
|
HCPCS 77316 26
|
| Min. Negotiated Rate |
$59.34 |
| Max. Negotiated Rate |
$777.34 |
| Rate for Payer: Cash Price |
$81.26
|
| Rate for Payer: Cash Price |
$81.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$76.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$76.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$80.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$84.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$80.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$84.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$84.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$63.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$80.53
|
| Rate for Payer: Healthfirst QHP |
$84.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$59.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$84.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$72.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$59.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$84.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$222.52
|
| Rate for Payer: SOMOS Essential |
$222.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$84.77
|
|
|
CHG BRACHYTX ISODOSE PLN SMPL W/DOSIMETRY CAL
|
Professional
|
$1,036.46
|
|
|
Service Code
|
HCPCS 77316
|
| Min. Negotiated Rate |
$59.34 |
| Max. Negotiated Rate |
$777.34 |
| Rate for Payer: Cash Price |
$286.75
|
| Rate for Payer: Cash Price |
$286.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$266.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$266.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$281.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$296.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$281.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$296.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$296.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$222.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$281.32
|
| Rate for Payer: Healthfirst QHP |
$296.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$207.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$296.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$251.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$207.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$296.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$777.34
|
| Rate for Payer: SOMOS Essential |
$777.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$296.13
|
|
|
CHG BRAIN IMAGING <4 STATIC VIEWS
|
Professional
|
$82.15
|
|
|
Service Code
|
HCPCS 78600 26
|
| Min. Negotiated Rate |
$16.43 |
| Max. Negotiated Rate |
$549.57 |
| Rate for Payer: Cash Price |
$22.49
|
| Rate for Payer: Cash Price |
$22.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$23.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.30
|
| Rate for Payer: Healthfirst QHP |
$23.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$16.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$23.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$19.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$16.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$61.61
|
| Rate for Payer: SOMOS Essential |
$61.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.47
|
|
|
CHG BRAIN IMAGING <4 STATIC VIEWS
|
Professional
|
$650.62
|
|
|
Service Code
|
HCPCS 78600 TC
|
| Min. Negotiated Rate |
$16.43 |
| Max. Negotiated Rate |
$549.57 |
| Rate for Payer: Cash Price |
$175.39
|
| Rate for Payer: Cash Price |
$175.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$167.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$167.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$176.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$185.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$176.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$185.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$185.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$139.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$176.60
|
| Rate for Payer: Healthfirst QHP |
$185.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$130.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$185.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$158.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$130.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$185.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$487.96
|
| Rate for Payer: SOMOS Essential |
$487.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$185.89
|
|
|
CHG BRAIN IMAGING <4 STATIC VIEWS
|
Professional
|
$732.76
|
|
|
Service Code
|
HCPCS 78600
|
| Min. Negotiated Rate |
$16.43 |
| Max. Negotiated Rate |
$549.57 |
| Rate for Payer: Cash Price |
$197.88
|
| Rate for Payer: Cash Price |
$197.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$188.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$188.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$198.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$209.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$198.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$157.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$198.89
|
| Rate for Payer: Healthfirst QHP |
$209.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$146.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$209.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$177.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$146.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$209.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$549.57
|
| Rate for Payer: SOMOS Essential |
$549.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$209.36
|
|
|
CHG BRAIN IMAGING <4 STATIC VIEWS W/VASCULAR FLOW
|
Professional
|
$93.80
|
|
|
Service Code
|
HCPCS 78601 26
|
| Min. Negotiated Rate |
$18.76 |
| Max. Negotiated Rate |
$653.18 |
| Rate for Payer: Cash Price |
$25.72
|
| Rate for Payer: Cash Price |
$25.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.46
|
| Rate for Payer: Healthfirst QHP |
$26.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$70.35
|
| Rate for Payer: SOMOS Essential |
$70.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.80
|
|
