|
CHG GASTROESOPHAGEAL REFLUX STUDY
|
Professional
|
$989.70
|
|
|
Service Code
|
HCPCS 78262
|
| Min. Negotiated Rate |
$26.41 |
| Max. Negotiated Rate |
$742.28 |
| Rate for Payer: Cash Price |
$265.66
|
| Rate for Payer: Cash Price |
$265.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$254.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$254.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$268.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$282.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$268.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$282.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$282.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$212.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$268.63
|
| Rate for Payer: Healthfirst QHP |
$282.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$197.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$282.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$240.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$197.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$282.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$742.28
|
| Rate for Payer: SOMOS Essential |
$742.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$282.77
|
|
|
CHG GASTROESOPHAGEAL REFLUX STUDY
|
Professional
|
$132.06
|
|
|
Service Code
|
HCPCS 78262 26
|
| Min. Negotiated Rate |
$26.41 |
| Max. Negotiated Rate |
$742.28 |
| Rate for Payer: Cash Price |
$35.02
|
| Rate for Payer: Cash Price |
$35.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.84
|
| Rate for Payer: Healthfirst QHP |
$37.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$99.04
|
| Rate for Payer: SOMOS Essential |
$99.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.73
|
|
|
CHG GASTROESOPHAGEAL REFLUX STUDY
|
Professional
|
$857.64
|
|
|
Service Code
|
HCPCS 78262 TC
|
| Min. Negotiated Rate |
$26.41 |
| Max. Negotiated Rate |
$742.28 |
| Rate for Payer: Cash Price |
$230.64
|
| Rate for Payer: Cash Price |
$230.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$220.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$220.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$232.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$245.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$232.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$245.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$245.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$183.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$232.79
|
| Rate for Payer: Healthfirst QHP |
$245.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$171.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$245.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$208.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$171.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$245.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$643.23
|
| Rate for Payer: SOMOS Essential |
$643.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$245.04
|
|
|
CHG GASTROINTESTINAL PROTEIN LOSS
|
Professional
|
$292.85
|
|
|
Service Code
|
HCPCS 78282
|
| Min. Negotiated Rate |
$11.79 |
| Max. Negotiated Rate |
$219.64 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$219.64
|
| Rate for Payer: SOMOS Essential |
$219.64
|
|
|
CHG GASTROINTESTINAL PROTEIN LOSS
|
Professional
|
$233.91
|
|
|
Service Code
|
HCPCS 78282 TC
|
| Min. Negotiated Rate |
$11.79 |
| Max. Negotiated Rate |
$219.64 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$175.43
|
| Rate for Payer: SOMOS Essential |
$175.43
|
|
|
CHG GASTROINTESTINAL PROTEIN LOSS
|
Professional
|
$58.94
|
|
|
Service Code
|
HCPCS 78282 26
|
| Min. Negotiated Rate |
$11.79 |
| Max. Negotiated Rate |
$219.64 |
| Rate for Payer: Cash Price |
$16.23
|
| Rate for Payer: Cash Price |
$16.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.00
|
| Rate for Payer: Healthfirst QHP |
$16.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$14.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$44.20
|
| Rate for Payer: SOMOS Essential |
$44.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.84
|
|
|
CHG GI ENDOSCOPIC US S&I
|
Professional
|
$311.64
|
|
|
Service Code
|
HCPCS 76975 TC
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$356.84 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$233.73
|
| Rate for Payer: SOMOS Essential |
$233.73
|
|
|
CHG GI ENDOSCOPIC US S&I
|
Professional
|
$475.79
|
|
|
Service Code
|
HCPCS 76975
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$356.84 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$356.84
|
| Rate for Payer: SOMOS Essential |
$356.84
|
|
|
CHG GI ENDOSCOPIC US S&I
|
Professional
|
$164.15
|
|
|
Service Code
|
HCPCS 76975 26
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$356.84 |
| Rate for Payer: Cash Price |
$44.27
|
| Rate for Payer: Cash Price |
$44.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$42.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$44.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$44.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.56
|
| Rate for Payer: Healthfirst QHP |
$46.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$46.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$123.11
|
| Rate for Payer: SOMOS Essential |
$123.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.90
|
|
|
CHG GLUC BLD GLUC MNTR DEV CLEARED FDA SPEC HOME USE
|
Professional
|
$8.00
|
|
|
Service Code
|
HCPCS 82962
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$6.00 |
| Rate for Payer: Cash Price |
$3.28
|
| Rate for Payer: Cash Price |
$3.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.12
|
| Rate for Payer: Healthfirst QHP |
$3.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.00
|
| Rate for Payer: SOMOS Essential |
$6.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.28
|
|
|
CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP
|
Professional
|
$9.82
|
|
|
Service Code
|
HCPCS 82947
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$7.36 |
| Rate for Payer: Cash Price |
$3.93
|
| Rate for Payer: Cash Price |
$3.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.73
|
| Rate for Payer: Healthfirst QHP |
$3.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.36
|
| Rate for Payer: SOMOS Essential |
$7.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.93
|
|
|
CHG GSTRC EMPTNG IMAG STD W/SM BWL COL TRNST MLT DAY
|
Professional
|
$1,584.59
|
|
|
Service Code
|
HCPCS 78266 TC
|
| Min. Negotiated Rate |
$38.44 |
| Max. Negotiated Rate |
$1,332.61 |
| Rate for Payer: Cash Price |
$426.39
|
| Rate for Payer: Cash Price |
$426.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$407.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$407.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$430.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$452.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$430.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$452.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$452.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$339.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$430.10
|
| Rate for Payer: Healthfirst QHP |
$452.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$316.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$452.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$384.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$316.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$452.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,188.44
|
| Rate for Payer: SOMOS Essential |
$1,188.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$452.74
|
|
|
CHG GSTRC EMPTNG IMAG STD W/SM BWL COL TRNST MLT DAY
|
Professional
|
$1,776.81
|
|
|
Service Code
|
HCPCS 78266
|
| Min. Negotiated Rate |
$38.44 |
| Max. Negotiated Rate |
$1,332.61 |
| Rate for Payer: Cash Price |
$479.13
|
| Rate for Payer: Cash Price |
$479.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$456.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$456.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$482.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$507.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$482.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$507.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$507.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$380.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$482.28
|
| Rate for Payer: Healthfirst QHP |
$507.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$355.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$507.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$431.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$355.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$507.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,332.61
|
| Rate for Payer: SOMOS Essential |
$1,332.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$507.66
|
|
|
CHG GSTRC EMPTNG IMAG STD W/SM BWL COL TRNST MLT DAY
|
Professional
|
$192.22
|
|
|
Service Code
|
HCPCS 78266 26
|
| Min. Negotiated Rate |
$38.44 |
| Max. Negotiated Rate |
$1,332.61 |
| Rate for Payer: Cash Price |
$52.74
|
| Rate for Payer: Cash Price |
$52.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$49.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$49.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$52.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$54.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$52.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$52.17
|
| Rate for Payer: Healthfirst QHP |
$54.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$38.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$54.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$46.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$38.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$54.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$144.16
|
| Rate for Payer: SOMOS Essential |
$144.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.92
|
|
|
CHG HDR RDNCL NTRSTL/INTRCAV BRACHYTX >12 CHANNELS
|
Professional
|
$3,796.03
|
|
|
Service Code
|
HCPCS 77772
|
| Min. Negotiated Rate |
$226.37 |
| Max. Negotiated Rate |
$2,847.02 |
| Rate for Payer: Cash Price |
$1,051.69
|
| Rate for Payer: Cash Price |
$1,051.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$976.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$976.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,030.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,084.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,030.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,084.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,084.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$813.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,030.35
|
| Rate for Payer: Healthfirst QHP |
$1,084.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$759.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,084.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$921.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$759.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,084.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,847.02
|
| Rate for Payer: SOMOS Essential |
$2,847.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,084.58
|
|
|
CHG HDR RDNCL NTRSTL/INTRCAV BRACHYTX >12 CHANNELS
|
Professional
|
$2,664.20
|
|
|
Service Code
|
HCPCS 77772 TC
|
| Min. Negotiated Rate |
$226.37 |
| Max. Negotiated Rate |
$2,847.02 |
| Rate for Payer: Cash Price |
$740.54
|
| Rate for Payer: Cash Price |
$740.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$685.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$685.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$723.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$761.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$723.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$761.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$761.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$570.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$723.14
|
| Rate for Payer: Healthfirst QHP |
$761.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$532.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$761.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$647.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$532.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$761.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,998.15
|
| Rate for Payer: SOMOS Essential |
$1,998.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$761.20
|
|
|
CHG HDR RDNCL NTRSTL/INTRCAV BRACHYTX >12 CHANNELS
|
Professional
|
$1,131.83
|
|
|
Service Code
|
HCPCS 77772 26
|
| Min. Negotiated Rate |
$226.37 |
| Max. Negotiated Rate |
$2,847.02 |
| Rate for Payer: Cash Price |
$311.15
|
| Rate for Payer: Cash Price |
$311.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$291.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$291.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$307.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$323.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$307.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$323.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$323.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$242.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$307.21
|
| Rate for Payer: Healthfirst QHP |
$323.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$226.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$323.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$274.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$226.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$323.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$848.87
|
| Rate for Payer: SOMOS Essential |
$848.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$323.38
|
|
|
CHG HDR RDNCL NTRSTL/INTRCAV BRACHYTX 1 CHANNEL
|
Professional
|
$1,054.55
|
|
|
Service Code
|
HCPCS 77770 TC
|
| Min. Negotiated Rate |
$82.26 |
| Max. Negotiated Rate |
$1,099.40 |
| Rate for Payer: Cash Price |
$292.17
|
| Rate for Payer: Cash Price |
$292.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$271.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$271.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$286.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$301.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$286.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$301.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$301.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$225.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$286.24
|
| Rate for Payer: Healthfirst QHP |
$301.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$210.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$301.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$256.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$210.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$301.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$790.91
|
| Rate for Payer: SOMOS Essential |
$790.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$301.30
|
|
|
CHG HDR RDNCL NTRSTL/INTRCAV BRACHYTX 1 CHANNEL
|
Professional
|
$1,465.87
|
|
|
Service Code
|
HCPCS 77770
|
| Min. Negotiated Rate |
$82.26 |
| Max. Negotiated Rate |
$1,099.40 |
| Rate for Payer: Cash Price |
$405.25
|
| Rate for Payer: Cash Price |
$405.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$376.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$376.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$397.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$418.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$397.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$418.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$418.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$314.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$397.88
|
| Rate for Payer: Healthfirst QHP |
$418.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$293.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$418.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$356.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$293.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$418.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,099.40
|
| Rate for Payer: SOMOS Essential |
$1,099.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$418.82
|
|
|
CHG HDR RDNCL NTRSTL/INTRCAV BRACHYTX 1 CHANNEL
|
Professional
|
$411.32
|
|
|
Service Code
|
HCPCS 77770 26
|
| Min. Negotiated Rate |
$82.26 |
| Max. Negotiated Rate |
$1,099.40 |
| Rate for Payer: Cash Price |
$113.09
|
| Rate for Payer: Cash Price |
$113.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$105.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$105.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$111.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$117.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$111.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$117.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$117.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$111.64
|
| Rate for Payer: Healthfirst QHP |
$117.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$82.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$117.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$99.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$82.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$117.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$308.49
|
| Rate for Payer: SOMOS Essential |
$308.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$117.52
|
|
|
CHG HDR RDNCL NTRSTL/INTRCAV BRACHYTX 2-12 CHANNEL
|
Professional
|
$1,740.87
|
|
|
Service Code
|
HCPCS 77771 TC
|
| Min. Negotiated Rate |
$161.41 |
| Max. Negotiated Rate |
$1,910.95 |
| Rate for Payer: Cash Price |
$483.11
|
| Rate for Payer: Cash Price |
$483.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$447.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$447.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$472.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$497.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$472.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$497.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$497.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$373.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$472.52
|
| Rate for Payer: Healthfirst QHP |
$497.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$348.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$497.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$422.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$348.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$497.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,305.65
|
| Rate for Payer: SOMOS Essential |
$1,305.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$497.39
|
|
|
CHG HDR RDNCL NTRSTL/INTRCAV BRACHYTX 2-12 CHANNEL
|
Professional
|
$2,547.93
|
|
|
Service Code
|
HCPCS 77771
|
| Min. Negotiated Rate |
$161.41 |
| Max. Negotiated Rate |
$1,910.95 |
| Rate for Payer: Cash Price |
$703.44
|
| Rate for Payer: Cash Price |
$703.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$655.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$655.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$691.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$727.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$691.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$727.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$727.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$545.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$691.58
|
| Rate for Payer: Healthfirst QHP |
$727.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$509.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$727.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$618.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$509.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$727.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,910.95
|
| Rate for Payer: SOMOS Essential |
$1,910.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$727.98
|
|
|
CHG HDR RDNCL NTRSTL/INTRCAV BRACHYTX 2-12 CHANNEL
|
Professional
|
$807.07
|
|
|
Service Code
|
HCPCS 77771 26
|
| Min. Negotiated Rate |
$161.41 |
| Max. Negotiated Rate |
$1,910.95 |
| Rate for Payer: Cash Price |
$220.33
|
| Rate for Payer: Cash Price |
$220.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$207.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$207.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$230.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$230.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$230.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$172.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$219.06
|
| Rate for Payer: Healthfirst QHP |
$230.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$161.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$230.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$196.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$161.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$230.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$605.30
|
| Rate for Payer: SOMOS Essential |
$605.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$230.59
|
|
|
CHG HDR RDNCL SKN SURF BRACHYTX LES <2CM/1 CHAN
|
Professional
|
$221.52
|
|
|
Service Code
|
HCPCS 77767 26
|
| Min. Negotiated Rate |
$44.30 |
| Max. Negotiated Rate |
$795.35 |
| Rate for Payer: Cash Price |
$60.73
|
| Rate for Payer: Cash Price |
$60.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$56.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$56.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$60.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$63.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$60.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.13
|
| Rate for Payer: Healthfirst QHP |
$63.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$44.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$63.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$53.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$44.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$63.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$166.14
|
| Rate for Payer: SOMOS Essential |
$166.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$63.29
|
|
|
CHG HDR RDNCL SKN SURF BRACHYTX LES <2CM/1 CHAN
|
Professional
|
$838.95
|
|
|
Service Code
|
HCPCS 77767 TC
|
| Min. Negotiated Rate |
$44.30 |
| Max. Negotiated Rate |
$795.35 |
| Rate for Payer: Cash Price |
$231.42
|
| Rate for Payer: Cash Price |
$231.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$215.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$215.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$227.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$239.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$227.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$239.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$239.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$179.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$227.72
|
| Rate for Payer: Healthfirst QHP |
$239.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$167.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$239.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$203.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$167.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$239.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$629.21
|
| Rate for Payer: SOMOS Essential |
$629.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$239.70
|
|
