|
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 SK SRF BRCHYTX LES >2CM&2CHAN/MLT LES
|
Professional
|
$1,256.85
|
|
|
Service Code
|
HCPCS 77768 TC
|
| Min. Negotiated Rate |
$59.34 |
| Max. Negotiated Rate |
$1,165.16 |
| Rate for Payer: Cash Price |
$347.41
|
| Rate for Payer: Cash Price |
$347.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$323.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$323.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$341.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$359.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$341.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$359.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$359.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$269.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$341.14
|
| Rate for Payer: Healthfirst QHP |
$359.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$251.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$359.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$305.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$251.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$359.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$942.64
|
| Rate for Payer: SOMOS Essential |
$942.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$359.10
|
|
|
CHG HDR RDNCL SK SRF BRCHYTX LES >2CM&2CHAN/MLT LES
|
Professional
|
$1,553.55
|
|
|
Service Code
|
HCPCS 77768
|
| Min. Negotiated Rate |
$59.34 |
| Max. Negotiated Rate |
$1,165.16 |
| Rate for Payer: Cash Price |
$428.67
|
| Rate for Payer: Cash Price |
$428.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$399.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$399.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$421.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$443.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$421.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$443.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$443.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$332.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$421.68
|
| Rate for Payer: Healthfirst QHP |
$443.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$310.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$443.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$377.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$310.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$443.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,165.16
|
| Rate for Payer: SOMOS Essential |
$1,165.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$443.87
|
|
|
CHG HDR RDNCL SK SRF BRCHYTX LES >2CM&2CHAN/MLT LES
|
Professional
|
$296.70
|
|
|
Service Code
|
HCPCS 77768 26
|
| Min. Negotiated Rate |
$59.34 |
| Max. Negotiated Rate |
$1,165.16 |
| 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 HEMOGLOBIN FRACTJ/QUANTJ ELECTROPHORESIS
|
Professional
|
$69.20
|
|
|
Service Code
|
HCPCS 83020 26
|
| Min. Negotiated Rate |
$13.84 |
| Max. Negotiated Rate |
$51.90 |
| Rate for Payer: Cash Price |
$19.03
|
| Rate for Payer: Cash Price |
$19.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.78
|
| Rate for Payer: Healthfirst QHP |
$19.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$51.90
|
| Rate for Payer: SOMOS Essential |
$51.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.77
|
|
|
CHG HEMOGLOBIN GLYCOSYLATED A1C
|
Professional
|
$24.27
|
|
|
Service Code
|
HCPCS 83036
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$18.20 |
| Rate for Payer: Cash Price |
$9.71
|
| Rate for Payer: Cash Price |
$9.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.22
|
| Rate for Payer: Healthfirst QHP |
$9.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18.20
|
| Rate for Payer: SOMOS Essential |
$18.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.71
|
|
|
CHG HEPATC VNGRPH WDG/FR HEMODYN EVAL RS&I
|
Professional
|
$525.21
|
|
|
Service Code
|
HCPCS 75889
|
| Min. Negotiated Rate |
$41.85 |
| Max. Negotiated Rate |
$393.91 |
| Rate for Payer: Cash Price |
$142.67
|
| Rate for Payer: Cash Price |
$142.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$135.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$135.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$142.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$150.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$142.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$112.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$142.56
|
| Rate for Payer: Healthfirst QHP |
$150.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$105.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$150.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$127.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$105.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$150.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$393.91
|
| Rate for Payer: SOMOS Essential |
$393.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$150.06
|
|
|
CHG HEPATC VNGRPH WDG/FR HEMODYN EVAL RS&I
|
Professional
|
$209.23
|
|
|
Service Code
|
HCPCS 75889 26
|
| Min. Negotiated Rate |
$41.85 |
| Max. Negotiated Rate |
$393.91 |
| Rate for Payer: Cash Price |
$56.94
|
| Rate for Payer: Cash Price |
$56.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$53.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$56.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$59.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$56.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$56.79
|
| Rate for Payer: Healthfirst QHP |
$59.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$41.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$59.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$50.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$41.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$59.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$156.92
|
| Rate for Payer: SOMOS Essential |
$156.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$59.78
|
|
|
CHG HEPATC VNGRPH WDG/FR HEMODYN EVAL RS&I
|
Professional
|
$315.98
|
|
|
Service Code
|
HCPCS 75889 TC
|
| Min. Negotiated Rate |
$41.85 |
| Max. Negotiated Rate |
$393.91 |
| Rate for Payer: Cash Price |
$85.73
|
| Rate for Payer: Cash Price |
$85.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$81.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$81.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$85.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$90.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$85.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$90.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$85.77
|
| Rate for Payer: Healthfirst QHP |
$90.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$63.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$90.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$76.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$63.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$90.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$236.98
|
| Rate for Payer: SOMOS Essential |
$236.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$90.28
|
|
|
CHG HEPATC VNGRPH WDG/FR W/O HEMODYN EVAL RS&I
|
Professional
|
$317.42
|
|
|
Service Code
|
HCPCS 75891 TC
|
| Min. Negotiated Rate |
$41.87 |
| Max. Negotiated Rate |
$395.09 |
| Rate for Payer: Cash Price |
$86.52
|
| Rate for Payer: Cash Price |
$86.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$81.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$81.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$86.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$90.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$86.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$90.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$68.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$86.16
|
| Rate for Payer: Healthfirst QHP |
$90.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$63.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$90.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$77.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$63.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$90.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$238.06
|
| Rate for Payer: SOMOS Essential |
$238.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$90.69
|
|
|
CHG HEPATC VNGRPH WDG/FR W/O HEMODYN EVAL RS&I
|
Professional
|
$209.37
|
|
|
Service Code
|
HCPCS 75891 26
|
| Min. Negotiated Rate |
$41.87 |
| Max. Negotiated Rate |
$395.09 |
| Rate for Payer: Cash Price |
$56.71
|
| Rate for Payer: Cash Price |
$56.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$53.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$56.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$59.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$56.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$56.83
|
| Rate for Payer: Healthfirst QHP |
$59.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$41.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$59.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$50.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$41.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$59.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$157.03
|
| Rate for Payer: SOMOS Essential |
$157.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$59.82
|
|
|
CHG HEPATC VNGRPH WDG/FR W/O HEMODYN EVAL RS&I
|
Professional
|
$526.79
|
|
|
Service Code
|
HCPCS 75891
|
| Min. Negotiated Rate |
$41.87 |
| Max. Negotiated Rate |
$395.09 |
| Rate for Payer: Cash Price |
$143.23
|
| Rate for Payer: Cash Price |
$143.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$135.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$135.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$142.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$150.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$142.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$112.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$142.98
|
| Rate for Payer: Healthfirst QHP |
$150.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$105.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$150.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$127.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$105.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$150.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$395.09
|
| Rate for Payer: SOMOS Essential |
$395.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$150.51
|
|
|
CHG HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER
|
Professional
|
$1,160.95
|
|
|
Service Code
|
HCPCS 78226 TC
|
| Min. Negotiated Rate |
$27.92 |
| Max. Negotiated Rate |
$975.38 |
| Rate for Payer: Cash Price |
$310.40
|
| Rate for Payer: Cash Price |
$310.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$298.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$298.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$315.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$331.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$315.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$331.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$331.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$248.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$315.12
|
| Rate for Payer: Healthfirst QHP |
$331.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$232.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$331.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$281.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$232.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$331.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$870.71
|
| Rate for Payer: SOMOS Essential |
$870.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$331.70
|
|
|
CHG HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER
|
Professional
|
$1,300.50
|
|
|
Service Code
|
HCPCS 78226
|
| Min. Negotiated Rate |
$27.92 |
| Max. Negotiated Rate |
$975.38 |
| Rate for Payer: Cash Price |
$348.53
|
| Rate for Payer: Cash Price |
$348.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$334.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$334.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$352.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$371.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$352.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$371.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$371.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$278.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$352.99
|
| Rate for Payer: Healthfirst QHP |
$371.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$260.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$371.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$315.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$260.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$371.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$975.38
|
| Rate for Payer: SOMOS Essential |
$975.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$371.57
|
|
|
CHG HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER
|
Professional
|
$139.58
|
|
|
Service Code
|
HCPCS 78226 26
|
| Min. Negotiated Rate |
$27.92 |
| Max. Negotiated Rate |
$975.38 |
| Rate for Payer: Cash Price |
$38.13
|
| Rate for Payer: Cash Price |
$38.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$39.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.89
|
| Rate for Payer: Healthfirst QHP |
$39.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$39.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$104.68
|
| Rate for Payer: SOMOS Essential |
$104.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.88
|
|
|
CHG HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ
|
Professional
|
$1,581.72
|
|
|
Service Code
|
HCPCS 78227 TC
|
| Min. Negotiated Rate |
$33.65 |
| Max. Negotiated Rate |
$1,312.45 |
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$406.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$406.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$429.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$451.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$429.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$451.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$451.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$338.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$429.32
|
| Rate for Payer: Healthfirst QHP |
$451.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$316.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$451.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$384.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$316.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$451.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,186.29
|
| Rate for Payer: SOMOS Essential |
$1,186.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$451.92
|
|
|
CHG HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ
|
Professional
|
$168.25
|
|
|
Service Code
|
HCPCS 78227 26
|
| Min. Negotiated Rate |
$33.65 |
| Max. Negotiated Rate |
$1,312.45 |
| Rate for Payer: Cash Price |
$45.68
|
| Rate for Payer: Cash Price |
$45.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$48.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$45.67
|
| Rate for Payer: Healthfirst QHP |
$48.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$48.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$40.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$48.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$126.19
|
| Rate for Payer: SOMOS Essential |
$126.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$48.07
|
|
|
CHG HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ
|
Professional
|
$1,749.93
|
|
|
Service Code
|
HCPCS 78227
|
| Min. Negotiated Rate |
$33.65 |
| Max. Negotiated Rate |
$1,312.45 |
| Rate for Payer: Cash Price |
$467.74
|
| Rate for Payer: Cash Price |
$467.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$449.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$449.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$474.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$499.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$474.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$499.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$499.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$374.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$474.98
|
| Rate for Payer: Healthfirst QHP |
$499.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$349.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$499.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$424.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$349.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$499.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,312.45
|
| Rate for Payer: SOMOS Essential |
$1,312.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$499.98
|
|
|
CHG HGB GLYCOSYLATED DEVICE CLEARED FDA HOME USE
|
Professional
|
$38.84
|
|
|
Service Code
|
HCPCS 83037
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$29.13 |
| Rate for Payer: Cash Price |
$9.71
|
| Rate for Payer: Cash Price |
$9.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.22
|
| Rate for Payer: Healthfirst QHP |
$9.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.13
|
| Rate for Payer: SOMOS Essential |
$29.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.71
|
|
|
CHG HYPERTHERMIA EXTERNAL GENERATED DEEP
|
Professional
|
$4,160.77
|
|
|
Service Code
|
HCPCS 77605
|
| Min. Negotiated Rate |
$87.70 |
| Max. Negotiated Rate |
$3,120.58 |
| Rate for Payer: Cash Price |
$1,115.37
|
| Rate for Payer: Cash Price |
$1,115.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,069.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,069.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,129.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,188.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,129.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,188.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,188.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$891.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,129.35
|
| Rate for Payer: Healthfirst QHP |
$1,188.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$832.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,188.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,010.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$832.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,188.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,120.58
|
| Rate for Payer: SOMOS Essential |
$3,120.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,188.79
|
|
|
CHG HYPERTHERMIA EXTERNAL GENERATED DEEP
|
Professional
|
$438.48
|
|
|
Service Code
|
HCPCS 77605 26
|
| Min. Negotiated Rate |
$87.70 |
| Max. Negotiated Rate |
$3,120.58 |
| Rate for Payer: Cash Price |
$117.27
|
| Rate for Payer: Cash Price |
$117.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$112.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$112.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$119.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$125.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$119.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$93.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$119.02
|
| Rate for Payer: Healthfirst QHP |
$125.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$87.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$125.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$106.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$87.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$125.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$328.86
|
| Rate for Payer: SOMOS Essential |
$328.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$125.28
|
|
|
CHG HYPERTHERMIA EXTERNAL GENERATED DEEP
|
Professional
|
$3,722.29
|
|
|
Service Code
|
HCPCS 77605 TC
|
| Min. Negotiated Rate |
$87.70 |
| Max. Negotiated Rate |
$3,120.58 |
| Rate for Payer: Cash Price |
$998.10
|
| Rate for Payer: Cash Price |
$998.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$957.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$957.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,010.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,063.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,010.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,063.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,063.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$797.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,010.33
|
| Rate for Payer: Healthfirst QHP |
$1,063.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$744.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,063.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$903.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$744.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,063.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,791.72
|
| Rate for Payer: SOMOS Essential |
$2,791.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,063.51
|
|
|
CHG HYPERTHERMIA EXTERNAL GENERATED SUPERFICIAL
|
Professional
|
$2,268.35
|
|
|
Service Code
|
HCPCS 77600
|
| Min. Negotiated Rate |
$57.37 |
| Max. Negotiated Rate |
$1,701.26 |
| Rate for Payer: Cash Price |
$639.44
|
| Rate for Payer: Cash Price |
$639.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$583.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$583.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$615.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$648.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$615.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$648.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$648.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$486.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$615.70
|
| Rate for Payer: Healthfirst QHP |
$648.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$453.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$648.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$550.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$453.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$648.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,701.26
|
| Rate for Payer: SOMOS Essential |
$1,701.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$648.10
|
|
|
CHG HYPERTHERMIA EXTERNAL GENERATED SUPERFICIAL
|
Professional
|
$1,981.49
|
|
|
Service Code
|
HCPCS 77600 TC
|
| Min. Negotiated Rate |
$57.37 |
| Max. Negotiated Rate |
$1,701.26 |
| Rate for Payer: Cash Price |
$560.54
|
| Rate for Payer: Cash Price |
$560.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$509.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$509.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$537.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$566.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$537.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$566.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$566.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$424.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$537.83
|
| Rate for Payer: Healthfirst QHP |
$566.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$396.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$566.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$481.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$396.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$566.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,486.12
|
| Rate for Payer: SOMOS Essential |
$1,486.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$566.14
|
|
|
CHG HYPERTHERMIA EXTERNAL GENERATED SUPERFICIAL
|
Professional
|
$286.86
|
|
|
Service Code
|
HCPCS 77600 26
|
| Min. Negotiated Rate |
$57.37 |
| Max. Negotiated Rate |
$1,701.26 |
| Rate for Payer: Cash Price |
$78.91
|
| Rate for Payer: Cash Price |
$78.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$73.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$77.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$61.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$77.86
|
| Rate for Payer: Healthfirst QHP |
$81.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$57.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$81.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$69.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$57.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$215.14
|
| Rate for Payer: SOMOS Essential |
$215.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.96
|
|
