|
CHG IMMUNOELECTROPHORESIS SERUM
|
Professional
|
$69.20
|
|
|
Service Code
|
HCPCS 86320 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 IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS
|
Professional
|
$69.20
|
|
|
Service Code
|
HCPCS 86335 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 IMMUNOFIXJ ELECTROPHORESIS SERUM
|
Professional
|
$69.20
|
|
|
Service Code
|
HCPCS 86334 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 IMMUNOFLUORESCENCE PER SPEC 1ST SINGLE ANTB STN
|
Professional
|
$502.99
|
|
|
Service Code
|
HCPCS 88346 TC
|
| Min. Negotiated Rate |
$27.42 |
| Max. Negotiated Rate |
$480.06 |
| Rate for Payer: Cash Price |
$136.42
|
| Rate for Payer: Cash Price |
$136.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$129.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$129.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$136.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$143.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$136.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$143.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$143.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$107.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$136.52
|
| Rate for Payer: Healthfirst QHP |
$143.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$100.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$143.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$122.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$100.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$143.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$377.24
|
| Rate for Payer: SOMOS Essential |
$377.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$143.71
|
|
|
CHG IMMUNOFLUORESCENCE PER SPEC 1ST SINGLE ANTB STN
|
Professional
|
$137.10
|
|
|
Service Code
|
HCPCS 88346 26
|
| Min. Negotiated Rate |
$27.42 |
| Max. Negotiated Rate |
$480.06 |
| Rate for Payer: Cash Price |
$37.83
|
| Rate for Payer: Cash Price |
$37.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$39.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.21
|
| Rate for Payer: Healthfirst QHP |
$39.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$39.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$102.82
|
| Rate for Payer: SOMOS Essential |
$102.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.17
|
|
|
CHG IMMUNOFLUORESCENCE PER SPEC 1ST SINGLE ANTB STN
|
Professional
|
$640.08
|
|
|
Service Code
|
HCPCS 88346
|
| Min. Negotiated Rate |
$27.42 |
| Max. Negotiated Rate |
$480.06 |
| Rate for Payer: Cash Price |
$174.25
|
| Rate for Payer: Cash Price |
$174.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$164.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$164.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$173.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$182.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$173.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$182.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$182.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$137.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$173.74
|
| Rate for Payer: Healthfirst QHP |
$182.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$128.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$182.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$155.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$128.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$182.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$480.06
|
| Rate for Payer: SOMOS Essential |
$480.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$182.88
|
|
|
CHG IMMUNOFLUORESCENCE PR SPEC EA ADD SINGL ANTB STN
|
Professional
|
$379.37
|
|
|
Service Code
|
HCPCS 88350 TC
|
| Min. Negotiated Rate |
$22.22 |
| Max. Negotiated Rate |
$367.87 |
| Rate for Payer: Cash Price |
$101.61
|
| Rate for Payer: Cash Price |
$101.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$97.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$97.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$102.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$108.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$102.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$108.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$108.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$81.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$102.97
|
| Rate for Payer: Healthfirst QHP |
$108.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$75.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$108.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$92.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$75.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$108.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$284.53
|
| Rate for Payer: SOMOS Essential |
$284.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$108.39
|
|
|
CHG IMMUNOFLUORESCENCE PR SPEC EA ADD SINGL ANTB STN
|
Professional
|
$111.13
|
|
|
Service Code
|
HCPCS 88350 26
|
| Min. Negotiated Rate |
$22.22 |
| Max. Negotiated Rate |
$367.87 |
| Rate for Payer: Cash Price |
$30.63
|
| Rate for Payer: Cash Price |
$30.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.16
|
| Rate for Payer: Healthfirst QHP |
$31.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$31.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$83.35
|
| Rate for Payer: SOMOS Essential |
$83.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.75
|
|
|
CHG IMMUNOFLUORESCENCE PR SPEC EA ADD SINGL ANTB STN
|
Professional
|
$490.49
|
|
|
Service Code
|
HCPCS 88350
|
| Min. Negotiated Rate |
$22.22 |
| Max. Negotiated Rate |
$367.87 |
| Rate for Payer: Cash Price |
$132.24
|
| Rate for Payer: Cash Price |
$132.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$126.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$126.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$133.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$140.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$133.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$140.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$140.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$105.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.13
|
| Rate for Payer: Healthfirst QHP |
$140.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$98.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$140.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$119.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$98.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$140.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$367.87
|
| Rate for Payer: SOMOS Essential |
$367.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$140.14
|
|
|
CHG IN SITU HYBRIDIZATION EA ADDL PROBE STAIN
|
Professional
|
$130.66
|
|
|
Service Code
|
HCPCS 88364 26
|
| Min. Negotiated Rate |
$26.13 |
| Max. Negotiated Rate |
$431.02 |
| Rate for Payer: Cash Price |
$35.65
|
| Rate for Payer: Cash Price |
$35.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.46
|
| Rate for Payer: Healthfirst QHP |
$37.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$31.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$98.00
|
| Rate for Payer: SOMOS Essential |
$98.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.33
|
|
|
CHG IN SITU HYBRIDIZATION EA ADDL PROBE STAIN
|
Professional
|
$444.05
|
|
|
Service Code
|
HCPCS 88364 TC
|
| Min. Negotiated Rate |
$26.13 |
| Max. Negotiated Rate |
$431.02 |
| Rate for Payer: Cash Price |
$118.90
|
| Rate for Payer: Cash Price |
$118.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$114.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$114.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$120.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$126.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$120.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$95.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$120.53
|
| Rate for Payer: Healthfirst QHP |
$126.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$88.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$126.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$107.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$88.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$126.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$333.04
|
| Rate for Payer: SOMOS Essential |
$333.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$126.87
|
|
|
CHG IN SITU HYBRIDIZATION EA ADDL PROBE STAIN
|
Professional
|
$574.70
|
|
|
Service Code
|
HCPCS 88364
|
| Min. Negotiated Rate |
$26.13 |
| Max. Negotiated Rate |
$431.02 |
| Rate for Payer: Cash Price |
$154.54
|
| Rate for Payer: Cash Price |
$154.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$147.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$147.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$155.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$164.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$155.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$164.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$164.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$123.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$155.99
|
| Rate for Payer: Healthfirst QHP |
$164.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$114.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$164.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$139.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$114.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$164.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$431.02
|
| Rate for Payer: SOMOS Essential |
$431.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$164.20
|
|
|
CHG IN SITU HYBRIDIZATION EA MULTIPLEX PROBE STAIN
|
Professional
|
$238.42
|
|
|
Service Code
|
HCPCS 88366 26
|
| Min. Negotiated Rate |
$47.68 |
| Max. Negotiated Rate |
$882.61 |
| Rate for Payer: Cash Price |
$64.93
|
| Rate for Payer: Cash Price |
$64.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$61.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$68.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$68.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$68.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$64.71
|
| Rate for Payer: Healthfirst QHP |
$68.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$47.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$68.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$57.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$47.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$68.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$178.82
|
| Rate for Payer: SOMOS Essential |
$178.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$68.12
|
|
|
CHG IN SITU HYBRIDIZATION EA MULTIPLEX PROBE STAIN
|
Professional
|
$1,176.81
|
|
|
Service Code
|
HCPCS 88366
|
| Min. Negotiated Rate |
$47.68 |
| Max. Negotiated Rate |
$882.61 |
| Rate for Payer: Cash Price |
$315.69
|
| Rate for Payer: Cash Price |
$315.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$302.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$302.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$319.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$336.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$319.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$336.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$336.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$252.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$319.42
|
| Rate for Payer: Healthfirst QHP |
$336.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$235.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$336.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$285.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$235.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$336.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$882.61
|
| Rate for Payer: SOMOS Essential |
$882.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$336.23
|
|
|
CHG IN SITU HYBRIDIZATION EA MULTIPLEX PROBE STAIN
|
Professional
|
$938.42
|
|
|
Service Code
|
HCPCS 88366 TC
|
| Min. Negotiated Rate |
$47.68 |
| Max. Negotiated Rate |
$882.61 |
| Rate for Payer: Cash Price |
$250.76
|
| Rate for Payer: Cash Price |
$250.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$241.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$241.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$254.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$268.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$254.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$268.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$268.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$201.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$254.71
|
| Rate for Payer: Healthfirst QHP |
$268.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$187.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$268.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$227.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$187.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$268.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$703.82
|
| Rate for Payer: SOMOS Essential |
$703.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$268.12
|
|
|
CHG INTERSTITIAL RADIATION SOURCE APPLIC COMPLEX
|
Professional
|
$1,850.80
|
|
|
Service Code
|
HCPCS 77778 26
|
| Min. Negotiated Rate |
$370.16 |
| Max. Negotiated Rate |
$2,867.66 |
| Rate for Payer: Cash Price |
$508.12
|
| Rate for Payer: Cash Price |
$508.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$475.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$475.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$502.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$528.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$502.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$528.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$528.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$396.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$502.36
|
| Rate for Payer: Healthfirst QHP |
$528.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$370.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$528.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$449.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$370.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$528.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,388.10
|
| Rate for Payer: SOMOS Essential |
$1,388.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$528.80
|
|
|
CHG INTERSTITIAL RADIATION SOURCE APPLIC COMPLEX
|
Professional
|
$3,823.54
|
|
|
Service Code
|
HCPCS 77778
|
| Min. Negotiated Rate |
$370.16 |
| Max. Negotiated Rate |
$2,867.66 |
| Rate for Payer: Cash Price |
$1,059.19
|
| Rate for Payer: Cash Price |
$1,059.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$983.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$983.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,037.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,092.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,037.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,092.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,092.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$819.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,037.82
|
| Rate for Payer: Healthfirst QHP |
$1,092.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$764.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,092.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$928.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$764.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,092.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,867.66
|
| Rate for Payer: SOMOS Essential |
$2,867.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,092.44
|
|
|
CHG INTERSTITIAL RADIATION SOURCE APPLIC COMPLEX
|
Professional
|
$1,972.78
|
|
|
Service Code
|
HCPCS 77778 TC
|
| Min. Negotiated Rate |
$370.16 |
| Max. Negotiated Rate |
$2,867.66 |
| Rate for Payer: Cash Price |
$551.08
|
| Rate for Payer: Cash Price |
$551.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$507.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$507.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$535.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$563.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$535.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$563.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$563.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$422.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$535.47
|
| Rate for Payer: Healthfirst QHP |
$563.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$394.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$563.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$479.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$394.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$563.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,479.58
|
| Rate for Payer: SOMOS Essential |
$1,479.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$563.65
|
|
|
CHG INTESTINE IMAGING
|
Professional
|
$1,192.56
|
|
|
Service Code
|
HCPCS 78290 TC
|
| Min. Negotiated Rate |
$25.84 |
| Max. Negotiated Rate |
$991.30 |
| Rate for Payer: Cash Price |
$318.88
|
| Rate for Payer: Cash Price |
$318.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$306.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$306.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$323.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$340.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$323.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$340.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$340.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$255.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$323.69
|
| Rate for Payer: Healthfirst QHP |
$340.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$238.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$340.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$289.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$238.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$340.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$894.42
|
| Rate for Payer: SOMOS Essential |
$894.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$340.73
|
|
|
CHG INTESTINE IMAGING
|
Professional
|
$129.19
|
|
|
Service Code
|
HCPCS 78290 26
|
| Min. Negotiated Rate |
$25.84 |
| Max. Negotiated Rate |
$991.30 |
| Rate for Payer: Cash Price |
$34.24
|
| Rate for Payer: Cash Price |
$34.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.06
|
| Rate for Payer: Healthfirst QHP |
$36.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$36.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$31.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$96.89
|
| Rate for Payer: SOMOS Essential |
$96.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.91
|
|
|
CHG INTESTINE IMAGING
|
Professional
|
$1,321.74
|
|
|
Service Code
|
HCPCS 78290
|
| Min. Negotiated Rate |
$25.84 |
| Max. Negotiated Rate |
$991.30 |
| Rate for Payer: Cash Price |
$353.12
|
| Rate for Payer: Cash Price |
$353.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$339.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$339.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$358.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$377.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$358.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$377.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$377.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$283.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$358.76
|
| Rate for Payer: Healthfirst QHP |
$377.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$264.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$377.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$320.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$264.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$377.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$991.30
|
| Rate for Payer: SOMOS Essential |
$991.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$377.64
|
|
|
CHG INTRACAVITARY RADIATION SOURCE APPLIC COMPLEX
|
Professional
|
$1,395.59
|
|
|
Service Code
|
HCPCS 77763 TC
|
| Min. Negotiated Rate |
$279.12 |
| Max. Negotiated Rate |
$2,419.30 |
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$358.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$358.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$378.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$398.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$378.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$398.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$398.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$299.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$378.80
|
| Rate for Payer: Healthfirst QHP |
$398.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$279.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$398.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$338.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$279.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$398.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,046.69
|
| Rate for Payer: SOMOS Essential |
$1,046.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$398.74
|
|
|
CHG INTRACAVITARY RADIATION SOURCE APPLIC COMPLEX
|
Professional
|
$3,225.74
|
|
|
Service Code
|
HCPCS 77763
|
| Min. Negotiated Rate |
$279.12 |
| Max. Negotiated Rate |
$2,419.30 |
| Rate for Payer: Cash Price |
$895.73
|
| Rate for Payer: Cash Price |
$895.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$829.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$829.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$875.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$921.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$875.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$921.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$921.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$691.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$875.56
|
| Rate for Payer: Healthfirst QHP |
$921.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$645.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$921.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$783.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$645.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$921.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,419.30
|
| Rate for Payer: SOMOS Essential |
$2,419.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$921.64
|
|
|
CHG INTRACAVITARY RADIATION SOURCE APPLIC COMPLEX
|
Professional
|
$1,830.15
|
|
|
Service Code
|
HCPCS 77763 26
|
| Min. Negotiated Rate |
$279.12 |
| Max. Negotiated Rate |
$2,419.30 |
| Rate for Payer: Cash Price |
$502.13
|
| Rate for Payer: Cash Price |
$502.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$470.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$470.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$496.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$522.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$496.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$522.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$522.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$392.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$496.76
|
| Rate for Payer: Healthfirst QHP |
$522.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$366.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$522.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$444.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$366.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$522.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,372.61
|
| Rate for Payer: SOMOS Essential |
$1,372.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$522.90
|
|
|
CHG INTRACAVITARY RADIATION SOURCE APPLIC INTERMED
|
Professional
|
$2,293.76
|
|
|
Service Code
|
HCPCS 77762
|
| Min. Negotiated Rate |
$215.64 |
| Max. Negotiated Rate |
$1,720.32 |
| Rate for Payer: Cash Price |
$635.27
|
| Rate for Payer: Cash Price |
$635.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$589.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$589.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$622.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$655.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$622.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$655.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$655.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$491.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$622.59
|
| Rate for Payer: Healthfirst QHP |
$655.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$458.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$655.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$557.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$458.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$655.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,720.32
|
| Rate for Payer: SOMOS Essential |
$1,720.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$655.36
|
|
