|
CHG INTRACAVITARY RADIATION SOURCE APPLIC INTERMED
|
Professional
|
$1,078.18
|
|
|
Service Code
|
HCPCS 77762 TC
|
| Min. Negotiated Rate |
$215.64 |
| Max. Negotiated Rate |
$1,720.32 |
| Rate for Payer: Cash Price |
$301.12
|
| Rate for Payer: Cash Price |
$301.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$277.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$277.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$292.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$308.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$292.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$308.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$308.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$231.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$292.65
|
| Rate for Payer: Healthfirst QHP |
$308.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$215.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$308.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$261.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$215.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$308.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$808.64
|
| Rate for Payer: SOMOS Essential |
$808.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$308.05
|
|
|
CHG INTRACAVITARY RADIATION SOURCE APPLIC INTERMED
|
Professional
|
$1,215.62
|
|
|
Service Code
|
HCPCS 77762 26
|
| Min. Negotiated Rate |
$215.64 |
| Max. Negotiated Rate |
$1,720.32 |
| Rate for Payer: Cash Price |
$334.16
|
| Rate for Payer: Cash Price |
$334.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$312.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$312.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$329.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$347.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$329.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$347.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$347.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$260.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$329.95
|
| Rate for Payer: Healthfirst QHP |
$347.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$243.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$347.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$295.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$243.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$347.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$911.72
|
| Rate for Payer: SOMOS Essential |
$911.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$347.32
|
|
|
CHG INTRACAVITARY RADIATION SOURCE APPLIC SIMPLE
|
Professional
|
$1,755.36
|
|
|
Service Code
|
HCPCS 77761
|
| Min. Negotiated Rate |
$163.53 |
| Max. Negotiated Rate |
$1,316.52 |
| Rate for Payer: Cash Price |
$485.39
|
| Rate for Payer: Cash Price |
$485.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$451.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$451.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$476.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$501.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$476.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$501.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$501.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$376.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$476.45
|
| Rate for Payer: Healthfirst QHP |
$501.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$351.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$501.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$426.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$351.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$501.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,316.52
|
| Rate for Payer: SOMOS Essential |
$1,316.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$501.53
|
|
|
CHG INTRACAVITARY RADIATION SOURCE APPLIC SIMPLE
|
Professional
|
$937.72
|
|
|
Service Code
|
HCPCS 77761 TC
|
| Min. Negotiated Rate |
$163.53 |
| Max. Negotiated Rate |
$1,316.52 |
| Rate for Payer: Cash Price |
$262.14
|
| Rate for Payer: Cash Price |
$262.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$241.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$241.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$254.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$267.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$254.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$267.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$267.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$200.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$254.52
|
| Rate for Payer: Healthfirst QHP |
$267.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$187.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$267.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$227.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$187.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$267.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$703.29
|
| Rate for Payer: SOMOS Essential |
$703.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$267.92
|
|
|
CHG INTRACAVITARY RADIATION SOURCE APPLIC SIMPLE
|
Professional
|
$817.67
|
|
|
Service Code
|
HCPCS 77761 26
|
| Min. Negotiated Rate |
$163.53 |
| Max. Negotiated Rate |
$1,316.52 |
| Rate for Payer: Cash Price |
$223.25
|
| Rate for Payer: Cash Price |
$223.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$210.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$210.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$221.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$233.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$221.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$233.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$233.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$175.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$221.94
|
| Rate for Payer: Healthfirst QHP |
$233.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$163.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$233.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$198.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$163.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$233.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$613.25
|
| Rate for Payer: SOMOS Essential |
$613.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$233.62
|
|
|
CHG INTRALUMINAL DILATION STRICTURES&/OBSTRCJS RS&I
|
Professional
|
$638.02
|
|
|
Service Code
|
HCPCS 74360 TC
|
| Min. Negotiated Rate |
$21.76 |
| Max. Negotiated Rate |
$560.10 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$478.52
|
| Rate for Payer: SOMOS Essential |
$478.52
|
|
|
CHG INTRALUMINAL DILATION STRICTURES&/OBSTRCJS RS&I
|
Professional
|
$746.80
|
|
|
Service Code
|
HCPCS 74360
|
| Min. Negotiated Rate |
$21.76 |
| Max. Negotiated Rate |
$560.10 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$560.10
|
| Rate for Payer: SOMOS Essential |
$560.10
|
|
|
CHG INTRALUMINAL DILATION STRICTURES&/OBSTRCJS RS&I
|
Professional
|
$108.78
|
|
|
Service Code
|
HCPCS 74360 26
|
| Min. Negotiated Rate |
$21.76 |
| Max. Negotiated Rate |
$560.10 |
| Rate for Payer: Cash Price |
$30.21
|
| Rate for Payer: Cash Price |
$30.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$27.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.53
|
| Rate for Payer: Healthfirst QHP |
$31.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$31.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$81.58
|
| Rate for Payer: SOMOS Essential |
$81.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.08
|
|
|
CHG INTRAOPERATIVE RADIATION TREATMENT MANAGEMENT
|
Professional
|
$1,314.95
|
|
|
Service Code
|
HCPCS 77469
|
| Min. Negotiated Rate |
$262.99 |
| Max. Negotiated Rate |
$986.21 |
| Rate for Payer: Cash Price |
$359.52
|
| Rate for Payer: Cash Price |
$359.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$338.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$338.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$356.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$375.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$356.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$375.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$375.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$281.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$356.92
|
| Rate for Payer: Healthfirst QHP |
$375.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$262.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$375.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$319.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$262.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$375.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$986.21
|
| Rate for Payer: SOMOS Essential |
$986.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$375.70
|
|
|
CHG INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I
|
Professional
|
$530.67
|
|
|
Service Code
|
HCPCS 74340 TC
|
| Min. Negotiated Rate |
$21.18 |
| Max. Negotiated Rate |
$477.41 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$398.00
|
| Rate for Payer: SOMOS Essential |
$398.00
|
|
|
CHG INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I
|
Professional
|
$105.88
|
|
|
Service Code
|
HCPCS 74340 26
|
| Min. Negotiated Rate |
$21.18 |
| Max. Negotiated Rate |
$477.41 |
| Rate for Payer: Cash Price |
$27.78
|
| Rate for Payer: Cash Price |
$27.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$27.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$28.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$30.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.74
|
| Rate for Payer: Healthfirst QHP |
$30.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$30.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$25.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$79.41
|
| Rate for Payer: SOMOS Essential |
$79.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.25
|
|
|
CHG INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I
|
Professional
|
$636.55
|
|
|
Service Code
|
HCPCS 74340
|
| Min. Negotiated Rate |
$21.18 |
| Max. Negotiated Rate |
$477.41 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$477.41
|
| Rate for Payer: SOMOS Essential |
$477.41
|
|
|
CHG JOINT SURVEY SINGLE VIEW 2 OR MORE JOINTS
|
Professional
|
$200.48
|
|
|
Service Code
|
HCPCS 77077
|
| Min. Negotiated Rate |
$13.38 |
| Max. Negotiated Rate |
$150.36 |
| Rate for Payer: Cash Price |
$54.64
|
| Rate for Payer: Cash Price |
$54.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$51.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$51.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$54.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$57.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$54.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$54.42
|
| Rate for Payer: Healthfirst QHP |
$57.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$40.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$57.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$48.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$40.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$57.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$150.36
|
| Rate for Payer: SOMOS Essential |
$150.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$57.28
|
|
|
CHG JOINT SURVEY SINGLE VIEW 2 OR MORE JOINTS
|
Professional
|
$66.92
|
|
|
Service Code
|
HCPCS 77077 26
|
| Min. Negotiated Rate |
$13.38 |
| Max. Negotiated Rate |
$150.36 |
| Rate for Payer: Cash Price |
$18.26
|
| Rate for Payer: Cash Price |
$18.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.16
|
| Rate for Payer: Healthfirst QHP |
$19.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$50.19
|
| Rate for Payer: SOMOS Essential |
$50.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.12
|
|
|
CHG JOINT SURVEY SINGLE VIEW 2 OR MORE JOINTS
|
Professional
|
$133.56
|
|
|
Service Code
|
HCPCS 77077 TC
|
| Min. Negotiated Rate |
$13.38 |
| Max. Negotiated Rate |
$150.36 |
| Rate for Payer: Cash Price |
$36.38
|
| Rate for Payer: Cash Price |
$36.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.25
|
| Rate for Payer: Healthfirst QHP |
$38.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$100.17
|
| Rate for Payer: SOMOS Essential |
$100.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.16
|
|
|
CHG KIDNEY FUNCJ STUDY NON-IMG RADIOISOTOPIC STUDY
|
Professional
|
$416.33
|
|
|
Service Code
|
HCPCS 78725 TC
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$364.01 |
| Rate for Payer: Cash Price |
$95.23
|
| Rate for Payer: Cash Price |
$95.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$107.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$107.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$118.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$118.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$118.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$89.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$113.00
|
| Rate for Payer: Healthfirst QHP |
$118.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$83.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$118.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$101.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$83.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$118.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$312.25
|
| Rate for Payer: SOMOS Essential |
$312.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$118.95
|
|
|
CHG KIDNEY FUNCJ STUDY NON-IMG RADIOISOTOPIC STUDY
|
Professional
|
$69.02
|
|
|
Service Code
|
HCPCS 78725 26
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$364.01 |
| Rate for Payer: Cash Price |
$18.20
|
| Rate for Payer: Cash Price |
$18.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.73
|
| Rate for Payer: Healthfirst QHP |
$19.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$51.76
|
| Rate for Payer: SOMOS Essential |
$51.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.72
|
|
|
CHG KIDNEY FUNCJ STUDY NON-IMG RADIOISOTOPIC STUDY
|
Professional
|
$485.35
|
|
|
Service Code
|
HCPCS 78725
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$364.01 |
| Rate for Payer: Cash Price |
$113.43
|
| Rate for Payer: Cash Price |
$113.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$124.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$124.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$138.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$138.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$138.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$104.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$131.74
|
| Rate for Payer: Healthfirst QHP |
$138.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$97.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$138.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$117.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$97.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$138.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$364.01
|
| Rate for Payer: SOMOS Essential |
$364.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$138.67
|
|
|
CHG KIDNEY IMAGING MORPHOLOGY
|
Professional
|
$83.41
|
|
|
Service Code
|
HCPCS 78700 26
|
| Min. Negotiated Rate |
$16.68 |
| Max. Negotiated Rate |
$518.18 |
| Rate for Payer: Cash Price |
$22.45
|
| Rate for Payer: Cash Price |
$22.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$23.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.64
|
| Rate for Payer: Healthfirst QHP |
$23.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$16.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$23.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$20.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$16.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$62.56
|
| Rate for Payer: SOMOS Essential |
$62.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.83
|
|
|
CHG KIDNEY IMAGING MORPHOLOGY
|
Professional
|
$607.50
|
|
|
Service Code
|
HCPCS 78700 TC
|
| Min. Negotiated Rate |
$16.68 |
| Max. Negotiated Rate |
$518.18 |
| Rate for Payer: Cash Price |
$163.60
|
| Rate for Payer: Cash Price |
$163.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$156.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$156.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$164.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$173.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$164.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$173.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$173.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$130.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$164.89
|
| Rate for Payer: Healthfirst QHP |
$173.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$121.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$173.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$147.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$121.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$173.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$455.62
|
| Rate for Payer: SOMOS Essential |
$455.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$173.57
|
|
|
CHG KIDNEY IMAGING MORPHOLOGY
|
Professional
|
$690.90
|
|
|
Service Code
|
HCPCS 78700
|
| Min. Negotiated Rate |
$16.68 |
| Max. Negotiated Rate |
$518.18 |
| Rate for Payer: Cash Price |
$186.05
|
| Rate for Payer: Cash Price |
$186.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$177.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$177.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$187.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$197.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$187.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$197.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$197.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$148.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$187.53
|
| Rate for Payer: Healthfirst QHP |
$197.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$138.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$197.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$167.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$138.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$197.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$518.18
|
| Rate for Payer: SOMOS Essential |
$518.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$197.40
|
|
|
CHG KIDNEY IMAGING MORPHOOGY W/VASCULAR FLOW
|
Professional
|
$814.52
|
|
|
Service Code
|
HCPCS 78701 TC
|
| Min. Negotiated Rate |
$18.54 |
| Max. Negotiated Rate |
$680.43 |
| Rate for Payer: Cash Price |
$219.40
|
| Rate for Payer: Cash Price |
$219.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$209.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$221.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$232.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$221.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$232.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$232.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$174.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$221.08
|
| Rate for Payer: Healthfirst QHP |
$232.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$162.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$232.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$197.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$162.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$232.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$610.89
|
| Rate for Payer: SOMOS Essential |
$610.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$232.72
|
|
|
CHG KIDNEY IMAGING MORPHOOGY W/VASCULAR FLOW
|
Professional
|
$92.72
|
|
|
Service Code
|
HCPCS 78701 26
|
| Min. Negotiated Rate |
$18.54 |
| Max. Negotiated Rate |
$680.43 |
| Rate for Payer: Cash Price |
$25.02
|
| Rate for Payer: Cash Price |
$25.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.17
|
| Rate for Payer: Healthfirst QHP |
$26.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.54
|
| Rate for Payer: SOMOS Essential |
$69.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.49
|
|
|
CHG KIDNEY IMAGING MORPHOOGY W/VASCULAR FLOW
|
Professional
|
$907.24
|
|
|
Service Code
|
HCPCS 78701
|
| Min. Negotiated Rate |
$18.54 |
| Max. Negotiated Rate |
$680.43 |
| Rate for Payer: Cash Price |
$244.42
|
| Rate for Payer: Cash Price |
$244.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$233.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$233.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$246.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$259.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$246.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$259.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$259.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$194.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$246.25
|
| Rate for Payer: Healthfirst QHP |
$259.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$181.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$259.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$220.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$181.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$259.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$680.43
|
| Rate for Payer: SOMOS Essential |
$680.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$259.21
|
|
|
CHG KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/O RX
|
Professional
|
$932.75
|
|
|
Service Code
|
HCPCS 78707
|
| Min. Negotiated Rate |
$35.15 |
| Max. Negotiated Rate |
$699.56 |
| Rate for Payer: Cash Price |
$251.06
|
| Rate for Payer: Cash Price |
$251.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$239.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$239.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$253.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$266.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$253.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$266.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$266.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$199.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$253.18
|
| Rate for Payer: Healthfirst QHP |
$266.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$186.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$266.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$226.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$186.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$266.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$699.56
|
| Rate for Payer: SOMOS Essential |
$699.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$266.50
|
|
