|
CHG RP LOCLZJ TUM PLNR 2+AREA 1+D IMG/1 AREA IMG>2+D
|
Professional
|
$1,096.55
|
|
|
Service Code
|
HCPCS 78801
|
| Min. Negotiated Rate |
$27.38 |
| Max. Negotiated Rate |
$822.41 |
| Rate for Payer: Cash Price |
$292.15
|
| Rate for Payer: Cash Price |
$292.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$281.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$281.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$297.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$313.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$297.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$313.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$313.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$234.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$297.64
|
| Rate for Payer: Healthfirst QHP |
$313.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$219.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$313.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$266.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$219.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$313.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$822.41
|
| Rate for Payer: SOMOS Essential |
$822.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$313.30
|
|
|
CHG RP LOCLZJ TUM PLNR 2+AREA 1+D IMG/1 AREA IMG>2+D
|
Professional
|
$959.70
|
|
|
Service Code
|
HCPCS 78801 TC
|
| Min. Negotiated Rate |
$27.38 |
| Max. Negotiated Rate |
$822.41 |
| Rate for Payer: Cash Price |
$255.16
|
| Rate for Payer: Cash Price |
$255.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$246.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$246.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$260.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$274.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$260.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$274.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$274.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$205.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$260.49
|
| Rate for Payer: Healthfirst QHP |
$274.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$191.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$274.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$233.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$191.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$274.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$719.78
|
| Rate for Payer: SOMOS Essential |
$719.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$274.20
|
|
|
CHG RP LOCLZJ TUM PLNR 2+AREA 1+D IMG/1 AREA IMG>2+D
|
Professional
|
$136.89
|
|
|
Service Code
|
HCPCS 78801 26
|
| Min. Negotiated Rate |
$27.38 |
| Max. Negotiated Rate |
$822.41 |
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$39.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.15
|
| Rate for Payer: Healthfirst QHP |
$39.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$39.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$102.67
|
| Rate for Payer: SOMOS Essential |
$102.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.11
|
|
|
CHG RP LOCLZJ TUM PLNR WHOLE BODY 2+ DAYS IMAGING
|
Professional
|
$2,588.71
|
|
|
Service Code
|
HCPCS 78804
|
| Min. Negotiated Rate |
$36.97 |
| Max. Negotiated Rate |
$1,941.53 |
| Rate for Payer: Cash Price |
$689.57
|
| Rate for Payer: Cash Price |
$689.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$665.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$665.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$702.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$739.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$702.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$739.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$739.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$554.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$702.65
|
| Rate for Payer: Healthfirst QHP |
$739.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$517.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$739.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$628.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$517.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$739.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,941.53
|
| Rate for Payer: SOMOS Essential |
$1,941.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$739.63
|
|
|
CHG RP LOCLZJ TUM PLNR WHOLE BODY 2+ DAYS IMAGING
|
Professional
|
$184.87
|
|
|
Service Code
|
HCPCS 78804 26
|
| Min. Negotiated Rate |
$36.97 |
| Max. Negotiated Rate |
$1,941.53 |
| Rate for Payer: Cash Price |
$50.92
|
| Rate for Payer: Cash Price |
$50.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.18
|
| Rate for Payer: Healthfirst QHP |
$52.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$138.65
|
| Rate for Payer: SOMOS Essential |
$138.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.82
|
|
|
CHG RP LOCLZJ TUM PLNR WHOLE BODY 2+ DAYS IMAGING
|
Professional
|
$2,403.84
|
|
|
Service Code
|
HCPCS 78804 TC
|
| Min. Negotiated Rate |
$36.97 |
| Max. Negotiated Rate |
$1,941.53 |
| Rate for Payer: Cash Price |
$638.64
|
| Rate for Payer: Cash Price |
$638.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$618.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$618.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$652.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$686.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$652.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$686.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$686.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$515.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$652.47
|
| Rate for Payer: Healthfirst QHP |
$686.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$480.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$686.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$583.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$480.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$686.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,802.88
|
| Rate for Payer: SOMOS Essential |
$1,802.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$686.81
|
|
|
CHG RP LOCLZJ TUM PLNR WHOLE BODY SINGLE DAY IMAGING
|
Professional
|
$1,237.60
|
|
|
Service Code
|
HCPCS 78802
|
| Min. Negotiated Rate |
$29.70 |
| Max. Negotiated Rate |
$928.20 |
| Rate for Payer: Cash Price |
$329.96
|
| Rate for Payer: Cash Price |
$329.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$318.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$318.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$335.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$353.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$335.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$353.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$353.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$265.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$335.92
|
| Rate for Payer: Healthfirst QHP |
$353.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$247.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$353.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$300.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$247.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$353.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$928.20
|
| Rate for Payer: SOMOS Essential |
$928.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$353.60
|
|
|
CHG RP LOCLZJ TUM PLNR WHOLE BODY SINGLE DAY IMAGING
|
Professional
|
$1,089.06
|
|
|
Service Code
|
HCPCS 78802 TC
|
| Min. Negotiated Rate |
$29.70 |
| Max. Negotiated Rate |
$928.20 |
| Rate for Payer: Cash Price |
$289.74
|
| Rate for Payer: Cash Price |
$289.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$280.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$280.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$295.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$311.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$295.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$311.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$311.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$233.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$295.60
|
| Rate for Payer: Healthfirst QHP |
$311.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$217.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$311.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$264.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$217.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$311.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$816.80
|
| Rate for Payer: SOMOS Essential |
$816.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$311.16
|
|
|
CHG RP LOCLZJ TUM PLNR WHOLE BODY SINGLE DAY IMAGING
|
Professional
|
$148.51
|
|
|
Service Code
|
HCPCS 78802 26
|
| Min. Negotiated Rate |
$29.70 |
| Max. Negotiated Rate |
$928.20 |
| Rate for Payer: Cash Price |
$40.22
|
| Rate for Payer: Cash Price |
$40.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$42.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$40.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.31
|
| Rate for Payer: Healthfirst QHP |
$42.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$42.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$36.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$42.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$111.38
|
| Rate for Payer: SOMOS Essential |
$111.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.43
|
|
|
CHG RP LOCLZJ TUM SPECT 1 AREA/ACQUISJ 1 DAY IMG
|
Professional
|
$197.79
|
|
|
Service Code
|
HCPCS 78803 26
|
| Min. Negotiated Rate |
$39.56 |
| Max. Negotiated Rate |
$1,138.70 |
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$50.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$50.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$53.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$56.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$53.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$53.68
|
| Rate for Payer: Healthfirst QHP |
$56.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$39.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$56.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$48.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$39.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$56.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$148.34
|
| Rate for Payer: SOMOS Essential |
$148.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56.51
|
|
|
CHG RP LOCLZJ TUM SPECT 1 AREA/ACQUISJ 1 DAY IMG
|
Professional
|
$1,320.52
|
|
|
Service Code
|
HCPCS 78803 TC
|
| Min. Negotiated Rate |
$39.56 |
| Max. Negotiated Rate |
$1,138.70 |
| Rate for Payer: Cash Price |
$352.44
|
| Rate for Payer: Cash Price |
$352.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$339.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$339.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$358.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$377.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$358.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$377.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$377.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$282.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$358.43
|
| Rate for Payer: Healthfirst QHP |
$377.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$264.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$377.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$320.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$264.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$377.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$990.39
|
| Rate for Payer: SOMOS Essential |
$990.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$377.29
|
|
|
CHG RP LOCLZJ TUM SPECT 1 AREA/ACQUISJ 1 DAY IMG
|
Professional
|
$1,518.27
|
|
|
Service Code
|
HCPCS 78803
|
| Min. Negotiated Rate |
$39.56 |
| Max. Negotiated Rate |
$1,138.70 |
| Rate for Payer: Cash Price |
$406.94
|
| Rate for Payer: Cash Price |
$406.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$390.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$390.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$412.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$433.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$412.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$433.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$433.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$325.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$412.10
|
| Rate for Payer: Healthfirst QHP |
$433.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$303.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$433.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$368.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$303.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$433.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,138.70
|
| Rate for Payer: SOMOS Essential |
$1,138.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$433.79
|
|
|
CHG RP LOCLZJ TUM SPECT 2 AREA/SEP ACQUISJ IMG
|
Professional
|
$334.64
|
|
|
Service Code
|
HCPCS 78831 26
|
| Min. Negotiated Rate |
$66.93 |
| Max. Negotiated Rate |
$2,124.81 |
| Rate for Payer: Cash Price |
$92.28
|
| Rate for Payer: Cash Price |
$92.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$86.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$86.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$90.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$95.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$90.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$95.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$95.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$71.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$90.83
|
| Rate for Payer: Healthfirst QHP |
$95.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$66.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$95.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$81.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$66.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$95.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$250.98
|
| Rate for Payer: SOMOS Essential |
$250.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$95.61
|
|
|
CHG RP LOCLZJ TUM SPECT 2 AREA/SEP ACQUISJ IMG
|
Professional
|
$2,833.08
|
|
|
Service Code
|
HCPCS 78831
|
| Min. Negotiated Rate |
$66.93 |
| Max. Negotiated Rate |
$2,124.81 |
| Rate for Payer: Cash Price |
$763.15
|
| Rate for Payer: Cash Price |
$763.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$728.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$728.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$768.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$809.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$768.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$809.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$809.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$607.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$768.98
|
| Rate for Payer: Healthfirst QHP |
$809.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$566.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$809.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$688.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$566.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$809.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,124.81
|
| Rate for Payer: SOMOS Essential |
$2,124.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$809.45
|
|
|
CHG RP LOCLZJ TUM SPECT 2 AREA/SEP ACQUISJ IMG
|
Professional
|
$2,498.41
|
|
|
Service Code
|
HCPCS 78831 TC
|
| Min. Negotiated Rate |
$66.93 |
| Max. Negotiated Rate |
$2,124.81 |
| Rate for Payer: Cash Price |
$670.86
|
| Rate for Payer: Cash Price |
$670.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$642.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$642.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$678.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$713.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$678.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$713.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$713.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$535.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$678.14
|
| Rate for Payer: Healthfirst QHP |
$713.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$499.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$713.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$606.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$499.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$713.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,873.81
|
| Rate for Payer: SOMOS Essential |
$1,873.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$713.83
|
|
|
CHG RP LOCLZJ TUM SPECT CT 2AREA/SEP ACQUISJ IMG
|
Professional
|
$387.77
|
|
|
Service Code
|
HCPCS 78832 26
|
| Min. Negotiated Rate |
$77.55 |
| Max. Negotiated Rate |
$2,722.02 |
| Rate for Payer: Cash Price |
$104.32
|
| Rate for Payer: Cash Price |
$104.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$99.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$99.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$105.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$110.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$105.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$110.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$110.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$83.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$105.25
|
| Rate for Payer: Healthfirst QHP |
$110.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$77.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$110.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$94.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$77.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$110.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$290.83
|
| Rate for Payer: SOMOS Essential |
$290.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$110.79
|
|
|
CHG RP LOCLZJ TUM SPECT CT 2AREA/SEP ACQUISJ IMG
|
Professional
|
$3,629.36
|
|
|
Service Code
|
HCPCS 78832
|
| Min. Negotiated Rate |
$77.55 |
| Max. Negotiated Rate |
$2,722.02 |
| Rate for Payer: Cash Price |
$964.25
|
| Rate for Payer: Cash Price |
$964.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$933.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$933.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$985.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,036.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$985.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,036.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,036.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$777.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$985.11
|
| Rate for Payer: Healthfirst QHP |
$1,036.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$725.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,036.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$881.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$725.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,036.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,722.02
|
| Rate for Payer: SOMOS Essential |
$2,722.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,036.96
|
|
|
CHG RP LOCLZJ TUM SPECT CT 2AREA/SEP ACQUISJ IMG
|
Professional
|
$3,241.60
|
|
|
Service Code
|
HCPCS 78832 TC
|
| Min. Negotiated Rate |
$77.55 |
| Max. Negotiated Rate |
$2,722.02 |
| Rate for Payer: Cash Price |
$859.94
|
| Rate for Payer: Cash Price |
$859.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$833.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$833.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$879.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$926.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$879.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$926.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$926.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$694.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$879.86
|
| Rate for Payer: Healthfirst QHP |
$926.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$648.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$926.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$787.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$648.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$926.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,431.20
|
| Rate for Payer: SOMOS Essential |
$2,431.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$926.17
|
|
|
CHG RP LOCLZJ TUM SPECT W/CT 1 AREA/ACQUISJ 1DAY IMG
|
Professional
|
$1,645.11
|
|
|
Service Code
|
HCPCS 78830 TC
|
| Min. Negotiated Rate |
$53.54 |
| Max. Negotiated Rate |
$1,434.62 |
| Rate for Payer: Cash Price |
$436.37
|
| Rate for Payer: Cash Price |
$436.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$423.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$423.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$446.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$470.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$446.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$470.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$470.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$352.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$446.53
|
| Rate for Payer: Healthfirst QHP |
$470.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$329.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$470.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$399.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$329.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$470.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,233.83
|
| Rate for Payer: SOMOS Essential |
$1,233.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$470.03
|
|
|
CHG RP LOCLZJ TUM SPECT W/CT 1 AREA/ACQUISJ 1DAY IMG
|
Professional
|
$1,912.82
|
|
|
Service Code
|
HCPCS 78830
|
| Min. Negotiated Rate |
$53.54 |
| Max. Negotiated Rate |
$1,434.62 |
| Rate for Payer: Cash Price |
$508.98
|
| Rate for Payer: Cash Price |
$508.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$491.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$491.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$519.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$546.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$519.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$546.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$546.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$409.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$519.19
|
| Rate for Payer: Healthfirst QHP |
$546.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$382.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$546.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$464.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$382.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$546.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,434.62
|
| Rate for Payer: SOMOS Essential |
$1,434.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$546.52
|
|
|
CHG RP LOCLZJ TUM SPECT W/CT 1 AREA/ACQUISJ 1DAY IMG
|
Professional
|
$267.72
|
|
|
Service Code
|
HCPCS 78830 26
|
| Min. Negotiated Rate |
$53.54 |
| Max. Negotiated Rate |
$1,434.62 |
| Rate for Payer: Cash Price |
$72.61
|
| Rate for Payer: Cash Price |
$72.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$68.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$68.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$72.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$76.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$72.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$72.67
|
| Rate for Payer: Healthfirst QHP |
$76.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$53.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$76.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$65.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$53.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$76.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$200.79
|
| Rate for Payer: SOMOS Essential |
$200.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$76.49
|
|
|
CHG RP THERAPY INRACAVITARY ADMINISTRATION
|
Professional
|
$302.16
|
|
|
Service Code
|
HCPCS 79200 26
|
| Min. Negotiated Rate |
$45.94 |
| Max. Negotiated Rate |
$398.90 |
| Rate for Payer: Cash Price |
$82.83
|
| Rate for Payer: Cash Price |
$82.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$77.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$77.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$82.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$86.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$82.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$82.01
|
| Rate for Payer: Healthfirst QHP |
$86.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$60.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$86.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$73.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$60.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$86.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$226.62
|
| Rate for Payer: SOMOS Essential |
$226.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$86.33
|
|
|
CHG RP THERAPY INRACAVITARY ADMINISTRATION
|
Professional
|
$531.86
|
|
|
Service Code
|
HCPCS 79200
|
| Min. Negotiated Rate |
$45.94 |
| Max. Negotiated Rate |
$398.90 |
| Rate for Payer: Cash Price |
$145.61
|
| Rate for Payer: Cash Price |
$145.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$136.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$136.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$144.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$151.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$144.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$151.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$151.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$113.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$144.36
|
| Rate for Payer: Healthfirst QHP |
$151.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$106.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$151.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$129.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$106.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$151.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$398.90
|
| Rate for Payer: SOMOS Essential |
$398.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$151.96
|
|
|
CHG RP THERAPY INRACAVITARY ADMINISTRATION
|
Professional
|
$229.71
|
|
|
Service Code
|
HCPCS 79200 TC
|
| Min. Negotiated Rate |
$45.94 |
| Max. Negotiated Rate |
$398.90 |
| Rate for Payer: Cash Price |
$62.78
|
| Rate for Payer: Cash Price |
$62.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$59.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$59.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$65.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$49.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.35
|
| Rate for Payer: Healthfirst QHP |
$65.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$65.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$55.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$65.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$172.28
|
| Rate for Payer: SOMOS Essential |
$172.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.63
|
|
|
CHG RP THERAPY INTERSTITIAL RADIOACTIVE COLLOID ADMN
|
Professional
|
$1,077.44
|
|
|
Service Code
|
HCPCS 79300 TC
|
| Min. Negotiated Rate |
$48.65 |
| Max. Negotiated Rate |
$990.52 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$808.08
|
| Rate for Payer: SOMOS Essential |
$808.08
|
|
