|
CHG RP THERAPY INTERSTITIAL RADIOACTIVE COLLOID ADMN
|
Professional
|
$1,320.69
|
|
|
Service Code
|
HCPCS 79300
|
| Min. Negotiated Rate |
$48.65 |
| Max. Negotiated Rate |
$990.52 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$990.52
|
| Rate for Payer: SOMOS Essential |
$990.52
|
|
|
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
|
|
|
CHG RP THERAPY INTRA-ARTERIAL PARTICULATE ADMN
|
Professional
|
$903.84
|
|
|
Service Code
|
HCPCS 79445
|
| Min. Negotiated Rate |
$87.91 |
| Max. Negotiated Rate |
$677.88 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$677.88
|
| Rate for Payer: SOMOS Essential |
$677.88
|
|
|
CHG RP THERAPY INTRA-ARTERIAL PARTICULATE ADMN
|
Professional
|
$439.53
|
|
|
Service Code
|
HCPCS 79445 26
|
| Min. Negotiated Rate |
$87.91 |
| Max. Negotiated Rate |
$677.88 |
| Rate for Payer: Cash Price |
$118.78
|
| Rate for Payer: Cash Price |
$118.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$113.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$113.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$119.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$125.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$119.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$94.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$119.30
|
| Rate for Payer: Healthfirst QHP |
$125.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$87.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$125.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$106.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$87.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$125.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$329.65
|
| Rate for Payer: SOMOS Essential |
$329.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$125.58
|
|
|
CHG RP THERAPY INTRA-ARTERIAL PARTICULATE ADMN
|
Professional
|
$464.31
|
|
|
Service Code
|
HCPCS 79445 TC
|
| Min. Negotiated Rate |
$87.91 |
| Max. Negotiated Rate |
$677.88 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$348.23
|
| Rate for Payer: SOMOS Essential |
$348.23
|
|
|
CHG RP THERAPY INTRA-ARTICULAR ADMINISTRATION
|
Professional
|
$475.83
|
|
|
Service Code
|
HCPCS 79440
|
| Min. Negotiated Rate |
$34.73 |
| Max. Negotiated Rate |
$356.87 |
| Rate for Payer: Cash Price |
$130.05
|
| Rate for Payer: Cash Price |
$130.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$122.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$122.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$129.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$135.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$129.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$135.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$135.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$101.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$129.15
|
| Rate for Payer: Healthfirst QHP |
$135.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$95.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$135.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$115.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$95.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$135.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$356.87
|
| Rate for Payer: SOMOS Essential |
$356.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$135.95
|
|
|
CHG RP THERAPY INTRA-ARTICULAR ADMINISTRATION
|
Professional
|
$302.16
|
|
|
Service Code
|
HCPCS 79440 26
|
| Min. Negotiated Rate |
$34.73 |
| Max. Negotiated Rate |
$356.87 |
| 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 INTRA-ARTICULAR ADMINISTRATION
|
Professional
|
$173.67
|
|
|
Service Code
|
HCPCS 79440 TC
|
| Min. Negotiated Rate |
$34.73 |
| Max. Negotiated Rate |
$356.87 |
| Rate for Payer: Cash Price |
$47.22
|
| Rate for Payer: Cash Price |
$47.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$44.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$44.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$47.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$49.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$47.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$37.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.14
|
| Rate for Payer: Healthfirst QHP |
$49.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$49.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$42.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$49.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$130.25
|
| Rate for Payer: SOMOS Essential |
$130.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$49.62
|
|
|
CHG RP THERAPY INTRAVENOUS ADMINISTRATION
|
Professional
|
$232.61
|
|
|
Service Code
|
HCPCS 79101 TC
|
| Min. Negotiated Rate |
$46.52 |
| Max. Negotiated Rate |
$453.79 |
| Rate for Payer: Cash Price |
$63.73
|
| Rate for Payer: Cash Price |
$63.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$59.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$59.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$63.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$66.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$63.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$66.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$66.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$49.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$63.14
|
| Rate for Payer: Healthfirst QHP |
$66.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$46.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$66.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$56.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$46.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$66.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$174.46
|
| Rate for Payer: SOMOS Essential |
$174.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$66.46
|
|
|
CHG RP THERAPY INTRAVENOUS ADMINISTRATION
|
Professional
|
$605.05
|
|
|
Service Code
|
HCPCS 79101
|
| Min. Negotiated Rate |
$46.52 |
| Max. Negotiated Rate |
$453.79 |
| Rate for Payer: Cash Price |
$164.75
|
| Rate for Payer: Cash Price |
$164.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$155.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$155.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$164.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$172.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$164.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$172.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$172.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$129.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$164.23
|
| Rate for Payer: Healthfirst QHP |
$172.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$121.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$172.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$146.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$121.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$172.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$453.79
|
| Rate for Payer: SOMOS Essential |
$453.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$172.87
|
|
|
CHG RP THERAPY INTRAVENOUS ADMINISTRATION
|
Professional
|
$372.44
|
|
|
Service Code
|
HCPCS 79101 26
|
| Min. Negotiated Rate |
$46.52 |
| Max. Negotiated Rate |
$453.79 |
| Rate for Payer: Cash Price |
$101.02
|
| Rate for Payer: Cash Price |
$101.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$95.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$95.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$101.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$106.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$101.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$106.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$79.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$101.09
|
| Rate for Payer: Healthfirst QHP |
$106.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$74.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$106.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$90.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$74.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$106.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$279.33
|
| Rate for Payer: SOMOS Essential |
$279.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$106.41
|
|
|
CHG RP THERAPY ORAL ADMINISTRATION
|
Professional
|
$222.53
|
|
|
Service Code
|
HCPCS 79005 TC
|
| Min. Negotiated Rate |
$44.51 |
| Max. Negotiated Rate |
$417.20 |
| Rate for Payer: Cash Price |
$60.98
|
| Rate for Payer: Cash Price |
$60.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$57.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$57.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$60.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$63.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$60.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.40
|
| Rate for Payer: Healthfirst QHP |
$63.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$44.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$63.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$54.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$44.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$63.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$166.90
|
| Rate for Payer: SOMOS Essential |
$166.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$63.58
|
|
|
CHG RP THERAPY ORAL ADMINISTRATION
|
Professional
|
$556.26
|
|
|
Service Code
|
HCPCS 79005
|
| Min. Negotiated Rate |
$44.51 |
| Max. Negotiated Rate |
$417.20 |
| Rate for Payer: Cash Price |
$151.70
|
| Rate for Payer: Cash Price |
$151.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$143.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$143.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$150.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$158.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$150.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$158.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$158.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$119.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$150.98
|
| Rate for Payer: Healthfirst QHP |
$158.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$111.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$158.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$135.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$111.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$158.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$417.20
|
| Rate for Payer: SOMOS Essential |
$417.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$158.93
|
|
|
CHG RP THERAPY ORAL ADMINISTRATION
|
Professional
|
$333.73
|
|
|
Service Code
|
HCPCS 79005 26
|
| Min. Negotiated Rate |
$44.51 |
| Max. Negotiated Rate |
$417.20 |
| Rate for Payer: Cash Price |
$90.73
|
| Rate for Payer: Cash Price |
$90.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$85.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$85.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$90.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$95.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$90.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$95.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$95.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$71.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$90.58
|
| Rate for Payer: Healthfirst QHP |
$95.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$66.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$95.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$81.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$66.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$95.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$250.30
|
| Rate for Payer: SOMOS Essential |
$250.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$95.35
|
|
|
CHG RP THER RADIOLBLD MONOCLONAL ANTIBODY IV INFUS
|
Professional
|
$407.68
|
|
|
Service Code
|
HCPCS 79403 TC
|
| Min. Negotiated Rate |
$81.54 |
| Max. Negotiated Rate |
$621.94 |
| Rate for Payer: Cash Price |
$119.99
|
| Rate for Payer: Cash Price |
$119.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$104.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$104.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$110.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$116.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$110.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$116.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$116.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$87.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$110.66
|
| Rate for Payer: Healthfirst QHP |
$116.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$81.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$116.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$99.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$81.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$116.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$305.76
|
| Rate for Payer: SOMOS Essential |
$305.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$116.48
|
|
|
CHG RP THER RADIOLBLD MONOCLONAL ANTIBODY IV INFUS
|
Professional
|
$829.26
|
|
|
Service Code
|
HCPCS 79403
|
| Min. Negotiated Rate |
$81.54 |
| Max. Negotiated Rate |
$621.94 |
| Rate for Payer: Cash Price |
$239.22
|
| Rate for Payer: Cash Price |
$239.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$213.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$213.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$225.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$236.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$225.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$236.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$236.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$177.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.08
|
| Rate for Payer: Healthfirst QHP |
$236.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$165.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$236.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$201.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$165.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$236.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$621.94
|
| Rate for Payer: SOMOS Essential |
$621.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$236.93
|
|
|
CHG RP THER RADIOLBLD MONOCLONAL ANTIBODY IV INFUS
|
Professional
|
$421.58
|
|
|
Service Code
|
HCPCS 79403 26
|
| Min. Negotiated Rate |
$81.54 |
| Max. Negotiated Rate |
$621.94 |
| Rate for Payer: Cash Price |
$119.23
|
| Rate for Payer: Cash Price |
$119.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$108.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$114.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$120.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$114.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$120.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$90.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$114.43
|
| Rate for Payer: Healthfirst QHP |
$120.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$84.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$120.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$102.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$84.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$120.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$316.18
|
| Rate for Payer: SOMOS Essential |
$316.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$120.45
|
|
|
CHG SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER
|
Professional
|
$357.81
|
|
|
Service Code
|
HCPCS 76831 TC
|
| Min. Negotiated Rate |
$27.18 |
| Max. Negotiated Rate |
$370.28 |
| Rate for Payer: Cash Price |
$97.29
|
| Rate for Payer: Cash Price |
$97.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$92.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$92.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$97.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$102.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$97.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$102.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$102.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$76.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$97.12
|
| Rate for Payer: Healthfirst QHP |
$102.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$71.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$102.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$86.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$71.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$102.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$268.36
|
| Rate for Payer: SOMOS Essential |
$268.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$102.23
|
|
|
CHG SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER
|
Professional
|
$135.91
|
|
|
Service Code
|
HCPCS 76831 26
|
| Min. Negotiated Rate |
$27.18 |
| Max. Negotiated Rate |
$370.28 |
| Rate for Payer: Cash Price |
$37.36
|
| Rate for Payer: Cash Price |
$37.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.89
|
| Rate for Payer: Healthfirst QHP |
$38.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$101.93
|
| Rate for Payer: SOMOS Essential |
$101.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.83
|
|
|
CHG SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER
|
Professional
|
$493.71
|
|
|
Service Code
|
HCPCS 76831
|
| Min. Negotiated Rate |
$27.18 |
| Max. Negotiated Rate |
$370.28 |
| Rate for Payer: Cash Price |
$134.65
|
| Rate for Payer: Cash Price |
$134.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$126.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$126.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$134.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$141.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$134.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$141.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$141.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$105.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$134.01
|
| Rate for Payer: Healthfirst QHP |
$141.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$98.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$141.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$119.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$98.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$141.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$370.28
|
| Rate for Payer: SOMOS Essential |
$370.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$141.06
|
|
|
CHG SALIVARY GLAND FUNCTION STUDY
|
Professional
|
$73.12
|
|
|
Service Code
|
HCPCS 78232 26
|
| Min. Negotiated Rate |
$14.62 |
| Max. Negotiated Rate |
$327.18 |
| Rate for Payer: Cash Price |
$19.77
|
| Rate for Payer: Cash Price |
$19.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.85
|
| Rate for Payer: Healthfirst QHP |
$20.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$20.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$17.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$14.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$54.84
|
| Rate for Payer: SOMOS Essential |
$54.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.89
|
|
|
CHG SALIVARY GLAND FUNCTION STUDY
|
Professional
|
$363.13
|
|
|
Service Code
|
HCPCS 78232 TC
|
| Min. Negotiated Rate |
$14.62 |
| Max. Negotiated Rate |
$327.18 |
| Rate for Payer: Cash Price |
$99.40
|
| Rate for Payer: Cash Price |
$99.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$93.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$93.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$98.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$103.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$98.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$103.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$77.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$98.56
|
| Rate for Payer: Healthfirst QHP |
$103.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$72.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$103.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$88.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$72.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$103.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$272.35
|
| Rate for Payer: SOMOS Essential |
$272.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$103.75
|
|
|
CHG SALIVARY GLAND FUNCTION STUDY
|
Professional
|
$436.24
|
|
|
Service Code
|
HCPCS 78232
|
| Min. Negotiated Rate |
$14.62 |
| Max. Negotiated Rate |
$327.18 |
| Rate for Payer: Cash Price |
$119.16
|
| Rate for Payer: Cash Price |
$119.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$112.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$112.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$118.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$124.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$118.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$124.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$124.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$93.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$118.41
|
| Rate for Payer: Healthfirst QHP |
$124.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$87.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$124.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$105.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$87.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$124.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$327.18
|
| Rate for Payer: SOMOS Essential |
$327.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$124.64
|
|
|
CHG SALIVARY GLAND IMAGING
|
Professional
|
$715.33
|
|
|
Service Code
|
HCPCS 78230
|
| Min. Negotiated Rate |
$16.97 |
| Max. Negotiated Rate |
$536.50 |
| Rate for Payer: Cash Price |
$192.34
|
| Rate for Payer: Cash Price |
$192.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$183.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$183.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$194.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$204.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$194.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$204.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$204.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$153.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$194.16
|
| Rate for Payer: Healthfirst QHP |
$204.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$143.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$204.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$173.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$143.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$204.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$536.50
|
| Rate for Payer: SOMOS Essential |
$536.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$204.38
|
|
|
CHG SALIVARY GLAND IMAGING
|
Professional
|
$84.84
|
|
|
Service Code
|
HCPCS 78230 26
|
| Min. Negotiated Rate |
$16.97 |
| Max. Negotiated Rate |
$536.50 |
| Rate for Payer: Cash Price |
$23.23
|
| Rate for Payer: Cash Price |
$23.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23.03
|
| Rate for Payer: Healthfirst QHP |
$24.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$16.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$24.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$20.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$16.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$63.63
|
| Rate for Payer: SOMOS Essential |
$63.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.24
|
|
