|
CHG SPECIAL TREATMENT PROCEDURE
|
Professional
|
$574.60
|
|
|
Service Code
|
HCPCS 77470
|
| Min. Negotiated Rate |
$28.41 |
| Max. Negotiated Rate |
$430.95 |
| Rate for Payer: Cash Price |
$160.98
|
| Rate for Payer: Cash Price |
$160.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$147.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$147.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$155.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$164.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$155.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$164.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$164.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$123.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$155.96
|
| Rate for Payer: Healthfirst QHP |
$164.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$114.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$164.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$139.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$114.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$164.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$430.95
|
| Rate for Payer: SOMOS Essential |
$430.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$164.17
|
|
|
CHG SPECIAL TREATMENT PROCEDURE
|
Professional
|
$432.57
|
|
|
Service Code
|
HCPCS 77470 26
|
| Min. Negotiated Rate |
$28.41 |
| Max. Negotiated Rate |
$430.95 |
| Rate for Payer: Cash Price |
$118.07
|
| Rate for Payer: Cash Price |
$118.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$111.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$111.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$117.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$123.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$117.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$123.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$123.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$92.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$117.41
|
| Rate for Payer: Healthfirst QHP |
$123.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$86.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$123.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$105.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$86.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$123.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$324.43
|
| Rate for Payer: SOMOS Essential |
$324.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$123.59
|
|
|
CHG SPEC MEDICAL RADJ PHYSICS CONSLTJ
|
Professional
|
$614.74
|
|
|
Service Code
|
HCPCS 77370
|
| Min. Negotiated Rate |
$122.95 |
| Max. Negotiated Rate |
$461.06 |
| Rate for Payer: Cash Price |
$174.02
|
| Rate for Payer: Cash Price |
$174.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$158.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$158.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$166.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$175.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$166.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$175.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$131.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$166.86
|
| Rate for Payer: Healthfirst QHP |
$175.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$122.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$175.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$149.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$122.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$175.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$461.06
|
| Rate for Payer: SOMOS Essential |
$461.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$175.64
|
|
|
CHG SPEC TELETHX PORT PLN PARTS HEMIBDY TOT BDY
|
Professional
|
$189.60
|
|
|
Service Code
|
HCPCS 77321 TC
|
| Min. Negotiated Rate |
$37.92 |
| Max. Negotiated Rate |
$293.56 |
| Rate for Payer: Cash Price |
$52.89
|
| Rate for Payer: Cash Price |
$52.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$48.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$48.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$51.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$54.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$51.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$51.46
|
| Rate for Payer: Healthfirst QHP |
$54.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$54.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$46.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$54.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$142.20
|
| Rate for Payer: SOMOS Essential |
$142.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.17
|
|
|
CHG SPEC TELETHX PORT PLN PARTS HEMIBDY TOT BDY
|
Professional
|
$391.41
|
|
|
Service Code
|
HCPCS 77321
|
| Min. Negotiated Rate |
$37.92 |
| Max. Negotiated Rate |
$293.56 |
| Rate for Payer: Cash Price |
$108.16
|
| Rate for Payer: Cash Price |
$108.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$100.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$100.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$106.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$111.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$106.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$111.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$83.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$106.24
|
| Rate for Payer: Healthfirst QHP |
$111.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$78.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$111.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$95.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$78.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$111.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$293.56
|
| Rate for Payer: SOMOS Essential |
$293.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$111.83
|
|
|
CHG SPEC TELETHX PORT PLN PARTS HEMIBDY TOT BDY
|
Professional
|
$201.81
|
|
|
Service Code
|
HCPCS 77321 26
|
| Min. Negotiated Rate |
$37.92 |
| Max. Negotiated Rate |
$293.56 |
| Rate for Payer: Cash Price |
$55.28
|
| Rate for Payer: Cash Price |
$55.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$51.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$51.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$54.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$57.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$54.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$54.78
|
| Rate for Payer: Healthfirst QHP |
$57.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$40.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$57.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$49.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$40.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$57.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$151.36
|
| Rate for Payer: SOMOS Essential |
$151.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$57.66
|
|
|
CHG SPLEEN IMAGING ONLY W/WO VASCULAR FLOW
|
Professional
|
$680.47
|
|
|
Service Code
|
HCPCS 78185
|
| Min. Negotiated Rate |
$12.58 |
| Max. Negotiated Rate |
$510.35 |
| Rate for Payer: Cash Price |
$181.72
|
| Rate for Payer: Cash Price |
$181.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$174.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$174.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$184.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$194.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$184.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$194.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$194.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$145.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$184.70
|
| Rate for Payer: Healthfirst QHP |
$194.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$136.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$194.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$165.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$136.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$194.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$510.35
|
| Rate for Payer: SOMOS Essential |
$510.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$194.42
|
|
|
CHG SPLEEN IMAGING ONLY W/WO VASCULAR FLOW
|
Professional
|
$62.90
|
|
|
Service Code
|
HCPCS 78185 26
|
| Min. Negotiated Rate |
$12.58 |
| Max. Negotiated Rate |
$510.35 |
| Rate for Payer: Cash Price |
$16.93
|
| Rate for Payer: Cash Price |
$16.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.07
|
| Rate for Payer: Healthfirst QHP |
$17.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$12.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$17.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$15.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$12.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.18
|
| Rate for Payer: SOMOS Essential |
$47.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.97
|
|
|
CHG SPLEEN IMAGING ONLY W/WO VASCULAR FLOW
|
Professional
|
$617.58
|
|
|
Service Code
|
HCPCS 78185 TC
|
| Min. Negotiated Rate |
$12.58 |
| Max. Negotiated Rate |
$510.35 |
| Rate for Payer: Cash Price |
$164.78
|
| Rate for Payer: Cash Price |
$164.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$158.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$158.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$167.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$176.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$167.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$176.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$176.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$132.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$167.63
|
| Rate for Payer: Healthfirst QHP |
$176.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$123.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$176.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$149.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$123.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$176.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$463.18
|
| Rate for Payer: SOMOS Essential |
$463.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$176.45
|
|
|
CHG SPLENOPORTOGRAPY RS&I
|
Professional
|
$2,544.19
|
|
|
Service Code
|
HCPCS 75810 TC
|
| Min. Negotiated Rate |
$39.49 |
| Max. Negotiated Rate |
$2,056.24 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,908.14
|
| Rate for Payer: SOMOS Essential |
$1,908.14
|
|
|
CHG SPLENOPORTOGRAPY RS&I
|
Professional
|
$2,741.66
|
|
|
Service Code
|
HCPCS 75810
|
| Min. Negotiated Rate |
$39.49 |
| Max. Negotiated Rate |
$2,056.24 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,056.24
|
| Rate for Payer: SOMOS Essential |
$2,056.24
|
|
|
CHG SPLENOPORTOGRAPY RS&I
|
Professional
|
$197.47
|
|
|
Service Code
|
HCPCS 75810 26
|
| Min. Negotiated Rate |
$39.49 |
| Max. Negotiated Rate |
$2,056.24 |
| Rate for Payer: Cash Price |
$53.08
|
| Rate for Payer: Cash Price |
$53.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$50.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$50.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$53.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$56.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$53.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$53.60
|
| Rate for Payer: Healthfirst QHP |
$56.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$39.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$56.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$47.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$39.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$56.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$148.10
|
| Rate for Payer: SOMOS Essential |
$148.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56.42
|
|
|
CHG STEREOTACTIC BODY RADIATION DELIVERY
|
Professional
|
$4,352.43
|
|
|
Service Code
|
HCPCS 77373
|
| Min. Negotiated Rate |
$870.48 |
| Max. Negotiated Rate |
$3,264.32 |
| Rate for Payer: Cash Price |
$1,178.72
|
| Rate for Payer: Cash Price |
$1,178.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,119.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,119.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,181.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,243.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,181.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,243.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,243.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$932.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,181.37
|
| Rate for Payer: Healthfirst QHP |
$1,243.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$870.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,243.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,057.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$870.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,243.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,264.32
|
| Rate for Payer: SOMOS Essential |
$3,264.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,243.55
|
|
|
CHG STEREOTACTIC BODY RADIATION MANAGEMENT
|
Professional
|
$2,642.75
|
|
|
Service Code
|
HCPCS 77435
|
| Min. Negotiated Rate |
$528.55 |
| Max. Negotiated Rate |
$1,982.06 |
| Rate for Payer: Cash Price |
$722.50
|
| Rate for Payer: Cash Price |
$722.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$679.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$679.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$717.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$755.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$717.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$755.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$755.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$566.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$717.32
|
| Rate for Payer: Healthfirst QHP |
$755.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$528.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$755.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$641.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$528.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$755.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,982.06
|
| Rate for Payer: SOMOS Essential |
$1,982.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$755.07
|
|
|
CHG STERETCTC RADIATION TX MANAGEMENT CRANIAL LESION
|
Professional
|
$1,748.39
|
|
|
Service Code
|
HCPCS 77432
|
| Min. Negotiated Rate |
$349.68 |
| Max. Negotiated Rate |
$1,311.29 |
| Rate for Payer: Cash Price |
$477.50
|
| Rate for Payer: Cash Price |
$477.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$449.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$449.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$474.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$499.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$474.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$499.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$499.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$374.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$474.56
|
| Rate for Payer: Healthfirst QHP |
$499.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$349.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$499.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$424.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$349.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$499.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,311.29
|
| Rate for Payer: SOMOS Essential |
$1,311.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$499.54
|
|
|
CHG SUPERVISION HANDLING LOADING RADIATION SOURCE
|
Professional
|
$77.35
|
|
|
Service Code
|
HCPCS 77790
|
| Min. Negotiated Rate |
$15.47 |
| Max. Negotiated Rate |
$58.01 |
| Rate for Payer: Cash Price |
$21.68
|
| Rate for Payer: Cash Price |
$21.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$19.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.00
|
| Rate for Payer: Healthfirst QHP |
$22.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$15.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$22.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$18.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$58.01
|
| Rate for Payer: SOMOS Essential |
$58.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.10
|
|
|
CHG SURFACE APPLIC LOW DOSE RATE RADIONUCLIDE SOURCE
|
Professional
|
$551.64
|
|
|
Service Code
|
HCPCS 77789
|
| Min. Negotiated Rate |
$47.99 |
| Max. Negotiated Rate |
$413.73 |
| Rate for Payer: Cash Price |
$153.76
|
| Rate for Payer: Cash Price |
$153.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$141.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$149.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$149.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$118.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$149.73
|
| Rate for Payer: Healthfirst QHP |
$157.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$110.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$157.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$133.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$110.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$413.73
|
| Rate for Payer: SOMOS Essential |
$413.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.61
|
|
|
CHG SURFACE APPLIC LOW DOSE RATE RADIONUCLIDE SOURCE
|
Professional
|
$311.68
|
|
|
Service Code
|
HCPCS 77789 TC
|
| Min. Negotiated Rate |
$47.99 |
| Max. Negotiated Rate |
$413.73 |
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$80.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$80.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$89.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$84.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$89.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$89.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$66.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$84.60
|
| Rate for Payer: Healthfirst QHP |
$89.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$62.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$89.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$75.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$62.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$89.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$233.76
|
| Rate for Payer: SOMOS Essential |
$233.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$89.05
|
|
|
CHG SURFACE APPLIC LOW DOSE RATE RADIONUCLIDE SOURCE
|
Professional
|
$239.96
|
|
|
Service Code
|
HCPCS 77789 26
|
| Min. Negotiated Rate |
$47.99 |
| Max. Negotiated Rate |
$413.73 |
| Rate for Payer: Cash Price |
$66.46
|
| Rate for Payer: Cash Price |
$66.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$61.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$65.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$68.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$65.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$68.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$68.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$65.13
|
| Rate for Payer: Healthfirst QHP |
$68.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$47.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$68.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$58.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$47.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$68.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$179.97
|
| Rate for Payer: SOMOS Essential |
$179.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$68.56
|
|
|
CHG TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON
|
Professional
|
$155.00
|
|
|
Service Code
|
HCPCS 86480
|
| Min. Negotiated Rate |
$43.39 |
| Max. Negotiated Rate |
$116.25 |
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$55.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$55.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$58.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$61.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$58.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$61.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$46.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$58.88
|
| Rate for Payer: Healthfirst QHP |
$61.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$43.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$61.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$52.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$43.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$61.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$116.25
|
| Rate for Payer: SOMOS Essential |
$116.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$61.98
|
|
|
CHG TBS DXA/OTHER IMG CALCULATION W/I&R FX RISK
|
Professional
|
$174.13
|
|
|
Service Code
|
HCPCS 77089
|
| Min. Negotiated Rate |
$34.82 |
| Max. Negotiated Rate |
$130.60 |
| Rate for Payer: Cash Price |
$47.36
|
| Rate for Payer: Cash Price |
$47.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$44.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$44.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$47.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$49.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$47.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$37.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.26
|
| Rate for Payer: Healthfirst QHP |
$49.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$49.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$42.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$49.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$130.60
|
| Rate for Payer: SOMOS Essential |
$130.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$49.75
|
|
|
CHG TBS INTERPRETATION & REPORT FX RISK BY OTHER QHP
|
Professional
|
$39.27
|
|
|
Service Code
|
HCPCS 77092
|
| Min. Negotiated Rate |
$7.85 |
| Max. Negotiated Rate |
$29.45 |
| Rate for Payer: Cash Price |
$10.74
|
| Rate for Payer: Cash Price |
$10.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.66
|
| Rate for Payer: Healthfirst QHP |
$11.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$7.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$11.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$9.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.45
|
| Rate for Payer: SOMOS Essential |
$29.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.22
|
|
|
CHG TBS TECHL PREP&TRANSMIS DATA ALYS PFRMD ELSEWHR
|
Professional
|
$12.81
|
|
|
Service Code
|
HCPCS 77090
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$9.61 |
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.48
|
| Rate for Payer: Healthfirst QHP |
$3.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.61
|
| Rate for Payer: SOMOS Essential |
$9.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.66
|
|
|
CHG TBS TECHNICAL CALCULATION ONLY
|
Professional
|
$122.05
|
|
|
Service Code
|
HCPCS 77091
|
| Min. Negotiated Rate |
$24.41 |
| Max. Negotiated Rate |
$91.54 |
| Rate for Payer: Cash Price |
$33.24
|
| Rate for Payer: Cash Price |
$33.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.13
|
| Rate for Payer: Healthfirst QHP |
$34.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$91.54
|
| Rate for Payer: SOMOS Essential |
$91.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.87
|
|
|
CHG TELETHX ISODOSE PLN CPLX W/BASIC DOSIMETRY
|
Professional
|
$581.63
|
|
|
Service Code
|
HCPCS 77307 TC
|
| Min. Negotiated Rate |
$116.33 |
| Max. Negotiated Rate |
$896.07 |
| Rate for Payer: Cash Price |
$161.64
|
| Rate for Payer: Cash Price |
$161.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$149.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$149.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$157.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$166.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$157.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$166.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$166.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$124.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$157.87
|
| Rate for Payer: Healthfirst QHP |
$166.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$116.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$166.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$141.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$116.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$166.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$436.22
|
| Rate for Payer: SOMOS Essential |
$436.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$166.18
|
|
