|
CHG TELETHX ISODOSE PLN CPLX W/BASIC DOSIMETRY
|
Professional
|
$1,194.76
|
|
|
Service Code
|
HCPCS 77307
|
| Min. Negotiated Rate |
$116.33 |
| Max. Negotiated Rate |
$896.07 |
| Rate for Payer: Cash Price |
$329.61
|
| Rate for Payer: Cash Price |
$329.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$307.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$307.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$324.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$341.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$324.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$341.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$341.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$256.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$324.29
|
| Rate for Payer: Healthfirst QHP |
$341.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$238.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$341.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$290.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$238.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$341.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$896.07
|
| Rate for Payer: SOMOS Essential |
$896.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$341.36
|
|
|
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
|
|
|
CHG TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION
|
Professional
|
$321.72
|
|
|
Service Code
|
HCPCS 77306 TC
|
| Min. Negotiated Rate |
$59.34 |
| Max. Negotiated Rate |
$463.82 |
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$82.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$82.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$87.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$91.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$87.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$91.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$68.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$87.32
|
| Rate for Payer: Healthfirst QHP |
$91.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$91.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$78.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$91.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$241.29
|
| Rate for Payer: SOMOS Essential |
$241.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$91.92
|
|
|
CHG TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION
|
Professional
|
$618.42
|
|
|
Service Code
|
HCPCS 77306
|
| Min. Negotiated Rate |
$59.34 |
| Max. Negotiated Rate |
$463.82 |
| Rate for Payer: Cash Price |
$170.53
|
| Rate for Payer: Cash Price |
$170.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$159.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$159.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$167.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$176.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$167.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$176.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$176.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$132.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$167.86
|
| Rate for Payer: Healthfirst QHP |
$176.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$123.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$176.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$150.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$123.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$176.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$463.82
|
| Rate for Payer: SOMOS Essential |
$463.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$176.69
|
|
|
CHG TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION
|
Professional
|
$296.70
|
|
|
Service Code
|
HCPCS 77306 26
|
| Min. Negotiated Rate |
$59.34 |
| Max. Negotiated Rate |
$463.82 |
| Rate for Payer: Cash Price |
$81.26
|
| Rate for Payer: Cash Price |
$81.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$76.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$76.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$80.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$84.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$80.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$84.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$84.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$63.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$80.53
|
| Rate for Payer: Healthfirst QHP |
$84.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$59.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$84.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$72.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$59.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$84.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$222.52
|
| Rate for Payer: SOMOS Essential |
$222.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$84.77
|
|
|
CHG TEMPOROMANDBLE JT ARTHROGRAPHY RS&I
|
Professional
|
$363.06
|
|
|
Service Code
|
HCPCS 70332
|
| Min. Negotiated Rate |
$21.47 |
| Max. Negotiated Rate |
$272.30 |
| Rate for Payer: Cash Price |
$95.99
|
| Rate for Payer: Cash Price |
$95.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$93.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$93.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$98.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$103.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$98.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$103.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$77.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$98.54
|
| Rate for Payer: Healthfirst QHP |
$103.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$72.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$103.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$88.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$72.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$103.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$272.30
|
| Rate for Payer: SOMOS Essential |
$272.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$103.73
|
|
|
CHG TEMPOROMANDBLE JT ARTHROGRAPHY RS&I
|
Professional
|
$255.75
|
|
|
Service Code
|
HCPCS 70332 TC
|
| Min. Negotiated Rate |
$21.47 |
| Max. Negotiated Rate |
$272.30 |
| Rate for Payer: Cash Price |
$67.82
|
| Rate for Payer: Cash Price |
$67.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$65.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$69.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$73.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$69.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.42
|
| Rate for Payer: Healthfirst QHP |
$73.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$51.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$73.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$62.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$51.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$73.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$191.81
|
| Rate for Payer: SOMOS Essential |
$191.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$73.07
|
|
|
CHG TEMPOROMANDBLE JT ARTHROGRAPHY RS&I
|
Professional
|
$107.35
|
|
|
Service Code
|
HCPCS 70332 26
|
| Min. Negotiated Rate |
$21.47 |
| Max. Negotiated Rate |
$272.30 |
| Rate for Payer: Cash Price |
$28.17
|
| Rate for Payer: Cash Price |
$28.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$27.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$30.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.14
|
| Rate for Payer: Healthfirst QHP |
$30.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$30.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$80.51
|
| Rate for Payer: SOMOS Essential |
$80.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.67
|
|
|
CHG TESTICULAR IMAGING WITH VASCULAR FLOW
|
Professional
|
$137.24
|
|
|
Service Code
|
HCPCS 78761 26
|
| Min. Negotiated Rate |
$27.45 |
| Max. Negotiated Rate |
$643.73 |
| Rate for Payer: Cash Price |
$37.09
|
| Rate for Payer: Cash Price |
$37.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$39.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.25
|
| Rate for Payer: Healthfirst QHP |
$39.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$39.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$102.93
|
| Rate for Payer: SOMOS Essential |
$102.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.21
|
|
|
CHG TESTICULAR IMAGING WITH VASCULAR FLOW
|
Professional
|
$721.07
|
|
|
Service Code
|
HCPCS 78761 TC
|
| Min. Negotiated Rate |
$27.45 |
| Max. Negotiated Rate |
$643.73 |
| Rate for Payer: Cash Price |
$193.86
|
| Rate for Payer: Cash Price |
$193.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$185.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$185.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$195.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$206.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$195.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$206.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$206.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$154.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$195.72
|
| Rate for Payer: Healthfirst QHP |
$206.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$144.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$206.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$175.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$144.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$206.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$540.80
|
| Rate for Payer: SOMOS Essential |
$540.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$206.02
|
|
|
CHG TESTICULAR IMAGING WITH VASCULAR FLOW
|
Professional
|
$858.31
|
|
|
Service Code
|
HCPCS 78761
|
| Min. Negotiated Rate |
$27.45 |
| Max. Negotiated Rate |
$643.73 |
| Rate for Payer: Cash Price |
$230.95
|
| Rate for Payer: Cash Price |
$230.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$220.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$220.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$232.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$245.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$232.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$245.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$245.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$183.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$232.97
|
| Rate for Payer: Healthfirst QHP |
$245.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$171.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$245.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$208.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$171.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$245.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$643.73
|
| Rate for Payer: SOMOS Essential |
$643.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$245.23
|
|
|
CHG THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ
|
Professional
|
$1,085.07
|
|
|
Service Code
|
HCPCS 74283
|
| Min. Negotiated Rate |
$80.48 |
| Max. Negotiated Rate |
$813.80 |
| Rate for Payer: Cash Price |
$293.83
|
| Rate for Payer: Cash Price |
$293.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$310.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$310.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$310.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$232.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$294.52
|
| Rate for Payer: Healthfirst QHP |
$310.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$217.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$310.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$263.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$217.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$310.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$813.80
|
| Rate for Payer: SOMOS Essential |
$813.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$310.02
|
|
|
CHG THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ
|
Professional
|
$402.40
|
|
|
Service Code
|
HCPCS 74283 26
|
| Min. Negotiated Rate |
$80.48 |
| Max. Negotiated Rate |
$813.80 |
| Rate for Payer: Cash Price |
$109.31
|
| Rate for Payer: Cash Price |
$109.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$103.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$103.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$109.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$114.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$109.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$114.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$114.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$86.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$109.22
|
| Rate for Payer: Healthfirst QHP |
$114.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$80.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$114.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$97.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$80.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$114.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$301.80
|
| Rate for Payer: SOMOS Essential |
$301.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$114.97
|
|
|
CHG THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ
|
Professional
|
$682.68
|
|
|
Service Code
|
HCPCS 74283 TC
|
| Min. Negotiated Rate |
$80.48 |
| Max. Negotiated Rate |
$813.80 |
| Rate for Payer: Cash Price |
$184.52
|
| Rate for Payer: Cash Price |
$184.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$175.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$175.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$185.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$195.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$185.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$195.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$146.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$185.30
|
| Rate for Payer: Healthfirst QHP |
$195.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$136.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$195.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$165.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$136.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$195.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$512.01
|
| Rate for Payer: SOMOS Essential |
$512.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$195.05
|
|
|
CHG THERAPEUTIC RADIOLOGY PORT IMAGES(S)
|
Professional
|
$60.24
|
|
|
Service Code
|
HCPCS 77417
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$45.18 |
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.35
|
| Rate for Payer: Healthfirst QHP |
$17.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$12.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$17.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$14.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$12.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$45.18
|
| Rate for Payer: SOMOS Essential |
$45.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.21
|
|
|
CHG THERAPEUTIC RADIOLOGY TX PLANNING COMPLEX
|
Professional
|
$696.01
|
|
|
Service Code
|
HCPCS 77263
|
| Min. Negotiated Rate |
$139.20 |
| Max. Negotiated Rate |
$522.01 |
| Rate for Payer: Cash Price |
$188.57
|
| Rate for Payer: Cash Price |
$188.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$178.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$178.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$188.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$198.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$188.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$198.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$198.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$149.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$188.92
|
| Rate for Payer: Healthfirst QHP |
$198.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$139.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$198.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$169.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$139.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$198.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$522.01
|
| Rate for Payer: SOMOS Essential |
$522.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$198.86
|
|
|
CHG THERAPEUTIC RADIOLOGY TX PLANNING INTERMEDIATE
|
Professional
|
$442.61
|
|
|
Service Code
|
HCPCS 77262
|
| Min. Negotiated Rate |
$88.52 |
| Max. Negotiated Rate |
$331.96 |
| Rate for Payer: Cash Price |
$121.10
|
| Rate for Payer: Cash Price |
$121.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$113.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$113.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$120.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$126.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$120.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$94.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$120.14
|
| Rate for Payer: Healthfirst QHP |
$126.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$88.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$126.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$107.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$88.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$126.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$331.96
|
| Rate for Payer: SOMOS Essential |
$331.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$126.46
|
|
|
CHG THERAPEUTIC RADIOLOGY TX PLANNING SIMPLE
|
Professional
|
$288.23
|
|
|
Service Code
|
HCPCS 77261
|
| Min. Negotiated Rate |
$57.64 |
| Max. Negotiated Rate |
$216.17 |
| Rate for Payer: Cash Price |
$79.02
|
| Rate for Payer: Cash Price |
$79.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$74.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$74.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$78.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$82.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$78.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$82.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$61.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$78.23
|
| Rate for Payer: Healthfirst QHP |
$82.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$57.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$82.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$70.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$57.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$82.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$216.17
|
| Rate for Payer: SOMOS Essential |
$216.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$82.35
|
|
|
CHG THER RAD SIMULAJ-AIDED FIELD SETTING COMPLEX
|
Professional
|
$1,929.20
|
|
|
Service Code
|
HCPCS 77290
|
| Min. Negotiated Rate |
$66.49 |
| Max. Negotiated Rate |
$1,446.90 |
| Rate for Payer: Cash Price |
$523.14
|
| Rate for Payer: Cash Price |
$523.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$496.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$496.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$523.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$551.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$523.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$551.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$551.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$413.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$523.64
|
| Rate for Payer: Healthfirst QHP |
$551.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$385.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$551.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$468.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$385.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$551.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,446.90
|
| Rate for Payer: SOMOS Essential |
$1,446.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$551.20
|
|
|
CHG THER RAD SIMULAJ-AIDED FIELD SETTING COMPLEX
|
Professional
|
$1,596.77
|
|
|
Service Code
|
HCPCS 77290 TC
|
| Min. Negotiated Rate |
$66.49 |
| Max. Negotiated Rate |
$1,446.90 |
| Rate for Payer: Cash Price |
$432.14
|
| Rate for Payer: Cash Price |
$432.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$410.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$410.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$433.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$456.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$433.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$456.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$456.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$342.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$433.41
|
| Rate for Payer: Healthfirst QHP |
$456.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$319.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$456.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$387.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$319.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$456.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,197.58
|
| Rate for Payer: SOMOS Essential |
$1,197.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$456.22
|
|
|
CHG THER RAD SIMULAJ-AIDED FIELD SETTING COMPLEX
|
Professional
|
$332.43
|
|
|
Service Code
|
HCPCS 77290 26
|
| Min. Negotiated Rate |
$66.49 |
| Max. Negotiated Rate |
$1,446.90 |
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$85.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$85.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$90.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$94.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$90.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$94.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$94.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$71.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$90.23
|
| Rate for Payer: Healthfirst QHP |
$94.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$66.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$94.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$80.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$66.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$94.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$249.32
|
| Rate for Payer: SOMOS Essential |
$249.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$94.98
|
|
|
CHG THER RAD SIMULAJ-AIDED FIELD SETTING INTERMED
|
Professional
|
$1,658.58
|
|
|
Service Code
|
HCPCS 77285 TC
|
| Min. Negotiated Rate |
$45.74 |
| Max. Negotiated Rate |
$1,415.48 |
| Rate for Payer: Cash Price |
$453.91
|
| Rate for Payer: Cash Price |
$453.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$426.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$426.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$450.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$473.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$450.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$473.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$473.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$355.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$450.19
|
| Rate for Payer: Healthfirst QHP |
$473.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$331.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$473.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$402.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$331.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$473.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,243.94
|
| Rate for Payer: SOMOS Essential |
$1,243.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$473.88
|
|
|
CHG THER RAD SIMULAJ-AIDED FIELD SETTING INTERMED
|
Professional
|
$1,887.31
|
|
|
Service Code
|
HCPCS 77285
|
| Min. Negotiated Rate |
$45.74 |
| Max. Negotiated Rate |
$1,415.48 |
| Rate for Payer: Cash Price |
$516.60
|
| Rate for Payer: Cash Price |
$516.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$485.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$485.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$512.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$539.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$512.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$539.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$539.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$404.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$512.27
|
| Rate for Payer: Healthfirst QHP |
$539.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$377.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$539.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$458.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$377.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$539.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,415.48
|
| Rate for Payer: SOMOS Essential |
$1,415.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$539.23
|
|
|
CHG THER RAD SIMULAJ-AIDED FIELD SETTING INTERMED
|
Professional
|
$228.69
|
|
|
Service Code
|
HCPCS 77285 26
|
| Min. Negotiated Rate |
$45.74 |
| Max. Negotiated Rate |
$1,415.48 |
| Rate for Payer: Cash Price |
$62.69
|
| Rate for Payer: Cash Price |
$62.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$58.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$65.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$49.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.07
|
| Rate for Payer: Healthfirst QHP |
$65.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$65.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$55.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$65.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$171.52
|
| Rate for Payer: SOMOS Essential |
$171.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.34
|
|
|
CHG THER RAD SIMULAJ-AIDED FIELD SETTING SIMPLE
|
Professional
|
$998.94
|
|
|
Service Code
|
HCPCS 77280 TC
|
| Min. Negotiated Rate |
$30.93 |
| Max. Negotiated Rate |
$865.20 |
| Rate for Payer: Cash Price |
$273.71
|
| Rate for Payer: Cash Price |
$273.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$256.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$256.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$271.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$285.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$271.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$285.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$285.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$214.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$271.14
|
| Rate for Payer: Healthfirst QHP |
$285.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$199.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$285.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$242.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$199.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$285.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$749.20
|
| Rate for Payer: SOMOS Essential |
$749.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$285.41
|
|
