|
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
|
|
|
CHG THER RAD SIMULAJ-AIDED FIELD SETTING SIMPLE
|
Professional
|
$154.67
|
|
|
Service Code
|
HCPCS 77280 26
|
| Min. Negotiated Rate |
$30.93 |
| Max. Negotiated Rate |
$865.20 |
| Rate for Payer: Cash Price |
$41.61
|
| Rate for Payer: Cash Price |
$41.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$44.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.98
|
| Rate for Payer: Healthfirst QHP |
$44.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$44.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$44.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$116.00
|
| Rate for Payer: SOMOS Essential |
$116.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44.19
|
|
|
CHG THYROID CARCINOMA METASTASES IMG ADDL STUDY
|
Professional
|
$125.58
|
|
|
Service Code
|
HCPCS 78016 26
|
| Min. Negotiated Rate |
$25.12 |
| Max. Negotiated Rate |
$828.82 |
| Rate for Payer: Cash Price |
$34.33
|
| Rate for Payer: Cash Price |
$34.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.09
|
| Rate for Payer: Healthfirst QHP |
$35.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$94.18
|
| Rate for Payer: SOMOS Essential |
$94.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.88
|
|
|
CHG THYROID CARCINOMA METASTASES IMG ADDL STUDY
|
Professional
|
$1,105.09
|
|
|
Service Code
|
HCPCS 78016
|
| Min. Negotiated Rate |
$25.12 |
| Max. Negotiated Rate |
$828.82 |
| Rate for Payer: Cash Price |
$295.85
|
| Rate for Payer: Cash Price |
$295.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$284.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$284.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$299.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$315.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$299.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$315.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$315.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$236.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$299.95
|
| Rate for Payer: Healthfirst QHP |
$315.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$221.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$315.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$268.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$221.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$315.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$828.82
|
| Rate for Payer: SOMOS Essential |
$828.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$315.74
|
|
|
CHG THYROID CARCINOMA METASTASES IMG ADDL STUDY
|
Professional
|
$979.55
|
|
|
Service Code
|
HCPCS 78016 TC
|
| Min. Negotiated Rate |
$25.12 |
| Max. Negotiated Rate |
$828.82 |
| Rate for Payer: Cash Price |
$261.52
|
| Rate for Payer: Cash Price |
$261.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$251.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$251.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$265.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$279.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$265.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$279.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$279.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$209.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$265.88
|
| Rate for Payer: Healthfirst QHP |
$279.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$195.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$279.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$237.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$195.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$279.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$734.66
|
| Rate for Payer: SOMOS Essential |
$734.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$279.87
|
|
|
CHG THYROID CARCINOMA METASTASES IMG LMTD AREA
|
Professional
|
$928.06
|
|
|
Service Code
|
HCPCS 78015
|
| Min. Negotiated Rate |
$26.16 |
| Max. Negotiated Rate |
$696.04 |
| Rate for Payer: Cash Price |
$248.57
|
| Rate for Payer: Cash Price |
$248.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$238.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$238.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$251.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$265.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$251.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$265.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$265.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$198.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$251.90
|
| Rate for Payer: Healthfirst QHP |
$265.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$185.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$265.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$225.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$185.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$265.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$696.04
|
| Rate for Payer: SOMOS Essential |
$696.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$265.16
|
|
|
CHG THYROID CARCINOMA METASTASES IMG LMTD AREA
|
Professional
|
$797.27
|
|
|
Service Code
|
HCPCS 78015 TC
|
| Min. Negotiated Rate |
$26.16 |
| Max. Negotiated Rate |
$696.04 |
| Rate for Payer: Cash Price |
$213.90
|
| Rate for Payer: Cash Price |
$213.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$205.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$205.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$216.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$227.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$216.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$227.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$227.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$170.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$216.40
|
| Rate for Payer: Healthfirst QHP |
$227.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$159.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$227.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$193.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$159.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$227.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$597.95
|
| Rate for Payer: SOMOS Essential |
$597.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$227.79
|
|
|
CHG THYROID CARCINOMA METASTASES IMG LMTD AREA
|
Professional
|
$130.80
|
|
|
Service Code
|
HCPCS 78015 26
|
| Min. Negotiated Rate |
$26.16 |
| Max. Negotiated Rate |
$696.04 |
| Rate for Payer: Cash Price |
$34.67
|
| Rate for Payer: Cash Price |
$34.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.50
|
| Rate for Payer: Healthfirst QHP |
$37.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$31.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$98.10
|
| Rate for Payer: SOMOS Essential |
$98.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.37
|
|
|
CHG THYROID CARCINOMA METASTASES IMG WHOLE BODY
|
Professional
|
$1,245.09
|
|
|
Service Code
|
HCPCS 78018
|
| Min. Negotiated Rate |
$31.21 |
| Max. Negotiated Rate |
$933.82 |
| Rate for Payer: Cash Price |
$332.84
|
| Rate for Payer: Cash Price |
$332.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$320.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$320.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$337.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$355.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$337.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$355.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$355.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$266.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$337.95
|
| Rate for Payer: Healthfirst QHP |
$355.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$249.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$355.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$302.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$249.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$355.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$933.82
|
| Rate for Payer: SOMOS Essential |
$933.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$355.74
|
|
|
CHG THYROID CARCINOMA METASTASES IMG WHOLE BODY
|
Professional
|
$156.03
|
|
|
Service Code
|
HCPCS 78018 26
|
| Min. Negotiated Rate |
$31.21 |
| Max. Negotiated Rate |
$933.82 |
| Rate for Payer: Cash Price |
$41.69
|
| Rate for Payer: Cash Price |
$41.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$44.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42.35
|
| Rate for Payer: Healthfirst QHP |
$44.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$44.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$44.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$117.02
|
| Rate for Payer: SOMOS Essential |
$117.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44.58
|
|
|
CHG THYROID CARCINOMA METASTASES IMG WHOLE BODY
|
Professional
|
$1,089.06
|
|
|
Service Code
|
HCPCS 78018 TC
|
| Min. Negotiated Rate |
$31.21 |
| Max. Negotiated Rate |
$933.82 |
| Rate for Payer: Cash Price |
$291.15
|
| Rate for Payer: Cash Price |
$291.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$280.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$280.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$295.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$311.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$295.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$311.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$311.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$233.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$295.60
|
| Rate for Payer: Healthfirst QHP |
$311.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$217.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$311.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$264.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$217.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$311.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$816.80
|
| Rate for Payer: SOMOS Essential |
$816.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$311.16
|
|
|
CHG THYROID CARCINOMA METASTASES UPTAKE
|
Professional
|
$103.64
|
|
|
Service Code
|
HCPCS 78020 26
|
| Min. Negotiated Rate |
$20.73 |
| Max. Negotiated Rate |
$248.93 |
| Rate for Payer: Cash Price |
$28.07
|
| Rate for Payer: Cash Price |
$28.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$28.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.13
|
| Rate for Payer: Healthfirst QHP |
$29.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$25.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$77.73
|
| Rate for Payer: SOMOS Essential |
$77.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.61
|
|
|
CHG THYROID CARCINOMA METASTASES UPTAKE
|
Professional
|
$228.27
|
|
|
Service Code
|
HCPCS 78020 TC
|
| Min. Negotiated Rate |
$20.73 |
| Max. Negotiated Rate |
$248.93 |
| Rate for Payer: Cash Price |
$62.16
|
| Rate for Payer: Cash Price |
$62.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$58.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$61.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$65.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$61.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.96
|
| Rate for Payer: Healthfirst QHP |
$65.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$65.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$55.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$65.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$171.20
|
| Rate for Payer: SOMOS Essential |
$171.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.22
|
|
|
CHG THYROID CARCINOMA METASTASES UPTAKE
|
Professional
|
$331.91
|
|
|
Service Code
|
HCPCS 78020
|
| Min. Negotiated Rate |
$20.73 |
| Max. Negotiated Rate |
$248.93 |
| Rate for Payer: Cash Price |
$90.22
|
| Rate for Payer: Cash Price |
$90.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$85.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$85.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$90.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$94.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$90.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$94.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$94.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$71.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$90.09
|
| Rate for Payer: Healthfirst QHP |
$94.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$66.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$94.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$80.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$66.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$94.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$248.93
|
| Rate for Payer: SOMOS Essential |
$248.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$94.83
|
|
|
CHG THYROID IMAGING WITH VASCULAR FLOW
|
Professional
|
$698.08
|
|
|
Service Code
|
HCPCS 78013 TC
|
| Min. Negotiated Rate |
$14.10 |
| Max. Negotiated Rate |
$576.43 |
| Rate for Payer: Cash Price |
$182.86
|
| Rate for Payer: Cash Price |
$182.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$179.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$179.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$189.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$199.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$189.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$199.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$199.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$149.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$189.48
|
| Rate for Payer: Healthfirst QHP |
$199.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$139.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$199.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$169.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$139.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$199.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$523.56
|
| Rate for Payer: SOMOS Essential |
$523.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$199.45
|
|
|
CHG THYROID IMAGING WITH VASCULAR FLOW
|
Professional
|
$768.57
|
|
|
Service Code
|
HCPCS 78013
|
| Min. Negotiated Rate |
$14.10 |
| Max. Negotiated Rate |
$576.43 |
| Rate for Payer: Cash Price |
$201.73
|
| Rate for Payer: Cash Price |
$201.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$197.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$197.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$208.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$219.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$208.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$219.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$219.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$164.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$208.61
|
| Rate for Payer: Healthfirst QHP |
$219.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$153.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$219.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$186.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$153.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$219.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$576.43
|
| Rate for Payer: SOMOS Essential |
$576.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$219.59
|
|
|
CHG THYROID IMAGING WITH VASCULAR FLOW
|
Professional
|
$70.49
|
|
|
Service Code
|
HCPCS 78013 26
|
| Min. Negotiated Rate |
$14.10 |
| Max. Negotiated Rate |
$576.43 |
| Rate for Payer: Cash Price |
$18.87
|
| Rate for Payer: Cash Price |
$18.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.13
|
| Rate for Payer: Healthfirst QHP |
$20.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$20.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$17.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$14.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$52.87
|
| Rate for Payer: SOMOS Essential |
$52.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.14
|
|
|
CHG THYROID UPTAKE SINGLE/MULTIPLE QUANT MEASUREMENT
|
Professional
|
$315.70
|
|
|
Service Code
|
HCPCS 78012 TC
|
| Min. Negotiated Rate |
$7.04 |
| Max. Negotiated Rate |
$263.13 |
| Rate for Payer: Cash Price |
$85.96
|
| Rate for Payer: Cash Price |
$85.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$81.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$81.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$85.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$90.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$85.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$90.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$85.69
|
| Rate for Payer: Healthfirst QHP |
$90.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$63.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$90.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$76.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$63.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$90.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$236.78
|
| Rate for Payer: SOMOS Essential |
$236.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$90.20
|
|
|
CHG THYROID UPTAKE SINGLE/MULTIPLE QUANT MEASUREMENT
|
Professional
|
$35.18
|
|
|
Service Code
|
HCPCS 78012 26
|
| Min. Negotiated Rate |
$7.04 |
| Max. Negotiated Rate |
$263.13 |
| Rate for Payer: Cash Price |
$9.61
|
| Rate for Payer: Cash Price |
$9.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.55
|
| Rate for Payer: Healthfirst QHP |
$10.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$7.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$10.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.38
|
| Rate for Payer: SOMOS Essential |
$26.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.05
|
|
|
CHG THYROID UPTAKE SINGLE/MULTIPLE QUANT MEASUREMENT
|
Professional
|
$350.84
|
|
|
Service Code
|
HCPCS 78012
|
| Min. Negotiated Rate |
$7.04 |
| Max. Negotiated Rate |
$263.13 |
| Rate for Payer: Cash Price |
$95.57
|
| Rate for Payer: Cash Price |
$95.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$90.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$90.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$95.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$100.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$95.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$75.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$95.23
|
| Rate for Payer: Healthfirst QHP |
$100.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$70.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$100.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$85.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$70.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$100.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$263.13
|
| Rate for Payer: SOMOS Essential |
$263.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$100.24
|
|
|
CHG THYROID UPTAKE W/BLOOD FLOW SNGLE/MULT QUAN MEAS
|
Professional
|
$92.54
|
|
|
Service Code
|
HCPCS 78014 26
|
| Min. Negotiated Rate |
$18.51 |
| Max. Negotiated Rate |
$716.94 |
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.12
|
| Rate for Payer: Healthfirst QHP |
$26.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.40
|
| Rate for Payer: SOMOS Essential |
$69.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.44
|
|
|
CHG THYROID UPTAKE W/BLOOD FLOW SNGLE/MULT QUAN MEAS
|
Professional
|
$955.92
|
|
|
Service Code
|
HCPCS 78014
|
| Min. Negotiated Rate |
$18.51 |
| Max. Negotiated Rate |
$716.94 |
| Rate for Payer: Cash Price |
$255.77
|
| Rate for Payer: Cash Price |
$255.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$245.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$245.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$259.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$273.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$259.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$273.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$273.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$204.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$259.46
|
| Rate for Payer: Healthfirst QHP |
$273.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$191.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$273.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$232.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$191.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$273.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$716.94
|
| Rate for Payer: SOMOS Essential |
$716.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$273.12
|
|
|
CHG THYROID UPTAKE W/BLOOD FLOW SNGLE/MULT QUAN MEAS
|
Professional
|
$863.38
|
|
|
Service Code
|
HCPCS 78014 TC
|
| Min. Negotiated Rate |
$18.51 |
| Max. Negotiated Rate |
$716.94 |
| Rate for Payer: Cash Price |
$230.80
|
| Rate for Payer: Cash Price |
$230.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$222.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$222.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$234.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$234.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$246.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$185.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$234.35
|
| Rate for Payer: Healthfirst QHP |
$246.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$172.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$246.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$209.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$172.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$647.54
|
| Rate for Payer: SOMOS Essential |
$647.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.68
|
|
|
CHG TRANSCATHETER BIOPSY RS&I
|
Professional
|
$2,483.57
|
|
|
Service Code
|
HCPCS 75970
|
| Min. Negotiated Rate |
$30.69 |
| Max. Negotiated Rate |
$1,862.68 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,862.68
|
| Rate for Payer: SOMOS Essential |
$1,862.68
|
|
|
CHG TRANSCATHETER BIOPSY RS&I
|
Professional
|
$2,330.13
|
|
|
Service Code
|
HCPCS 75970 TC
|
| Min. Negotiated Rate |
$30.69 |
| Max. Negotiated Rate |
$1,862.68 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,747.60
|
| Rate for Payer: SOMOS Essential |
$1,747.60
|
|
