|
CHG BASIC RADIATION DOSIMETRY CALCULATION
|
Professional
|
Both
|
$143.61
|
|
|
Service Code
|
HCPCS 77300 TC
|
| Min. Negotiated Rate |
$28.15 |
| Max. Negotiated Rate |
$90.47 |
| Rate for Payer: Cash Price |
$39.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$40.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.16
|
| Rate for Payer: Healthfirst Commercial |
$40.21
|
| Rate for Payer: Healthfirst Essential Plan |
$90.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.20
|
| Rate for Payer: Healthfirst QHP |
$40.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$40.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$30.16
|
| Rate for Payer: SOMOS Essential |
$30.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.21
|
|
|
CHG BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER
|
Professional
|
Both
|
$11.00
|
|
|
Service Code
|
HCPCS 82270
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$9.86 |
| Rate for Payer: Cash Price |
$4.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.29
|
| Rate for Payer: Healthfirst Commercial |
$4.38
|
| Rate for Payer: Healthfirst Essential Plan |
$9.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.16
|
| Rate for Payer: Healthfirst QHP |
$4.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.75
|
| Rate for Payer: SOMOS Essential |
$1.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.38
|
|
|
CHG BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES
|
Professional
|
Both
|
$21.28
|
|
|
Service Code
|
HCPCS 82271
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$11.97 |
| Rate for Payer: Cash Price |
$5.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.99
|
| Rate for Payer: Healthfirst Commercial |
$5.32
|
| Rate for Payer: Healthfirst Essential Plan |
$11.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.05
|
| Rate for Payer: Healthfirst QHP |
$5.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$5.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$4.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2.13
|
| Rate for Payer: SOMOS Essential |
$2.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.32
|
|
|
CHG BLOOD SMEAR PERIPHERAL INTERP PHYS W/WRIT REPORT
|
Professional
|
Both
|
$98.95
|
|
|
Service Code
|
HCPCS 85060
|
| Min. Negotiated Rate |
$18.13 |
| Max. Negotiated Rate |
$58.27 |
| Rate for Payer: Cash Price |
$26.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.43
|
| Rate for Payer: Healthfirst Commercial |
$25.90
|
| Rate for Payer: Healthfirst Essential Plan |
$58.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24.61
|
| Rate for Payer: Healthfirst QHP |
$25.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$25.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19.43
|
| Rate for Payer: SOMOS Essential |
$19.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.90
|
|
|
CHG BONE AGE STUDIES
|
Professional
|
Both
|
$36.61
|
|
|
Service Code
|
HCPCS 77072 26
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$22.23 |
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.41
|
| Rate for Payer: Healthfirst Commercial |
$9.88
|
| Rate for Payer: Healthfirst Essential Plan |
$22.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.39
|
| Rate for Payer: Healthfirst QHP |
$9.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.41
|
| Rate for Payer: SOMOS Essential |
$7.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.88
|
|
|
CHG BONE AGE STUDIES
|
Professional
|
Both
|
$111.20
|
|
|
Service Code
|
HCPCS 77072
|
| Min. Negotiated Rate |
$20.66 |
| Max. Negotiated Rate |
$66.42 |
| Rate for Payer: Cash Price |
$30.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$28.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.14
|
| Rate for Payer: Healthfirst Commercial |
$29.52
|
| Rate for Payer: Healthfirst Essential Plan |
$66.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.04
|
| Rate for Payer: Healthfirst QHP |
$29.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$25.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.14
|
| Rate for Payer: SOMOS Essential |
$22.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.52
|
|
|
CHG BONE AGE STUDIES
|
Professional
|
Both
|
$74.62
|
|
|
Service Code
|
HCPCS 77072 TC
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$44.19 |
| Rate for Payer: Cash Price |
$20.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.73
|
| Rate for Payer: Healthfirst Commercial |
$19.64
|
| Rate for Payer: Healthfirst Essential Plan |
$44.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.66
|
| Rate for Payer: Healthfirst QHP |
$19.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$14.73
|
| Rate for Payer: SOMOS Essential |
$14.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.64
|
|
|
CHG BONE &/JOINT IMAGING 3 PHASE STUDY
|
Professional
|
Both
|
$189.00
|
|
|
Service Code
|
HCPCS 78315 26
|
| Min. Negotiated Rate |
$35.84 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Cash Price |
$52.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$51.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$46.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$46.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$48.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$51.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$48.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.40
|
| Rate for Payer: Healthfirst Commercial |
$51.20
|
| Rate for Payer: Healthfirst Essential Plan |
$115.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$48.64
|
| Rate for Payer: Healthfirst QHP |
$51.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$35.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$51.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$43.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$35.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$51.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$38.40
|
| Rate for Payer: SOMOS Essential |
$38.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$51.20
|
|
|
CHG BONE &/JOINT IMAGING 3 PHASE STUDY
|
Professional
|
Both
|
$1,191.12
|
|
|
Service Code
|
HCPCS 78315 TC
|
| Min. Negotiated Rate |
$215.19 |
| Max. Negotiated Rate |
$691.67 |
| Rate for Payer: Cash Price |
$319.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$307.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$276.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$276.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$292.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$307.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$292.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$307.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$307.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$230.56
|
| Rate for Payer: Healthfirst Commercial |
$307.41
|
| Rate for Payer: Healthfirst Essential Plan |
$691.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$292.04
|
| Rate for Payer: Healthfirst QHP |
$307.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$215.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$307.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$261.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$215.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$307.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$230.56
|
| Rate for Payer: SOMOS Essential |
$230.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$307.41
|
|
|
CHG BONE &/JOINT IMAGING 3 PHASE STUDY
|
Professional
|
Both
|
$1,380.16
|
|
|
Service Code
|
HCPCS 78315
|
| Min. Negotiated Rate |
$251.02 |
| Max. Negotiated Rate |
$806.85 |
| Rate for Payer: Cash Price |
$371.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$358.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$322.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$322.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$340.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$358.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$340.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$358.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$358.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$268.95
|
| Rate for Payer: Healthfirst Commercial |
$358.60
|
| Rate for Payer: Healthfirst Essential Plan |
$806.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$340.67
|
| Rate for Payer: Healthfirst QHP |
$358.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$251.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$358.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$304.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$251.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$358.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$268.95
|
| Rate for Payer: SOMOS Essential |
$268.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$358.60
|
|
|
CHG BONE &/JOINT IMAGING LIMITED AREA
|
Professional
|
Both
|
$911.72
|
|
|
Service Code
|
HCPCS 78300
|
| Min. Negotiated Rate |
$164.27 |
| Max. Negotiated Rate |
$528.01 |
| Rate for Payer: Cash Price |
$242.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$234.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$211.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$211.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$222.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$234.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$222.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$234.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$234.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$176.00
|
| Rate for Payer: Healthfirst Commercial |
$234.67
|
| Rate for Payer: Healthfirst Essential Plan |
$528.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$222.94
|
| Rate for Payer: Healthfirst QHP |
$234.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$164.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$234.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$199.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$164.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$234.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$176.00
|
| Rate for Payer: SOMOS Essential |
$176.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$234.67
|
|
|
CHG BONE &/JOINT IMAGING LIMITED AREA
|
Professional
|
Both
|
$791.49
|
|
|
Service Code
|
HCPCS 78300 TC
|
| Min. Negotiated Rate |
$142.04 |
| Max. Negotiated Rate |
$456.57 |
| Rate for Payer: Cash Price |
$210.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$202.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$182.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$182.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$192.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$202.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$192.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$202.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$202.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$152.19
|
| Rate for Payer: Healthfirst Commercial |
$202.92
|
| Rate for Payer: Healthfirst Essential Plan |
$456.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$192.77
|
| Rate for Payer: Healthfirst QHP |
$202.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$142.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$202.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$172.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$142.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$202.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$152.19
|
| Rate for Payer: SOMOS Essential |
$152.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$202.92
|
|
|
CHG BONE &/JOINT IMAGING LIMITED AREA
|
Professional
|
Both
|
$120.23
|
|
|
Service Code
|
HCPCS 78300 26
|
| Min. Negotiated Rate |
$22.23 |
| Max. Negotiated Rate |
$71.44 |
| Rate for Payer: Cash Price |
$31.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.81
|
| Rate for Payer: Healthfirst Commercial |
$31.75
|
| Rate for Payer: Healthfirst Essential Plan |
$71.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.16
|
| Rate for Payer: Healthfirst QHP |
$31.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$31.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.81
|
| Rate for Payer: SOMOS Essential |
$23.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.75
|
|
|
CHG BONE &/JOINT IMAGING MULTIPLE AREAS
|
Professional
|
Both
|
$156.59
|
|
|
Service Code
|
HCPCS 78305 26
|
| Min. Negotiated Rate |
$29.62 |
| Max. Negotiated Rate |
$95.22 |
| Rate for Payer: Cash Price |
$42.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$42.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$42.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$40.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.74
|
| Rate for Payer: Healthfirst Commercial |
$42.32
|
| Rate for Payer: Healthfirst Essential Plan |
$95.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.20
|
| Rate for Payer: Healthfirst QHP |
$42.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$42.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$35.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$42.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31.74
|
| Rate for Payer: SOMOS Essential |
$31.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.32
|
|
|
CHG BONE &/JOINT IMAGING MULTIPLE AREAS
|
Professional
|
Both
|
$948.19
|
|
|
Service Code
|
HCPCS 78305 TC
|
| Min. Negotiated Rate |
$170.46 |
| Max. Negotiated Rate |
$547.92 |
| Rate for Payer: Cash Price |
$250.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$243.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$219.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$219.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$231.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$243.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$231.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$243.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$243.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$182.64
|
| Rate for Payer: Healthfirst Commercial |
$243.52
|
| Rate for Payer: Healthfirst Essential Plan |
$547.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$231.34
|
| Rate for Payer: Healthfirst QHP |
$243.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$170.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$243.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$206.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$170.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$243.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$182.64
|
| Rate for Payer: SOMOS Essential |
$182.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$243.52
|
|
|
CHG BONE &/JOINT IMAGING MULTIPLE AREAS
|
Professional
|
Both
|
$1,104.78
|
|
|
Service Code
|
HCPCS 78305
|
| Min. Negotiated Rate |
$200.09 |
| Max. Negotiated Rate |
$643.14 |
| Rate for Payer: Cash Price |
$292.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$285.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$257.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$257.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$271.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$285.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$271.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$285.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$285.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$214.38
|
| Rate for Payer: Healthfirst Commercial |
$285.84
|
| Rate for Payer: Healthfirst Essential Plan |
$643.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$271.55
|
| Rate for Payer: Healthfirst QHP |
$285.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$200.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$285.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$242.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$200.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$285.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$214.38
|
| Rate for Payer: SOMOS Essential |
$214.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$285.84
|
|
|
CHG BONE &/JOINT IMAGING WHOLE BODY
|
Professional
|
Both
|
$160.34
|
|
|
Service Code
|
HCPCS 78306 26
|
| Min. Negotiated Rate |
$30.35 |
| Max. Negotiated Rate |
$97.56 |
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$43.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.52
|
| Rate for Payer: Healthfirst Commercial |
$43.36
|
| Rate for Payer: Healthfirst Essential Plan |
$97.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.19
|
| Rate for Payer: Healthfirst QHP |
$43.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$43.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$36.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.52
|
| Rate for Payer: SOMOS Essential |
$32.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.36
|
|
|
CHG BONE &/JOINT IMAGING WHOLE BODY
|
Professional
|
Both
|
$1,180.41
|
|
|
Service Code
|
HCPCS 78306
|
| Min. Negotiated Rate |
$213.86 |
| Max. Negotiated Rate |
$687.40 |
| Rate for Payer: Cash Price |
$315.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$305.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$274.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$274.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$290.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$305.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$290.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$305.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$305.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$229.13
|
| Rate for Payer: Healthfirst Commercial |
$305.51
|
| Rate for Payer: Healthfirst Essential Plan |
$687.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$290.23
|
| Rate for Payer: Healthfirst QHP |
$305.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$213.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$305.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$259.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$213.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$305.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$229.13
|
| Rate for Payer: SOMOS Essential |
$229.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$305.51
|
|
|
CHG BONE &/JOINT IMAGING WHOLE BODY
|
Professional
|
Both
|
$1,020.08
|
|
|
Service Code
|
HCPCS 78306 TC
|
| Min. Negotiated Rate |
$183.50 |
| Max. Negotiated Rate |
$589.84 |
| Rate for Payer: Cash Price |
$272.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$262.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$235.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$235.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$249.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$262.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$249.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$262.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$262.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$196.61
|
| Rate for Payer: Healthfirst Commercial |
$262.15
|
| Rate for Payer: Healthfirst Essential Plan |
$589.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$249.04
|
| Rate for Payer: Healthfirst QHP |
$262.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$183.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$262.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$222.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$183.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$262.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$196.61
|
| Rate for Payer: SOMOS Essential |
$196.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$262.15
|
|
|
CHG BONE LENGTH STUDIES
|
Professional
|
Both
|
$53.87
|
|
|
Service Code
|
HCPCS 77073 26
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$32.53 |
| Rate for Payer: Cash Price |
$14.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.85
|
| Rate for Payer: Healthfirst Commercial |
$14.46
|
| Rate for Payer: Healthfirst Essential Plan |
$32.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.74
|
| Rate for Payer: Healthfirst QHP |
$14.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$10.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$14.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$12.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$10.85
|
| Rate for Payer: SOMOS Essential |
$10.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.46
|
|
|
CHG BONE LENGTH STUDIES
|
Professional
|
Both
|
$193.13
|
|
|
Service Code
|
HCPCS 77073
|
| Min. Negotiated Rate |
$36.64 |
| Max. Negotiated Rate |
$117.77 |
| Rate for Payer: Cash Price |
$52.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.26
|
| Rate for Payer: Healthfirst Commercial |
$52.34
|
| Rate for Payer: Healthfirst Essential Plan |
$117.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.72
|
| Rate for Payer: Healthfirst QHP |
$52.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.26
|
| Rate for Payer: SOMOS Essential |
$39.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.34
|
|
|
CHG BONE LENGTH STUDIES
|
Professional
|
Both
|
$139.30
|
|
|
Service Code
|
HCPCS 77073 TC
|
| Min. Negotiated Rate |
$26.52 |
| Max. Negotiated Rate |
$85.23 |
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.41
|
| Rate for Payer: Healthfirst Commercial |
$37.88
|
| Rate for Payer: Healthfirst Essential Plan |
$85.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.99
|
| Rate for Payer: Healthfirst QHP |
$37.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.41
|
| Rate for Payer: SOMOS Essential |
$28.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.88
|
|
|
CHG BONE MARROW BLOOD SUPPLY
|
Professional
|
Both
|
$307.09
|
|
|
Service Code
|
HCPCS 77084 26
|
| Min. Negotiated Rate |
$57.65 |
| Max. Negotiated Rate |
$185.29 |
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$82.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$74.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$74.11
|
| 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 Commercial |
$82.35
|
| Rate for Payer: Healthfirst Essential Plan |
$185.29
|
| 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 |
$57.65
|
| 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) |
$57.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$82.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$61.76
|
| Rate for Payer: SOMOS Essential |
$61.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$82.35
|
|
|
CHG BONE MARROW BLOOD SUPPLY
|
Professional
|
Both
|
$997.08
|
|
|
Service Code
|
HCPCS 77084 TC
|
| Min. Negotiated Rate |
$199.92 |
| Max. Negotiated Rate |
$642.60 |
| Rate for Payer: Cash Price |
$296.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$285.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$257.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$257.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$271.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$285.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$271.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$285.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$285.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$214.20
|
| Rate for Payer: Healthfirst Commercial |
$285.60
|
| Rate for Payer: Healthfirst Essential Plan |
$642.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$271.32
|
| Rate for Payer: Healthfirst QHP |
$285.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$199.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$285.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$242.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$199.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$285.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$214.20
|
| Rate for Payer: SOMOS Essential |
$214.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$285.60
|
|
|
CHG BONE MARROW BLOOD SUPPLY
|
Professional
|
Both
|
$1,304.17
|
|
|
Service Code
|
HCPCS 77084
|
| Min. Negotiated Rate |
$257.56 |
| Max. Negotiated Rate |
$827.87 |
| Rate for Payer: Cash Price |
$379.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$367.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$331.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$331.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$349.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$367.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$349.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$367.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$367.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$275.95
|
| Rate for Payer: Healthfirst Commercial |
$367.94
|
| Rate for Payer: Healthfirst Essential Plan |
$827.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$349.54
|
| Rate for Payer: Healthfirst QHP |
$367.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$257.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$367.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$312.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$257.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$367.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$275.95
|
| Rate for Payer: SOMOS Essential |
$275.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$367.94
|
|
