|
CHG BONE MARROW IMAGING LIMITED AREA
|
Professional
|
Both
|
$597.45
|
|
|
Service Code
|
HCPCS 78102 TC
|
| Min. Negotiated Rate |
$110.14 |
| Max. Negotiated Rate |
$354.04 |
| Rate for Payer: Cash Price |
$161.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$141.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$149.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$149.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$118.01
|
| Rate for Payer: Healthfirst Commercial |
$157.35
|
| Rate for Payer: Healthfirst Essential Plan |
$354.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$149.48
|
| Rate for Payer: Healthfirst QHP |
$157.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$110.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$157.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$133.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$110.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$118.01
|
| Rate for Payer: SOMOS Essential |
$118.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.35
|
|
|
CHG BONE MARROW IMAGING LIMITED AREA
|
Professional
|
Both
|
$98.81
|
|
|
Service Code
|
HCPCS 78102 26
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$60.26 |
| Rate for Payer: Cash Price |
$26.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.09
|
| Rate for Payer: Healthfirst Commercial |
$26.78
|
| Rate for Payer: Healthfirst Essential Plan |
$60.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.44
|
| Rate for Payer: Healthfirst QHP |
$26.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.09
|
| Rate for Payer: SOMOS Essential |
$20.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.78
|
|
|
CHG BONE MARROW IMAGING LIMITED AREA
|
Professional
|
Both
|
$696.26
|
|
|
Service Code
|
HCPCS 78102
|
| Min. Negotiated Rate |
$128.89 |
| Max. Negotiated Rate |
$414.29 |
| Rate for Payer: Cash Price |
$187.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$184.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$165.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$165.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$174.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$184.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$174.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$184.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$184.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$138.10
|
| Rate for Payer: Healthfirst Commercial |
$184.13
|
| Rate for Payer: Healthfirst Essential Plan |
$414.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$174.92
|
| Rate for Payer: Healthfirst QHP |
$184.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$128.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$184.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$156.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$128.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$184.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$138.10
|
| Rate for Payer: SOMOS Essential |
$138.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$184.13
|
|
|
CHG BONE MARROW IMAGING MULTIPLE AREAS
|
Professional
|
Both
|
$113.93
|
|
|
Service Code
|
HCPCS 78103 26
|
| Min. Negotiated Rate |
$21.78 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.33
|
| Rate for Payer: Healthfirst Commercial |
$31.11
|
| Rate for Payer: Healthfirst Essential Plan |
$70.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.55
|
| Rate for Payer: Healthfirst QHP |
$31.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$31.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.33
|
| Rate for Payer: SOMOS Essential |
$23.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.11
|
|
|
CHG BONE MARROW IMAGING MULTIPLE AREAS
|
Professional
|
Both
|
$742.98
|
|
|
Service Code
|
HCPCS 78103
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$437.13 |
| Rate for Payer: Cash Price |
$199.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$194.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$174.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$174.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$184.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$194.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$184.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$194.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$194.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$145.71
|
| Rate for Payer: Healthfirst Commercial |
$194.28
|
| Rate for Payer: Healthfirst Essential Plan |
$437.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$184.57
|
| Rate for Payer: Healthfirst QHP |
$194.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$136.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$194.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$165.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$136.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$194.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$145.71
|
| Rate for Payer: SOMOS Essential |
$145.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$194.28
|
|
|
CHG BONE MARROW IMAGING MULTIPLE AREAS
|
Professional
|
Both
|
$629.06
|
|
|
Service Code
|
HCPCS 78103 TC
|
| Min. Negotiated Rate |
$114.22 |
| Max. Negotiated Rate |
$367.13 |
| Rate for Payer: Cash Price |
$167.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$163.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$146.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$146.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$155.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$163.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$155.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$163.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$163.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$122.38
|
| Rate for Payer: Healthfirst Commercial |
$163.17
|
| Rate for Payer: Healthfirst Essential Plan |
$367.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$155.01
|
| Rate for Payer: Healthfirst QHP |
$163.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$114.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$163.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$138.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$114.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$163.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$122.38
|
| Rate for Payer: SOMOS Essential |
$122.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$163.17
|
|
|
CHG BONE MARROW IMAGING WHOLE BODY
|
Professional
|
Both
|
$148.51
|
|
|
Service Code
|
HCPCS 78104 26
|
| Min. Negotiated Rate |
$27.38 |
| Max. Negotiated Rate |
$88.02 |
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$39.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.34
|
| Rate for Payer: Healthfirst Commercial |
$39.12
|
| Rate for Payer: Healthfirst Essential Plan |
$88.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.16
|
| Rate for Payer: Healthfirst QHP |
$39.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$39.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.34
|
| Rate for Payer: SOMOS Essential |
$29.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.12
|
|
|
CHG BONE MARROW IMAGING WHOLE BODY
|
Professional
|
Both
|
$856.21
|
|
|
Service Code
|
HCPCS 78104 TC
|
| Min. Negotiated Rate |
$154.43 |
| Max. Negotiated Rate |
$496.39 |
| Rate for Payer: Cash Price |
$229.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$220.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$198.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$198.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$209.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$220.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$209.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$220.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$220.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.47
|
| Rate for Payer: Healthfirst Commercial |
$220.62
|
| Rate for Payer: Healthfirst Essential Plan |
$496.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.59
|
| Rate for Payer: Healthfirst QHP |
$220.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$154.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$220.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$187.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$154.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$220.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$165.47
|
| Rate for Payer: SOMOS Essential |
$165.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$220.62
|
|
|
CHG BONE MARROW IMAGING WHOLE BODY
|
Professional
|
Both
|
$1,004.71
|
|
|
Service Code
|
HCPCS 78104
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$584.39 |
| Rate for Payer: Cash Price |
$269.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$259.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$233.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$233.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$246.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$259.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$246.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$259.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$259.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$194.80
|
| Rate for Payer: Healthfirst Commercial |
$259.73
|
| Rate for Payer: Healthfirst Essential Plan |
$584.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$246.74
|
| Rate for Payer: Healthfirst QHP |
$259.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$181.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$259.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$220.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$181.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$259.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$194.80
|
| Rate for Payer: SOMOS Essential |
$194.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$259.73
|
|
|
CHG BONE MARROW SMEAR INTERPRETATION
|
Professional
|
Both
|
$190.51
|
|
|
Service Code
|
HCPCS 85097
|
| Min. Negotiated Rate |
$35.81 |
| Max. Negotiated Rate |
$115.11 |
| Rate for Payer: Cash Price |
$52.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$51.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$46.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$46.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$48.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$51.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$48.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.37
|
| Rate for Payer: Healthfirst Commercial |
$51.16
|
| Rate for Payer: Healthfirst Essential Plan |
$115.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$48.60
|
| Rate for Payer: Healthfirst QHP |
$51.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$35.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$51.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$43.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$35.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$51.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$38.37
|
| Rate for Payer: SOMOS Essential |
$38.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$51.16
|
|
|
CHG BRACHYTX ISODOSE PLN CPLX W/DOSIMETRY CAL
|
Professional
|
Both
|
$1,319.96
|
|
|
Service Code
|
HCPCS 77318 TC
|
| Min. Negotiated Rate |
$254.25 |
| Max. Negotiated Rate |
$817.22 |
| Rate for Payer: Cash Price |
$365.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$363.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$326.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$326.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$345.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$363.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$345.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$363.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$363.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$272.41
|
| Rate for Payer: Healthfirst Commercial |
$363.21
|
| Rate for Payer: Healthfirst Essential Plan |
$817.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$345.05
|
| Rate for Payer: Healthfirst QHP |
$363.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$254.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$363.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$308.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$254.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$363.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$272.41
|
| Rate for Payer: SOMOS Essential |
$272.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$363.21
|
|
|
CHG BRACHYTX ISODOSE PLN CPLX W/DOSIMETRY CAL
|
Professional
|
Both
|
$1,931.62
|
|
|
Service Code
|
HCPCS 77318
|
| Min. Negotiated Rate |
$372.74 |
| Max. Negotiated Rate |
$1,198.08 |
| Rate for Payer: Cash Price |
$533.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$532.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$479.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$479.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$505.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$532.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$505.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$532.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$532.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$399.36
|
| Rate for Payer: Healthfirst Commercial |
$532.48
|
| Rate for Payer: Healthfirst Essential Plan |
$1,198.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$505.86
|
| Rate for Payer: Healthfirst QHP |
$532.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$372.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$532.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$452.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$372.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$532.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$399.36
|
| Rate for Payer: SOMOS Essential |
$399.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$532.48
|
|
|
CHG BRACHYTX ISODOSE PLN CPLX W/DOSIMETRY CAL
|
Professional
|
Both
|
$611.66
|
|
|
Service Code
|
HCPCS 77318 26
|
| Min. Negotiated Rate |
$118.49 |
| Max. Negotiated Rate |
$380.86 |
| Rate for Payer: Cash Price |
$167.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$169.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$152.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$152.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$160.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$169.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$160.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$126.95
|
| Rate for Payer: Healthfirst Commercial |
$169.27
|
| Rate for Payer: Healthfirst Essential Plan |
$380.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$160.81
|
| Rate for Payer: Healthfirst QHP |
$169.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$118.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$169.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$143.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$118.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$169.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$126.95
|
| Rate for Payer: SOMOS Essential |
$126.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$169.27
|
|
|
CHG BRACHYTX ISODOSE PLN INTERMED W/DOSIMETRY CAL
|
Professional
|
Both
|
$387.66
|
|
|
Service Code
|
HCPCS 77317 26
|
| Min. Negotiated Rate |
$74.60 |
| Max. Negotiated Rate |
$239.78 |
| Rate for Payer: Cash Price |
$106.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$106.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$95.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$95.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$101.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$106.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$101.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$106.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$79.93
|
| Rate for Payer: Healthfirst Commercial |
$106.57
|
| Rate for Payer: Healthfirst Essential Plan |
$239.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$101.24
|
| Rate for Payer: Healthfirst QHP |
$106.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$74.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$106.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$90.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$74.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$106.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$79.93
|
| Rate for Payer: SOMOS Essential |
$79.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$106.57
|
|
|
CHG BRACHYTX ISODOSE PLN INTERMED W/DOSIMETRY CAL
|
Professional
|
Both
|
$976.68
|
|
|
Service Code
|
HCPCS 77317 TC
|
| Min. Negotiated Rate |
$187.74 |
| Max. Negotiated Rate |
$603.45 |
| Rate for Payer: Cash Price |
$270.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$268.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$241.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$241.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$254.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$268.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$254.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$268.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$268.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$201.15
|
| Rate for Payer: Healthfirst Commercial |
$268.20
|
| Rate for Payer: Healthfirst Essential Plan |
$603.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$254.79
|
| Rate for Payer: Healthfirst QHP |
$268.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$187.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$268.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$227.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$187.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$268.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$201.15
|
| Rate for Payer: SOMOS Essential |
$201.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$268.20
|
|
|
CHG BRACHYTX ISODOSE PLN INTERMED W/DOSIMETRY CAL
|
Professional
|
Both
|
$1,364.34
|
|
|
Service Code
|
HCPCS 77317
|
| Min. Negotiated Rate |
$262.35 |
| Max. Negotiated Rate |
$843.25 |
| Rate for Payer: Cash Price |
$377.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$374.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$337.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$337.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$356.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$374.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$356.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$374.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$374.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$281.08
|
| Rate for Payer: Healthfirst Commercial |
$374.78
|
| Rate for Payer: Healthfirst Essential Plan |
$843.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$356.04
|
| Rate for Payer: Healthfirst QHP |
$374.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$262.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$374.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$318.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$262.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$374.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$281.08
|
| Rate for Payer: SOMOS Essential |
$281.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$374.78
|
|
|
CHG BRACHYTX ISODOSE PLN SMPL W/DOSIMETRY CAL
|
Professional
|
Both
|
$739.76
|
|
|
Service Code
|
HCPCS 77316 TC
|
| Min. Negotiated Rate |
$142.48 |
| Max. Negotiated Rate |
$457.96 |
| Rate for Payer: Cash Price |
$205.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$203.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$183.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$183.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$193.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$203.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$193.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$203.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$203.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$152.66
|
| Rate for Payer: Healthfirst Commercial |
$203.54
|
| Rate for Payer: Healthfirst Essential Plan |
$457.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$193.36
|
| Rate for Payer: Healthfirst QHP |
$203.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$142.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$203.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$173.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$142.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$203.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$152.66
|
| Rate for Payer: SOMOS Essential |
$152.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$203.54
|
|
|
CHG BRACHYTX ISODOSE PLN SMPL W/DOSIMETRY CAL
|
Professional
|
Both
|
$296.70
|
|
|
Service Code
|
HCPCS 77316 26
|
| Min. Negotiated Rate |
$56.85 |
| Max. Negotiated Rate |
$182.72 |
| Rate for Payer: Cash Price |
$81.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$81.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$73.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$77.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.91
|
| Rate for Payer: Healthfirst Commercial |
$81.21
|
| Rate for Payer: Healthfirst Essential Plan |
$182.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$77.15
|
| Rate for Payer: Healthfirst QHP |
$81.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$56.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$81.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$69.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$56.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$60.91
|
| Rate for Payer: SOMOS Essential |
$60.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.21
|
|
|
CHG BRACHYTX ISODOSE PLN SMPL W/DOSIMETRY CAL
|
Professional
|
Both
|
$1,036.46
|
|
|
Service Code
|
HCPCS 77316
|
| Min. Negotiated Rate |
$199.32 |
| Max. Negotiated Rate |
$640.69 |
| Rate for Payer: Cash Price |
$286.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$284.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$256.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$256.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$270.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$284.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$270.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$284.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$284.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$213.56
|
| Rate for Payer: Healthfirst Commercial |
$284.75
|
| Rate for Payer: Healthfirst Essential Plan |
$640.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$270.51
|
| Rate for Payer: Healthfirst QHP |
$284.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$199.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$284.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$242.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$199.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$284.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$213.56
|
| Rate for Payer: SOMOS Essential |
$213.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$284.75
|
|
|
CHG BRAIN IMAGING <4 STATIC VIEWS
|
Professional
|
Both
|
$650.62
|
|
|
Service Code
|
HCPCS 78600 TC
|
| Min. Negotiated Rate |
$119.65 |
| Max. Negotiated Rate |
$384.59 |
| Rate for Payer: Cash Price |
$175.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$170.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$153.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$153.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$170.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$170.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$170.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$128.20
|
| Rate for Payer: Healthfirst Commercial |
$170.93
|
| Rate for Payer: Healthfirst Essential Plan |
$384.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$162.38
|
| Rate for Payer: Healthfirst QHP |
$170.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$119.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$170.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$145.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$119.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$170.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$128.20
|
| Rate for Payer: SOMOS Essential |
$128.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$170.93
|
|
|
CHG BRAIN IMAGING <4 STATIC VIEWS
|
Professional
|
Both
|
$82.15
|
|
|
Service Code
|
HCPCS 78600 26
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$49.99 |
| Rate for Payer: Cash Price |
$22.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.66
|
| Rate for Payer: Healthfirst Commercial |
$22.22
|
| Rate for Payer: Healthfirst Essential Plan |
$49.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.11
|
| Rate for Payer: Healthfirst QHP |
$22.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$15.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$22.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$18.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$16.66
|
| Rate for Payer: SOMOS Essential |
$16.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.22
|
|
|
CHG BRAIN IMAGING <4 STATIC VIEWS
|
Professional
|
Both
|
$732.76
|
|
|
Service Code
|
HCPCS 78600
|
| Min. Negotiated Rate |
$135.21 |
| Max. Negotiated Rate |
$434.59 |
| Rate for Payer: Cash Price |
$197.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$193.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$173.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$173.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$183.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$193.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$183.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$193.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$193.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$144.86
|
| Rate for Payer: Healthfirst Commercial |
$193.15
|
| Rate for Payer: Healthfirst Essential Plan |
$434.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$183.49
|
| Rate for Payer: Healthfirst QHP |
$193.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$135.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$193.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$164.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$135.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$193.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$144.86
|
| Rate for Payer: SOMOS Essential |
$144.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$193.15
|
|
|
CHG BRAIN IMAGING <4 STATIC VIEWS W/VASCULAR FLOW
|
Professional
|
Both
|
$870.91
|
|
|
Service Code
|
HCPCS 78601
|
| Min. Negotiated Rate |
$159.45 |
| Max. Negotiated Rate |
$512.50 |
| Rate for Payer: Cash Price |
$235.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$227.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$205.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$205.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$216.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$227.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$216.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$227.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$227.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$170.84
|
| Rate for Payer: Healthfirst Commercial |
$227.78
|
| Rate for Payer: Healthfirst Essential Plan |
$512.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$216.39
|
| Rate for Payer: Healthfirst QHP |
$227.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$159.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$227.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$193.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$159.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$227.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$170.84
|
| Rate for Payer: SOMOS Essential |
$170.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$227.78
|
|
|
CHG BRAIN IMAGING <4 STATIC VIEWS W/VASCULAR FLOW
|
Professional
|
Both
|
$777.14
|
|
|
Service Code
|
HCPCS 78601 TC
|
| Min. Negotiated Rate |
$141.66 |
| Max. Negotiated Rate |
$455.33 |
| Rate for Payer: Cash Price |
$209.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$202.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$182.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$182.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$192.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$202.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$192.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$202.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$202.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$151.78
|
| Rate for Payer: Healthfirst Commercial |
$202.37
|
| Rate for Payer: Healthfirst Essential Plan |
$455.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$192.25
|
| Rate for Payer: Healthfirst QHP |
$202.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$141.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$202.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$172.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$141.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$202.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$151.78
|
| Rate for Payer: SOMOS Essential |
$151.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$202.37
|
|
|
CHG BRAIN IMAGING <4 STATIC VIEWS W/VASCULAR FLOW
|
Professional
|
Both
|
$93.80
|
|
|
Service Code
|
HCPCS 78601 26
|
| Min. Negotiated Rate |
$17.78 |
| Max. Negotiated Rate |
$57.15 |
| Rate for Payer: Cash Price |
$25.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.05
|
| Rate for Payer: Healthfirst Commercial |
$25.40
|
| Rate for Payer: Healthfirst Essential Plan |
$57.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24.13
|
| Rate for Payer: Healthfirst QHP |
$25.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$25.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$21.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19.05
|
| Rate for Payer: SOMOS Essential |
$19.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.40
|
|
