|
CHG CEPHALOGRAM ORTHODONTIC
|
Professional
|
Both
|
$69.90
|
|
|
Service Code
|
HCPCS 70350
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$45.65 |
| Rate for Payer: Cash Price |
$19.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.22
|
| Rate for Payer: Healthfirst Commercial |
$20.29
|
| Rate for Payer: Healthfirst Essential Plan |
$45.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.28
|
| Rate for Payer: Healthfirst QHP |
$20.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$20.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$17.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$14.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.22
|
| Rate for Payer: SOMOS Essential |
$15.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.29
|
|
|
CHG CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY
|
Professional
|
Both
|
$1,219.89
|
|
|
Service Code
|
HCPCS 78630 TC
|
| Min. Negotiated Rate |
$220.89 |
| Max. Negotiated Rate |
$710.01 |
| Rate for Payer: Cash Price |
$327.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$315.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$284.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$284.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$299.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$315.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$299.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$315.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$315.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$236.67
|
| Rate for Payer: Healthfirst Commercial |
$315.56
|
| Rate for Payer: Healthfirst Essential Plan |
$710.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$299.78
|
| Rate for Payer: Healthfirst QHP |
$315.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$220.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$315.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$268.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$220.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$315.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$236.67
|
| Rate for Payer: SOMOS Essential |
$236.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$315.56
|
|
|
CHG CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY
|
Professional
|
Both
|
$1,349.04
|
|
|
Service Code
|
HCPCS 78630
|
| Min. Negotiated Rate |
$244.84 |
| Max. Negotiated Rate |
$786.98 |
| Rate for Payer: Cash Price |
$361.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$349.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$314.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$314.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$332.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$349.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$332.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$349.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$349.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$262.33
|
| Rate for Payer: Healthfirst Commercial |
$349.77
|
| Rate for Payer: Healthfirst Essential Plan |
$786.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$332.28
|
| Rate for Payer: Healthfirst QHP |
$349.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$244.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$349.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$297.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$244.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$349.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$262.33
|
| Rate for Payer: SOMOS Essential |
$262.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$349.77
|
|
|
CHG CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY
|
Professional
|
Both
|
$129.19
|
|
|
Service Code
|
HCPCS 78630 26
|
| Min. Negotiated Rate |
$23.95 |
| Max. Negotiated Rate |
$76.97 |
| Rate for Payer: Cash Price |
$34.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.66
|
| Rate for Payer: Healthfirst Commercial |
$34.21
|
| Rate for Payer: Healthfirst Essential Plan |
$76.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.50
|
| Rate for Payer: Healthfirst QHP |
$34.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.66
|
| Rate for Payer: SOMOS Essential |
$25.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.21
|
|
|
CHG CEREBROSPINAL FLUID FLOW W/O MATL SHUNT EVALTJ
|
Professional
|
Both
|
$102.73
|
|
|
Service Code
|
HCPCS 78645 26
|
| Min. Negotiated Rate |
$19.94 |
| Max. Negotiated Rate |
$64.08 |
| Rate for Payer: Cash Price |
$28.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.36
|
| Rate for Payer: Healthfirst Commercial |
$28.48
|
| Rate for Payer: Healthfirst Essential Plan |
$64.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.06
|
| Rate for Payer: Healthfirst QHP |
$28.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.36
|
| Rate for Payer: SOMOS Essential |
$21.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.48
|
|
|
CHG CEREBROSPINAL FLUID FLOW W/O MATL SHUNT EVALTJ
|
Professional
|
Both
|
$1,186.82
|
|
|
Service Code
|
HCPCS 78645 TC
|
| Min. Negotiated Rate |
$216.00 |
| Max. Negotiated Rate |
$694.28 |
| Rate for Payer: Cash Price |
$318.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$308.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$277.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$277.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$293.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$308.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$293.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$308.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$308.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$231.43
|
| Rate for Payer: Healthfirst Commercial |
$308.57
|
| Rate for Payer: Healthfirst Essential Plan |
$694.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$293.14
|
| Rate for Payer: Healthfirst QHP |
$308.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$216.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$308.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$262.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$216.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$308.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$231.43
|
| Rate for Payer: SOMOS Essential |
$231.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$308.57
|
|
|
CHG CEREBROSPINAL FLUID FLOW W/O MATL SHUNT EVALTJ
|
Professional
|
Both
|
$1,289.54
|
|
|
Service Code
|
HCPCS 78645
|
| Min. Negotiated Rate |
$235.94 |
| Max. Negotiated Rate |
$758.36 |
| Rate for Payer: Cash Price |
$347.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$337.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$303.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$303.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$320.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$337.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$320.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$337.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$337.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$252.79
|
| Rate for Payer: Healthfirst Commercial |
$337.05
|
| Rate for Payer: Healthfirst Essential Plan |
$758.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$320.20
|
| Rate for Payer: Healthfirst QHP |
$337.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$235.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$337.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$286.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$235.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$337.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$252.79
|
| Rate for Payer: SOMOS Essential |
$252.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$337.05
|
|
|
CHG CEREBROSPINAL FLUID FLOW W/O MATL VENTRICLGRAPHY
|
Professional
|
Both
|
$1,234.24
|
|
|
Service Code
|
HCPCS 78635 TC
|
| Min. Negotiated Rate |
$223.61 |
| Max. Negotiated Rate |
$718.74 |
| Rate for Payer: Cash Price |
$331.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$319.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$287.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$287.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$303.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$319.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$303.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$319.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$319.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$239.58
|
| Rate for Payer: Healthfirst Commercial |
$319.44
|
| Rate for Payer: Healthfirst Essential Plan |
$718.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$303.47
|
| Rate for Payer: Healthfirst QHP |
$319.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$223.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$319.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$271.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$223.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$319.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$239.58
|
| Rate for Payer: SOMOS Essential |
$239.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$319.44
|
|
|
CHG CEREBROSPINAL FLUID FLOW W/O MATL VENTRICLGRAPHY
|
Professional
|
Both
|
$1,353.24
|
|
|
Service Code
|
HCPCS 78635
|
| Min. Negotiated Rate |
$245.59 |
| Max. Negotiated Rate |
$789.41 |
| Rate for Payer: Cash Price |
$363.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$350.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$315.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$315.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$333.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$350.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$333.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$350.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$350.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$263.14
|
| Rate for Payer: Healthfirst Commercial |
$350.85
|
| Rate for Payer: Healthfirst Essential Plan |
$789.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$333.31
|
| Rate for Payer: Healthfirst QHP |
$350.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$245.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$350.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$298.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$245.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$350.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$263.14
|
| Rate for Payer: SOMOS Essential |
$263.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$350.85
|
|
|
CHG CEREBROSPINAL FLUID FLOW W/O MATL VENTRICLGRAPHY
|
Professional
|
Both
|
$118.97
|
|
|
Service Code
|
HCPCS 78635 26
|
| Min. Negotiated Rate |
$21.99 |
| Max. Negotiated Rate |
$70.67 |
| Rate for Payer: Cash Price |
$31.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.56
|
| Rate for Payer: Healthfirst Commercial |
$31.41
|
| Rate for Payer: Healthfirst Essential Plan |
$70.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.84
|
| Rate for Payer: Healthfirst QHP |
$31.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$31.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.56
|
| Rate for Payer: SOMOS Essential |
$23.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.41
|
|
|
CHG CEREBROSPINAL FLUID LEAK DETECTION&LOCALIZATIO
|
Professional
|
Both
|
$1,081.96
|
|
|
Service Code
|
HCPCS 78650
|
| Min. Negotiated Rate |
$196.64 |
| Max. Negotiated Rate |
$632.05 |
| Rate for Payer: Cash Price |
$290.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$280.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$252.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$252.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$266.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$280.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$266.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$280.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$280.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$210.68
|
| Rate for Payer: Healthfirst Commercial |
$280.91
|
| Rate for Payer: Healthfirst Essential Plan |
$632.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$266.86
|
| Rate for Payer: Healthfirst QHP |
$280.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$196.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$280.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$238.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$196.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$280.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$210.68
|
| Rate for Payer: SOMOS Essential |
$210.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$280.91
|
|
|
CHG CEREBROSPINAL FLUID LEAK DETECTION&LOCALIZATIO
|
Professional
|
Both
|
$988.44
|
|
|
Service Code
|
HCPCS 78650 TC
|
| Min. Negotiated Rate |
$178.77 |
| Max. Negotiated Rate |
$574.63 |
| Rate for Payer: Cash Price |
$265.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$255.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$229.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$229.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$242.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$255.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$242.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$255.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$255.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$191.54
|
| Rate for Payer: Healthfirst Commercial |
$255.39
|
| Rate for Payer: Healthfirst Essential Plan |
$574.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$242.62
|
| Rate for Payer: Healthfirst QHP |
$255.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$178.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$255.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$217.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$178.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$255.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$191.54
|
| Rate for Payer: SOMOS Essential |
$191.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$255.39
|
|
|
CHG CEREBROSPINAL FLUID LEAK DETECTION&LOCALIZATIO
|
Professional
|
Both
|
$93.52
|
|
|
Service Code
|
HCPCS 78650 26
|
| Min. Negotiated Rate |
$17.86 |
| Max. Negotiated Rate |
$57.40 |
| Rate for Payer: Cash Price |
$25.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.13
|
| Rate for Payer: Healthfirst Commercial |
$25.51
|
| Rate for Payer: Healthfirst Essential Plan |
$57.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24.23
|
| Rate for Payer: Healthfirst QHP |
$25.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$25.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$21.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19.13
|
| Rate for Payer: SOMOS Essential |
$19.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.51
|
|
|
CHG CHANGE PRQ TUBE/DRAINAGE CATH W CONTRAST RS&I
|
Professional
|
Both
|
$405.13
|
|
|
Service Code
|
HCPCS 75984
|
| Min. Negotiated Rate |
$75.32 |
| Max. Negotiated Rate |
$242.10 |
| Rate for Payer: Cash Price |
$110.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$107.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$96.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$96.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$102.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$102.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$107.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.70
|
| Rate for Payer: Healthfirst Commercial |
$107.60
|
| Rate for Payer: Healthfirst Essential Plan |
$242.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$102.22
|
| Rate for Payer: Healthfirst QHP |
$107.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$75.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$107.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$91.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$75.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$107.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$80.70
|
| Rate for Payer: SOMOS Essential |
$80.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$107.60
|
|
|
CHG CHANGE PRQ TUBE/DRAINAGE CATH W CONTRAST RS&I
|
Professional
|
Both
|
$149.42
|
|
|
Service Code
|
HCPCS 75984 26
|
| Min. Negotiated Rate |
$28.70 |
| Max. Negotiated Rate |
$92.25 |
| Rate for Payer: Cash Price |
$41.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$41.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.75
|
| Rate for Payer: Healthfirst Commercial |
$41.00
|
| Rate for Payer: Healthfirst Essential Plan |
$92.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.95
|
| Rate for Payer: Healthfirst QHP |
$41.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$41.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$30.75
|
| Rate for Payer: SOMOS Essential |
$30.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.00
|
|
|
CHG CHANGE PRQ TUBE/DRAINAGE CATH W CONTRAST RS&I
|
Professional
|
Both
|
$255.75
|
|
|
Service Code
|
HCPCS 75984 TC
|
| Min. Negotiated Rate |
$46.63 |
| Max. Negotiated Rate |
$149.87 |
| Rate for Payer: Cash Price |
$68.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$66.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$59.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$59.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$63.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$66.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$63.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$66.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$66.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$49.96
|
| Rate for Payer: Healthfirst Commercial |
$66.61
|
| Rate for Payer: Healthfirst Essential Plan |
$149.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$63.28
|
| Rate for Payer: Healthfirst QHP |
$66.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$46.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$66.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$56.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$46.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$66.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$49.96
|
| Rate for Payer: SOMOS Essential |
$49.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$66.61
|
|
|
CHG CHOLANGIOGRAPHY&/PANCREATOGRAPHY NTRAOP RS&I
|
Professional
|
Both
|
$53.66
|
|
|
Service Code
|
HCPCS 74300 26
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$32.45 |
| Rate for Payer: Cash Price |
$14.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.81
|
| Rate for Payer: Healthfirst Commercial |
$14.42
|
| Rate for Payer: Healthfirst Essential Plan |
$32.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.70
|
| Rate for Payer: Healthfirst QHP |
$14.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$10.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$14.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$12.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$10.81
|
| Rate for Payer: SOMOS Essential |
$10.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.42
|
|
|
CHG CHOLANGIO&/PANCREATOGRAPHY ADDL SET INTRAOP RS
|
Professional
|
Both
|
$40.53
|
|
|
Service Code
|
HCPCS 74301 26
|
| Min. Negotiated Rate |
$7.67 |
| Max. Negotiated Rate |
$24.66 |
| Rate for Payer: Cash Price |
$10.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.22
|
| Rate for Payer: Healthfirst Commercial |
$10.96
|
| Rate for Payer: Healthfirst Essential Plan |
$24.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.41
|
| Rate for Payer: Healthfirst QHP |
$10.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$7.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$10.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$9.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.22
|
| Rate for Payer: SOMOS Essential |
$8.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.96
|
|
|
CHG CHOLECYSTOGRAPHY ORAL CONTRST
|
Professional
|
Both
|
$62.79
|
|
|
Service Code
|
HCPCS 74290 26
|
| Min. Negotiated Rate |
$11.84 |
| Max. Negotiated Rate |
$38.07 |
| Rate for Payer: Cash Price |
$16.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.69
|
| Rate for Payer: Healthfirst Commercial |
$16.92
|
| Rate for Payer: Healthfirst Essential Plan |
$38.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.07
|
| Rate for Payer: Healthfirst QHP |
$16.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$14.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.69
|
| Rate for Payer: SOMOS Essential |
$12.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.92
|
|
|
CHG CHOLECYSTOGRAPHY ORAL CONTRST
|
Professional
|
Both
|
$374.61
|
|
|
Service Code
|
HCPCS 74290
|
| Min. Negotiated Rate |
$67.43 |
| Max. Negotiated Rate |
$216.74 |
| Rate for Payer: Cash Price |
$99.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$96.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$86.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$86.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$91.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$96.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$91.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$96.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$96.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.25
|
| Rate for Payer: Healthfirst Commercial |
$96.33
|
| Rate for Payer: Healthfirst Essential Plan |
$216.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$91.51
|
| Rate for Payer: Healthfirst QHP |
$96.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$67.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$96.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$81.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$67.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$96.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$72.25
|
| Rate for Payer: SOMOS Essential |
$72.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$96.33
|
|
|
CHG CHOLECYSTOGRAPHY ORAL CONTRST
|
Professional
|
Both
|
$311.82
|
|
|
Service Code
|
HCPCS 74290 TC
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$178.67 |
| Rate for Payer: Cash Price |
$82.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$79.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$71.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$71.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$75.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$79.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$75.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$79.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$59.56
|
| Rate for Payer: Healthfirst Commercial |
$79.41
|
| Rate for Payer: Healthfirst Essential Plan |
$178.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$75.44
|
| Rate for Payer: Healthfirst QHP |
$79.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$55.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$79.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$67.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$55.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$79.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$59.56
|
| Rate for Payer: SOMOS Essential |
$59.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$79.41
|
|
|
CHG CINERADIOGRAPY/VIDRADIOGRAPY ROUTINE EXAMINATION
|
Professional
|
Both
|
$50.93
|
|
|
Service Code
|
HCPCS 76125 26
|
| Min. Negotiated Rate |
$10.37 |
| Max. Negotiated Rate |
$33.32 |
| Rate for Payer: Cash Price |
$14.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.11
|
| Rate for Payer: Healthfirst Commercial |
$14.81
|
| Rate for Payer: Healthfirst Essential Plan |
$33.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.07
|
| Rate for Payer: Healthfirst QHP |
$14.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$10.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$14.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$12.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$11.11
|
| Rate for Payer: SOMOS Essential |
$11.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.81
|
|
|
CHG CINERADIOGRAPY/VIDRADIOGRAPY XCPT WHERE SPEC
|
Professional
|
Both
|
$80.12
|
|
|
Service Code
|
HCPCS 76120 26
|
| Min. Negotiated Rate |
$14.38 |
| Max. Negotiated Rate |
$46.22 |
| Rate for Payer: Cash Price |
$21.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.40
|
| Rate for Payer: Healthfirst Commercial |
$20.54
|
| Rate for Payer: Healthfirst Essential Plan |
$46.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.51
|
| Rate for Payer: Healthfirst QHP |
$20.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$20.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$17.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$14.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.40
|
| Rate for Payer: SOMOS Essential |
$15.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.54
|
|
|
CHG CINERADIOGRAPY/VIDRADIOGRAPY XCPT WHERE SPEC
|
Professional
|
Both
|
$505.47
|
|
|
Service Code
|
HCPCS 76120
|
| Min. Negotiated Rate |
$88.71 |
| Max. Negotiated Rate |
$285.14 |
| Rate for Payer: Cash Price |
$138.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$126.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$114.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$114.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$120.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$126.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$120.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$95.05
|
| Rate for Payer: Healthfirst Commercial |
$126.73
|
| Rate for Payer: Healthfirst Essential Plan |
$285.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$120.39
|
| Rate for Payer: Healthfirst QHP |
$126.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$88.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$126.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$107.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$88.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$126.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$95.05
|
| Rate for Payer: SOMOS Essential |
$95.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$126.73
|
|
|
CHG CINERADIOGRAPY/VIDRADIOGRAPY XCPT WHERE SPEC
|
Professional
|
Both
|
$425.36
|
|
|
Service Code
|
HCPCS 76120 TC
|
| Min. Negotiated Rate |
$74.34 |
| Max. Negotiated Rate |
$238.95 |
| Rate for Payer: Cash Price |
$116.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$106.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$95.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$95.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$100.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$106.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$100.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$106.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$79.65
|
| Rate for Payer: Healthfirst Commercial |
$106.20
|
| Rate for Payer: Healthfirst Essential Plan |
$238.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$100.89
|
| Rate for Payer: Healthfirst QHP |
$106.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$74.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$106.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$90.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$74.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$106.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$79.65
|
| Rate for Payer: SOMOS Essential |
$79.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$106.20
|
|
