|
CHG CISTERNOGRAPHY POSITIVE CONTRAST RS&I
|
Professional
|
Both
|
$228.73
|
|
|
Service Code
|
HCPCS 70015 26
|
| Min. Negotiated Rate |
$42.81 |
| Max. Negotiated Rate |
$137.61 |
| Rate for Payer: Cash Price |
$61.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$61.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$55.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$55.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$58.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$61.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$58.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$61.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.87
|
| Rate for Payer: Healthfirst Commercial |
$61.16
|
| Rate for Payer: Healthfirst Essential Plan |
$137.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$58.10
|
| Rate for Payer: Healthfirst QHP |
$61.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$42.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$61.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$51.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$42.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$61.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$45.87
|
| Rate for Payer: SOMOS Essential |
$45.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$61.16
|
|
|
CHG CISTERNOGRAPHY POSITIVE CONTRAST RS&I
|
Professional
|
Both
|
$485.73
|
|
|
Service Code
|
HCPCS 70015 TC
|
| Min. Negotiated Rate |
$87.93 |
| Max. Negotiated Rate |
$282.62 |
| Rate for Payer: Cash Price |
$130.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$125.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$113.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$113.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$119.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$125.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$119.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$94.21
|
| Rate for Payer: Healthfirst Commercial |
$125.61
|
| Rate for Payer: Healthfirst Essential Plan |
$282.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$119.33
|
| Rate for Payer: Healthfirst QHP |
$125.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$87.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$125.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$106.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$87.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$125.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$94.21
|
| Rate for Payer: SOMOS Essential |
$94.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$125.61
|
|
|
CHG CISTERNOGRAPHY POSITIVE CONTRAST RS&I
|
Professional
|
Both
|
$714.46
|
|
|
Service Code
|
HCPCS 70015
|
| Min. Negotiated Rate |
$130.74 |
| Max. Negotiated Rate |
$420.23 |
| Rate for Payer: Cash Price |
$192.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$186.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$168.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$168.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$177.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$186.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$177.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$186.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$186.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$140.08
|
| Rate for Payer: Healthfirst Commercial |
$186.77
|
| Rate for Payer: Healthfirst Essential Plan |
$420.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$177.43
|
| Rate for Payer: Healthfirst QHP |
$186.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$130.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$186.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$158.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$130.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$186.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$140.08
|
| Rate for Payer: SOMOS Essential |
$140.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$186.77
|
|
|
CHG CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I
|
Professional
|
Both
|
$112.70
|
|
|
Service Code
|
HCPCS 74330 26
|
| Min. Negotiated Rate |
$20.35 |
| Max. Negotiated Rate |
$65.41 |
| Rate for Payer: Cash Price |
$29.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.80
|
| Rate for Payer: Healthfirst Commercial |
$29.07
|
| Rate for Payer: Healthfirst Essential Plan |
$65.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.62
|
| Rate for Payer: Healthfirst QHP |
$29.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.80
|
| Rate for Payer: SOMOS Essential |
$21.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.07
|
|
|
CHG COAGJ/FBRNLYS ASSAY WHOLE BLOOD ADDITIVE PER DAY
|
Professional
|
Both
|
$77.70
|
|
|
Service Code
|
HCPCS 85396
|
| Min. Negotiated Rate |
$14.68 |
| Max. Negotiated Rate |
$47.18 |
| Rate for Payer: Cash Price |
$21.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.73
|
| Rate for Payer: Healthfirst Commercial |
$20.97
|
| Rate for Payer: Healthfirst Essential Plan |
$47.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.92
|
| Rate for Payer: Healthfirst QHP |
$20.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$20.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$17.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$14.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.73
|
| Rate for Payer: SOMOS Essential |
$15.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.97
|
|
|
CHG COAGULATION TIME ACTIVATED
|
Professional
|
Both
|
$17.12
|
|
|
Service Code
|
HCPCS 85347
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$9.63 |
| Rate for Payer: Cash Price |
$4.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.21
|
| Rate for Payer: Healthfirst Commercial |
$4.28
|
| Rate for Payer: Healthfirst Essential Plan |
$9.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.07
|
| Rate for Payer: Healthfirst QHP |
$4.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.71
|
| Rate for Payer: SOMOS Essential |
$1.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.28
|
|
|
CHG COMPREHENSIVE METABOLIC PANEL
|
Professional
|
Both
|
$26.40
|
|
|
Service Code
|
HCPCS 80053
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$23.76 |
| Rate for Payer: Cash Price |
$10.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.92
|
| Rate for Payer: Healthfirst Commercial |
$10.56
|
| Rate for Payer: Healthfirst Essential Plan |
$23.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.03
|
| Rate for Payer: Healthfirst QHP |
$10.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$7.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$10.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4.22
|
| Rate for Payer: SOMOS Essential |
$4.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.56
|
|
|
CHG COMPUTED TOMOGRAPHY THORAX LW DOSE LNG CA SCR C-
|
Professional
|
Both
|
$207.76
|
|
|
Service Code
|
HCPCS 71271 26
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$124.72 |
| Rate for Payer: Cash Price |
$56.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$55.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$49.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$49.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$52.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$55.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$52.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.57
|
| Rate for Payer: Healthfirst Commercial |
$55.43
|
| Rate for Payer: Healthfirst Essential Plan |
$124.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$52.66
|
| Rate for Payer: Healthfirst QHP |
$55.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$38.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$55.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$47.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$38.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$55.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$41.57
|
| Rate for Payer: SOMOS Essential |
$41.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.43
|
|
|
CHG COMPUTED TOMOGRAPHY THORAX LW DOSE LNG CA SCR C-
|
Professional
|
Both
|
$395.19
|
|
|
Service Code
|
HCPCS 71271 TC
|
| Min. Negotiated Rate |
$72.87 |
| Max. Negotiated Rate |
$234.22 |
| Rate for Payer: Cash Price |
$106.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$104.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$93.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$93.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$98.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$104.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$98.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$104.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$104.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$78.08
|
| Rate for Payer: Healthfirst Commercial |
$104.10
|
| Rate for Payer: Healthfirst Essential Plan |
$234.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$98.89
|
| Rate for Payer: Healthfirst QHP |
$104.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$72.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$104.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$88.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$72.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$104.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$78.08
|
| Rate for Payer: SOMOS Essential |
$78.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$104.10
|
|
|
CHG COMPUTED TOMOGRAPHY THORAX LW DOSE LNG CA SCR C-
|
Professional
|
Both
|
$602.91
|
|
|
Service Code
|
HCPCS 71271
|
| Min. Negotiated Rate |
$111.67 |
| Max. Negotiated Rate |
$358.94 |
| Rate for Payer: Cash Price |
$163.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$159.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$143.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$143.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$151.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$159.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$151.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$159.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$159.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$119.65
|
| Rate for Payer: Healthfirst Commercial |
$159.53
|
| Rate for Payer: Healthfirst Essential Plan |
$358.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$151.55
|
| Rate for Payer: Healthfirst QHP |
$159.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$111.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$159.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$135.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$111.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$159.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$119.65
|
| Rate for Payer: SOMOS Essential |
$119.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$159.53
|
|
|
CHG CONSLTJ COMPRE RVW RECORD REPRT REFERRED MATRL
|
Professional
|
Both
|
$526.37
|
|
|
Service Code
|
HCPCS 88325
|
| Min. Negotiated Rate |
$101.52 |
| Max. Negotiated Rate |
$326.32 |
| Rate for Payer: Cash Price |
$144.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$145.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$130.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$130.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$137.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$145.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$137.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$145.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$145.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$108.77
|
| Rate for Payer: Healthfirst Commercial |
$145.03
|
| Rate for Payer: Healthfirst Essential Plan |
$326.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$137.78
|
| Rate for Payer: Healthfirst QHP |
$145.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$101.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$145.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$123.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$101.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$145.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$108.77
|
| Rate for Payer: SOMOS Essential |
$108.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$145.03
|
|
|
CHG CONSLTJ&REPRT REFERRED MATRL REQUIRING PREPJ SLD
|
Professional
|
Both
|
$122.05
|
|
|
Service Code
|
HCPCS 88323 TC
|
| Min. Negotiated Rate |
$24.61 |
| Max. Negotiated Rate |
$79.11 |
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.37
|
| Rate for Payer: Healthfirst Commercial |
$35.16
|
| Rate for Payer: Healthfirst Essential Plan |
$79.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.40
|
| Rate for Payer: Healthfirst QHP |
$35.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.37
|
| Rate for Payer: SOMOS Essential |
$26.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.16
|
|
|
CHG CONSLTJ&REPRT REFERRED MATRL REQUIRING PREPJ SLD
|
Professional
|
Both
|
$332.57
|
|
|
Service Code
|
HCPCS 88323 26
|
| Min. Negotiated Rate |
$64.83 |
| Max. Negotiated Rate |
$208.37 |
| Rate for Payer: Cash Price |
$92.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$92.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$83.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$83.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$87.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$92.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$87.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.46
|
| Rate for Payer: Healthfirst Commercial |
$92.61
|
| Rate for Payer: Healthfirst Essential Plan |
$208.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$87.98
|
| Rate for Payer: Healthfirst QHP |
$92.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$92.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$78.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$92.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.46
|
| Rate for Payer: SOMOS Essential |
$69.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$92.61
|
|
|
CHG CONSLTJ&REPRT REFERRED MATRL REQUIRING PREPJ SLD
|
Professional
|
Both
|
$454.62
|
|
|
Service Code
|
HCPCS 88323
|
| Min. Negotiated Rate |
$89.45 |
| Max. Negotiated Rate |
$287.50 |
| Rate for Payer: Cash Price |
$128.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$115.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$115.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$121.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$121.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$127.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$95.83
|
| Rate for Payer: Healthfirst Commercial |
$127.78
|
| Rate for Payer: Healthfirst Essential Plan |
$287.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$121.39
|
| Rate for Payer: Healthfirst QHP |
$127.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$89.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$127.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$108.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$89.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$95.83
|
| Rate for Payer: SOMOS Essential |
$95.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.78
|
|
|
CHG CONSLTJ&REPRT REFERRED SLIDES PREPARED ELSEWHERE
|
Professional
|
Both
|
$332.43
|
|
|
Service Code
|
HCPCS 88321
|
| Min. Negotiated Rate |
$62.71 |
| Max. Negotiated Rate |
$201.58 |
| Rate for Payer: Cash Price |
$90.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$89.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$80.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$80.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$85.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$89.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$85.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$89.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$89.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67.19
|
| Rate for Payer: Healthfirst Commercial |
$89.59
|
| Rate for Payer: Healthfirst Essential Plan |
$201.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$85.11
|
| Rate for Payer: Healthfirst QHP |
$89.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$62.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$89.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$76.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$62.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$89.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$67.19
|
| Rate for Payer: SOMOS Essential |
$67.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$89.59
|
|
|
CHG CONTINUING MEDICAL PHYSICS CONSLTJ PR WK
|
Professional
|
Both
|
$381.26
|
|
|
Service Code
|
HCPCS 77336
|
| Min. Negotiated Rate |
$75.58 |
| Max. Negotiated Rate |
$242.93 |
| Rate for Payer: Cash Price |
$106.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$107.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$97.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$97.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$102.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$102.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$107.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.98
|
| Rate for Payer: Healthfirst Commercial |
$107.97
|
| Rate for Payer: Healthfirst Essential Plan |
$242.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$102.57
|
| Rate for Payer: Healthfirst QHP |
$107.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$75.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$107.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$91.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$75.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$107.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$80.98
|
| Rate for Payer: SOMOS Essential |
$80.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$107.97
|
|
|
CHG CORPORA CAVERNOSOGRAPY RS&I
|
Professional
|
Both
|
$209.79
|
|
|
Service Code
|
HCPCS 74445 26
|
| Min. Negotiated Rate |
$40.36 |
| Max. Negotiated Rate |
$129.74 |
| Rate for Payer: Cash Price |
$57.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$57.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$51.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$51.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$54.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$57.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$54.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.24
|
| Rate for Payer: Healthfirst Commercial |
$57.66
|
| Rate for Payer: Healthfirst Essential Plan |
$129.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$54.78
|
| Rate for Payer: Healthfirst QHP |
$57.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$40.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$57.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$49.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$40.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$57.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$43.24
|
| Rate for Payer: SOMOS Essential |
$43.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$57.66
|
|
|
CHG CPLX DYNAMIC PHARYNGEAL&SP EVAL C/V REC
|
Professional
|
Both
|
$165.03
|
|
|
Service Code
|
HCPCS 70371 26
|
| Min. Negotiated Rate |
$31.88 |
| Max. Negotiated Rate |
$102.47 |
| Rate for Payer: Cash Price |
$45.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$45.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$45.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.16
|
| Rate for Payer: Healthfirst Commercial |
$45.54
|
| Rate for Payer: Healthfirst Essential Plan |
$102.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43.26
|
| Rate for Payer: Healthfirst QHP |
$45.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$45.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$38.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$34.16
|
| Rate for Payer: SOMOS Essential |
$34.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.54
|
|
|
CHG CPLX DYNAMIC PHARYNGEAL&SP EVAL C/V REC
|
Professional
|
Both
|
$458.15
|
|
|
Service Code
|
HCPCS 70371
|
| Min. Negotiated Rate |
$89.10 |
| Max. Negotiated Rate |
$286.38 |
| Rate for Payer: Cash Price |
$126.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$114.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$114.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$120.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$120.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$127.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$95.46
|
| Rate for Payer: Healthfirst Commercial |
$127.28
|
| Rate for Payer: Healthfirst Essential Plan |
$286.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$120.92
|
| Rate for Payer: Healthfirst QHP |
$127.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$89.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$127.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$108.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$89.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$95.46
|
| Rate for Payer: SOMOS Essential |
$95.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.28
|
|
|
CHG CPLX DYNAMIC PHARYNGEAL&SP EVAL C/V REC
|
Professional
|
Both
|
$293.13
|
|
|
Service Code
|
HCPCS 70371 TC
|
| Min. Negotiated Rate |
$57.22 |
| Max. Negotiated Rate |
$183.91 |
| Rate for Payer: Cash Price |
$80.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$81.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$73.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$77.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$61.30
|
| Rate for Payer: Healthfirst Commercial |
$81.74
|
| Rate for Payer: Healthfirst Essential Plan |
$183.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$77.65
|
| Rate for Payer: Healthfirst QHP |
$81.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$57.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$81.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$69.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$57.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$61.30
|
| Rate for Payer: SOMOS Essential |
$61.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.74
|
|
|
CHG CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTP
|
Professional
|
Both
|
$449.86
|
|
|
Service Code
|
HCPCS 75635 26
|
| Min. Negotiated Rate |
$85.50 |
| Max. Negotiated Rate |
$274.84 |
| Rate for Payer: Cash Price |
$122.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$122.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$109.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$109.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$116.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$122.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$116.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$122.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$122.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$91.61
|
| Rate for Payer: Healthfirst Commercial |
$122.15
|
| Rate for Payer: Healthfirst Essential Plan |
$274.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$116.04
|
| Rate for Payer: Healthfirst QHP |
$122.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$85.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$122.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$103.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$85.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$122.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$91.61
|
| Rate for Payer: SOMOS Essential |
$91.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$122.15
|
|
|
CHG CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTP
|
Professional
|
Both
|
$1,217.20
|
|
|
Service Code
|
HCPCS 75635
|
| Min. Negotiated Rate |
$335.31 |
| Max. Negotiated Rate |
$1,077.80 |
| Rate for Payer: Cash Price |
$490.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$479.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$431.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$431.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$455.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$479.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$455.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$479.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$479.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$359.26
|
| Rate for Payer: Healthfirst Commercial |
$479.02
|
| Rate for Payer: Healthfirst Essential Plan |
$1,077.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$455.07
|
| Rate for Payer: Healthfirst QHP |
$479.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$335.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$479.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$407.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$335.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$479.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$359.26
|
| Rate for Payer: SOMOS Essential |
$359.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$479.02
|
|
|
CHG CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTP
|
Professional
|
Both
|
$767.34
|
|
|
Service Code
|
HCPCS 75635 TC
|
| Min. Negotiated Rate |
$249.80 |
| Max. Negotiated Rate |
$802.93 |
| Rate for Payer: Cash Price |
$367.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$356.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$321.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$321.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$339.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$356.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$339.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$356.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$356.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$267.64
|
| Rate for Payer: Healthfirst Commercial |
$356.86
|
| Rate for Payer: Healthfirst Essential Plan |
$802.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$339.02
|
| Rate for Payer: Healthfirst QHP |
$356.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$249.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$356.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$303.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$249.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$356.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$267.64
|
| Rate for Payer: SOMOS Essential |
$267.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$356.86
|
|
|
CHG CT ABDOMEN & PELVIS W/CONTRAST MATERIAL
|
Professional
|
Both
|
$1,350.41
|
|
|
Service Code
|
HCPCS 74177
|
| Min. Negotiated Rate |
$246.07 |
| Max. Negotiated Rate |
$790.94 |
| Rate for Payer: Cash Price |
$361.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$351.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$316.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$316.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$333.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$351.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$333.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$351.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$351.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$263.65
|
| Rate for Payer: Healthfirst Commercial |
$351.53
|
| Rate for Payer: Healthfirst Essential Plan |
$790.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$333.95
|
| Rate for Payer: Healthfirst QHP |
$351.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$246.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$351.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$298.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$246.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$351.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$263.65
|
| Rate for Payer: SOMOS Essential |
$263.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$351.53
|
|
|
CHG CT ABDOMEN & PELVIS W/CONTRAST MATERIAL
|
Professional
|
Both
|
$1,000.23
|
|
|
Service Code
|
HCPCS 74177 TC
|
| Min. Negotiated Rate |
$179.92 |
| Max. Negotiated Rate |
$578.32 |
| Rate for Payer: Cash Price |
$267.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$257.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$231.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$231.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$244.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$257.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$244.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$257.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$257.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$192.77
|
| Rate for Payer: Healthfirst Commercial |
$257.03
|
| Rate for Payer: Healthfirst Essential Plan |
$578.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$244.18
|
| Rate for Payer: Healthfirst QHP |
$257.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$179.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$257.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$218.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$179.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$257.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$192.77
|
| Rate for Payer: SOMOS Essential |
$192.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$257.03
|
|
