|
CHG CT THORACIC SPINE W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$565.88
|
|
|
Service Code
|
HCPCS 72128
|
| Min. Negotiated Rate |
$105.08 |
| Max. Negotiated Rate |
$337.75 |
| Rate for Payer: Cash Price |
$153.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$150.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$135.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$135.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$142.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$150.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$142.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$112.58
|
| Rate for Payer: Healthfirst Commercial |
$150.11
|
| Rate for Payer: Healthfirst Essential Plan |
$337.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$142.60
|
| Rate for Payer: Healthfirst QHP |
$150.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$105.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$150.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$127.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$105.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$150.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$112.58
|
| Rate for Payer: SOMOS Essential |
$112.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$150.11
|
|
|
CHG CT THORACIC SPINE W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$187.95
|
|
|
Service Code
|
HCPCS 72128 26
|
| Min. Negotiated Rate |
$35.63 |
| Max. Negotiated Rate |
$114.53 |
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$50.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$45.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$45.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$48.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$50.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$48.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.17
|
| Rate for Payer: Healthfirst Commercial |
$50.90
|
| Rate for Payer: Healthfirst Essential Plan |
$114.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$48.35
|
| Rate for Payer: Healthfirst QHP |
$50.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$35.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$50.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$43.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$35.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$50.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$38.17
|
| Rate for Payer: SOMOS Essential |
$38.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.90
|
|
|
CHG CT THORACIC SPINE W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$635.11
|
|
|
Service Code
|
HCPCS 72130 TC
|
| Min. Negotiated Rate |
$116.07 |
| Max. Negotiated Rate |
$373.10 |
| Rate for Payer: Cash Price |
$170.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$165.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$149.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$149.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$157.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$165.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$157.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$165.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$124.36
|
| Rate for Payer: Healthfirst Commercial |
$165.82
|
| Rate for Payer: Healthfirst Essential Plan |
$373.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$157.53
|
| Rate for Payer: Healthfirst QHP |
$165.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$116.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$165.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$140.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$116.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$165.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$124.36
|
| Rate for Payer: SOMOS Essential |
$124.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$165.82
|
|
|
CHG CT THORACIC SPINE W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$244.34
|
|
|
Service Code
|
HCPCS 72130 26
|
| Min. Negotiated Rate |
$45.72 |
| Max. Negotiated Rate |
$146.95 |
| Rate for Payer: Cash Price |
$66.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$65.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$58.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$65.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.98
|
| Rate for Payer: Healthfirst Commercial |
$65.31
|
| Rate for Payer: Healthfirst Essential Plan |
$146.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.04
|
| Rate for Payer: Healthfirst QHP |
$65.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$65.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$55.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$65.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$48.98
|
| Rate for Payer: SOMOS Essential |
$48.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.31
|
|
|
CHG CT THORACIC SPINE W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$879.45
|
|
|
Service Code
|
HCPCS 72130
|
| Min. Negotiated Rate |
$161.79 |
| Max. Negotiated Rate |
$520.04 |
| Rate for Payer: Cash Price |
$236.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$208.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$208.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$231.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$173.35
|
| Rate for Payer: Healthfirst Commercial |
$231.13
|
| Rate for Payer: Healthfirst Essential Plan |
$520.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$219.57
|
| Rate for Payer: Healthfirst QHP |
$231.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$161.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$231.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$196.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$161.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$173.35
|
| Rate for Payer: SOMOS Essential |
$173.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.13
|
|
|
CHG CT UPPER EXTREMITY W/CONTRAST MATERIAL
|
Professional
|
Both
|
$669.59
|
|
|
Service Code
|
HCPCS 73201 TC
|
| Min. Negotiated Rate |
$121.23 |
| Max. Negotiated Rate |
$389.68 |
| Rate for Payer: Cash Price |
$179.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$173.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$155.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$155.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$164.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$173.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$164.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$173.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$173.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$129.89
|
| Rate for Payer: Healthfirst Commercial |
$173.19
|
| Rate for Payer: Healthfirst Essential Plan |
$389.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$164.53
|
| Rate for Payer: Healthfirst QHP |
$173.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$121.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$173.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$147.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$121.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$173.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$129.89
|
| Rate for Payer: SOMOS Essential |
$129.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$173.19
|
|
|
CHG CT UPPER EXTREMITY W/CONTRAST MATERIAL
|
Professional
|
Both
|
$222.08
|
|
|
Service Code
|
HCPCS 73201 26
|
| Min. Negotiated Rate |
$41.55 |
| Max. Negotiated Rate |
$133.54 |
| Rate for Payer: Cash Price |
$60.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$59.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$53.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$56.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$59.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$56.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.51
|
| Rate for Payer: Healthfirst Commercial |
$59.35
|
| Rate for Payer: Healthfirst Essential Plan |
$133.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$56.38
|
| Rate for Payer: Healthfirst QHP |
$59.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$41.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$59.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$50.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$41.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$59.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$44.51
|
| Rate for Payer: SOMOS Essential |
$44.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$59.35
|
|
|
CHG CT UPPER EXTREMITY W/CONTRAST MATERIAL
|
Professional
|
Both
|
$891.66
|
|
|
Service Code
|
HCPCS 73201
|
| Min. Negotiated Rate |
$162.78 |
| Max. Negotiated Rate |
$523.22 |
| Rate for Payer: Cash Price |
$239.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$232.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$209.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$220.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$232.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$220.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$232.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$232.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$174.41
|
| Rate for Payer: Healthfirst Commercial |
$232.54
|
| Rate for Payer: Healthfirst Essential Plan |
$523.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$220.91
|
| Rate for Payer: Healthfirst QHP |
$232.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$162.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$232.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$197.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$162.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$232.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$174.41
|
| Rate for Payer: SOMOS Essential |
$174.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$232.54
|
|
|
CHG CT UPPER EXTREMITY W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$455.56
|
|
|
Service Code
|
HCPCS 73200 TC
|
| Min. Negotiated Rate |
$95.15 |
| Max. Negotiated Rate |
$305.84 |
| Rate for Payer: Cash Price |
$140.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$135.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$122.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$122.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$129.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$135.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$129.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$135.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$135.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$101.95
|
| Rate for Payer: Healthfirst Commercial |
$135.93
|
| Rate for Payer: Healthfirst Essential Plan |
$305.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$129.13
|
| Rate for Payer: Healthfirst QHP |
$135.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$95.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$135.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$115.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$95.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$135.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$101.95
|
| Rate for Payer: SOMOS Essential |
$101.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$135.93
|
|
|
CHG CT UPPER EXTREMITY W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$643.48
|
|
|
Service Code
|
HCPCS 73200
|
| Min. Negotiated Rate |
$130.77 |
| Max. Negotiated Rate |
$420.35 |
| Rate for Payer: Cash Price |
$191.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$186.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$168.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$168.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$177.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$186.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$177.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$186.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$186.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$140.12
|
| Rate for Payer: Healthfirst Commercial |
$186.82
|
| Rate for Payer: Healthfirst Essential Plan |
$420.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$177.48
|
| Rate for Payer: Healthfirst QHP |
$186.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$130.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$186.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$158.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$130.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$186.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$140.12
|
| Rate for Payer: SOMOS Essential |
$140.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$186.82
|
|
|
CHG CT UPPER EXTREMITY W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$187.95
|
|
|
Service Code
|
HCPCS 73200 26
|
| Min. Negotiated Rate |
$35.63 |
| Max. Negotiated Rate |
$114.53 |
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$50.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$45.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$45.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$48.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$50.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$48.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.17
|
| Rate for Payer: Healthfirst Commercial |
$50.90
|
| Rate for Payer: Healthfirst Essential Plan |
$114.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$48.35
|
| Rate for Payer: Healthfirst QHP |
$50.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$35.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$50.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$43.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$35.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$50.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$38.17
|
| Rate for Payer: SOMOS Essential |
$38.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.90
|
|
|
CHG CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$767.34
|
|
|
Service Code
|
HCPCS 73202 TC
|
| Min. Negotiated Rate |
$157.80 |
| Max. Negotiated Rate |
$507.22 |
| Rate for Payer: Cash Price |
$234.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$225.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$202.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$202.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$214.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$225.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$214.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$225.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$169.07
|
| Rate for Payer: Healthfirst Commercial |
$225.43
|
| Rate for Payer: Healthfirst Essential Plan |
$507.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$214.16
|
| Rate for Payer: Healthfirst QHP |
$225.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$157.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$225.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$191.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$157.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$225.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$169.07
|
| Rate for Payer: SOMOS Essential |
$169.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$225.43
|
|
|
CHG CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$232.47
|
|
|
Service Code
|
HCPCS 73202 26
|
| Min. Negotiated Rate |
$43.27 |
| Max. Negotiated Rate |
$139.07 |
| Rate for Payer: Cash Price |
$62.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$61.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$55.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$55.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$58.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$61.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$58.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$61.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$46.36
|
| Rate for Payer: Healthfirst Commercial |
$61.81
|
| Rate for Payer: Healthfirst Essential Plan |
$139.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$58.72
|
| Rate for Payer: Healthfirst QHP |
$61.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$43.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$61.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$52.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$43.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$61.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$46.36
|
| Rate for Payer: SOMOS Essential |
$46.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$61.81
|
|
|
CHG CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$999.81
|
|
|
Service Code
|
HCPCS 73202
|
| Min. Negotiated Rate |
$201.07 |
| Max. Negotiated Rate |
$646.29 |
| Rate for Payer: Cash Price |
$297.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$287.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$258.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$258.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$272.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$287.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$272.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$287.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$287.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$215.43
|
| Rate for Payer: Healthfirst Commercial |
$287.24
|
| Rate for Payer: Healthfirst Essential Plan |
$646.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$272.88
|
| Rate for Payer: Healthfirst QHP |
$287.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$201.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$287.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$244.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$201.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$287.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$215.43
|
| Rate for Payer: SOMOS Essential |
$215.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$287.24
|
|
|
CHG CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL
|
Professional
|
Both
|
$32.32
|
|
|
Service Code
|
HCPCS 87077
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$18.18 |
| Rate for Payer: Cash Price |
$8.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.06
|
| Rate for Payer: Healthfirst Commercial |
$8.08
|
| Rate for Payer: Healthfirst Essential Plan |
$18.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.68
|
| Rate for Payer: Healthfirst QHP |
$8.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$5.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$6.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$5.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.23
|
| Rate for Payer: SOMOS Essential |
$3.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.08
|
|
|
CHG CYSTOGRAPHY MINIMUM 3 VIEWS RS&I
|
Professional
|
Both
|
$176.23
|
|
|
Service Code
|
HCPCS 74430
|
| Min. Negotiated Rate |
$33.19 |
| Max. Negotiated Rate |
$106.69 |
| Rate for Payer: Cash Price |
$48.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$42.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.56
|
| Rate for Payer: Healthfirst Commercial |
$47.42
|
| Rate for Payer: Healthfirst Essential Plan |
$106.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$45.05
|
| Rate for Payer: Healthfirst QHP |
$47.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$47.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$40.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35.56
|
| Rate for Payer: SOMOS Essential |
$35.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.42
|
|
|
CHG CYSTOGRAPHY MINIMUM 3 VIEWS RS&I
|
Professional
|
Both
|
$61.36
|
|
|
Service Code
|
HCPCS 74430 26
|
| Min. Negotiated Rate |
$11.57 |
| Max. Negotiated Rate |
$37.19 |
| Rate for Payer: Cash Price |
$16.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.40
|
| Rate for Payer: Healthfirst Commercial |
$16.53
|
| Rate for Payer: Healthfirst Essential Plan |
$37.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.70
|
| Rate for Payer: Healthfirst QHP |
$16.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$14.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.40
|
| Rate for Payer: SOMOS Essential |
$12.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.53
|
|
|
CHG CYSTOGRAPHY MINIMUM 3 VIEWS RS&I
|
Professional
|
Both
|
$114.87
|
|
|
Service Code
|
HCPCS 74430 TC
|
| Min. Negotiated Rate |
$21.62 |
| Max. Negotiated Rate |
$69.50 |
| Rate for Payer: Cash Price |
$31.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$27.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$30.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.17
|
| Rate for Payer: Healthfirst Commercial |
$30.89
|
| Rate for Payer: Healthfirst Essential Plan |
$69.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.35
|
| Rate for Payer: Healthfirst QHP |
$30.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$30.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.17
|
| Rate for Payer: SOMOS Essential |
$23.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.89
|
|
|
CHG CYTOPATHOLOGY FORENSIC
|
Professional
|
Both
|
$118.55
|
|
|
Service Code
|
HCPCS 88125
|
| Min. Negotiated Rate |
$23.16 |
| Max. Negotiated Rate |
$74.45 |
| Rate for Payer: Cash Price |
$33.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.82
|
| Rate for Payer: Healthfirst Commercial |
$33.09
|
| Rate for Payer: Healthfirst Essential Plan |
$74.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.44
|
| Rate for Payer: Healthfirst QHP |
$33.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$33.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.82
|
| Rate for Payer: SOMOS Essential |
$24.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.09
|
|
|
CHG CYTOPATHOLOGY FORENSIC
|
Professional
|
Both
|
$64.54
|
|
|
Service Code
|
HCPCS 88125 TC
|
| Min. Negotiated Rate |
$12.93 |
| Max. Negotiated Rate |
$41.56 |
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.85
|
| Rate for Payer: Healthfirst Commercial |
$18.47
|
| Rate for Payer: Healthfirst Essential Plan |
$41.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.55
|
| Rate for Payer: Healthfirst QHP |
$18.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$12.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$18.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$15.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$12.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$13.85
|
| Rate for Payer: SOMOS Essential |
$13.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.47
|
|
|
CHG CYTOPATHOLOGY FORENSIC
|
Professional
|
Both
|
$54.01
|
|
|
Service Code
|
HCPCS 88125 26
|
| Min. Negotiated Rate |
$10.23 |
| Max. Negotiated Rate |
$32.90 |
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.96
|
| Rate for Payer: Healthfirst Commercial |
$14.62
|
| Rate for Payer: Healthfirst Essential Plan |
$32.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.89
|
| Rate for Payer: Healthfirst QHP |
$14.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$10.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$14.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$12.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$10.96
|
| Rate for Payer: SOMOS Essential |
$10.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.62
|
|
|
CHG CYTP CERVICAL/VAGINAL REQ INTERP PHYSICIAN
|
Professional
|
Both
|
$94.26
|
|
|
Service Code
|
HCPCS 88141
|
| Min. Negotiated Rate |
$19.75 |
| Max. Negotiated Rate |
$63.47 |
| Rate for Payer: Cash Price |
$27.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.16
|
| Rate for Payer: Healthfirst Commercial |
$28.21
|
| Rate for Payer: Healthfirst Essential Plan |
$63.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.80
|
| Rate for Payer: Healthfirst QHP |
$28.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.16
|
| Rate for Payer: SOMOS Essential |
$21.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.21
|
|
|
CHG CYTP CONCENTRATION SMEARS & INTERPRETATION
|
Professional
|
Both
|
$86.59
|
|
|
Service Code
|
HCPCS 88108 26
|
| Min. Negotiated Rate |
$16.48 |
| Max. Negotiated Rate |
$52.97 |
| Rate for Payer: Cash Price |
$23.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$23.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$23.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.66
|
| Rate for Payer: Healthfirst Commercial |
$23.54
|
| Rate for Payer: Healthfirst Essential Plan |
$52.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.36
|
| Rate for Payer: Healthfirst QHP |
$23.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$16.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$23.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$20.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$16.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$17.66
|
| Rate for Payer: SOMOS Essential |
$17.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.54
|
|
|
CHG CYTP CONCENTRATION SMEARS & INTERPRETATION
|
Professional
|
Both
|
$277.66
|
|
|
Service Code
|
HCPCS 88108
|
| Min. Negotiated Rate |
$56.03 |
| Max. Negotiated Rate |
$180.11 |
| Rate for Payer: Cash Price |
$79.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$80.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$72.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$72.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$76.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$80.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$76.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.04
|
| Rate for Payer: Healthfirst Commercial |
$80.05
|
| Rate for Payer: Healthfirst Essential Plan |
$180.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$76.05
|
| Rate for Payer: Healthfirst QHP |
$80.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$56.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$80.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$68.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$56.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$80.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$60.04
|
| Rate for Payer: SOMOS Essential |
$60.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$80.05
|
|
|
CHG CYTP CONCENTRATION SMEARS & INTERPRETATION
|
Professional
|
Both
|
$191.07
|
|
|
Service Code
|
HCPCS 88108 TC
|
| Min. Negotiated Rate |
$39.56 |
| Max. Negotiated Rate |
$127.15 |
| Rate for Payer: Cash Price |
$55.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$56.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$50.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$50.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$53.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$56.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$53.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.38
|
| Rate for Payer: Healthfirst Commercial |
$56.51
|
| Rate for Payer: Healthfirst Essential Plan |
$127.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$53.68
|
| Rate for Payer: Healthfirst QHP |
$56.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$39.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$56.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$48.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$39.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$56.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$42.38
|
| Rate for Payer: SOMOS Essential |
$42.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56.51
|
|
