|
CHG CYTP SMRS ANY OTH SRC EXTND STD > 5 SLIDES
|
Professional
|
Both
|
$151.10
|
|
|
Service Code
|
HCPCS 88162 26
|
| Min. Negotiated Rate |
$28.81 |
| Max. Negotiated Rate |
$92.61 |
| Rate for Payer: Cash Price |
$41.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$41.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$39.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.87
|
| Rate for Payer: Healthfirst Commercial |
$41.16
|
| Rate for Payer: Healthfirst Essential Plan |
$92.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.10
|
| Rate for Payer: Healthfirst QHP |
$41.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$41.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$30.87
|
| Rate for Payer: SOMOS Essential |
$30.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.16
|
|
|
CHG CYTP SMRS ANY OTH SRC EXTND STD > 5 SLIDES
|
Professional
|
Both
|
$498.72
|
|
|
Service Code
|
HCPCS 88162
|
| Min. Negotiated Rate |
$105.92 |
| Max. Negotiated Rate |
$340.45 |
| Rate for Payer: Cash Price |
$149.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$151.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$136.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$136.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$143.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$151.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$143.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$151.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$151.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$113.48
|
| Rate for Payer: Healthfirst Commercial |
$151.31
|
| Rate for Payer: Healthfirst Essential Plan |
$340.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$143.74
|
| Rate for Payer: Healthfirst QHP |
$151.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$105.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$151.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$128.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$105.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$151.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$113.48
|
| Rate for Payer: SOMOS Essential |
$113.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$151.31
|
|
|
CHG CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ
|
Professional
|
Both
|
$225.40
|
|
|
Service Code
|
HCPCS 88161 TC
|
| Min. Negotiated Rate |
$48.69 |
| Max. Negotiated Rate |
$156.49 |
| Rate for Payer: Cash Price |
$67.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$69.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$62.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$66.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$69.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$66.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$69.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$69.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$52.16
|
| Rate for Payer: Healthfirst Commercial |
$69.55
|
| Rate for Payer: Healthfirst Essential Plan |
$156.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$66.07
|
| Rate for Payer: Healthfirst QHP |
$69.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$48.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$69.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$59.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$48.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$69.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$52.16
|
| Rate for Payer: SOMOS Essential |
$52.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$69.55
|
|
|
CHG CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ
|
Professional
|
Both
|
$323.82
|
|
|
Service Code
|
HCPCS 88161
|
| Min. Negotiated Rate |
$67.42 |
| Max. Negotiated Rate |
$216.72 |
| Rate for Payer: Cash Price |
$94.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$96.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$86.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$86.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$91.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$96.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$91.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$96.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$96.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.24
|
| Rate for Payer: Healthfirst Commercial |
$96.32
|
| Rate for Payer: Healthfirst Essential Plan |
$216.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$91.50
|
| Rate for Payer: Healthfirst QHP |
$96.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$67.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$96.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$81.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$67.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$96.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$72.24
|
| Rate for Payer: SOMOS Essential |
$72.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$96.32
|
|
|
CHG CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ
|
Professional
|
Both
|
$98.42
|
|
|
Service Code
|
HCPCS 88161 26
|
| Min. Negotiated Rate |
$18.74 |
| Max. Negotiated Rate |
$60.23 |
| Rate for Payer: Cash Price |
$26.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.08
|
| Rate for Payer: Healthfirst Commercial |
$26.77
|
| Rate for Payer: Healthfirst Essential Plan |
$60.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.43
|
| Rate for Payer: Healthfirst QHP |
$26.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.08
|
| Rate for Payer: SOMOS Essential |
$20.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.77
|
|
|
CHG CYTP SMRS ANY OTH SRC SCR&INTERPJ
|
Professional
|
Both
|
$99.86
|
|
|
Service Code
|
HCPCS 88160 26
|
| Min. Negotiated Rate |
$19.01 |
| Max. Negotiated Rate |
$61.11 |
| Rate for Payer: Cash Price |
$27.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.37
|
| Rate for Payer: Healthfirst Commercial |
$27.16
|
| Rate for Payer: Healthfirst Essential Plan |
$61.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.80
|
| Rate for Payer: Healthfirst QHP |
$27.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$27.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.37
|
| Rate for Payer: SOMOS Essential |
$20.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.16
|
|
|
CHG CYTP SMRS ANY OTH SRC SCR&INTERPJ
|
Professional
|
Both
|
$316.65
|
|
|
Service Code
|
HCPCS 88160
|
| Min. Negotiated Rate |
$66.89 |
| Max. Negotiated Rate |
$214.99 |
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$95.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$86.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$86.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$90.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$95.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$90.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$95.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$95.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$71.66
|
| Rate for Payer: Healthfirst Commercial |
$95.55
|
| Rate for Payer: Healthfirst Essential Plan |
$214.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$90.77
|
| Rate for Payer: Healthfirst QHP |
$95.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$66.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$95.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$81.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$66.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$95.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$71.66
|
| Rate for Payer: SOMOS Essential |
$71.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$95.55
|
|
|
CHG CYTP SMRS ANY OTH SRC SCR&INTERPJ
|
Professional
|
Both
|
$216.79
|
|
|
Service Code
|
HCPCS 88160 TC
|
| Min. Negotiated Rate |
$47.87 |
| Max. Negotiated Rate |
$153.88 |
| Rate for Payer: Cash Price |
$65.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$68.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$61.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$68.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$68.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$68.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51.29
|
| Rate for Payer: Healthfirst Commercial |
$68.39
|
| Rate for Payer: Healthfirst Essential Plan |
$153.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$64.97
|
| Rate for Payer: Healthfirst QHP |
$68.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$47.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$68.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$58.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$47.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$68.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$51.29
|
| Rate for Payer: SOMOS Essential |
$51.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$68.39
|
|
|
CHG DACRYOCSTOGRAPY NASOLACRIMAL DUCT RS&I
|
Professional
|
Both
|
$58.87
|
|
|
Service Code
|
HCPCS 70170 26
|
| Min. Negotiated Rate |
$11.09 |
| Max. Negotiated Rate |
$35.64 |
| Rate for Payer: Cash Price |
$16.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.88
|
| Rate for Payer: Healthfirst Commercial |
$15.84
|
| Rate for Payer: Healthfirst Essential Plan |
$35.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.05
|
| Rate for Payer: Healthfirst QHP |
$15.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$15.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$13.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$11.88
|
| Rate for Payer: SOMOS Essential |
$11.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.84
|
|
|
CHG DARK FIELD EXAM ANY SOURCE W/SPECIMEN COLLECTION
|
Professional
|
Both
|
$74.97
|
|
|
Service Code
|
HCPCS 87164 26
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$45.79 |
| Rate for Payer: Cash Price |
$20.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.26
|
| Rate for Payer: Healthfirst Commercial |
$20.35
|
| Rate for Payer: Healthfirst Essential Plan |
$45.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.33
|
| Rate for Payer: Healthfirst QHP |
$20.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$20.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$17.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$14.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.14
|
| Rate for Payer: SOMOS Essential |
$8.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.35
|
|
|
CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX C-/C+
|
Professional
|
Both
|
$627.90
|
|
|
Service Code
|
HCPCS 71270 TC
|
| Min. Negotiated Rate |
$114.71 |
| Max. Negotiated Rate |
$368.71 |
| Rate for Payer: Cash Price |
$169.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$163.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$147.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$147.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$155.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$163.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$155.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$163.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$163.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$122.90
|
| Rate for Payer: Healthfirst Commercial |
$163.87
|
| Rate for Payer: Healthfirst Essential Plan |
$368.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$155.68
|
| Rate for Payer: Healthfirst QHP |
$163.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$114.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$163.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$139.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$114.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$163.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$122.90
|
| Rate for Payer: SOMOS Essential |
$122.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$163.87
|
|
|
CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX C-/C+
|
Professional
|
Both
|
$865.59
|
|
|
Service Code
|
HCPCS 71270
|
| Min. Negotiated Rate |
$159.68 |
| Max. Negotiated Rate |
$513.25 |
| Rate for Payer: Cash Price |
$233.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$228.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$205.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$205.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$216.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$228.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$216.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$228.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$228.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$171.08
|
| Rate for Payer: Healthfirst Commercial |
$228.11
|
| Rate for Payer: Healthfirst Essential Plan |
$513.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$216.70
|
| Rate for Payer: Healthfirst QHP |
$228.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$159.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$228.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$193.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$159.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$228.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$171.08
|
| Rate for Payer: SOMOS Essential |
$171.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$228.11
|
|
|
CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX C-/C+
|
Professional
|
Both
|
$237.65
|
|
|
Service Code
|
HCPCS 71270 26
|
| Min. Negotiated Rate |
$44.97 |
| Max. Negotiated Rate |
$144.54 |
| Rate for Payer: Cash Price |
$64.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$64.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$57.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$57.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$61.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$64.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$61.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.18
|
| Rate for Payer: Healthfirst Commercial |
$64.24
|
| Rate for Payer: Healthfirst Essential Plan |
$144.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.03
|
| Rate for Payer: Healthfirst QHP |
$64.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$44.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$64.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$54.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$44.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$64.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$48.18
|
| Rate for Payer: SOMOS Essential |
$48.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$64.24
|
|
|
CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/CONTRAST
|
Professional
|
Both
|
$510.02
|
|
|
Service Code
|
HCPCS 71260 TC
|
| Min. Negotiated Rate |
$93.79 |
| Max. Negotiated Rate |
$301.48 |
| Rate for Payer: Cash Price |
$137.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$133.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$120.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$120.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$127.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$133.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$127.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$133.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$133.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$100.49
|
| Rate for Payer: Healthfirst Commercial |
$133.99
|
| Rate for Payer: Healthfirst Essential Plan |
$301.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$127.29
|
| Rate for Payer: Healthfirst QHP |
$133.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$93.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$133.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$113.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$93.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$133.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$100.49
|
| Rate for Payer: SOMOS Essential |
$100.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$133.99
|
|
|
CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/CONTRAST
|
Professional
|
Both
|
$223.51
|
|
|
Service Code
|
HCPCS 71260 26
|
| Min. Negotiated Rate |
$41.82 |
| Max. Negotiated Rate |
$134.41 |
| Rate for Payer: Cash Price |
$60.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$59.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$53.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$56.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$59.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$56.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.80
|
| Rate for Payer: Healthfirst Commercial |
$59.74
|
| Rate for Payer: Healthfirst Essential Plan |
$134.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$56.75
|
| Rate for Payer: Healthfirst QHP |
$59.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$41.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$59.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$50.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$41.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$59.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$44.80
|
| Rate for Payer: SOMOS Essential |
$44.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$59.74
|
|
|
CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/CONTRAST
|
Professional
|
Both
|
$733.57
|
|
|
Service Code
|
HCPCS 71260
|
| Min. Negotiated Rate |
$135.61 |
| Max. Negotiated Rate |
$435.89 |
| Rate for Payer: Cash Price |
$198.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$193.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$174.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$174.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$184.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$193.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$184.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$193.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$193.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$145.30
|
| Rate for Payer: Healthfirst Commercial |
$193.73
|
| Rate for Payer: Healthfirst Essential Plan |
$435.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$184.04
|
| Rate for Payer: Healthfirst QHP |
$193.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$135.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$193.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$164.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$135.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$193.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$145.30
|
| Rate for Payer: SOMOS Essential |
$145.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$193.73
|
|
|
CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST
|
Professional
|
Both
|
$582.79
|
|
|
Service Code
|
HCPCS 71250
|
| Min. Negotiated Rate |
$107.71 |
| Max. Negotiated Rate |
$346.21 |
| Rate for Payer: Cash Price |
$157.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$153.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$138.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$138.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$146.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$153.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$146.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$153.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$153.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$115.40
|
| Rate for Payer: Healthfirst Commercial |
$153.87
|
| Rate for Payer: Healthfirst Essential Plan |
$346.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$146.18
|
| Rate for Payer: Healthfirst QHP |
$153.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$107.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$153.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$130.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$107.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$153.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$115.40
|
| Rate for Payer: SOMOS Essential |
$115.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$153.87
|
|
|
CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST
|
Professional
|
Both
|
$375.06
|
|
|
Service Code
|
HCPCS 71250 TC
|
| Min. Negotiated Rate |
$68.90 |
| Max. Negotiated Rate |
$221.47 |
| Rate for Payer: Cash Price |
$101.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$98.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$88.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$88.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$93.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$98.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$93.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$98.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$98.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.82
|
| Rate for Payer: Healthfirst Commercial |
$98.43
|
| Rate for Payer: Healthfirst Essential Plan |
$221.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$93.51
|
| Rate for Payer: Healthfirst QHP |
$98.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$68.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$98.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$83.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$68.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$98.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$73.82
|
| Rate for Payer: SOMOS Essential |
$73.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$98.43
|
|
|
CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST
|
Professional
|
Both
|
$207.76
|
|
|
Service Code
|
HCPCS 71250 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 DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI
|
Professional
|
Both
|
$187.95
|
|
|
Service Code
|
HCPCS 77066 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 DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI
|
Professional
|
Both
|
$669.38
|
|
|
Service Code
|
HCPCS 77066
|
| Min. Negotiated Rate |
$126.97 |
| Max. Negotiated Rate |
$408.13 |
| Rate for Payer: Cash Price |
$184.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$181.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$163.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$163.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$172.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$181.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$172.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$181.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$181.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$136.04
|
| Rate for Payer: Healthfirst Commercial |
$181.39
|
| Rate for Payer: Healthfirst Essential Plan |
$408.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$172.32
|
| Rate for Payer: Healthfirst QHP |
$181.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$126.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$181.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$154.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$126.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$181.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$136.04
|
| Rate for Payer: SOMOS Essential |
$136.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$181.39
|
|
|
CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI
|
Professional
|
Both
|
$481.43
|
|
|
Service Code
|
HCPCS 77066 TC
|
| Min. Negotiated Rate |
$91.34 |
| Max. Negotiated Rate |
$293.60 |
| Rate for Payer: Cash Price |
$132.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$130.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$117.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$117.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$123.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$130.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$123.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$97.87
|
| Rate for Payer: Healthfirst Commercial |
$130.49
|
| Rate for Payer: Healthfirst Essential Plan |
$293.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$123.97
|
| Rate for Payer: Healthfirst QHP |
$130.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$91.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$130.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$110.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$91.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$130.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$97.87
|
| Rate for Payer: SOMOS Essential |
$97.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.49
|
|
|
CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI
|
Professional
|
Both
|
$377.93
|
|
|
Service Code
|
HCPCS 77065 TC
|
| Min. Negotiated Rate |
$71.78 |
| Max. Negotiated Rate |
$230.74 |
| Rate for Payer: Cash Price |
$103.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$102.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$92.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$92.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$97.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$102.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$97.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$102.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$102.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$76.91
|
| Rate for Payer: Healthfirst Commercial |
$102.55
|
| Rate for Payer: Healthfirst Essential Plan |
$230.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$97.42
|
| Rate for Payer: Healthfirst QHP |
$102.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$71.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$102.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$87.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$71.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$102.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$76.91
|
| Rate for Payer: SOMOS Essential |
$76.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$102.55
|
|
|
CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI
|
Professional
|
Both
|
$532.00
|
|
|
Service Code
|
HCPCS 77065
|
| Min. Negotiated Rate |
$100.93 |
| Max. Negotiated Rate |
$324.40 |
| Rate for Payer: Cash Price |
$145.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$144.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$129.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$129.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$136.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$144.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$136.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$144.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$144.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$108.14
|
| Rate for Payer: Healthfirst Commercial |
$144.18
|
| Rate for Payer: Healthfirst Essential Plan |
$324.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$136.97
|
| Rate for Payer: Healthfirst QHP |
$144.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$100.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$144.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$122.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$100.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$144.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$108.14
|
| Rate for Payer: SOMOS Essential |
$108.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$144.18
|
|
|
CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI
|
Professional
|
Both
|
$154.07
|
|
|
Service Code
|
HCPCS 77065 26
|
| Min. Negotiated Rate |
$29.14 |
| Max. Negotiated Rate |
$93.67 |
| Rate for Payer: Cash Price |
$42.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$41.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$39.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.22
|
| Rate for Payer: Healthfirst Commercial |
$41.63
|
| Rate for Payer: Healthfirst Essential Plan |
$93.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.55
|
| Rate for Payer: Healthfirst QHP |
$41.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$41.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$35.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31.22
|
| Rate for Payer: SOMOS Essential |
$31.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.63
|
|
