|
CHG DILATION URETERS/URETHRA RS&I
|
Professional
|
Both
|
$505.75
|
|
|
Service Code
|
HCPCS 74485
|
| Min. Negotiated Rate |
$94.02 |
| Max. Negotiated Rate |
$302.22 |
| Rate for Payer: Cash Price |
$137.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$134.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$120.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$120.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$127.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$134.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$127.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$134.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$134.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$100.74
|
| Rate for Payer: Healthfirst Commercial |
$134.32
|
| Rate for Payer: Healthfirst Essential Plan |
$302.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$127.60
|
| Rate for Payer: Healthfirst QHP |
$134.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$94.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$134.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$114.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$94.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$134.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$100.74
|
| Rate for Payer: SOMOS Essential |
$100.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$134.32
|
|
|
CHG DILATION URETERS/URETHRA RS&I
|
Professional
|
Both
|
$156.59
|
|
|
Service Code
|
HCPCS 74485 26
|
| Min. Negotiated Rate |
$29.46 |
| Max. Negotiated Rate |
$94.70 |
| Rate for Payer: Cash Price |
$42.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$42.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$39.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$42.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.57
|
| Rate for Payer: Healthfirst Commercial |
$42.09
|
| Rate for Payer: Healthfirst Essential Plan |
$94.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.99
|
| Rate for Payer: Healthfirst QHP |
$42.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$42.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$35.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$42.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31.57
|
| Rate for Payer: SOMOS Essential |
$31.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.09
|
|
|
CHG DILATION URETERS/URETHRA RS&I
|
Professional
|
Both
|
$349.16
|
|
|
Service Code
|
HCPCS 74485 TC
|
| Min. Negotiated Rate |
$64.55 |
| Max. Negotiated Rate |
$207.50 |
| Rate for Payer: Cash Price |
$95.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$92.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$83.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$83.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$87.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$92.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$87.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.17
|
| Rate for Payer: Healthfirst Commercial |
$92.22
|
| Rate for Payer: Healthfirst Essential Plan |
$207.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$87.61
|
| Rate for Payer: Healthfirst QHP |
$92.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$92.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$78.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$92.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.17
|
| Rate for Payer: SOMOS Essential |
$69.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$92.22
|
|
|
CHG DISKOGRAPY CERVICAL/THORACIC RS&I
|
Professional
|
Both
|
$539.91
|
|
|
Service Code
|
HCPCS 72285
|
| Min. Negotiated Rate |
$104.59 |
| Max. Negotiated Rate |
$336.17 |
| Rate for Payer: Cash Price |
$151.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$149.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$134.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$134.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$141.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$149.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$141.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$149.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$149.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$112.06
|
| Rate for Payer: Healthfirst Commercial |
$149.41
|
| Rate for Payer: Healthfirst Essential Plan |
$336.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$141.94
|
| Rate for Payer: Healthfirst QHP |
$149.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$104.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$149.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$127.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$104.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$149.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$112.06
|
| Rate for Payer: SOMOS Essential |
$112.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$149.41
|
|
|
CHG DISKOGRAPY CERVICAL/THORACIC RS&I
|
Professional
|
Both
|
$220.92
|
|
|
Service Code
|
HCPCS 72285 26
|
| Min. Negotiated Rate |
$42.20 |
| Max. Negotiated Rate |
$135.65 |
| Rate for Payer: Cash Price |
$60.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$60.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$54.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$54.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$57.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$60.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$57.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.22
|
| Rate for Payer: Healthfirst Commercial |
$60.29
|
| Rate for Payer: Healthfirst Essential Plan |
$135.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$57.28
|
| Rate for Payer: Healthfirst QHP |
$60.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$42.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$60.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$51.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$42.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$60.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$45.22
|
| Rate for Payer: SOMOS Essential |
$45.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$60.29
|
|
|
CHG DISKOGRAPY CERVICAL/THORACIC RS&I
|
Professional
|
Both
|
$318.99
|
|
|
Service Code
|
HCPCS 72285 TC
|
| Min. Negotiated Rate |
$62.38 |
| Max. Negotiated Rate |
$200.52 |
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$89.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$80.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$80.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$89.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$84.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$89.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$89.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$66.84
|
| Rate for Payer: Healthfirst Commercial |
$89.12
|
| Rate for Payer: Healthfirst Essential Plan |
$200.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$84.66
|
| Rate for Payer: Healthfirst QHP |
$89.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$62.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$89.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$75.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$62.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$89.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$66.84
|
| Rate for Payer: SOMOS Essential |
$66.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$89.12
|
|
|
CHG DISKOGRAPY LUMBAR RS&I
|
Professional
|
Both
|
$469.81
|
|
|
Service Code
|
HCPCS 72295
|
| Min. Negotiated Rate |
$88.47 |
| Max. Negotiated Rate |
$284.38 |
| Rate for Payer: Cash Price |
$128.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$126.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$113.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$113.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$120.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$126.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$120.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$94.79
|
| Rate for Payer: Healthfirst Commercial |
$126.39
|
| Rate for Payer: Healthfirst Essential Plan |
$284.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$120.07
|
| Rate for Payer: Healthfirst QHP |
$126.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$88.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$126.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$107.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$88.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$126.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$94.79
|
| Rate for Payer: SOMOS Essential |
$94.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$126.39
|
|
|
CHG DISKOGRAPY LUMBAR RS&I
|
Professional
|
Both
|
$310.35
|
|
|
Service Code
|
HCPCS 72295 TC
|
| Min. Negotiated Rate |
$58.31 |
| Max. Negotiated Rate |
$187.43 |
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$83.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$74.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$74.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$79.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$83.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$79.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$62.48
|
| Rate for Payer: Healthfirst Commercial |
$83.30
|
| Rate for Payer: Healthfirst Essential Plan |
$187.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$79.14
|
| Rate for Payer: Healthfirst QHP |
$83.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$58.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$83.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$70.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$58.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$83.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$62.48
|
| Rate for Payer: SOMOS Essential |
$62.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$83.30
|
|
|
CHG DISKOGRAPY LUMBAR RS&I
|
Professional
|
Both
|
$159.46
|
|
|
Service Code
|
HCPCS 72295 26
|
| Min. Negotiated Rate |
$30.17 |
| Max. Negotiated Rate |
$96.97 |
| Rate for Payer: Cash Price |
$43.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$43.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$40.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.33
|
| Rate for Payer: Healthfirst Commercial |
$43.10
|
| Rate for Payer: Healthfirst Essential Plan |
$96.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.95
|
| Rate for Payer: Healthfirst QHP |
$43.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$43.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$36.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.33
|
| Rate for Payer: SOMOS Essential |
$32.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.10
|
|
|
CHG DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT
|
Professional
|
Both
|
$103.08
|
|
|
Service Code
|
HCPCS 76828 26
|
| Min. Negotiated Rate |
$19.64 |
| Max. Negotiated Rate |
$63.13 |
| Rate for Payer: Cash Price |
$28.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.05
|
| Rate for Payer: Healthfirst Commercial |
$28.06
|
| Rate for Payer: Healthfirst Essential Plan |
$63.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.66
|
| Rate for Payer: Healthfirst QHP |
$28.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.05
|
| Rate for Payer: SOMOS Essential |
$21.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.06
|
|
|
CHG DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT
|
Professional
|
Both
|
$203.56
|
|
|
Service Code
|
HCPCS 76828
|
| Min. Negotiated Rate |
$37.74 |
| Max. Negotiated Rate |
$121.30 |
| Rate for Payer: Cash Price |
$55.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$53.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$48.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$48.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$51.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$53.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$51.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.43
|
| Rate for Payer: Healthfirst Commercial |
$53.91
|
| Rate for Payer: Healthfirst Essential Plan |
$121.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$51.21
|
| Rate for Payer: Healthfirst QHP |
$53.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$53.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$45.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$53.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.43
|
| Rate for Payer: SOMOS Essential |
$40.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.91
|
|
|
CHG DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT
|
Professional
|
Both
|
$100.49
|
|
|
Service Code
|
HCPCS 76828 TC
|
| Min. Negotiated Rate |
$18.09 |
| Max. Negotiated Rate |
$58.16 |
| Rate for Payer: Cash Price |
$26.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.39
|
| Rate for Payer: Healthfirst Commercial |
$25.85
|
| Rate for Payer: Healthfirst Essential Plan |
$58.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24.56
|
| Rate for Payer: Healthfirst QHP |
$25.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$25.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$21.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19.39
|
| Rate for Payer: SOMOS Essential |
$19.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.85
|
|
|
CHG DOPPLER ECHO FETAL SPECTRAL DISPLAY COMPLETE
|
Professional
|
Both
|
$293.62
|
|
|
Service Code
|
HCPCS 76827
|
| Min. Negotiated Rate |
$54.68 |
| Max. Negotiated Rate |
$175.77 |
| Rate for Payer: Cash Price |
$80.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$78.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$70.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$70.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$74.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$78.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$74.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$78.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$78.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$58.59
|
| Rate for Payer: Healthfirst Commercial |
$78.12
|
| Rate for Payer: Healthfirst Essential Plan |
$175.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$74.21
|
| Rate for Payer: Healthfirst QHP |
$78.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$54.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$78.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$66.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$54.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$78.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$58.59
|
| Rate for Payer: SOMOS Essential |
$58.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$78.12
|
|
|
CHG DOPPLER ECHO FETAL SPECTRAL DISPLAY COMPLETE
|
Professional
|
Both
|
$183.86
|
|
|
Service Code
|
HCPCS 76827 TC
|
| Min. Negotiated Rate |
$33.85 |
| Max. Negotiated Rate |
$108.81 |
| Rate for Payer: Cash Price |
$50.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$48.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$48.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.27
|
| Rate for Payer: Healthfirst Commercial |
$48.36
|
| Rate for Payer: Healthfirst Essential Plan |
$108.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$45.94
|
| Rate for Payer: Healthfirst QHP |
$48.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$48.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$48.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36.27
|
| Rate for Payer: SOMOS Essential |
$36.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$48.36
|
|
|
CHG DOPPLER ECHO FETAL SPECTRAL DISPLAY COMPLETE
|
Professional
|
Both
|
$109.73
|
|
|
Service Code
|
HCPCS 76827 26
|
| Min. Negotiated Rate |
$20.83 |
| Max. Negotiated Rate |
$66.96 |
| Rate for Payer: Cash Price |
$30.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$28.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.32
|
| Rate for Payer: Healthfirst Commercial |
$29.76
|
| Rate for Payer: Healthfirst Essential Plan |
$66.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.27
|
| Rate for Payer: Healthfirst QHP |
$29.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$25.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.32
|
| Rate for Payer: SOMOS Essential |
$22.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.76
|
|
|
CHG DOPPLER VELOCIMETRY FETAL MIDDLE CEREBRAL ART
|
Professional
|
Both
|
$131.95
|
|
|
Service Code
|
HCPCS 76821 26
|
| Min. Negotiated Rate |
$25.08 |
| Max. Negotiated Rate |
$80.62 |
| Rate for Payer: Cash Price |
$36.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.87
|
| Rate for Payer: Healthfirst Commercial |
$35.83
|
| Rate for Payer: Healthfirst Essential Plan |
$80.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.04
|
| Rate for Payer: Healthfirst QHP |
$35.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.87
|
| Rate for Payer: SOMOS Essential |
$26.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.83
|
|
|
CHG DOPPLER VELOCIMETRY FETAL MIDDLE CEREBRAL ART
|
Professional
|
Both
|
$373.31
|
|
|
Service Code
|
HCPCS 76821
|
| Min. Negotiated Rate |
$69.80 |
| Max. Negotiated Rate |
$224.37 |
| Rate for Payer: Cash Price |
$102.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$99.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$89.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$89.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$94.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$99.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$94.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$99.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$99.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$74.79
|
| Rate for Payer: Healthfirst Commercial |
$99.72
|
| Rate for Payer: Healthfirst Essential Plan |
$224.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$94.73
|
| Rate for Payer: Healthfirst QHP |
$99.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$69.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$99.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$84.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$69.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$99.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$74.79
|
| Rate for Payer: SOMOS Essential |
$74.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$99.72
|
|
|
CHG DOPPLER VELOCIMETRY FETAL MIDDLE CEREBRAL ART
|
Professional
|
Both
|
$241.36
|
|
|
Service Code
|
HCPCS 76821 TC
|
| Min. Negotiated Rate |
$44.72 |
| Max. Negotiated Rate |
$143.75 |
| Rate for Payer: Cash Price |
$66.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$63.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$57.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$57.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$60.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$63.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$60.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.92
|
| Rate for Payer: Healthfirst Commercial |
$63.89
|
| Rate for Payer: Healthfirst Essential Plan |
$143.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.70
|
| Rate for Payer: Healthfirst QHP |
$63.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$44.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$63.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$54.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$44.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$63.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.92
|
| Rate for Payer: SOMOS Essential |
$47.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$63.89
|
|
|
CHG DOPPLER VELOCIMETRY FETAL UMBILICAL ARTERY
|
Professional
|
Both
|
$93.31
|
|
|
Service Code
|
HCPCS 76820 TC
|
| Min. Negotiated Rate |
$17.01 |
| Max. Negotiated Rate |
$54.67 |
| Rate for Payer: Cash Price |
$25.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.23
|
| Rate for Payer: Healthfirst Commercial |
$24.30
|
| Rate for Payer: Healthfirst Essential Plan |
$54.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23.09
|
| Rate for Payer: Healthfirst QHP |
$24.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$24.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$20.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18.23
|
| Rate for Payer: SOMOS Essential |
$18.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.30
|
|
|
CHG DOPPLER VELOCIMETRY FETAL UMBILICAL ARTERY
|
Professional
|
Both
|
$92.68
|
|
|
Service Code
|
HCPCS 76820 26
|
| Min. Negotiated Rate |
$17.65 |
| Max. Negotiated Rate |
$56.74 |
| Rate for Payer: Cash Price |
$25.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.91
|
| Rate for Payer: Healthfirst Commercial |
$25.22
|
| Rate for Payer: Healthfirst Essential Plan |
$56.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23.96
|
| Rate for Payer: Healthfirst QHP |
$25.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$25.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$21.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18.91
|
| Rate for Payer: SOMOS Essential |
$18.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.22
|
|
|
CHG DOPPLER VELOCIMETRY FETAL UMBILICAL ARTERY
|
Professional
|
Both
|
$185.96
|
|
|
Service Code
|
HCPCS 76820
|
| Min. Negotiated Rate |
$34.66 |
| Max. Negotiated Rate |
$111.40 |
| Rate for Payer: Cash Price |
$50.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$49.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$44.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$44.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$47.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$49.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$47.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$37.13
|
| Rate for Payer: Healthfirst Commercial |
$49.51
|
| Rate for Payer: Healthfirst Essential Plan |
$111.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.03
|
| Rate for Payer: Healthfirst QHP |
$49.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$49.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$42.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$49.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$37.13
|
| Rate for Payer: SOMOS Essential |
$37.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$49.51
|
|
|
CHG DRUG SCREEN QUANTITATIVE LIDOCAINE
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 80176
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$33.05 |
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.02
|
| Rate for Payer: Healthfirst Commercial |
$14.69
|
| Rate for Payer: Healthfirst Essential Plan |
$33.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.96
|
| Rate for Payer: Healthfirst QHP |
$14.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$10.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$14.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$12.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5.88
|
| Rate for Payer: SOMOS Essential |
$5.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.69
|
|
|
CHG DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL
|
Professional
|
Both
|
$94.75
|
|
|
Service Code
|
HCPCS 77081 TC
|
| Min. Negotiated Rate |
$18.63 |
| Max. Negotiated Rate |
$59.90 |
| Rate for Payer: Cash Price |
$26.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.96
|
| Rate for Payer: Healthfirst Commercial |
$26.62
|
| Rate for Payer: Healthfirst Essential Plan |
$59.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.29
|
| Rate for Payer: Healthfirst QHP |
$26.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19.96
|
| Rate for Payer: SOMOS Essential |
$19.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.62
|
|
|
CHG DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL
|
Professional
|
Both
|
$134.02
|
|
|
Service Code
|
HCPCS 77081
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$82.91 |
| Rate for Payer: Cash Price |
$36.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$36.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.64
|
| Rate for Payer: Healthfirst Commercial |
$36.85
|
| Rate for Payer: Healthfirst Essential Plan |
$82.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.01
|
| Rate for Payer: Healthfirst QHP |
$36.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$36.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$31.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.64
|
| Rate for Payer: SOMOS Essential |
$27.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.85
|
|
|
CHG DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL
|
Professional
|
Both
|
$39.27
|
|
|
Service Code
|
HCPCS 77081 26
|
| Min. Negotiated Rate |
$7.16 |
| Max. Negotiated Rate |
$23.02 |
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.67
|
| Rate for Payer: Healthfirst Commercial |
$10.23
|
| Rate for Payer: Healthfirst Essential Plan |
$23.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.72
|
| Rate for Payer: Healthfirst QHP |
$10.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$7.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$10.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.67
|
| Rate for Payer: SOMOS Essential |
$7.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.23
|
|
