|
CHG DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL
|
Professional
|
Both
|
$162.79
|
|
|
Service Code
|
HCPCS 77080
|
| Min. Negotiated Rate |
$31.77 |
| Max. Negotiated Rate |
$102.13 |
| Rate for Payer: Cash Price |
$45.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$45.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$45.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.04
|
| Rate for Payer: Healthfirst Commercial |
$45.39
|
| Rate for Payer: Healthfirst Essential Plan |
$102.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43.12
|
| Rate for Payer: Healthfirst QHP |
$45.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$45.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$38.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$34.04
|
| Rate for Payer: SOMOS Essential |
$34.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.39
|
|
|
CHG DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL
|
Professional
|
Both
|
$124.92
|
|
|
Service Code
|
HCPCS 77080 TC
|
| Min. Negotiated Rate |
$24.61 |
| Max. Negotiated Rate |
$79.11 |
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.37
|
| Rate for Payer: Healthfirst Commercial |
$35.16
|
| Rate for Payer: Healthfirst Essential Plan |
$79.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.40
|
| Rate for Payer: Healthfirst QHP |
$35.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.37
|
| Rate for Payer: SOMOS Essential |
$26.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.16
|
|
|
CHG DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL
|
Professional
|
Both
|
$37.84
|
|
|
Service Code
|
HCPCS 77080 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
|
|
|
CHG DXA BONE DENSITY STUDY AXIAL SKELETON
|
Professional
|
Both
|
$162.30
|
|
|
Service Code
|
HCPCS 77085 TC
|
| Min. Negotiated Rate |
$32.93 |
| Max. Negotiated Rate |
$105.84 |
| Rate for Payer: Cash Price |
$46.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$42.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$44.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$44.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.28
|
| Rate for Payer: Healthfirst Commercial |
$47.04
|
| Rate for Payer: Healthfirst Essential Plan |
$105.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.69
|
| Rate for Payer: Healthfirst QHP |
$47.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$47.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35.28
|
| Rate for Payer: SOMOS Essential |
$35.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.04
|
|
|
CHG DXA BONE DENSITY STUDY AXIAL SKELETON
|
Professional
|
Both
|
$57.58
|
|
|
Service Code
|
HCPCS 77085 26
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$34.24 |
| Rate for Payer: Cash Price |
$15.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.41
|
| Rate for Payer: Healthfirst Commercial |
$15.22
|
| Rate for Payer: Healthfirst Essential Plan |
$34.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.46
|
| Rate for Payer: Healthfirst QHP |
$15.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$10.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$15.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$12.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$11.41
|
| Rate for Payer: SOMOS Essential |
$11.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.22
|
|
|
CHG DXA BONE DENSITY STUDY AXIAL SKELETON
|
Professional
|
Both
|
$219.87
|
|
|
Service Code
|
HCPCS 77085
|
| Min. Negotiated Rate |
$43.58 |
| Max. Negotiated Rate |
$140.09 |
| Rate for Payer: Cash Price |
$62.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$56.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$56.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$59.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$59.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$62.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$46.70
|
| Rate for Payer: Healthfirst Commercial |
$62.26
|
| Rate for Payer: Healthfirst Essential Plan |
$140.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$59.15
|
| Rate for Payer: Healthfirst QHP |
$62.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$43.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$62.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$52.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$43.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$46.70
|
| Rate for Payer: SOMOS Essential |
$46.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.26
|
|
|
CHG DX OPHTHALMIC US ANT SEGMENT IMMERSION UNI/BI
|
Professional
|
Both
|
$186.73
|
|
|
Service Code
|
HCPCS 76513 TC
|
| Min. Negotiated Rate |
$34.67 |
| Max. Negotiated Rate |
$111.44 |
| Rate for Payer: Cash Price |
$51.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$49.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$44.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$44.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$47.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$49.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$47.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$37.15
|
| Rate for Payer: Healthfirst Commercial |
$49.53
|
| Rate for Payer: Healthfirst Essential Plan |
$111.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.05
|
| Rate for Payer: Healthfirst QHP |
$49.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$49.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$42.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$49.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$37.15
|
| Rate for Payer: SOMOS Essential |
$37.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$49.53
|
|
|
CHG DX OPHTHALMIC US ANT SEGMENT IMMERSION UNI/BI
|
Professional
|
Both
|
$126.77
|
|
|
Service Code
|
HCPCS 76513 26
|
| Min. Negotiated Rate |
$24.41 |
| Max. Negotiated Rate |
$78.46 |
| Rate for Payer: Cash Price |
$34.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.15
|
| Rate for Payer: Healthfirst Commercial |
$34.87
|
| Rate for Payer: Healthfirst Essential Plan |
$78.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.13
|
| Rate for Payer: Healthfirst QHP |
$34.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.15
|
| Rate for Payer: SOMOS Essential |
$26.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.87
|
|
|
CHG DX OPHTHALMIC US ANT SEGMENT IMMERSION UNI/BI
|
Professional
|
Both
|
$313.50
|
|
|
Service Code
|
HCPCS 76513
|
| Min. Negotiated Rate |
$59.08 |
| Max. Negotiated Rate |
$189.90 |
| Rate for Payer: Cash Price |
$86.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$84.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$75.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$75.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$80.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$84.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$80.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$84.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$84.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$63.30
|
| Rate for Payer: Healthfirst Commercial |
$84.40
|
| Rate for Payer: Healthfirst Essential Plan |
$189.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$80.18
|
| Rate for Payer: Healthfirst QHP |
$84.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$59.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$84.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$71.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$59.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$84.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$63.30
|
| Rate for Payer: SOMOS Essential |
$63.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$84.40
|
|
|
CHG ECHOENCEPHALOGRAPHY REAL TIME IMAGING
|
Professional
|
Both
|
$122.92
|
|
|
Service Code
|
HCPCS 76506 26
|
| Min. Negotiated Rate |
$23.17 |
| Max. Negotiated Rate |
$74.47 |
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.82
|
| Rate for Payer: Healthfirst Commercial |
$33.10
|
| Rate for Payer: Healthfirst Essential Plan |
$74.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.45
|
| Rate for Payer: Healthfirst QHP |
$33.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$33.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.10
|
| 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 |
$33.10
|
|
|
CHG ECHOENCEPHALOGRAPHY REAL TIME IMAGING
|
Professional
|
Both
|
$362.11
|
|
|
Service Code
|
HCPCS 76506 TC
|
| Min. Negotiated Rate |
$64.83 |
| Max. Negotiated Rate |
$208.37 |
| Rate for Payer: Cash Price |
$97.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$92.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$83.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$83.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$87.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$92.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$87.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.46
|
| Rate for Payer: Healthfirst Commercial |
$92.61
|
| Rate for Payer: Healthfirst Essential Plan |
$208.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$87.98
|
| Rate for Payer: Healthfirst QHP |
$92.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$92.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$78.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$92.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.46
|
| Rate for Payer: SOMOS Essential |
$69.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$92.61
|
|
|
CHG ECHOENCEPHALOGRAPHY REAL TIME IMAGING
|
Professional
|
Both
|
$485.03
|
|
|
Service Code
|
HCPCS 76506
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$282.85 |
| Rate for Payer: Cash Price |
$132.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$125.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$113.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$113.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$119.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$125.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$119.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$94.28
|
| Rate for Payer: Healthfirst Commercial |
$125.71
|
| Rate for Payer: Healthfirst Essential Plan |
$282.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$119.42
|
| Rate for Payer: Healthfirst QHP |
$125.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$88.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$125.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$106.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$88.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$125.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$94.28
|
| Rate for Payer: SOMOS Essential |
$94.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$125.71
|
|
|
CHG ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING
|
Professional
|
Both
|
$310.66
|
|
|
Service Code
|
HCPCS 76825 26
|
| Min. Negotiated Rate |
$58.85 |
| Max. Negotiated Rate |
$189.16 |
| Rate for Payer: Cash Price |
$85.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$84.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$75.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$75.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$79.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$84.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$79.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$84.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$84.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$63.05
|
| Rate for Payer: Healthfirst Commercial |
$84.07
|
| Rate for Payer: Healthfirst Essential Plan |
$189.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$79.87
|
| Rate for Payer: Healthfirst QHP |
$84.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$58.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$84.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$71.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$58.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$84.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$63.05
|
| Rate for Payer: SOMOS Essential |
$63.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$84.07
|
|
|
CHG ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING
|
Professional
|
Both
|
$1,110.80
|
|
|
Service Code
|
HCPCS 76825
|
| Min. Negotiated Rate |
$204.42 |
| Max. Negotiated Rate |
$657.07 |
| Rate for Payer: Cash Price |
$302.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$292.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$262.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$262.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$277.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$292.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$277.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$292.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$292.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$219.02
|
| Rate for Payer: Healthfirst Commercial |
$292.03
|
| Rate for Payer: Healthfirst Essential Plan |
$657.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$277.43
|
| Rate for Payer: Healthfirst QHP |
$292.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$204.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$292.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$248.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$204.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$292.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$219.02
|
| Rate for Payer: SOMOS Essential |
$219.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$292.03
|
|
|
CHG ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING
|
Professional
|
Both
|
$800.14
|
|
|
Service Code
|
HCPCS 76825 TC
|
| Min. Negotiated Rate |
$145.58 |
| Max. Negotiated Rate |
$467.93 |
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$207.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$187.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$187.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$197.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$207.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$197.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$207.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$207.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$155.98
|
| Rate for Payer: Healthfirst Commercial |
$207.97
|
| Rate for Payer: Healthfirst Essential Plan |
$467.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$197.57
|
| Rate for Payer: Healthfirst QHP |
$207.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$145.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$207.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$176.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$145.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$207.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$155.98
|
| Rate for Payer: SOMOS Essential |
$155.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$207.97
|
|
|
CHG ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD
|
Professional
|
Both
|
$154.00
|
|
|
Service Code
|
HCPCS 76826 26
|
| Min. Negotiated Rate |
$29.30 |
| Max. Negotiated Rate |
$94.19 |
| Rate for Payer: Cash Price |
$42.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$41.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$39.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.39
|
| Rate for Payer: Healthfirst Commercial |
$41.86
|
| Rate for Payer: Healthfirst Essential Plan |
$94.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.77
|
| Rate for Payer: Healthfirst QHP |
$41.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$41.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$35.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31.39
|
| Rate for Payer: SOMOS Essential |
$31.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.86
|
|
|
CHG ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD
|
Professional
|
Both
|
$666.89
|
|
|
Service Code
|
HCPCS 76826
|
| Min. Negotiated Rate |
$123.37 |
| Max. Negotiated Rate |
$396.54 |
| Rate for Payer: Cash Price |
$181.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$176.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$158.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$158.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$167.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$176.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$167.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$176.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$176.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$132.18
|
| Rate for Payer: Healthfirst Commercial |
$176.24
|
| Rate for Payer: Healthfirst Essential Plan |
$396.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$167.43
|
| Rate for Payer: Healthfirst QHP |
$176.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$123.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$176.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$149.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$123.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$176.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$132.18
|
| Rate for Payer: SOMOS Essential |
$132.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$176.24
|
|
|
CHG ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD
|
Professional
|
Both
|
$512.93
|
|
|
Service Code
|
HCPCS 76826 TC
|
| Min. Negotiated Rate |
$94.06 |
| Max. Negotiated Rate |
$302.33 |
| Rate for Payer: Cash Price |
$139.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$134.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$120.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$120.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$127.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$134.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$127.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$134.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$134.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$100.78
|
| Rate for Payer: Healthfirst Commercial |
$134.37
|
| Rate for Payer: Healthfirst Essential Plan |
$302.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$127.65
|
| Rate for Payer: Healthfirst QHP |
$134.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$94.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$134.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$114.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$94.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$134.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$100.78
|
| Rate for Payer: SOMOS Essential |
$100.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$134.37
|
|
|
CHG ELECTRON MICROSCOPY DIAGNOSTIC
|
Professional
|
Both
|
$1,715.25
|
|
|
Service Code
|
HCPCS 88348 TC
|
| Min. Negotiated Rate |
$341.52 |
| Max. Negotiated Rate |
$1,097.75 |
| Rate for Payer: Cash Price |
$485.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$487.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$439.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$439.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$463.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$487.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$463.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$487.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$487.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$365.92
|
| Rate for Payer: Healthfirst Commercial |
$487.89
|
| Rate for Payer: Healthfirst Essential Plan |
$1,097.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$463.50
|
| Rate for Payer: Healthfirst QHP |
$487.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$341.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$487.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$414.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$341.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$487.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$365.92
|
| Rate for Payer: SOMOS Essential |
$365.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$487.89
|
|
|
CHG ELECTRON MICROSCOPY DIAGNOSTIC
|
Professional
|
Both
|
$296.66
|
|
|
Service Code
|
HCPCS 88348 26
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$183.22 |
| Rate for Payer: Cash Price |
$81.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$81.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$73.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$77.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$61.07
|
| Rate for Payer: Healthfirst Commercial |
$81.43
|
| Rate for Payer: Healthfirst Essential Plan |
$183.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$77.36
|
| Rate for Payer: Healthfirst QHP |
$81.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$57.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$81.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$69.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$57.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$61.07
|
| Rate for Payer: SOMOS Essential |
$61.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.43
|
|
|
CHG ELECTRON MICROSCOPY DIAGNOSTIC
|
Professional
|
Both
|
$2,011.91
|
|
|
Service Code
|
HCPCS 88348
|
| Min. Negotiated Rate |
$398.52 |
| Max. Negotiated Rate |
$1,280.97 |
| Rate for Payer: Cash Price |
$566.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$569.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$512.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$512.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$540.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$569.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$540.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$569.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$569.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$426.99
|
| Rate for Payer: Healthfirst Commercial |
$569.32
|
| Rate for Payer: Healthfirst Essential Plan |
$1,280.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$540.85
|
| Rate for Payer: Healthfirst QHP |
$569.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$398.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$569.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$483.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$398.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$569.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$426.99
|
| Rate for Payer: SOMOS Essential |
$426.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$569.32
|
|
|
CHG ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I
|
Professional
|
Both
|
$91.67
|
|
|
Service Code
|
HCPCS 74328 26
|
| Min. Negotiated Rate |
$17.36 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Cash Price |
$25.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.60
|
| Rate for Payer: Healthfirst Commercial |
$24.80
|
| Rate for Payer: Healthfirst Essential Plan |
$55.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23.56
|
| Rate for Payer: Healthfirst QHP |
$24.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$24.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$21.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18.60
|
| Rate for Payer: SOMOS Essential |
$18.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.80
|
|
|
CHG ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS RS&I
|
Professional
|
Both
|
$93.10
|
|
|
Service Code
|
HCPCS 74329 26
|
| Min. Negotiated Rate |
$17.63 |
| Max. Negotiated Rate |
$56.68 |
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.89
|
| Rate for Payer: Healthfirst Commercial |
$25.19
|
| Rate for Payer: Healthfirst Essential Plan |
$56.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23.93
|
| Rate for Payer: Healthfirst QHP |
$25.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$25.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$21.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18.89
|
| Rate for Payer: SOMOS Essential |
$18.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.19
|
|
|
CHG ESOPHAGEAL MOTILITY
|
Professional
|
Both
|
$725.38
|
|
|
Service Code
|
HCPCS 78258 TC
|
| Min. Negotiated Rate |
$133.78 |
| Max. Negotiated Rate |
$430.02 |
| Rate for Payer: Cash Price |
$195.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$191.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$172.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$172.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$181.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$191.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$181.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$191.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$143.34
|
| Rate for Payer: Healthfirst Commercial |
$191.12
|
| Rate for Payer: Healthfirst Essential Plan |
$430.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$181.56
|
| Rate for Payer: Healthfirst QHP |
$191.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$133.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$191.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$162.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$133.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$191.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$143.34
|
| Rate for Payer: SOMOS Essential |
$143.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$191.12
|
|
|
CHG ESOPHAGEAL MOTILITY
|
Professional
|
Both
|
$135.24
|
|
|
Service Code
|
HCPCS 78258 26
|
| Min. Negotiated Rate |
$25.12 |
| Max. Negotiated Rate |
$80.75 |
| Rate for Payer: Cash Price |
$35.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.92
|
| Rate for Payer: Healthfirst Commercial |
$35.89
|
| Rate for Payer: Healthfirst Essential Plan |
$80.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.10
|
| Rate for Payer: Healthfirst QHP |
$35.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.92
|
| Rate for Payer: SOMOS Essential |
$26.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.89
|
|
