|
CHG ESOPHAGEAL MOTILITY
|
Professional
|
Both
|
$860.65
|
|
|
Service Code
|
HCPCS 78258
|
| Min. Negotiated Rate |
$158.90 |
| Max. Negotiated Rate |
$510.75 |
| Rate for Payer: Cash Price |
$231.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$227.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$204.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$204.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$215.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$227.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$215.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$227.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$227.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$170.25
|
| Rate for Payer: Healthfirst Commercial |
$227.00
|
| Rate for Payer: Healthfirst Essential Plan |
$510.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$215.65
|
| Rate for Payer: Healthfirst QHP |
$227.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$158.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$227.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$192.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$158.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$227.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$170.25
|
| Rate for Payer: SOMOS Essential |
$170.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$227.00
|
|
|
CHG EVASC RPR DESCND THORCIC AORTA CELIAC ORIG RS&I
|
Professional
|
Both
|
$1,240.37
|
|
|
Service Code
|
HCPCS 75957 26
|
| Min. Negotiated Rate |
$228.30 |
| Max. Negotiated Rate |
$733.82 |
| Rate for Payer: Cash Price |
$331.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$326.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$293.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$293.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$309.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$326.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$309.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$326.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$326.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$244.60
|
| Rate for Payer: Healthfirst Commercial |
$326.14
|
| Rate for Payer: Healthfirst Essential Plan |
$733.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$309.83
|
| Rate for Payer: Healthfirst QHP |
$326.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$228.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$326.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$277.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$228.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$326.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$244.60
|
| Rate for Payer: SOMOS Essential |
$244.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$326.14
|
|
|
CHG EVASC RPR DESCND THORCIC AORTA SUBCLAV ORIG RS&I
|
Professional
|
Both
|
$1,446.48
|
|
|
Service Code
|
HCPCS 75956 26
|
| Min. Negotiated Rate |
$266.67 |
| Max. Negotiated Rate |
$857.14 |
| Rate for Payer: Cash Price |
$385.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$380.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$342.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$342.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$361.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$380.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$361.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$380.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$380.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$285.71
|
| Rate for Payer: Healthfirst Commercial |
$380.95
|
| Rate for Payer: Healthfirst Essential Plan |
$857.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$361.90
|
| Rate for Payer: Healthfirst QHP |
$380.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$266.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$380.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$323.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$266.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$380.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$285.71
|
| Rate for Payer: SOMOS Essential |
$285.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$380.95
|
|
|
CHG FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING
|
Professional
|
Both
|
$201.39
|
|
|
Service Code
|
HCPCS 76818 26
|
| Min. Negotiated Rate |
$37.32 |
| Max. Negotiated Rate |
$119.97 |
| Rate for Payer: Cash Price |
$53.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$53.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$53.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.99
|
| Rate for Payer: Healthfirst Commercial |
$53.32
|
| Rate for Payer: Healthfirst Essential Plan |
$119.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.65
|
| Rate for Payer: Healthfirst QHP |
$53.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$53.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$45.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$53.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.99
|
| Rate for Payer: SOMOS Essential |
$39.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.32
|
|
|
CHG FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING
|
Professional
|
Both
|
$491.51
|
|
|
Service Code
|
HCPCS 76818
|
| Min. Negotiated Rate |
$94.33 |
| Max. Negotiated Rate |
$303.19 |
| Rate for Payer: Cash Price |
$136.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$134.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$121.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$121.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$128.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$134.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$128.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$134.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$134.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$101.06
|
| Rate for Payer: Healthfirst Commercial |
$134.75
|
| Rate for Payer: Healthfirst Essential Plan |
$303.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$128.01
|
| Rate for Payer: Healthfirst QHP |
$134.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$94.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$134.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$114.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$94.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$134.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$101.06
|
| Rate for Payer: SOMOS Essential |
$101.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$134.75
|
|
|
CHG FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING
|
Professional
|
Both
|
$290.08
|
|
|
Service Code
|
HCPCS 76818 TC
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$183.22 |
| Rate for Payer: Cash Price |
$82.43
|
| 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 FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING
|
Professional
|
Both
|
$351.89
|
|
|
Service Code
|
HCPCS 76819
|
| Min. Negotiated Rate |
$68.12 |
| Max. Negotiated Rate |
$218.95 |
| Rate for Payer: Cash Price |
$98.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$97.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$87.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$87.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$92.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$97.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$92.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$97.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$97.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.98
|
| Rate for Payer: Healthfirst Commercial |
$97.31
|
| Rate for Payer: Healthfirst Essential Plan |
$218.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$92.44
|
| Rate for Payer: Healthfirst QHP |
$97.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$68.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$97.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$82.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$68.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$97.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$72.98
|
| Rate for Payer: SOMOS Essential |
$72.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$97.31
|
|
|
CHG FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING
|
Professional
|
Both
|
$143.61
|
|
|
Service Code
|
HCPCS 76819 26
|
| Min. Negotiated Rate |
$27.31 |
| Max. Negotiated Rate |
$87.80 |
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$39.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.27
|
| Rate for Payer: Healthfirst Commercial |
$39.02
|
| Rate for Payer: Healthfirst Essential Plan |
$87.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.07
|
| Rate for Payer: Healthfirst QHP |
$39.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$39.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.27
|
| Rate for Payer: SOMOS Essential |
$29.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.02
|
|
|
CHG FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING
|
Professional
|
Both
|
$208.29
|
|
|
Service Code
|
HCPCS 76819 TC
|
| Min. Negotiated Rate |
$40.81 |
| Max. Negotiated Rate |
$131.18 |
| Rate for Payer: Cash Price |
$59.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$58.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$52.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$52.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$55.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$58.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$55.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$58.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$58.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.73
|
| Rate for Payer: Healthfirst Commercial |
$58.30
|
| Rate for Payer: Healthfirst Essential Plan |
$131.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$55.38
|
| Rate for Payer: Healthfirst QHP |
$58.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$40.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$58.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$49.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$40.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$58.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$43.73
|
| Rate for Payer: SOMOS Essential |
$43.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$58.30
|
|
|
CHG FETAL MRI W/PLACNTL MATRNL PLVC IMG EA ADDL GES
|
Professional
|
Both
|
$356.83
|
|
|
Service Code
|
HCPCS 74713 26
|
| Min. Negotiated Rate |
$67.42 |
| Max. Negotiated Rate |
$216.70 |
| Rate for Payer: Cash Price |
$96.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$96.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$86.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$86.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$91.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$96.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$91.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$96.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$96.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.23
|
| Rate for Payer: Healthfirst Commercial |
$96.31
|
| Rate for Payer: Healthfirst Essential Plan |
$216.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$91.49
|
| Rate for Payer: Healthfirst QHP |
$96.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$67.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$96.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$81.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$67.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$96.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$72.23
|
| Rate for Payer: SOMOS Essential |
$72.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$96.31
|
|
|
CHG FETAL MRI W/PLACNTL MATRNL PLVC IMG EA ADDL GES
|
Professional
|
Both
|
$517.37
|
|
|
Service Code
|
HCPCS 74713 TC
|
| Min. Negotiated Rate |
$93.09 |
| Max. Negotiated Rate |
$299.20 |
| Rate for Payer: Cash Price |
$138.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$132.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$119.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$119.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$126.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$132.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$126.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$132.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$132.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$99.73
|
| Rate for Payer: Healthfirst Commercial |
$132.98
|
| Rate for Payer: Healthfirst Essential Plan |
$299.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$126.33
|
| Rate for Payer: Healthfirst QHP |
$132.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$93.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$132.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$113.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$93.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$132.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$99.73
|
| Rate for Payer: SOMOS Essential |
$99.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$132.98
|
|
|
CHG FETAL MRI W/PLACNTL MATRNL PLVC IMG EA ADDL GES
|
Professional
|
Both
|
$874.20
|
|
|
Service Code
|
HCPCS 74713
|
| Min. Negotiated Rate |
$160.50 |
| Max. Negotiated Rate |
$515.90 |
| Rate for Payer: Cash Price |
$234.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$229.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$206.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$206.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$217.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$229.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$217.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$229.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$229.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$171.97
|
| Rate for Payer: Healthfirst Commercial |
$229.29
|
| Rate for Payer: Healthfirst Essential Plan |
$515.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$217.83
|
| Rate for Payer: Healthfirst QHP |
$229.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$160.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$229.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$194.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$160.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$229.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$171.97
|
| Rate for Payer: SOMOS Essential |
$171.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$229.29
|
|
|
CHG FETAL MRI W/PLACNTL MATRNL PLVC IMG SING/1ST GES
|
Professional
|
Both
|
$1,573.29
|
|
|
Service Code
|
HCPCS 74712
|
| Min. Negotiated Rate |
$331.62 |
| Max. Negotiated Rate |
$1,065.94 |
| Rate for Payer: Cash Price |
$486.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$473.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$426.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$426.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$450.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$473.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$450.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$473.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$473.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$355.31
|
| Rate for Payer: Healthfirst Commercial |
$473.75
|
| Rate for Payer: Healthfirst Essential Plan |
$1,065.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$450.06
|
| Rate for Payer: Healthfirst QHP |
$473.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$331.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$473.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$402.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$331.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$473.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$355.31
|
| Rate for Payer: SOMOS Essential |
$355.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$473.75
|
|
|
CHG FETAL MRI W/PLACNTL MATRNL PLVC IMG SING/1ST GES
|
Professional
|
Both
|
$994.32
|
|
|
Service Code
|
HCPCS 74712 TC
|
| Min. Negotiated Rate |
$222.47 |
| Max. Negotiated Rate |
$715.10 |
| Rate for Payer: Cash Price |
$329.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$317.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$286.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$286.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$301.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$317.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$301.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$317.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$317.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$238.37
|
| Rate for Payer: Healthfirst Commercial |
$317.82
|
| Rate for Payer: Healthfirst Essential Plan |
$715.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$301.93
|
| Rate for Payer: Healthfirst QHP |
$317.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$222.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$317.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$270.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$222.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$317.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$238.37
|
| Rate for Payer: SOMOS Essential |
$238.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$317.82
|
|
|
CHG FETAL MRI W/PLACNTL MATRNL PLVC IMG SING/1ST GES
|
Professional
|
Both
|
$578.94
|
|
|
Service Code
|
HCPCS 74712 26
|
| Min. Negotiated Rate |
$109.15 |
| Max. Negotiated Rate |
$350.84 |
| Rate for Payer: Cash Price |
$156.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$155.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$140.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$140.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$148.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$155.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$148.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$155.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$155.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$116.95
|
| Rate for Payer: Healthfirst Commercial |
$155.93
|
| Rate for Payer: Healthfirst Essential Plan |
$350.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$148.13
|
| Rate for Payer: Healthfirst QHP |
$155.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$109.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$155.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$132.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$109.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$155.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$116.95
|
| Rate for Payer: SOMOS Essential |
$116.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$155.93
|
|
|
CHG FIBRINOLYSINS/COAGULOPATHY SCREEN INTERP&REPOR
|
Professional
|
Both
|
$141.09
|
|
|
Service Code
|
HCPCS 85390 26
|
| Min. Negotiated Rate |
$15.33 |
| Max. Negotiated Rate |
$86.24 |
| Rate for Payer: Cash Price |
$38.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.75
|
| Rate for Payer: Healthfirst Commercial |
$38.33
|
| Rate for Payer: Healthfirst Essential Plan |
$86.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.41
|
| Rate for Payer: Healthfirst QHP |
$38.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.33
|
| Rate for Payer: SOMOS Essential |
$15.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.33
|
|
|
CHG FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS
|
Professional
|
Both
|
$529.87
|
|
|
Service Code
|
HCPCS 88182 TC
|
| Min. Negotiated Rate |
$101.45 |
| Max. Negotiated Rate |
$326.09 |
| Rate for Payer: Cash Price |
$154.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$144.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$130.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$130.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$137.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$144.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$137.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$144.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$144.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$108.70
|
| Rate for Payer: Healthfirst Commercial |
$144.93
|
| Rate for Payer: Healthfirst Essential Plan |
$326.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$137.68
|
| Rate for Payer: Healthfirst QHP |
$144.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$101.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$144.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$123.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$101.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$144.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$108.70
|
| Rate for Payer: SOMOS Essential |
$108.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$144.93
|
|
|
CHG FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS
|
Professional
|
Both
|
$679.39
|
|
|
Service Code
|
HCPCS 88182
|
| Min. Negotiated Rate |
$129.14 |
| Max. Negotiated Rate |
$415.10 |
| Rate for Payer: Cash Price |
$194.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$184.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$166.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$166.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$175.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$184.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$175.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$184.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$184.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$138.37
|
| Rate for Payer: Healthfirst Commercial |
$184.49
|
| Rate for Payer: Healthfirst Essential Plan |
$415.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$175.27
|
| Rate for Payer: Healthfirst QHP |
$184.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$129.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$184.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$156.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$129.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$184.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$138.37
|
| Rate for Payer: SOMOS Essential |
$138.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$184.49
|
|
|
CHG FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS
|
Professional
|
Both
|
$149.49
|
|
|
Service Code
|
HCPCS 88182 26
|
| Min. Negotiated Rate |
$27.69 |
| Max. Negotiated Rate |
$89.01 |
| Rate for Payer: Cash Price |
$40.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$39.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.67
|
| Rate for Payer: Healthfirst Commercial |
$39.56
|
| Rate for Payer: Healthfirst Essential Plan |
$89.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.58
|
| Rate for Payer: Healthfirst QHP |
$39.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$39.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.67
|
| Rate for Payer: SOMOS Essential |
$29.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.56
|
|
|
CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY 1ST
|
Professional
|
Both
|
$321.72
|
|
|
Service Code
|
HCPCS 88184
|
| Min. Negotiated Rate |
$64.06 |
| Max. Negotiated Rate |
$205.92 |
| Rate for Payer: Cash Price |
$92.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$91.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$82.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$82.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$86.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$91.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$86.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$91.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$68.64
|
| Rate for Payer: Healthfirst Commercial |
$91.52
|
| Rate for Payer: Healthfirst Essential Plan |
$205.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$86.94
|
| Rate for Payer: Healthfirst QHP |
$91.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$91.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$77.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$91.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$68.64
|
| Rate for Payer: SOMOS Essential |
$68.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$91.52
|
|
|
CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA
|
Professional
|
Both
|
$102.06
|
|
|
Service Code
|
HCPCS 88185
|
| Min. Negotiated Rate |
$18.47 |
| Max. Negotiated Rate |
$59.38 |
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.79
|
| Rate for Payer: Healthfirst Commercial |
$26.39
|
| Rate for Payer: Healthfirst Essential Plan |
$59.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.07
|
| Rate for Payer: Healthfirst QHP |
$26.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19.79
|
| Rate for Payer: SOMOS Essential |
$19.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.39
|
|
|
CHG FLOW CYTOMETRY INTERPJ 2-8 MARKERS
|
Professional
|
Both
|
$141.02
|
|
|
Service Code
|
HCPCS 88187
|
| Min. Negotiated Rate |
$27.02 |
| Max. Negotiated Rate |
$86.85 |
| Rate for Payer: Cash Price |
$38.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.95
|
| Rate for Payer: Healthfirst Commercial |
$38.60
|
| Rate for Payer: Healthfirst Essential Plan |
$86.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.67
|
| Rate for Payer: Healthfirst QHP |
$38.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.95
|
| Rate for Payer: SOMOS Essential |
$28.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.60
|
|
|
CHG FLOW CYTOMETRY INTERPJ 9-15 MARKERS
|
Professional
|
Both
|
$247.21
|
|
|
Service Code
|
HCPCS 88188
|
| Min. Negotiated Rate |
$46.05 |
| Max. Negotiated Rate |
$148.00 |
| Rate for Payer: Cash Price |
$67.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$65.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$59.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$59.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$65.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$49.34
|
| Rate for Payer: Healthfirst Commercial |
$65.78
|
| Rate for Payer: Healthfirst Essential Plan |
$148.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.49
|
| Rate for Payer: Healthfirst QHP |
$65.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$46.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$65.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$55.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$46.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$65.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$49.34
|
| Rate for Payer: SOMOS Essential |
$49.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.78
|
|
|
CHG FLOW CYTOMETRY INTERPRETATION 16/> MARKERS
|
Professional
|
Both
|
$332.57
|
|
|
Service Code
|
HCPCS 88189
|
| Min. Negotiated Rate |
$62.50 |
| Max. Negotiated Rate |
$200.90 |
| Rate for Payer: Cash Price |
$90.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$89.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$80.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$80.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$89.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$84.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$89.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$89.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$66.97
|
| Rate for Payer: Healthfirst Commercial |
$89.29
|
| Rate for Payer: Healthfirst Essential Plan |
$200.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$84.83
|
| Rate for Payer: Healthfirst QHP |
$89.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$62.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$89.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$75.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$62.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$89.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$66.97
|
| Rate for Payer: SOMOS Essential |
$66.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$89.29
|
|
|
CHG FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY
|
Professional
|
Both
|
$69.20
|
|
|
Service Code
|
HCPCS 86255 26
|
| Min. Negotiated Rate |
$7.68 |
| Max. Negotiated Rate |
$43.18 |
| Rate for Payer: Cash Price |
$19.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.39
|
| Rate for Payer: Healthfirst Commercial |
$19.19
|
| Rate for Payer: Healthfirst Essential Plan |
$43.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.23
|
| Rate for Payer: Healthfirst QHP |
$19.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.68
|
| Rate for Payer: SOMOS Essential |
$7.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.19
|
|
