|
CHG FLUORESCENT NONNFCT AGT ANTB TITER EA ANTIBODY
|
Professional
|
Both
|
$69.20
|
|
|
Service Code
|
HCPCS 86256 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
|
|
|
CHG FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON
|
Professional
|
Both
|
$452.52
|
|
|
Service Code
|
HCPCS 77003
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$265.16 |
| Rate for Payer: Cash Price |
$122.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$117.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$106.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$106.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$111.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$117.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$111.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$117.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$117.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.39
|
| Rate for Payer: Healthfirst Commercial |
$117.85
|
| Rate for Payer: Healthfirst Essential Plan |
$265.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$111.96
|
| Rate for Payer: Healthfirst QHP |
$117.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$82.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$117.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$100.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$82.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$117.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$88.39
|
| Rate for Payer: SOMOS Essential |
$88.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$117.85
|
|
|
CHG FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON
|
Professional
|
Both
|
$336.25
|
|
|
Service Code
|
HCPCS 77003 TC
|
| Min. Negotiated Rate |
$61.03 |
| Max. Negotiated Rate |
$196.16 |
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$87.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$78.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$78.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$82.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$87.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$82.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$87.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$87.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$65.39
|
| Rate for Payer: Healthfirst Commercial |
$87.18
|
| Rate for Payer: Healthfirst Essential Plan |
$196.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$82.82
|
| Rate for Payer: Healthfirst QHP |
$87.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$61.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$87.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$74.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$61.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$87.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$65.39
|
| Rate for Payer: SOMOS Essential |
$65.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$87.18
|
|
|
CHG FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON
|
Professional
|
Both
|
$116.27
|
|
|
Service Code
|
HCPCS 77003 26
|
| Min. Negotiated Rate |
$21.48 |
| Max. Negotiated Rate |
$69.03 |
| Rate for Payer: Cash Price |
$31.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$27.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$30.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.01
|
| Rate for Payer: Healthfirst Commercial |
$30.68
|
| Rate for Payer: Healthfirst Essential Plan |
$69.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.15
|
| Rate for Payer: Healthfirst QHP |
$30.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$30.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.01
|
| Rate for Payer: SOMOS Essential |
$23.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.68
|
|
|
CHG FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT
|
Professional
|
Both
|
$74.34
|
|
|
Service Code
|
HCPCS 77001 26
|
| Min. Negotiated Rate |
$14.15 |
| Max. Negotiated Rate |
$45.49 |
| Rate for Payer: Cash Price |
$20.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.16
|
| Rate for Payer: Healthfirst Commercial |
$20.22
|
| Rate for Payer: Healthfirst Essential Plan |
$45.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.21
|
| Rate for Payer: Healthfirst QHP |
$20.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$20.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$17.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$14.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.16
|
| Rate for Payer: SOMOS Essential |
$15.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.22
|
|
|
CHG FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT
|
Professional
|
Both
|
$359.24
|
|
|
Service Code
|
HCPCS 77001 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 FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT
|
Professional
|
Both
|
$433.58
|
|
|
Service Code
|
HCPCS 77001
|
| Min. Negotiated Rate |
$78.71 |
| Max. Negotiated Rate |
$252.99 |
| Rate for Payer: Cash Price |
$115.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$112.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$101.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$101.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$106.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$112.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$106.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$112.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$84.33
|
| Rate for Payer: Healthfirst Commercial |
$112.44
|
| Rate for Payer: Healthfirst Essential Plan |
$252.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$106.82
|
| Rate for Payer: Healthfirst QHP |
$112.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$78.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$112.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$95.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$78.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$112.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$84.33
|
| Rate for Payer: SOMOS Essential |
$84.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$112.44
|
|
|
CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON
|
Professional
|
Both
|
$110.22
|
|
|
Service Code
|
HCPCS 77002 26
|
| Min. Negotiated Rate |
$20.30 |
| Max. Negotiated Rate |
$65.25 |
| Rate for Payer: Cash Price |
$29.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.75
|
| Rate for Payer: Healthfirst Commercial |
$29.00
|
| Rate for Payer: Healthfirst Essential Plan |
$65.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.55
|
| Rate for Payer: Healthfirst QHP |
$29.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.75
|
| Rate for Payer: SOMOS Essential |
$21.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.00
|
|
|
CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON
|
Professional
|
Both
|
$389.41
|
|
|
Service Code
|
HCPCS 77002 TC
|
| Min. Negotiated Rate |
$71.35 |
| Max. Negotiated Rate |
$229.34 |
| Rate for Payer: Cash Price |
$105.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$101.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$91.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$91.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$96.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$101.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$96.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$101.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$101.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$76.45
|
| Rate for Payer: Healthfirst Commercial |
$101.93
|
| Rate for Payer: Healthfirst Essential Plan |
$229.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$96.83
|
| Rate for Payer: Healthfirst QHP |
$101.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$71.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$101.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$86.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$71.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$101.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$76.45
|
| Rate for Payer: SOMOS Essential |
$76.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$101.93
|
|
|
CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON
|
Professional
|
Both
|
$499.63
|
|
|
Service Code
|
HCPCS 77002
|
| Min. Negotiated Rate |
$91.64 |
| Max. Negotiated Rate |
$294.57 |
| Rate for Payer: Cash Price |
$135.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$130.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$117.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$117.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$124.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$130.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$124.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$98.19
|
| Rate for Payer: Healthfirst Commercial |
$130.92
|
| Rate for Payer: Healthfirst Essential Plan |
$294.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$124.37
|
| Rate for Payer: Healthfirst QHP |
$130.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$91.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$130.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$111.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$91.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$130.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$98.19
|
| Rate for Payer: SOMOS Essential |
$98.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.92
|
|
|
CHG FLUOROSCOPY UP TO 1 HOUR PHYSICIAN/QHP TIME
|
Professional
|
Both
|
$187.81
|
|
|
Service Code
|
HCPCS 76000
|
| Min. Negotiated Rate |
$34.78 |
| Max. Negotiated Rate |
$111.78 |
| Rate for Payer: Cash Price |
$49.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$49.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$44.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$44.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$47.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$49.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$47.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$37.26
|
| Rate for Payer: Healthfirst Commercial |
$49.68
|
| Rate for Payer: Healthfirst Essential Plan |
$111.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.20
|
| Rate for Payer: Healthfirst QHP |
$49.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$49.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$42.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$49.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$37.26
|
| Rate for Payer: SOMOS Essential |
$37.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$49.68
|
|
|
CHG FLUOROSCOPY UP TO 1 HOUR PHYSICIAN/QHP TIME
|
Professional
|
Both
|
$65.77
|
|
|
Service Code
|
HCPCS 76000 26
|
| Min. Negotiated Rate |
$11.79 |
| Max. Negotiated Rate |
$37.91 |
| Rate for Payer: Cash Price |
$16.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.64
|
| Rate for Payer: Healthfirst Commercial |
$16.85
|
| Rate for Payer: Healthfirst Essential Plan |
$37.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.01
|
| Rate for Payer: Healthfirst QHP |
$16.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$14.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.64
|
| Rate for Payer: SOMOS Essential |
$12.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.85
|
|
|
CHG FLUOROSCOPY UP TO 1 HOUR PHYSICIAN/QHP TIME
|
Professional
|
Both
|
$122.05
|
|
|
Service Code
|
HCPCS 76000 TC
|
| Min. Negotiated Rate |
$22.99 |
| Max. Negotiated Rate |
$73.89 |
| Rate for Payer: Cash Price |
$33.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.63
|
| Rate for Payer: Healthfirst Commercial |
$32.84
|
| Rate for Payer: Healthfirst Essential Plan |
$73.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.20
|
| Rate for Payer: Healthfirst QHP |
$32.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.63
|
| Rate for Payer: SOMOS Essential |
$24.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.84
|
|
|
CHG GASTRIC EMPTYING IMAGING STUDY
|
Professional
|
Both
|
$1,321.15
|
|
|
Service Code
|
HCPCS 78264
|
| Min. Negotiated Rate |
$240.31 |
| Max. Negotiated Rate |
$772.42 |
| Rate for Payer: Cash Price |
$354.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$343.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$308.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$308.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$326.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$343.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$326.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$343.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$343.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$257.48
|
| Rate for Payer: Healthfirst Commercial |
$343.30
|
| Rate for Payer: Healthfirst Essential Plan |
$772.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$326.13
|
| Rate for Payer: Healthfirst QHP |
$343.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$240.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$343.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$291.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$240.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$343.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$257.48
|
| Rate for Payer: SOMOS Essential |
$257.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$343.30
|
|
|
CHG GASTRIC EMPTYING IMAGING STUDY
|
Professional
|
Both
|
$148.72
|
|
|
Service Code
|
HCPCS 78264 26
|
| Min. Negotiated Rate |
$28.12 |
| Max. Negotiated Rate |
$90.38 |
| Rate for Payer: Cash Price |
$40.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$40.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.13
|
| Rate for Payer: Healthfirst Commercial |
$40.17
|
| Rate for Payer: Healthfirst Essential Plan |
$90.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.16
|
| Rate for Payer: Healthfirst QHP |
$40.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$40.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$30.13
|
| Rate for Payer: SOMOS Essential |
$30.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.17
|
|
|
CHG GASTRIC EMPTYING IMAGING STUDY
|
Professional
|
Both
|
$1,172.43
|
|
|
Service Code
|
HCPCS 78264 TC
|
| Min. Negotiated Rate |
$212.20 |
| Max. Negotiated Rate |
$682.07 |
| Rate for Payer: Cash Price |
$314.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$303.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$272.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$272.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$287.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$303.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$287.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$303.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$303.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$227.35
|
| Rate for Payer: Healthfirst Commercial |
$303.14
|
| Rate for Payer: Healthfirst Essential Plan |
$682.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$287.98
|
| Rate for Payer: Healthfirst QHP |
$303.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$212.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$303.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$257.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$212.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$303.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$227.35
|
| Rate for Payer: SOMOS Essential |
$227.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$303.14
|
|
|
CHG GASTRIC EMPTYNG IMAG STD W/SM BWL TRANSIT
|
Professional
|
Both
|
$181.13
|
|
|
Service Code
|
HCPCS 78265 26
|
| Min. Negotiated Rate |
$34.33 |
| Max. Negotiated Rate |
$110.34 |
| Rate for Payer: Cash Price |
$49.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$49.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$44.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$44.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$46.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$49.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$46.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.78
|
| Rate for Payer: Healthfirst Commercial |
$49.04
|
| Rate for Payer: Healthfirst Essential Plan |
$110.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.59
|
| Rate for Payer: Healthfirst QHP |
$49.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$49.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$49.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36.78
|
| Rate for Payer: SOMOS Essential |
$36.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$49.04
|
|
|
CHG GASTRIC EMPTYNG IMAG STD W/SM BWL TRANSIT
|
Professional
|
Both
|
$1,382.05
|
|
|
Service Code
|
HCPCS 78265 TC
|
| Min. Negotiated Rate |
$251.59 |
| Max. Negotiated Rate |
$808.70 |
| Rate for Payer: Cash Price |
$371.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$359.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$323.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$323.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$341.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$359.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$341.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$359.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$359.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$269.56
|
| Rate for Payer: Healthfirst Commercial |
$359.42
|
| Rate for Payer: Healthfirst Essential Plan |
$808.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$341.45
|
| Rate for Payer: Healthfirst QHP |
$359.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$251.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$359.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$305.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$251.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$359.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$269.56
|
| Rate for Payer: SOMOS Essential |
$269.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$359.42
|
|
|
CHG GASTRIC EMPTYNG IMAG STD W/SM BWL TRANSIT
|
Professional
|
Both
|
$1,563.17
|
|
|
Service Code
|
HCPCS 78265
|
| Min. Negotiated Rate |
$285.92 |
| Max. Negotiated Rate |
$919.03 |
| Rate for Payer: Cash Price |
$421.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$408.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$367.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$367.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$388.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$408.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$388.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$408.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$408.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$306.35
|
| Rate for Payer: Healthfirst Commercial |
$408.46
|
| Rate for Payer: Healthfirst Essential Plan |
$919.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$388.04
|
| Rate for Payer: Healthfirst QHP |
$408.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$285.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$408.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$347.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$285.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$408.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$306.35
|
| Rate for Payer: SOMOS Essential |
$306.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$408.46
|
|
|
CHG GASTRIC MUCOSA IMAGING
|
Professional
|
Both
|
$803.04
|
|
|
Service Code
|
HCPCS 78261
|
| Min. Negotiated Rate |
$146.50 |
| Max. Negotiated Rate |
$470.90 |
| Rate for Payer: Cash Price |
$216.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$209.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$188.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$188.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$198.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$209.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$198.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$156.97
|
| Rate for Payer: Healthfirst Commercial |
$209.29
|
| Rate for Payer: Healthfirst Essential Plan |
$470.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$198.83
|
| Rate for Payer: Healthfirst QHP |
$209.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$146.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$209.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$177.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$146.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$209.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$156.97
|
| Rate for Payer: SOMOS Essential |
$156.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$209.29
|
|
|
CHG GASTRIC MUCOSA IMAGING
|
Professional
|
Both
|
$698.08
|
|
|
Service Code
|
HCPCS 78261 TC
|
| Min. Negotiated Rate |
$126.45 |
| Max. Negotiated Rate |
$406.44 |
| Rate for Payer: Cash Price |
$187.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$180.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$162.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$162.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$171.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$180.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$171.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$180.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$180.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$135.48
|
| Rate for Payer: Healthfirst Commercial |
$180.64
|
| Rate for Payer: Healthfirst Essential Plan |
$406.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$171.61
|
| Rate for Payer: Healthfirst QHP |
$180.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$126.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$180.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$153.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$126.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$180.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$135.48
|
| Rate for Payer: SOMOS Essential |
$135.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$180.64
|
|
|
CHG GASTRIC MUCOSA IMAGING
|
Professional
|
Both
|
$104.97
|
|
|
Service Code
|
HCPCS 78261 26
|
| Min. Negotiated Rate |
$20.06 |
| Max. Negotiated Rate |
$64.48 |
| Rate for Payer: Cash Price |
$29.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.50
|
| Rate for Payer: Healthfirst Commercial |
$28.66
|
| Rate for Payer: Healthfirst Essential Plan |
$64.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.23
|
| Rate for Payer: Healthfirst QHP |
$28.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.50
|
| Rate for Payer: SOMOS Essential |
$21.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.66
|
|
|
CHG GASTROESOPHAGEAL REFLUX STUDY
|
Professional
|
Both
|
$857.64
|
|
|
Service Code
|
HCPCS 78262 TC
|
| Min. Negotiated Rate |
$156.06 |
| Max. Negotiated Rate |
$501.64 |
| Rate for Payer: Cash Price |
$230.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$222.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$200.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$200.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$211.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$222.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$211.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$222.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$222.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$167.21
|
| Rate for Payer: Healthfirst Commercial |
$222.95
|
| Rate for Payer: Healthfirst Essential Plan |
$501.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$211.80
|
| Rate for Payer: Healthfirst QHP |
$222.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$156.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$222.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$189.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$156.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$222.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$167.21
|
| Rate for Payer: SOMOS Essential |
$167.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$222.95
|
|
|
CHG GASTROESOPHAGEAL REFLUX STUDY
|
Professional
|
Both
|
$989.70
|
|
|
Service Code
|
HCPCS 78262
|
| Min. Negotiated Rate |
$180.55 |
| Max. Negotiated Rate |
$580.34 |
| Rate for Payer: Cash Price |
$265.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$257.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$232.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$232.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$245.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$257.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$245.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$257.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$257.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$193.45
|
| Rate for Payer: Healthfirst Commercial |
$257.93
|
| Rate for Payer: Healthfirst Essential Plan |
$580.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$245.03
|
| Rate for Payer: Healthfirst QHP |
$257.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$180.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$257.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$219.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$180.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$257.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$193.45
|
| Rate for Payer: SOMOS Essential |
$193.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$257.93
|
|
|
CHG GASTROESOPHAGEAL REFLUX STUDY
|
Professional
|
Both
|
$132.06
|
|
|
Service Code
|
HCPCS 78262 26
|
| Min. Negotiated Rate |
$24.49 |
| Max. Negotiated Rate |
$78.70 |
| Rate for Payer: Cash Price |
$35.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.23
|
| Rate for Payer: Healthfirst Commercial |
$34.98
|
| Rate for Payer: Healthfirst Essential Plan |
$78.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.23
|
| Rate for Payer: Healthfirst QHP |
$34.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.23
|
| Rate for Payer: SOMOS Essential |
$26.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.98
|
|
