|
CHG MAGNETIC RESONANCE ELASTOGRAPHY
|
Professional
|
Both
|
$688.28
|
|
|
Service Code
|
HCPCS 76391 TC
|
| Min. Negotiated Rate |
$123.14 |
| Max. Negotiated Rate |
$395.80 |
| Rate for Payer: Cash Price |
$183.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$175.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$158.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$158.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$167.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$175.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$167.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$175.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$131.93
|
| Rate for Payer: Healthfirst Commercial |
$175.91
|
| Rate for Payer: Healthfirst Essential Plan |
$395.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$167.11
|
| Rate for Payer: Healthfirst QHP |
$175.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$123.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$175.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$149.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$123.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$175.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$131.93
|
| Rate for Payer: SOMOS Essential |
$131.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$175.91
|
|
|
CHG MAMMARY DUCTOGRAM OR GALACTOGRAM MULTIPLE
|
Professional
|
Both
|
$208.29
|
|
|
Service Code
|
HCPCS 77054 TC
|
| Min. Negotiated Rate |
$39.56 |
| Max. Negotiated Rate |
$127.15 |
| Rate for Payer: Cash Price |
$57.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$56.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$50.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$50.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$53.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$56.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$53.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.38
|
| Rate for Payer: Healthfirst Commercial |
$56.51
|
| Rate for Payer: Healthfirst Essential Plan |
$127.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$53.68
|
| Rate for Payer: Healthfirst QHP |
$56.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$39.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$56.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$48.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$39.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$56.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$42.38
|
| Rate for Payer: SOMOS Essential |
$42.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56.51
|
|
|
CHG MAMMARY DUCTOGRAM OR GALACTOGRAM MULTIPLE
|
Professional
|
Both
|
$84.84
|
|
|
Service Code
|
HCPCS 77054 26
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$51.64 |
| Rate for Payer: Cash Price |
$23.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.21
|
| Rate for Payer: Healthfirst Commercial |
$22.95
|
| Rate for Payer: Healthfirst Essential Plan |
$51.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.80
|
| Rate for Payer: Healthfirst QHP |
$22.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$16.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$22.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$19.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$16.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$17.21
|
| Rate for Payer: SOMOS Essential |
$17.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.95
|
|
|
CHG MAMMARY DUCTOGRAM OR GALACTOGRAM MULTIPLE
|
Professional
|
Both
|
$293.13
|
|
|
Service Code
|
HCPCS 77054
|
| Min. Negotiated Rate |
$55.62 |
| Max. Negotiated Rate |
$178.78 |
| Rate for Payer: Cash Price |
$80.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$79.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$71.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$71.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$75.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$79.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$75.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$79.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$59.59
|
| Rate for Payer: Healthfirst Commercial |
$79.46
|
| Rate for Payer: Healthfirst Essential Plan |
$178.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$75.49
|
| Rate for Payer: Healthfirst QHP |
$79.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$55.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$79.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$67.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$55.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$79.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$59.59
|
| Rate for Payer: SOMOS Essential |
$59.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$79.46
|
|
|
CHG MAMMARY DUCTOGRAM OR GALACTOGRAM SINGLE
|
Professional
|
Both
|
$227.22
|
|
|
Service Code
|
HCPCS 77053
|
| Min. Negotiated Rate |
$43.13 |
| Max. Negotiated Rate |
$138.62 |
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$61.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$55.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$55.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$58.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$61.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$58.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$61.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$46.21
|
| Rate for Payer: Healthfirst Commercial |
$61.61
|
| Rate for Payer: Healthfirst Essential Plan |
$138.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$58.53
|
| Rate for Payer: Healthfirst QHP |
$61.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$43.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$61.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$52.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$43.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$61.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$46.21
|
| Rate for Payer: SOMOS Essential |
$46.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$61.61
|
|
|
CHG MAMMARY DUCTOGRAM OR GALACTOGRAM SINGLE
|
Professional
|
Both
|
$157.99
|
|
|
Service Code
|
HCPCS 77053 TC
|
| Min. Negotiated Rate |
$30.05 |
| Max. Negotiated Rate |
$96.59 |
| Rate for Payer: Cash Price |
$43.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$42.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$42.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$40.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.20
|
| Rate for Payer: Healthfirst Commercial |
$42.93
|
| Rate for Payer: Healthfirst Essential Plan |
$96.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.78
|
| Rate for Payer: Healthfirst QHP |
$42.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$42.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$36.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$42.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.20
|
| Rate for Payer: SOMOS Essential |
$32.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.93
|
|
|
CHG MAMMARY DUCTOGRAM OR GALACTOGRAM SINGLE
|
Professional
|
Both
|
$69.27
|
|
|
Service Code
|
HCPCS 77053 26
|
| Min. Negotiated Rate |
$13.08 |
| Max. Negotiated Rate |
$42.03 |
| Rate for Payer: Cash Price |
$18.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.01
|
| Rate for Payer: Healthfirst Commercial |
$18.68
|
| Rate for Payer: Healthfirst Essential Plan |
$42.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.75
|
| Rate for Payer: Healthfirst QHP |
$18.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$18.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$15.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$14.01
|
| Rate for Payer: SOMOS Essential |
$14.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.68
|
|
|
CHG MANUAL APPL STRESS PFRMD PHYS/QHP JOINT FILMS
|
Professional
|
Both
|
$237.27
|
|
|
Service Code
|
HCPCS 77071
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$141.44 |
| Rate for Payer: Cash Price |
$64.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$56.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$56.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$59.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$59.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$62.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.15
|
| Rate for Payer: Healthfirst Commercial |
$62.86
|
| Rate for Payer: Healthfirst Essential Plan |
$141.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$59.72
|
| Rate for Payer: Healthfirst QHP |
$62.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$44.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$62.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$53.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$44.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.15
|
| Rate for Payer: SOMOS Essential |
$47.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.86
|
|
|
CHG MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I
|
Professional
|
Both
|
$390.29
|
|
|
Service Code
|
HCPCS 75902
|
| Min. Negotiated Rate |
$69.01 |
| Max. Negotiated Rate |
$221.83 |
| Rate for Payer: Cash Price |
$102.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$98.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$88.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$88.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$93.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$98.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$93.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$98.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$98.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.94
|
| Rate for Payer: Healthfirst Commercial |
$98.59
|
| Rate for Payer: Healthfirst Essential Plan |
$221.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$93.66
|
| Rate for Payer: Healthfirst QHP |
$98.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$69.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$98.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$83.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$69.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$98.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$73.94
|
| Rate for Payer: SOMOS Essential |
$73.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$98.59
|
|
|
CHG MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I
|
Professional
|
Both
|
$313.25
|
|
|
Service Code
|
HCPCS 75902 TC
|
| Min. Negotiated Rate |
$55.05 |
| Max. Negotiated Rate |
$176.94 |
| Rate for Payer: Cash Price |
$82.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$78.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$70.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$70.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$74.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$78.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$74.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$78.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$78.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$58.98
|
| Rate for Payer: Healthfirst Commercial |
$78.64
|
| Rate for Payer: Healthfirst Essential Plan |
$176.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$74.71
|
| Rate for Payer: Healthfirst QHP |
$78.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$55.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$78.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$66.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$55.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$78.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$58.98
|
| Rate for Payer: SOMOS Essential |
$58.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$78.64
|
|
|
CHG MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I
|
Professional
|
Both
|
$77.04
|
|
|
Service Code
|
HCPCS 75902 26
|
| Min. Negotiated Rate |
$13.96 |
| Max. Negotiated Rate |
$44.89 |
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.96
|
| Rate for Payer: Healthfirst Commercial |
$19.95
|
| Rate for Payer: Healthfirst Essential Plan |
$44.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.95
|
| Rate for Payer: Healthfirst QHP |
$19.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$14.96
|
| Rate for Payer: SOMOS Essential |
$14.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.95
|
|
|
CHG MECHANICAL RMVL PERICATHETER OBSTR MATRL RS&I
|
Professional
|
Both
|
$92.44
|
|
|
Service Code
|
HCPCS 75901 26
|
| Min. Negotiated Rate |
$16.92 |
| Max. Negotiated Rate |
$54.38 |
| Rate for Payer: Cash Price |
$24.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.13
|
| Rate for Payer: Healthfirst Commercial |
$24.17
|
| Rate for Payer: Healthfirst Essential Plan |
$54.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.96
|
| Rate for Payer: Healthfirst QHP |
$24.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$16.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$24.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$20.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$16.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18.13
|
| Rate for Payer: SOMOS Essential |
$18.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.17
|
|
|
CHG MECHANICAL RMVL PERICATHETER OBSTR MATRL RS&I
|
Professional
|
Both
|
$903.91
|
|
|
Service Code
|
HCPCS 75901 TC
|
| Min. Negotiated Rate |
$163.34 |
| Max. Negotiated Rate |
$525.04 |
| Rate for Payer: Cash Price |
$242.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$233.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$210.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$210.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$221.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$233.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$221.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$233.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$233.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$175.01
|
| Rate for Payer: Healthfirst Commercial |
$233.35
|
| Rate for Payer: Healthfirst Essential Plan |
$525.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$221.68
|
| Rate for Payer: Healthfirst QHP |
$233.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$163.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$233.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$198.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$163.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$233.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$175.01
|
| Rate for Payer: SOMOS Essential |
$175.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$233.35
|
|
|
CHG MECHANICAL RMVL PERICATHETER OBSTR MATRL RS&I
|
Professional
|
Both
|
$996.35
|
|
|
Service Code
|
HCPCS 75901
|
| Min. Negotiated Rate |
$180.26 |
| Max. Negotiated Rate |
$579.42 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$257.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$231.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$231.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$244.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$257.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$244.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$257.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$257.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$193.14
|
| Rate for Payer: Healthfirst Commercial |
$257.52
|
| Rate for Payer: Healthfirst Essential Plan |
$579.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$244.64
|
| Rate for Payer: Healthfirst QHP |
$257.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$180.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$257.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$218.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$180.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$257.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$193.14
|
| Rate for Payer: SOMOS Essential |
$193.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$257.52
|
|
|
CHG MEDICAL PHYSICS DOSE EVAL RADIATION EXPOS W/RPRT
|
Professional
|
Both
|
$3,990.60
|
|
|
Service Code
|
HCPCS 76145
|
| Min. Negotiated Rate |
$810.85 |
| Max. Negotiated Rate |
$2,606.29 |
| Rate for Payer: Cash Price |
$1,088.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,158.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,042.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,042.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,100.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,158.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,100.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,158.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,158.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$868.76
|
| Rate for Payer: Healthfirst Commercial |
$1,158.35
|
| Rate for Payer: Healthfirst Essential Plan |
$2,606.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,100.43
|
| Rate for Payer: Healthfirst QHP |
$1,158.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$810.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,158.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$984.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$810.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,158.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$868.76
|
| Rate for Payer: SOMOS Essential |
$868.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,158.35
|
|
|
CHG MLC IMRT DESIGN & CONSTRUCTION PER IMRT PLAN
|
Professional
|
Both
|
$907.13
|
|
|
Service Code
|
HCPCS 77338 26
|
| Min. Negotiated Rate |
$174.66 |
| Max. Negotiated Rate |
$561.40 |
| Rate for Payer: Cash Price |
$248.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$249.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$224.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$224.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$237.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$249.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$237.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$249.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$249.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$187.13
|
| Rate for Payer: Healthfirst Commercial |
$249.51
|
| Rate for Payer: Healthfirst Essential Plan |
$561.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$237.03
|
| Rate for Payer: Healthfirst QHP |
$249.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$174.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$249.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$212.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$174.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$249.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$187.13
|
| Rate for Payer: SOMOS Essential |
$187.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$249.51
|
|
|
CHG MLC IMRT DESIGN & CONSTRUCTION PER IMRT PLAN
|
Professional
|
Both
|
$1,039.64
|
|
|
Service Code
|
HCPCS 77338 TC
|
| Min. Negotiated Rate |
$203.99 |
| Max. Negotiated Rate |
$655.67 |
| Rate for Payer: Cash Price |
$290.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$291.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$262.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$262.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$276.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$291.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$276.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$291.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$291.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$218.56
|
| Rate for Payer: Healthfirst Commercial |
$291.41
|
| Rate for Payer: Healthfirst Essential Plan |
$655.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$276.84
|
| Rate for Payer: Healthfirst QHP |
$291.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$203.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$291.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$247.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$203.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$291.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$218.56
|
| Rate for Payer: SOMOS Essential |
$218.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$291.41
|
|
|
CHG MLC IMRT DESIGN & CONSTRUCTION PER IMRT PLAN
|
Professional
|
Both
|
$1,946.77
|
|
|
Service Code
|
HCPCS 77338
|
| Min. Negotiated Rate |
$378.64 |
| Max. Negotiated Rate |
$1,217.07 |
| Rate for Payer: Cash Price |
$539.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$540.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$486.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$486.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$513.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$540.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$513.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$540.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$540.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$405.69
|
| Rate for Payer: Healthfirst Commercial |
$540.92
|
| Rate for Payer: Healthfirst Essential Plan |
$1,217.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$513.87
|
| Rate for Payer: Healthfirst QHP |
$540.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$378.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$540.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$459.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$378.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$540.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$405.69
|
| Rate for Payer: SOMOS Essential |
$405.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$540.92
|
|
|
CHG MORPHOMETRIC ANALYSIS SKELETAL MUSCLE
|
Professional
|
Both
|
$309.19
|
|
|
Service Code
|
HCPCS 88355 26
|
| Min. Negotiated Rate |
$59.72 |
| Max. Negotiated Rate |
$191.95 |
| Rate for Payer: Cash Price |
$78.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$85.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$76.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$76.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$81.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$85.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$81.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$63.98
|
| Rate for Payer: Healthfirst Commercial |
$85.31
|
| Rate for Payer: Healthfirst Essential Plan |
$191.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$81.04
|
| Rate for Payer: Healthfirst QHP |
$85.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$59.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$85.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$72.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$59.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$85.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$63.98
|
| Rate for Payer: SOMOS Essential |
$63.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$85.31
|
|
|
CHG MORPHOMETRIC ANALYSIS SKELETAL MUSCLE
|
Professional
|
Both
|
$262.78
|
|
|
Service Code
|
HCPCS 88355 TC
|
| Min. Negotiated Rate |
$50.86 |
| Max. Negotiated Rate |
$163.49 |
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$72.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$65.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$69.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$69.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.49
|
| Rate for Payer: Healthfirst Commercial |
$72.66
|
| Rate for Payer: Healthfirst Essential Plan |
$163.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.03
|
| Rate for Payer: Healthfirst QHP |
$72.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$50.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$72.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$61.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$50.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$54.49
|
| Rate for Payer: SOMOS Essential |
$54.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.66
|
|
|
CHG MORPHOMETRIC ANALYSIS SKELETAL MUSCLE
|
Professional
|
Both
|
$571.97
|
|
|
Service Code
|
HCPCS 88355
|
| Min. Negotiated Rate |
$110.58 |
| Max. Negotiated Rate |
$355.43 |
| Rate for Payer: Cash Price |
$141.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$142.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$142.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$150.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$150.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$118.48
|
| Rate for Payer: Healthfirst Commercial |
$157.97
|
| Rate for Payer: Healthfirst Essential Plan |
$355.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$150.07
|
| Rate for Payer: Healthfirst QHP |
$157.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$110.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$157.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$134.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$110.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$118.48
|
| Rate for Payer: SOMOS Essential |
$118.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.97
|
|
|
CHG M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR EACH MULTIPRB
|
Professional
|
Both
|
$1,122.56
|
|
|
Service Code
|
HCPCS 88374 TC
|
| Min. Negotiated Rate |
$189.43 |
| Max. Negotiated Rate |
$608.89 |
| Rate for Payer: Cash Price |
$291.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$270.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$243.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$243.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$257.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$270.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$257.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$270.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$270.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$202.97
|
| Rate for Payer: Healthfirst Commercial |
$270.62
|
| Rate for Payer: Healthfirst Essential Plan |
$608.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$257.09
|
| Rate for Payer: Healthfirst QHP |
$270.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$189.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$270.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$230.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$189.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$270.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$202.97
|
| Rate for Payer: SOMOS Essential |
$202.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$270.62
|
|
|
CHG M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR EACH MULTIPRB
|
Professional
|
Both
|
$162.33
|
|
|
Service Code
|
HCPCS 88374 26
|
| Min. Negotiated Rate |
$30.20 |
| Max. Negotiated Rate |
$97.06 |
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$43.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$40.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.35
|
| Rate for Payer: Healthfirst Commercial |
$43.14
|
| Rate for Payer: Healthfirst Essential Plan |
$97.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.98
|
| Rate for Payer: Healthfirst QHP |
$43.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$43.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$36.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.35
|
| Rate for Payer: SOMOS Essential |
$32.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.14
|
|
|
CHG M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR EACH MULTIPRB
|
Professional
|
Both
|
$1,284.89
|
|
|
Service Code
|
HCPCS 88374
|
| Min. Negotiated Rate |
$219.62 |
| Max. Negotiated Rate |
$705.94 |
| Rate for Payer: Cash Price |
$335.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$313.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$282.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$282.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$298.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$313.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$298.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$313.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$313.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$235.31
|
| Rate for Payer: Healthfirst Commercial |
$313.75
|
| Rate for Payer: Healthfirst Essential Plan |
$705.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$298.06
|
| Rate for Payer: Healthfirst QHP |
$313.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$219.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$313.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$266.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$219.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$313.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$235.31
|
| Rate for Payer: SOMOS Essential |
$235.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$313.75
|
|
|
CHG M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR PER SPEC EACH
|
Professional
|
Both
|
$188.30
|
|
|
Service Code
|
HCPCS 88373 TC
|
| Min. Negotiated Rate |
$33.85 |
| Max. Negotiated Rate |
$108.81 |
| Rate for Payer: Cash Price |
$51.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$48.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$48.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.27
|
| Rate for Payer: Healthfirst Commercial |
$48.36
|
| Rate for Payer: Healthfirst Essential Plan |
$108.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$45.94
|
| Rate for Payer: Healthfirst QHP |
$48.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$48.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$48.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36.27
|
| Rate for Payer: SOMOS Essential |
$36.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$48.36
|
|
