|
CHG NONCARDIAC VASCULAR FLOW IMAGING
|
Professional
|
Both
|
$748.37
|
|
|
Service Code
|
HCPCS 78445 TC
|
| Min. Negotiated Rate |
$121.28 |
| Max. Negotiated Rate |
$389.83 |
| Rate for Payer: Cash Price |
$195.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$173.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$155.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$155.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$164.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$173.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$164.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$173.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$173.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$129.94
|
| Rate for Payer: Healthfirst Commercial |
$173.26
|
| Rate for Payer: Healthfirst Essential Plan |
$389.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$164.60
|
| Rate for Payer: Healthfirst QHP |
$173.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$121.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$173.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$147.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$121.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$173.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$129.94
|
| Rate for Payer: SOMOS Essential |
$129.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$173.26
|
|
|
CHG NONCARDIAC VASCULAR FLOW IMAGING
|
Professional
|
Both
|
$848.02
|
|
|
Service Code
|
HCPCS 78445
|
| Min. Negotiated Rate |
$139.29 |
| Max. Negotiated Rate |
$447.70 |
| Rate for Payer: Cash Price |
$222.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$198.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$179.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$179.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$189.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$198.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$189.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$198.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$198.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$149.24
|
| Rate for Payer: Healthfirst Commercial |
$198.98
|
| Rate for Payer: Healthfirst Essential Plan |
$447.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$189.03
|
| Rate for Payer: Healthfirst QHP |
$198.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$139.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$198.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$169.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$139.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$198.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$149.24
|
| Rate for Payer: SOMOS Essential |
$149.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$198.98
|
|
|
CHG NTSTY MODUL RADTHX PLN DOSE-VOL HISTOS
|
Professional
|
Both
|
$6,142.43
|
|
|
Service Code
|
HCPCS 77301 TC
|
| Min. Negotiated Rate |
$1,170.62 |
| Max. Negotiated Rate |
$3,762.70 |
| Rate for Payer: Cash Price |
$1,692.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,672.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,505.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,505.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,588.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,672.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,588.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,672.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,672.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,254.23
|
| Rate for Payer: Healthfirst Commercial |
$1,672.31
|
| Rate for Payer: Healthfirst Essential Plan |
$3,762.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,588.69
|
| Rate for Payer: Healthfirst QHP |
$1,672.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,170.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,672.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,421.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,170.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,672.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,254.23
|
| Rate for Payer: SOMOS Essential |
$1,254.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,672.31
|
|
|
CHG NTSTY MODUL RADTHX PLN DOSE-VOL HISTOS
|
Professional
|
Both
|
$1,691.76
|
|
|
Service Code
|
HCPCS 77301 26
|
| Min. Negotiated Rate |
$326.40 |
| Max. Negotiated Rate |
$1,049.13 |
| Rate for Payer: Cash Price |
$463.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$466.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$419.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$419.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$442.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$466.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$442.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$466.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$466.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$349.71
|
| Rate for Payer: Healthfirst Commercial |
$466.28
|
| Rate for Payer: Healthfirst Essential Plan |
$1,049.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$442.97
|
| Rate for Payer: Healthfirst QHP |
$466.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$326.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$466.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$396.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$326.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$466.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$349.71
|
| Rate for Payer: SOMOS Essential |
$349.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$466.28
|
|
|
CHG NTSTY MODUL RADTHX PLN DOSE-VOL HISTOS
|
Professional
|
Both
|
$7,834.19
|
|
|
Service Code
|
HCPCS 77301
|
| Min. Negotiated Rate |
$1,497.01 |
| Max. Negotiated Rate |
$4,811.83 |
| Rate for Payer: Cash Price |
$2,156.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,138.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,924.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,924.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,031.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,138.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,031.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,138.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,138.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,603.94
|
| Rate for Payer: Healthfirst Commercial |
$2,138.59
|
| Rate for Payer: Healthfirst Essential Plan |
$4,811.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,031.66
|
| Rate for Payer: Healthfirst QHP |
$2,138.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,497.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,138.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,817.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,497.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,138.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,603.94
|
| Rate for Payer: SOMOS Essential |
$1,603.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,138.59
|
|
|
CHG OPH BMTRY US ECHOGRAPY A-SCAN IO LENS PWR CAL
|
Professional
|
Both
|
$281.54
|
|
|
Service Code
|
HCPCS 76519
|
| Min. Negotiated Rate |
$54.10 |
| Max. Negotiated Rate |
$173.90 |
| Rate for Payer: Cash Price |
$78.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$77.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$69.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$69.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$73.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$77.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$73.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.97
|
| Rate for Payer: Healthfirst Commercial |
$77.29
|
| Rate for Payer: Healthfirst Essential Plan |
$173.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$73.43
|
| Rate for Payer: Healthfirst QHP |
$77.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$54.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$77.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$65.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$54.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$77.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$57.97
|
| Rate for Payer: SOMOS Essential |
$57.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$77.29
|
|
|
CHG OPH BMTRY US ECHOGRAPY A-SCAN IO LENS PWR CAL
|
Professional
|
Both
|
$119.25
|
|
|
Service Code
|
HCPCS 76519 26
|
| Min. Negotiated Rate |
$22.97 |
| Max. Negotiated Rate |
$73.82 |
| Rate for Payer: Cash Price |
$32.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.61
|
| Rate for Payer: Healthfirst Commercial |
$32.81
|
| Rate for Payer: Healthfirst Essential Plan |
$73.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.17
|
| Rate for Payer: Healthfirst QHP |
$32.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.61
|
| Rate for Payer: SOMOS Essential |
$24.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.81
|
|
|
CHG OPH BMTRY US ECHOGRAPY A-SCAN IO LENS PWR CAL
|
Professional
|
Both
|
$162.30
|
|
|
Service Code
|
HCPCS 76519 TC
|
| Min. Negotiated Rate |
$31.14 |
| Max. Negotiated Rate |
$100.08 |
| Rate for Payer: Cash Price |
$45.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$44.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$44.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.36
|
| Rate for Payer: Healthfirst Commercial |
$44.48
|
| Rate for Payer: Healthfirst Essential Plan |
$100.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42.26
|
| Rate for Payer: Healthfirst QHP |
$44.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$44.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$44.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$33.36
|
| Rate for Payer: SOMOS Essential |
$33.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44.48
|
|
|
CHG OPHTHALMIC BIOMETRY US ECHOGRAPY A-SCAN
|
Professional
|
Both
|
$195.02
|
|
|
Service Code
|
HCPCS 76516
|
| Min. Negotiated Rate |
$37.14 |
| Max. Negotiated Rate |
$119.39 |
| Rate for Payer: Cash Price |
$53.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$53.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$53.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.80
|
| Rate for Payer: Healthfirst Commercial |
$53.06
|
| Rate for Payer: Healthfirst Essential Plan |
$119.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.41
|
| Rate for Payer: Healthfirst QHP |
$53.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$53.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$45.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$53.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.80
|
| Rate for Payer: SOMOS Essential |
$39.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.06
|
|
|
CHG OPHTHALMIC BIOMETRY US ECHOGRAPY A-SCAN
|
Professional
|
Both
|
$88.76
|
|
|
Service Code
|
HCPCS 76516 26
|
| Min. Negotiated Rate |
$17.14 |
| Max. Negotiated Rate |
$55.10 |
| Rate for Payer: Cash Price |
$24.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.37
|
| Rate for Payer: Healthfirst Commercial |
$24.49
|
| Rate for Payer: Healthfirst Essential Plan |
$55.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23.27
|
| Rate for Payer: Healthfirst QHP |
$24.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$24.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$20.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18.37
|
| Rate for Payer: SOMOS Essential |
$18.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.49
|
|
|
CHG OPHTHALMIC BIOMETRY US ECHOGRAPY A-SCAN
|
Professional
|
Both
|
$106.23
|
|
|
Service Code
|
HCPCS 76516 TC
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$64.28 |
| Rate for Payer: Cash Price |
$29.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.43
|
| Rate for Payer: Healthfirst Commercial |
$28.57
|
| Rate for Payer: Healthfirst Essential Plan |
$64.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.14
|
| Rate for Payer: Healthfirst QHP |
$28.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.43
|
| Rate for Payer: SOMOS Essential |
$21.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.57
|
|
|
CHG OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION
|
Professional
|
Both
|
$125.86
|
|
|
Service Code
|
HCPCS 76529 26
|
| Min. Negotiated Rate |
$23.85 |
| Max. Negotiated Rate |
$76.66 |
| Rate for Payer: Cash Price |
$35.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.55
|
| Rate for Payer: Healthfirst Commercial |
$34.07
|
| Rate for Payer: Healthfirst Essential Plan |
$76.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.37
|
| Rate for Payer: Healthfirst QHP |
$34.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.55
|
| Rate for Payer: SOMOS Essential |
$25.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.07
|
|
|
CHG OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION
|
Professional
|
Both
|
$234.19
|
|
|
Service Code
|
HCPCS 76529 TC
|
| Min. Negotiated Rate |
$43.37 |
| Max. Negotiated Rate |
$139.39 |
| Rate for Payer: Cash Price |
$63.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$61.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$55.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$55.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$58.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$61.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$58.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$61.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$46.46
|
| Rate for Payer: Healthfirst Commercial |
$61.95
|
| Rate for Payer: Healthfirst Essential Plan |
$139.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$58.85
|
| Rate for Payer: Healthfirst QHP |
$61.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$43.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$61.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$52.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$43.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$61.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$46.46
|
| Rate for Payer: SOMOS Essential |
$46.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$61.95
|
|
|
CHG OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION
|
Professional
|
Both
|
$360.05
|
|
|
Service Code
|
HCPCS 76529
|
| Min. Negotiated Rate |
$67.21 |
| Max. Negotiated Rate |
$216.04 |
| Rate for Payer: Cash Price |
$98.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$96.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$86.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$86.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$91.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$96.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$91.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$96.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$96.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.02
|
| Rate for Payer: Healthfirst Commercial |
$96.02
|
| Rate for Payer: Healthfirst Essential Plan |
$216.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$91.22
|
| Rate for Payer: Healthfirst QHP |
$96.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$67.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$96.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$81.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$67.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$96.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$72.02
|
| Rate for Payer: SOMOS Essential |
$72.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$96.02
|
|
|
CHG OPHTHALMIC US DX B-SCAN&QUAN A-SCAN SM PT ENCTR
|
Professional
|
Both
|
$153.65
|
|
|
Service Code
|
HCPCS 76510 26
|
| Min. Negotiated Rate |
$29.27 |
| Max. Negotiated Rate |
$94.07 |
| Rate for Payer: Cash Price |
$42.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$41.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$39.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.36
|
| Rate for Payer: Healthfirst Commercial |
$41.81
|
| Rate for Payer: Healthfirst Essential Plan |
$94.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.72
|
| Rate for Payer: Healthfirst QHP |
$41.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$41.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$35.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31.36
|
| Rate for Payer: SOMOS Essential |
$31.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.81
|
|
|
CHG OPHTHALMIC US DX B-SCAN&QUAN A-SCAN SM PT ENCTR
|
Professional
|
Both
|
$132.13
|
|
|
Service Code
|
HCPCS 76510 TC
|
| Min. Negotiated Rate |
$24.07 |
| Max. Negotiated Rate |
$77.38 |
| Rate for Payer: Cash Price |
$35.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.79
|
| Rate for Payer: Healthfirst Commercial |
$34.39
|
| Rate for Payer: Healthfirst Essential Plan |
$77.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.67
|
| Rate for Payer: Healthfirst QHP |
$34.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.79
|
| Rate for Payer: SOMOS Essential |
$25.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.39
|
|
|
CHG OPHTHALMIC US DX B-SCAN&QUAN A-SCAN SM PT ENCTR
|
Professional
|
Both
|
$285.78
|
|
|
Service Code
|
HCPCS 76510
|
| Min. Negotiated Rate |
$53.34 |
| Max. Negotiated Rate |
$171.45 |
| Rate for Payer: Cash Price |
$78.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$76.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$68.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$68.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$72.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$76.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$72.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.15
|
| Rate for Payer: Healthfirst Commercial |
$76.20
|
| Rate for Payer: Healthfirst Essential Plan |
$171.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$72.39
|
| Rate for Payer: Healthfirst QHP |
$76.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$53.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$76.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$64.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$53.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$76.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$57.15
|
| Rate for Payer: SOMOS Essential |
$57.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$76.20
|
|
|
CHG OPHTHALMIC US DX B-SCAN W/WO NON-QUAN A-SCAN
|
Professional
|
Both
|
$77.49
|
|
|
Service Code
|
HCPCS 76512 TC
|
| Min. Negotiated Rate |
$14.56 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Cash Price |
$21.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.60
|
| Rate for Payer: Healthfirst Commercial |
$20.80
|
| Rate for Payer: Healthfirst Essential Plan |
$46.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.76
|
| Rate for Payer: Healthfirst QHP |
$20.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$20.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$17.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$14.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.60
|
| Rate for Payer: SOMOS Essential |
$15.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.80
|
|
|
CHG OPHTHALMIC US DX B-SCAN W/WO NON-QUAN A-SCAN
|
Professional
|
Both
|
$197.79
|
|
|
Service Code
|
HCPCS 76512
|
| Min. Negotiated Rate |
$37.46 |
| Max. Negotiated Rate |
$120.42 |
| Rate for Payer: Cash Price |
$54.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$53.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$48.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$48.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$53.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.14
|
| Rate for Payer: Healthfirst Commercial |
$53.52
|
| Rate for Payer: Healthfirst Essential Plan |
$120.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.84
|
| Rate for Payer: Healthfirst QHP |
$53.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$53.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$45.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$53.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.14
|
| Rate for Payer: SOMOS Essential |
$40.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.52
|
|
|
CHG OPHTHALMIC US DX B-SCAN W/WO NON-QUAN A-SCAN
|
Professional
|
Both
|
$120.30
|
|
|
Service Code
|
HCPCS 76512 26
|
| Min. Negotiated Rate |
$22.90 |
| Max. Negotiated Rate |
$73.62 |
| Rate for Payer: Cash Price |
$33.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.54
|
| Rate for Payer: Healthfirst Commercial |
$32.72
|
| Rate for Payer: Healthfirst Essential Plan |
$73.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.08
|
| Rate for Payer: Healthfirst QHP |
$32.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.54
|
| Rate for Payer: SOMOS Essential |
$24.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.72
|
|
|
CHG OPHTHALMIC US DX CORNEAL PACHYMETRY UNI/BI
|
Professional
|
Both
|
$48.90
|
|
|
Service Code
|
HCPCS 76514
|
| Min. Negotiated Rate |
$9.13 |
| Max. Negotiated Rate |
$29.36 |
| Rate for Payer: Cash Price |
$13.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.79
|
| Rate for Payer: Healthfirst Commercial |
$13.05
|
| Rate for Payer: Healthfirst Essential Plan |
$29.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.40
|
| Rate for Payer: Healthfirst QHP |
$13.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$13.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$11.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.79
|
| Rate for Payer: SOMOS Essential |
$9.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.05
|
|
|
CHG OPHTHALMIC US DX CORNEAL PACHYMETRY UNI/BI
|
Professional
|
Both
|
$31.78
|
|
|
Service Code
|
HCPCS 76514 26
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$19.24 |
| Rate for Payer: Cash Price |
$8.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.41
|
| Rate for Payer: Healthfirst Commercial |
$8.55
|
| Rate for Payer: Healthfirst Essential Plan |
$19.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.12
|
| Rate for Payer: Healthfirst QHP |
$8.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$5.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$5.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.41
|
| Rate for Payer: SOMOS Essential |
$6.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.55
|
|
|
CHG OPHTHALMIC US DX CORNEAL PACHYMETRY UNI/BI
|
Professional
|
Both
|
$17.12
|
|
|
Service Code
|
HCPCS 76514 TC
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$10.12 |
| Rate for Payer: Cash Price |
$4.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.38
|
| Rate for Payer: Healthfirst Commercial |
$4.50
|
| Rate for Payer: Healthfirst Essential Plan |
$10.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.28
|
| Rate for Payer: Healthfirst QHP |
$4.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.38
|
| Rate for Payer: SOMOS Essential |
$3.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.50
|
|
|
CHG OPHTHALMIC US DX QUANTITATIVE A-SCAN ONLY
|
Professional
|
Both
|
$140.39
|
|
|
Service Code
|
HCPCS 76511 26
|
| Min. Negotiated Rate |
$26.73 |
| Max. Negotiated Rate |
$85.93 |
| Rate for Payer: Cash Price |
$38.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.64
|
| Rate for Payer: Healthfirst Commercial |
$38.19
|
| Rate for Payer: Healthfirst Essential Plan |
$85.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.28
|
| Rate for Payer: Healthfirst QHP |
$38.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.64
|
| Rate for Payer: SOMOS Essential |
$28.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.19
|
|
|
CHG OPHTHALMIC US DX QUANTITATIVE A-SCAN ONLY
|
Professional
|
Both
|
$235.13
|
|
|
Service Code
|
HCPCS 76511
|
| Min. Negotiated Rate |
$44.28 |
| Max. Negotiated Rate |
$142.34 |
| Rate for Payer: Cash Price |
$64.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$63.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$56.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$56.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$60.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$63.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$60.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.45
|
| Rate for Payer: Healthfirst Commercial |
$63.26
|
| Rate for Payer: Healthfirst Essential Plan |
$142.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.10
|
| Rate for Payer: Healthfirst QHP |
$63.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$44.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$63.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$53.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$44.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$63.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.45
|
| Rate for Payer: SOMOS Essential |
$47.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$63.26
|
|
