|
CHG RADIOLOGIC EXAM SMALL INT SINGLE CONTRAST STUDY
|
Professional
|
Both
|
$154.07
|
|
|
Service Code
|
HCPCS 74250 26
|
| Min. Negotiated Rate |
$29.14 |
| Max. Negotiated Rate |
$93.67 |
| Rate for Payer: Cash Price |
$41.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$41.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$39.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.22
|
| Rate for Payer: Healthfirst Commercial |
$41.63
|
| Rate for Payer: Healthfirst Essential Plan |
$93.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.55
|
| Rate for Payer: Healthfirst QHP |
$41.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$41.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$35.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31.22
|
| Rate for Payer: SOMOS Essential |
$31.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.63
|
|
|
CHG RADIOLOGIC EXAM SWALLOW FUNCTION CONTRAST STUDY
|
Professional
|
Both
|
$104.65
|
|
|
Service Code
|
HCPCS 74230 26
|
| Min. Negotiated Rate |
$19.24 |
| Max. Negotiated Rate |
$61.85 |
| Rate for Payer: Cash Price |
$27.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.62
|
| Rate for Payer: Healthfirst Commercial |
$27.49
|
| Rate for Payer: Healthfirst Essential Plan |
$61.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.12
|
| Rate for Payer: Healthfirst QHP |
$27.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$27.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.62
|
| Rate for Payer: SOMOS Essential |
$20.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.49
|
|
|
CHG RADIOLOGIC EXAM SWALLOW FUNCTION CONTRAST STUDY
|
Professional
|
Both
|
$441.18
|
|
|
Service Code
|
HCPCS 74230 TC
|
| Min. Negotiated Rate |
$78.96 |
| Max. Negotiated Rate |
$253.80 |
| Rate for Payer: Cash Price |
$117.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$112.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$101.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$101.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$107.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$112.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$107.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$112.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$84.60
|
| Rate for Payer: Healthfirst Commercial |
$112.80
|
| Rate for Payer: Healthfirst Essential Plan |
$253.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$107.16
|
| Rate for Payer: Healthfirst QHP |
$112.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$78.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$112.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$95.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$78.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$112.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$84.60
|
| Rate for Payer: SOMOS Essential |
$84.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$112.80
|
|
|
CHG RADIOLOGIC EXAM SWALLOW FUNCTION CONTRAST STUDY
|
Professional
|
Both
|
$545.83
|
|
|
Service Code
|
HCPCS 74230
|
| Min. Negotiated Rate |
$98.20 |
| Max. Negotiated Rate |
$315.63 |
| Rate for Payer: Cash Price |
$145.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$140.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$126.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$126.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$133.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$140.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$133.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$140.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$140.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$105.21
|
| Rate for Payer: Healthfirst Commercial |
$140.28
|
| Rate for Payer: Healthfirst Essential Plan |
$315.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.27
|
| Rate for Payer: Healthfirst QHP |
$140.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$98.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$140.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$119.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$98.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$140.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$105.21
|
| Rate for Payer: SOMOS Essential |
$105.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$140.28
|
|
|
CHG RADIOLOGIC EXAM TEETH COMPLETE FULL MOUTH
|
Professional
|
Both
|
$182.42
|
|
|
Service Code
|
HCPCS 70320 TC
|
| Min. Negotiated Rate |
$35.48 |
| Max. Negotiated Rate |
$114.05 |
| Rate for Payer: Cash Price |
$50.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$50.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$45.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$45.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$48.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$50.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$48.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.02
|
| Rate for Payer: Healthfirst Commercial |
$50.69
|
| Rate for Payer: Healthfirst Essential Plan |
$114.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$48.16
|
| Rate for Payer: Healthfirst QHP |
$50.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$35.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$50.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$43.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$35.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$50.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$38.02
|
| Rate for Payer: SOMOS Essential |
$38.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.69
|
|
|
CHG RADIOLOGIC EXAM TEETH COMPLETE FULL MOUTH
|
Professional
|
Both
|
$225.65
|
|
|
Service Code
|
HCPCS 70320
|
| Min. Negotiated Rate |
$43.94 |
| Max. Negotiated Rate |
$141.23 |
| Rate for Payer: Cash Price |
$62.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$56.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$56.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$59.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$59.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$62.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.08
|
| Rate for Payer: Healthfirst Commercial |
$62.77
|
| Rate for Payer: Healthfirst Essential Plan |
$141.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$59.63
|
| Rate for Payer: Healthfirst QHP |
$62.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$43.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$62.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$53.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$43.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.08
|
| Rate for Payer: SOMOS Essential |
$47.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.77
|
|
|
CHG RADIOLOGIC EXAM TEETH COMPLETE FULL MOUTH
|
Professional
|
Both
|
$43.23
|
|
|
Service Code
|
HCPCS 70320 26
|
| Min. Negotiated Rate |
$8.46 |
| Max. Negotiated Rate |
$27.18 |
| Rate for Payer: Cash Price |
$11.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.06
|
| Rate for Payer: Healthfirst Commercial |
$12.08
|
| Rate for Payer: Healthfirst Essential Plan |
$27.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.48
|
| Rate for Payer: Healthfirst QHP |
$12.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$12.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$10.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.06
|
| Rate for Payer: SOMOS Essential |
$9.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.08
|
|
|
CHG RADIOLOGIC EXAM TEETH PRTL EXAM < FULL MOUTH
|
Professional
|
Both
|
$169.26
|
|
|
Service Code
|
HCPCS 70310
|
| Min. Negotiated Rate |
$32.98 |
| Max. Negotiated Rate |
$106.02 |
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$42.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$44.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$44.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.34
|
| Rate for Payer: Healthfirst Commercial |
$47.12
|
| Rate for Payer: Healthfirst Essential Plan |
$106.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.76
|
| Rate for Payer: Healthfirst QHP |
$47.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$47.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$40.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35.34
|
| Rate for Payer: SOMOS Essential |
$35.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.12
|
|
|
CHG RADIOLOGIC EXAM TEETH PRTL EXAM < FULL MOUTH
|
Professional
|
Both
|
$137.87
|
|
|
Service Code
|
HCPCS 70310 TC
|
| Min. Negotiated Rate |
$26.79 |
| Max. Negotiated Rate |
$86.11 |
| Rate for Payer: Cash Price |
$38.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.70
|
| Rate for Payer: Healthfirst Commercial |
$38.27
|
| Rate for Payer: Healthfirst Essential Plan |
$86.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.36
|
| Rate for Payer: Healthfirst QHP |
$38.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.70
|
| Rate for Payer: SOMOS Essential |
$28.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.27
|
|
|
CHG RADIOLOGIC EXAM TEETH PRTL EXAM < FULL MOUTH
|
Professional
|
Both
|
$31.40
|
|
|
Service Code
|
HCPCS 70310 26
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$19.91 |
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.64
|
| Rate for Payer: Healthfirst Commercial |
$8.85
|
| Rate for Payer: Healthfirst Essential Plan |
$19.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.41
|
| Rate for Payer: Healthfirst QHP |
$8.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.64
|
| Rate for Payer: SOMOS Essential |
$6.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.85
|
|
|
CHG RADIOLOGIC EXAM UPR GI TRC DOUBLE CONTRAST STUDY
|
Professional
|
Both
|
$429.66
|
|
|
Service Code
|
HCPCS 74246 TC
|
| Min. Negotiated Rate |
$77.06 |
| Max. Negotiated Rate |
$247.68 |
| Rate for Payer: Cash Price |
$114.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$110.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$99.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$99.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$104.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$110.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$104.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$110.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$110.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$82.56
|
| Rate for Payer: Healthfirst Commercial |
$110.08
|
| Rate for Payer: Healthfirst Essential Plan |
$247.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$104.58
|
| Rate for Payer: Healthfirst QHP |
$110.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$77.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$110.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$93.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$77.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$110.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$82.56
|
| Rate for Payer: SOMOS Essential |
$82.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$110.08
|
|
|
CHG RADIOLOGIC EXAM UPR GI TRC DOUBLE CONTRAST STUDY
|
Professional
|
Both
|
$169.68
|
|
|
Service Code
|
HCPCS 74246 26
|
| Min. Negotiated Rate |
$32.13 |
| Max. Negotiated Rate |
$103.28 |
| Rate for Payer: Cash Price |
$46.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$45.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$45.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.42
|
| Rate for Payer: Healthfirst Commercial |
$45.90
|
| Rate for Payer: Healthfirst Essential Plan |
$103.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43.60
|
| Rate for Payer: Healthfirst QHP |
$45.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$45.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$34.42
|
| Rate for Payer: SOMOS Essential |
$34.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.90
|
|
|
CHG RADIOLOGIC EXAM UPR GI TRC DOUBLE CONTRAST STUDY
|
Professional
|
Both
|
$599.34
|
|
|
Service Code
|
HCPCS 74246
|
| Min. Negotiated Rate |
$109.19 |
| Max. Negotiated Rate |
$350.95 |
| Rate for Payer: Cash Price |
$161.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$155.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$140.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$140.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$148.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$155.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$148.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$155.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$155.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$116.98
|
| Rate for Payer: Healthfirst Commercial |
$155.98
|
| Rate for Payer: Healthfirst Essential Plan |
$350.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$148.18
|
| Rate for Payer: Healthfirst QHP |
$155.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$109.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$155.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$132.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$109.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$155.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$116.98
|
| Rate for Payer: SOMOS Essential |
$116.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$155.98
|
|
|
CHG RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY
|
Professional
|
Both
|
$529.31
|
|
|
Service Code
|
HCPCS 74240
|
| Min. Negotiated Rate |
$96.72 |
| Max. Negotiated Rate |
$310.88 |
| Rate for Payer: Cash Price |
$142.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$138.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$124.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$124.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$138.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$138.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$138.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$103.63
|
| Rate for Payer: Healthfirst Commercial |
$138.17
|
| Rate for Payer: Healthfirst Essential Plan |
$310.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$131.26
|
| Rate for Payer: Healthfirst QHP |
$138.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$96.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$138.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$117.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$96.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$138.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$103.63
|
| Rate for Payer: SOMOS Essential |
$103.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$138.17
|
|
|
CHG RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY
|
Professional
|
Both
|
$154.28
|
|
|
Service Code
|
HCPCS 74240 26
|
| Min. Negotiated Rate |
$29.18 |
| Max. Negotiated Rate |
$93.78 |
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$41.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$39.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.26
|
| Rate for Payer: Healthfirst Commercial |
$41.68
|
| Rate for Payer: Healthfirst Essential Plan |
$93.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.60
|
| Rate for Payer: Healthfirst QHP |
$41.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$41.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$35.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31.26
|
| Rate for Payer: SOMOS Essential |
$31.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.68
|
|
|
CHG RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY
|
Professional
|
Both
|
$375.06
|
|
|
Service Code
|
HCPCS 74240 TC
|
| Min. Negotiated Rate |
$67.54 |
| Max. Negotiated Rate |
$217.10 |
| Rate for Payer: Cash Price |
$100.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$96.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$86.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$86.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$91.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$96.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$91.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$96.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$96.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.37
|
| Rate for Payer: Healthfirst Commercial |
$96.49
|
| Rate for Payer: Healthfirst Essential Plan |
$217.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$91.67
|
| Rate for Payer: Healthfirst QHP |
$96.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$67.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$96.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$82.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$67.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$96.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$72.37
|
| Rate for Payer: SOMOS Essential |
$72.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$96.49
|
|
|
CHG RADIOLOGIC SMALL INTESTINE FOLLOW-THROUGH STUDY
|
Professional
|
Both
|
$134.54
|
|
|
Service Code
|
HCPCS 74248 26
|
| Min. Negotiated Rate |
$25.40 |
| Max. Negotiated Rate |
$81.65 |
| Rate for Payer: Cash Price |
$36.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$36.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.22
|
| Rate for Payer: Healthfirst Commercial |
$36.29
|
| Rate for Payer: Healthfirst Essential Plan |
$81.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.48
|
| Rate for Payer: Healthfirst QHP |
$36.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$36.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.22
|
| Rate for Payer: SOMOS Essential |
$27.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.29
|
|
|
CHG RADIOLOGIC SMALL INTESTINE FOLLOW-THROUGH STUDY
|
Professional
|
Both
|
$354.34
|
|
|
Service Code
|
HCPCS 74248
|
| Min. Negotiated Rate |
$64.96 |
| Max. Negotiated Rate |
$208.80 |
| Rate for Payer: Cash Price |
$95.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$92.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$83.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$83.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$88.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$92.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$88.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.60
|
| Rate for Payer: Healthfirst Commercial |
$92.80
|
| Rate for Payer: Healthfirst Essential Plan |
$208.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$88.16
|
| Rate for Payer: Healthfirst QHP |
$92.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$92.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$78.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$92.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.60
|
| Rate for Payer: SOMOS Essential |
$69.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$92.80
|
|
|
CHG RADIOLOGIC SMALL INTESTINE FOLLOW-THROUGH STUDY
|
Professional
|
Both
|
$219.80
|
|
|
Service Code
|
HCPCS 74248 TC
|
| Min. Negotiated Rate |
$39.56 |
| Max. Negotiated Rate |
$127.15 |
| Rate for Payer: Cash Price |
$58.78
|
| 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 RADIOPHARMACEUTICAL DACRYOCYSTOGRAPHY
|
Professional
|
Both
|
$616.25
|
|
|
Service Code
|
HCPCS 78660
|
| Min. Negotiated Rate |
$106.24 |
| Max. Negotiated Rate |
$341.48 |
| Rate for Payer: Cash Price |
$155.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$151.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$136.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$136.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$144.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$151.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$144.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$151.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$151.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$113.83
|
| Rate for Payer: Healthfirst Commercial |
$151.77
|
| Rate for Payer: Healthfirst Essential Plan |
$341.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$144.18
|
| Rate for Payer: Healthfirst QHP |
$151.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$106.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$151.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$129.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$106.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$151.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$113.83
|
| Rate for Payer: SOMOS Essential |
$113.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$151.77
|
|
|
CHG RADIOPHARMACEUTICAL DACRYOCYSTOGRAPHY
|
Professional
|
Both
|
$82.04
|
|
|
Service Code
|
HCPCS 78660 26
|
| Min. Negotiated Rate |
$15.66 |
| Max. Negotiated Rate |
$50.33 |
| Rate for Payer: Cash Price |
$22.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.78
|
| Rate for Payer: Healthfirst Commercial |
$22.37
|
| Rate for Payer: Healthfirst Essential Plan |
$50.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.25
|
| Rate for Payer: Healthfirst QHP |
$22.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$15.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$22.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$19.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$16.78
|
| Rate for Payer: SOMOS Essential |
$16.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.37
|
|
|
CHG RADIOPHARMACEUTICAL DACRYOCYSTOGRAPHY
|
Professional
|
Both
|
$534.21
|
|
|
Service Code
|
HCPCS 78660 TC
|
| Min. Negotiated Rate |
$90.58 |
| Max. Negotiated Rate |
$291.15 |
| Rate for Payer: Cash Price |
$132.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$129.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$116.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$116.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$122.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$129.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$122.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$129.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$129.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$97.05
|
| Rate for Payer: Healthfirst Commercial |
$129.40
|
| Rate for Payer: Healthfirst Essential Plan |
$291.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$122.93
|
| Rate for Payer: Healthfirst QHP |
$129.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$90.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$129.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$109.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$90.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$129.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$97.05
|
| Rate for Payer: SOMOS Essential |
$97.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$129.40
|
|
|
CHG RADIOPHARMACEUTICAL QUANTIFICATION MEAS 1 AREA
|
Professional
|
Both
|
$393.40
|
|
|
Service Code
|
HCPCS 78835
|
| Min. Negotiated Rate |
$71.05 |
| Max. Negotiated Rate |
$228.38 |
| Rate for Payer: Cash Price |
$103.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$101.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$91.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$91.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$96.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$101.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$96.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$101.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$101.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$76.12
|
| Rate for Payer: Healthfirst Commercial |
$101.50
|
| Rate for Payer: Healthfirst Essential Plan |
$228.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$96.42
|
| Rate for Payer: Healthfirst QHP |
$101.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$71.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$101.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$86.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$71.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$101.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$76.12
|
| Rate for Payer: SOMOS Essential |
$76.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$101.50
|
|
|
CHG RADIOPHARMACEUTICAL QUANTIFICATION MEAS 1 AREA
|
Professional
|
Both
|
$308.91
|
|
|
Service Code
|
HCPCS 78835 TC
|
| Min. Negotiated Rate |
$55.05 |
| Max. Negotiated Rate |
$176.94 |
| Rate for Payer: Cash Price |
$80.78
|
| 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 RADIOPHARMACEUTICAL QUANTIFICATION MEAS 1 AREA
|
Professional
|
Both
|
$84.46
|
|
|
Service Code
|
HCPCS 78835 26
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$51.44 |
| Rate for Payer: Cash Price |
$22.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.14
|
| Rate for Payer: Healthfirst Commercial |
$22.86
|
| Rate for Payer: Healthfirst Essential Plan |
$51.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.72
|
| Rate for Payer: Healthfirst QHP |
$22.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$16.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$22.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$19.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$16.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$17.14
|
| Rate for Payer: SOMOS Essential |
$17.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.86
|
|
