|
CHG RP THERAPY ORAL ADMINISTRATION
|
Professional
|
Both
|
$333.73
|
|
|
Service Code
|
HCPCS 79005 26
|
| Min. Negotiated Rate |
$63.28 |
| Max. Negotiated Rate |
$203.40 |
| Rate for Payer: Cash Price |
$90.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$90.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$81.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$81.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$85.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$90.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$85.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$90.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67.80
|
| Rate for Payer: Healthfirst Commercial |
$90.40
|
| Rate for Payer: Healthfirst Essential Plan |
$203.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$85.88
|
| Rate for Payer: Healthfirst QHP |
$90.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$63.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$90.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$76.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$63.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$90.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$67.80
|
| Rate for Payer: SOMOS Essential |
$67.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$90.40
|
|
|
CHG RP THER RADIOLBLD MONOCLONAL ANTIBODY IV INFUS
|
Professional
|
Both
|
$421.58
|
|
|
Service Code
|
HCPCS 79403 26
|
| Min. Negotiated Rate |
$65.61 |
| Max. Negotiated Rate |
$210.89 |
| Rate for Payer: Cash Price |
$119.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$93.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$84.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$84.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$89.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$93.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$89.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$70.30
|
| Rate for Payer: Healthfirst Commercial |
$93.73
|
| Rate for Payer: Healthfirst Essential Plan |
$210.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$89.04
|
| Rate for Payer: Healthfirst QHP |
$93.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$65.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$93.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$79.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$65.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$93.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$70.30
|
| Rate for Payer: SOMOS Essential |
$70.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$93.73
|
|
|
CHG RP THER RADIOLBLD MONOCLONAL ANTIBODY IV INFUS
|
Professional
|
Both
|
$407.68
|
|
|
Service Code
|
HCPCS 79403 TC
|
| Min. Negotiated Rate |
$67.21 |
| Max. Negotiated Rate |
$216.04 |
| Rate for Payer: Cash Price |
$119.99
|
| 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 RP THER RADIOLBLD MONOCLONAL ANTIBODY IV INFUS
|
Professional
|
Both
|
$829.26
|
|
|
Service Code
|
HCPCS 79403
|
| Min. Negotiated Rate |
$132.82 |
| Max. Negotiated Rate |
$426.94 |
| Rate for Payer: Cash Price |
$239.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$189.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$170.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$170.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$180.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$189.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$180.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$189.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$189.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$142.31
|
| Rate for Payer: Healthfirst Commercial |
$189.75
|
| Rate for Payer: Healthfirst Essential Plan |
$426.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$180.26
|
| Rate for Payer: Healthfirst QHP |
$189.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$132.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$189.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$161.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$132.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$189.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$142.31
|
| Rate for Payer: SOMOS Essential |
$142.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$189.75
|
|
|
CHG SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER
|
Professional
|
Both
|
$135.91
|
|
|
Service Code
|
HCPCS 76831 26
|
| Min. Negotiated Rate |
$25.84 |
| Max. Negotiated Rate |
$83.05 |
| Rate for Payer: Cash Price |
$37.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$36.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.68
|
| Rate for Payer: Healthfirst Commercial |
$36.91
|
| Rate for Payer: Healthfirst Essential Plan |
$83.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.06
|
| Rate for Payer: Healthfirst QHP |
$36.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$36.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$31.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.68
|
| Rate for Payer: SOMOS Essential |
$27.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.91
|
|
|
CHG SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER
|
Professional
|
Both
|
$493.71
|
|
|
Service Code
|
HCPCS 76831
|
| Min. Negotiated Rate |
$91.37 |
| Max. Negotiated Rate |
$293.69 |
| Rate for Payer: Cash Price |
$134.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$130.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$117.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$117.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$124.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$130.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$124.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$97.90
|
| Rate for Payer: Healthfirst Commercial |
$130.53
|
| Rate for Payer: Healthfirst Essential Plan |
$293.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$124.00
|
| Rate for Payer: Healthfirst QHP |
$130.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$91.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$130.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$110.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$91.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$130.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$97.90
|
| Rate for Payer: SOMOS Essential |
$97.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.53
|
|
|
CHG SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER
|
Professional
|
Both
|
$357.81
|
|
|
Service Code
|
HCPCS 76831 TC
|
| Min. Negotiated Rate |
$65.53 |
| Max. Negotiated Rate |
$210.65 |
| Rate for Payer: Cash Price |
$97.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$93.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$84.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$84.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$88.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$93.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$88.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$70.22
|
| Rate for Payer: Healthfirst Commercial |
$93.62
|
| Rate for Payer: Healthfirst Essential Plan |
$210.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$88.94
|
| Rate for Payer: Healthfirst QHP |
$93.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$65.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$93.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$79.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$65.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$93.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$70.22
|
| Rate for Payer: SOMOS Essential |
$70.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$93.62
|
|
|
CHG SALIVARY GLAND FUNCTION STUDY
|
Professional
|
Both
|
$73.12
|
|
|
Service Code
|
HCPCS 78232 26
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$44.80 |
| Rate for Payer: Cash Price |
$19.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.93
|
| Rate for Payer: Healthfirst Commercial |
$19.91
|
| Rate for Payer: Healthfirst Essential Plan |
$44.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.91
|
| Rate for Payer: Healthfirst QHP |
$19.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$14.93
|
| Rate for Payer: SOMOS Essential |
$14.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.91
|
|
|
CHG SALIVARY GLAND FUNCTION STUDY
|
Professional
|
Both
|
$436.24
|
|
|
Service Code
|
HCPCS 78232
|
| Min. Negotiated Rate |
$82.78 |
| Max. Negotiated Rate |
$266.08 |
| Rate for Payer: Cash Price |
$119.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$118.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$106.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$106.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$112.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$118.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$112.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$118.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$118.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.69
|
| Rate for Payer: Healthfirst Commercial |
$118.26
|
| Rate for Payer: Healthfirst Essential Plan |
$266.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$112.35
|
| Rate for Payer: Healthfirst QHP |
$118.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$82.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$118.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$100.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$82.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$118.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$88.69
|
| Rate for Payer: SOMOS Essential |
$88.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$118.26
|
|
|
CHG SALIVARY GLAND FUNCTION STUDY
|
Professional
|
Both
|
$363.13
|
|
|
Service Code
|
HCPCS 78232 TC
|
| Min. Negotiated Rate |
$68.84 |
| Max. Negotiated Rate |
$221.29 |
| Rate for Payer: Cash Price |
$99.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$98.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$88.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$88.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$93.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$98.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$93.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$98.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$98.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.76
|
| Rate for Payer: Healthfirst Commercial |
$98.35
|
| Rate for Payer: Healthfirst Essential Plan |
$221.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$93.43
|
| Rate for Payer: Healthfirst QHP |
$98.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$68.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$98.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$83.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$68.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$98.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$73.76
|
| Rate for Payer: SOMOS Essential |
$73.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$98.35
|
|
|
CHG SALIVARY GLAND IMAGING
|
Professional
|
Both
|
$630.49
|
|
|
Service Code
|
HCPCS 78230 TC
|
| Min. Negotiated Rate |
$115.58 |
| Max. Negotiated Rate |
$371.50 |
| Rate for Payer: Cash Price |
$169.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$165.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$148.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$148.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$156.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$165.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$156.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$165.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$123.83
|
| Rate for Payer: Healthfirst Commercial |
$165.11
|
| Rate for Payer: Healthfirst Essential Plan |
$371.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$156.85
|
| Rate for Payer: Healthfirst QHP |
$165.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$115.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$165.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$140.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$115.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$165.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$123.83
|
| Rate for Payer: SOMOS Essential |
$123.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$165.11
|
|
|
CHG SALIVARY GLAND IMAGING
|
Professional
|
Both
|
$84.84
|
|
|
Service Code
|
HCPCS 78230 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 SALIVARY GLAND IMAGING
|
Professional
|
Both
|
$715.33
|
|
|
Service Code
|
HCPCS 78230
|
| Min. Negotiated Rate |
$131.64 |
| Max. Negotiated Rate |
$423.13 |
| Rate for Payer: Cash Price |
$192.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$188.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$169.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$169.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$178.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$188.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$178.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$188.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$188.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$141.04
|
| Rate for Payer: Healthfirst Commercial |
$188.06
|
| Rate for Payer: Healthfirst Essential Plan |
$423.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$178.66
|
| Rate for Payer: Healthfirst QHP |
$188.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$131.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$188.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$159.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$131.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$188.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$141.04
|
| Rate for Payer: SOMOS Essential |
$141.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$188.06
|
|
|
CHG SALIVARY GLAND IMAGING SERIAL IMAGES
|
Professional
|
Both
|
$80.82
|
|
|
Service Code
|
HCPCS 78231 26
|
| Min. Negotiated Rate |
$15.42 |
| Max. Negotiated Rate |
$49.57 |
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$19.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$20.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.52
|
| Rate for Payer: Healthfirst Commercial |
$22.03
|
| Rate for Payer: Healthfirst Essential Plan |
$49.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20.93
|
| Rate for Payer: Healthfirst QHP |
$22.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$15.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$22.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$18.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$16.52
|
| Rate for Payer: SOMOS Essential |
$16.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.03
|
|
|
CHG SALIVARY GLAND IMAGING SERIAL IMAGES
|
Professional
|
Both
|
$442.51
|
|
|
Service Code
|
HCPCS 78231
|
| Min. Negotiated Rate |
$83.99 |
| Max. Negotiated Rate |
$269.95 |
| Rate for Payer: Cash Price |
$121.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$119.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$107.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$107.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$119.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$119.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$119.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$89.98
|
| Rate for Payer: Healthfirst Commercial |
$119.98
|
| Rate for Payer: Healthfirst Essential Plan |
$269.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$113.98
|
| Rate for Payer: Healthfirst QHP |
$119.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$83.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$119.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$101.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$83.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$119.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$89.98
|
| Rate for Payer: SOMOS Essential |
$89.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$119.98
|
|
|
CHG SALIVARY GLAND IMAGING SERIAL IMAGES
|
Professional
|
Both
|
$361.69
|
|
|
Service Code
|
HCPCS 78231 TC
|
| Min. Negotiated Rate |
$68.57 |
| Max. Negotiated Rate |
$220.41 |
| Rate for Payer: Cash Price |
$99.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$97.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$88.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$88.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$93.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$97.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$93.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$97.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$97.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.47
|
| Rate for Payer: Healthfirst Commercial |
$97.96
|
| Rate for Payer: Healthfirst Essential Plan |
$220.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$93.06
|
| Rate for Payer: Healthfirst QHP |
$97.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$68.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$97.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$83.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$68.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$97.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$73.47
|
| Rate for Payer: SOMOS Essential |
$73.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$97.96
|
|
|
CHG SCREENING DIGITAL BREAST TOMOSYNTHESIS BI
|
Professional
|
Both
|
$103.50
|
|
|
Service Code
|
HCPCS 77063 TC
|
| Min. Negotiated Rate |
$19.57 |
| Max. Negotiated Rate |
$62.89 |
| Rate for Payer: Cash Price |
$28.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.96
|
| Rate for Payer: Healthfirst Commercial |
$27.95
|
| Rate for Payer: Healthfirst Essential Plan |
$62.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.55
|
| Rate for Payer: Healthfirst QHP |
$27.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$27.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.96
|
| Rate for Payer: SOMOS Essential |
$20.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.95
|
|
|
CHG SCREENING DIGITAL BREAST TOMOSYNTHESIS BI
|
Professional
|
Both
|
$221.24
|
|
|
Service Code
|
HCPCS 77063
|
| Min. Negotiated Rate |
$41.31 |
| Max. Negotiated Rate |
$132.77 |
| Rate for Payer: Cash Price |
$59.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$59.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$53.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$56.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$59.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$56.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.26
|
| Rate for Payer: Healthfirst Commercial |
$59.01
|
| Rate for Payer: Healthfirst Essential Plan |
$132.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$56.06
|
| Rate for Payer: Healthfirst QHP |
$59.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$41.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$59.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$50.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$41.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$59.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$44.26
|
| Rate for Payer: SOMOS Essential |
$44.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$59.01
|
|
|
CHG SCREENING DIGITAL BREAST TOMOSYNTHESIS BI
|
Professional
|
Both
|
$117.71
|
|
|
Service Code
|
HCPCS 77063 26
|
| Min. Negotiated Rate |
$21.74 |
| Max. Negotiated Rate |
$69.89 |
| Rate for Payer: Cash Price |
$31.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$27.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.30
|
| Rate for Payer: Healthfirst Commercial |
$31.06
|
| Rate for Payer: Healthfirst Essential Plan |
$69.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.51
|
| Rate for Payer: Healthfirst QHP |
$31.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$31.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.30
|
| Rate for Payer: SOMOS Essential |
$23.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.06
|
|
|
CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD
|
Professional
|
Both
|
$545.86
|
|
|
Service Code
|
HCPCS 77067
|
| Min. Negotiated Rate |
$103.09 |
| Max. Negotiated Rate |
$331.36 |
| Rate for Payer: Cash Price |
$148.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$132.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$132.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$139.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$139.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$147.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$110.45
|
| Rate for Payer: Healthfirst Commercial |
$147.27
|
| Rate for Payer: Healthfirst Essential Plan |
$331.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$139.91
|
| Rate for Payer: Healthfirst QHP |
$147.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$103.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$147.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$125.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$103.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$110.45
|
| Rate for Payer: SOMOS Essential |
$110.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.27
|
|
|
CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD
|
Professional
|
Both
|
$146.37
|
|
|
Service Code
|
HCPCS 77067 26
|
| Min. Negotiated Rate |
$27.66 |
| Max. Negotiated Rate |
$88.92 |
| Rate for Payer: Cash Price |
$39.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$39.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.64
|
| Rate for Payer: Healthfirst Commercial |
$39.52
|
| Rate for Payer: Healthfirst Essential Plan |
$88.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.54
|
| Rate for Payer: Healthfirst QHP |
$39.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$39.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.64
|
| Rate for Payer: SOMOS Essential |
$29.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.52
|
|
|
CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD
|
Professional
|
Both
|
$399.49
|
|
|
Service Code
|
HCPCS 77067 TC
|
| Min. Negotiated Rate |
$75.42 |
| Max. Negotiated Rate |
$242.44 |
| Rate for Payer: Cash Price |
$109.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$107.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$96.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$96.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$102.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$102.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$107.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.81
|
| Rate for Payer: Healthfirst Commercial |
$107.75
|
| Rate for Payer: Healthfirst Essential Plan |
$242.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$102.36
|
| Rate for Payer: Healthfirst QHP |
$107.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$75.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$107.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$91.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$75.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$107.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$80.81
|
| Rate for Payer: SOMOS Essential |
$80.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$107.75
|
|
|
CHG SHUNTOGRAM INDWELLING NONVASCULAR SHUNT RS&I
|
Professional
|
Both
|
$95.69
|
|
|
Service Code
|
HCPCS 75809 26
|
| Min. Negotiated Rate |
$17.52 |
| Max. Negotiated Rate |
$56.32 |
| Rate for Payer: Cash Price |
$24.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.77
|
| Rate for Payer: Healthfirst Commercial |
$25.03
|
| Rate for Payer: Healthfirst Essential Plan |
$56.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23.78
|
| Rate for Payer: Healthfirst QHP |
$25.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$25.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$21.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18.77
|
| Rate for Payer: SOMOS Essential |
$18.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.03
|
|
|
CHG SHUNTOGRAM INDWELLING NONVASCULAR SHUNT RS&I
|
Professional
|
Both
|
$352.87
|
|
|
Service Code
|
HCPCS 75809
|
| Min. Negotiated Rate |
$65.23 |
| Max. Negotiated Rate |
$209.68 |
| Rate for Payer: Cash Price |
$95.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$93.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$83.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$83.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$88.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$93.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$88.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.89
|
| Rate for Payer: Healthfirst Commercial |
$93.19
|
| Rate for Payer: Healthfirst Essential Plan |
$209.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$88.53
|
| Rate for Payer: Healthfirst QHP |
$93.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$65.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$93.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$79.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$65.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$93.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.89
|
| Rate for Payer: SOMOS Essential |
$69.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$93.19
|
|
|
CHG SHUNTOGRAM INDWELLING NONVASCULAR SHUNT RS&I
|
Professional
|
Both
|
$257.18
|
|
|
Service Code
|
HCPCS 75809 TC
|
| Min. Negotiated Rate |
$47.71 |
| Max. Negotiated Rate |
$153.36 |
| Rate for Payer: Cash Price |
$70.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$68.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$61.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$68.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$68.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$68.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51.12
|
| Rate for Payer: Healthfirst Commercial |
$68.16
|
| Rate for Payer: Healthfirst Essential Plan |
$153.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$64.75
|
| Rate for Payer: Healthfirst QHP |
$68.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$47.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$68.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$57.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$47.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$68.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$51.12
|
| Rate for Payer: SOMOS Essential |
$51.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$68.16
|
|
