|
CHG ULTRASOUND ELASTOGRAPHY FIRST TARGET LESION
|
Professional
|
Both
|
$116.48
|
|
|
Service Code
|
HCPCS 76982 26
|
| Min. Negotiated Rate |
$21.50 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Cash Price |
$31.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$27.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$30.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.04
|
| Rate for Payer: Healthfirst Commercial |
$30.72
|
| Rate for Payer: Healthfirst Essential Plan |
$69.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.18
|
| Rate for Payer: Healthfirst QHP |
$30.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$30.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.04
|
| Rate for Payer: SOMOS Essential |
$23.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.72
|
|
|
CHG ULTRASOUND ELASTOGRAPHY PARENCHYMA
|
Professional
|
Both
|
$116.48
|
|
|
Service Code
|
HCPCS 76981 26
|
| Min. Negotiated Rate |
$21.78 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Cash Price |
$31.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.33
|
| Rate for Payer: Healthfirst Commercial |
$31.11
|
| Rate for Payer: Healthfirst Essential Plan |
$70.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.55
|
| Rate for Payer: Healthfirst QHP |
$31.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$31.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.33
|
| Rate for Payer: SOMOS Essential |
$23.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.11
|
|
|
CHG ULTRASOUND ELASTOGRAPHY PARENCHYMA
|
Professional
|
Both
|
$445.52
|
|
|
Service Code
|
HCPCS 76981
|
| Min. Negotiated Rate |
$85.13 |
| Max. Negotiated Rate |
$273.64 |
| Rate for Payer: Cash Price |
$121.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$121.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$109.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$109.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$115.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$121.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$115.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$121.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$121.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$91.22
|
| Rate for Payer: Healthfirst Commercial |
$121.62
|
| Rate for Payer: Healthfirst Essential Plan |
$273.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$115.54
|
| Rate for Payer: Healthfirst QHP |
$121.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$85.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$121.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$103.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$85.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$121.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$91.22
|
| Rate for Payer: SOMOS Essential |
$91.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$121.62
|
|
|
CHG ULTRASOUND ELASTOGRAPHY PARENCHYMA
|
Professional
|
Both
|
$329.04
|
|
|
Service Code
|
HCPCS 76981 TC
|
| Min. Negotiated Rate |
$63.36 |
| Max. Negotiated Rate |
$203.65 |
| Rate for Payer: Cash Price |
$90.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$90.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$81.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$81.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$85.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$90.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$85.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$90.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67.88
|
| Rate for Payer: Healthfirst Commercial |
$90.51
|
| Rate for Payer: Healthfirst Essential Plan |
$203.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$85.98
|
| Rate for Payer: Healthfirst QHP |
$90.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$63.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$90.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$76.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$63.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$90.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$67.88
|
| Rate for Payer: SOMOS Essential |
$67.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$90.51
|
|
|
CHG ULTRASOUND SPINAL CANAL & CONTENTS
|
Professional
|
Both
|
$261.21
|
|
|
Service Code
|
HCPCS 76800 26
|
| Min. Negotiated Rate |
$51.01 |
| Max. Negotiated Rate |
$163.96 |
| Rate for Payer: Cash Price |
$71.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$72.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$65.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$69.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$69.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.65
|
| Rate for Payer: Healthfirst Commercial |
$72.87
|
| Rate for Payer: Healthfirst Essential Plan |
$163.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.23
|
| Rate for Payer: Healthfirst QHP |
$72.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$51.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$72.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$61.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$51.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$54.65
|
| Rate for Payer: SOMOS Essential |
$54.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.87
|
|
|
CHG ULTRASOUND SPINAL CANAL & CONTENTS
|
Professional
|
Both
|
$418.18
|
|
|
Service Code
|
HCPCS 76800 TC
|
| Min. Negotiated Rate |
$96.35 |
| Max. Negotiated Rate |
$309.69 |
| Rate for Payer: Cash Price |
$131.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$137.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$123.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$123.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$130.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$137.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$130.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$137.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$137.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$103.23
|
| Rate for Payer: Healthfirst Commercial |
$137.64
|
| Rate for Payer: Healthfirst Essential Plan |
$309.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$130.76
|
| Rate for Payer: Healthfirst QHP |
$137.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$96.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$137.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$116.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$96.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$137.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$103.23
|
| Rate for Payer: SOMOS Essential |
$103.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$137.64
|
|
|
CHG ULTRASOUND SPINAL CANAL & CONTENTS
|
Professional
|
Both
|
$679.39
|
|
|
Service Code
|
HCPCS 76800
|
| Min. Negotiated Rate |
$147.36 |
| Max. Negotiated Rate |
$473.65 |
| Rate for Payer: Cash Price |
$203.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$210.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$189.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$189.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$199.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$210.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$199.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$210.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$210.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$157.88
|
| Rate for Payer: Healthfirst Commercial |
$210.51
|
| Rate for Payer: Healthfirst Essential Plan |
$473.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$199.98
|
| Rate for Payer: Healthfirst QHP |
$210.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$147.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$210.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$178.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$147.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$210.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$157.88
|
| Rate for Payer: SOMOS Essential |
$157.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$210.51
|
|
|
CHG ULTRASOUND TRGT DYNAMIC MICROBUBBLE 1ST LESION
|
Professional
|
Both
|
$1,087.00
|
|
|
Service Code
|
HCPCS 76978
|
| Min. Negotiated Rate |
$154.63 |
| Max. Negotiated Rate |
$497.02 |
| Rate for Payer: Cash Price |
$256.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$220.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$198.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$198.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$209.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$220.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$209.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$220.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$220.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.68
|
| Rate for Payer: Healthfirst Commercial |
$220.90
|
| Rate for Payer: Healthfirst Essential Plan |
$497.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.85
|
| Rate for Payer: Healthfirst QHP |
$220.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$154.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$220.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$187.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$154.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$220.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$165.68
|
| Rate for Payer: SOMOS Essential |
$165.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$220.90
|
|
|
CHG ULTRASOUND TRGT DYNAMIC MICROBUBBLE 1ST LESION
|
Professional
|
Both
|
$309.61
|
|
|
Service Code
|
HCPCS 76978 26
|
| Min. Negotiated Rate |
$58.13 |
| Max. Negotiated Rate |
$186.84 |
| Rate for Payer: Cash Price |
$84.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$83.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$74.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$74.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$78.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$83.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$78.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$62.28
|
| Rate for Payer: Healthfirst Commercial |
$83.04
|
| Rate for Payer: Healthfirst Essential Plan |
$186.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$78.89
|
| Rate for Payer: Healthfirst QHP |
$83.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$58.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$83.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$70.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$58.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$83.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$62.28
|
| Rate for Payer: SOMOS Essential |
$62.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$83.04
|
|
|
CHG ULTRASOUND TRGT DYNAMIC MICROBUBBLE 1ST LESION
|
Professional
|
Both
|
$777.42
|
|
|
Service Code
|
HCPCS 76978 TC
|
| Min. Negotiated Rate |
$96.51 |
| Max. Negotiated Rate |
$310.21 |
| Rate for Payer: Cash Price |
$172.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$137.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$124.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$124.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$130.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$137.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$130.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$137.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$137.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$103.40
|
| Rate for Payer: Healthfirst Commercial |
$137.87
|
| Rate for Payer: Healthfirst Essential Plan |
$310.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$130.98
|
| Rate for Payer: Healthfirst QHP |
$137.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$96.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$137.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$117.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$96.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$137.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$103.40
|
| Rate for Payer: SOMOS Essential |
$103.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$137.87
|
|
|
CHG ULTRASOUND TRGT DYNAMIC MICROBUBBLE EA ADDL LES
|
Professional
|
Both
|
$550.41
|
|
|
Service Code
|
HCPCS 76979 TC
|
| Min. Negotiated Rate |
$68.09 |
| Max. Negotiated Rate |
$218.86 |
| Rate for Payer: Cash Price |
$121.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$97.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$87.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$87.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$92.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$97.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$92.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$97.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$97.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.95
|
| Rate for Payer: Healthfirst Commercial |
$97.27
|
| Rate for Payer: Healthfirst Essential Plan |
$218.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$92.41
|
| Rate for Payer: Healthfirst QHP |
$97.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$68.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$97.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$82.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$68.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$97.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$72.95
|
| Rate for Payer: SOMOS Essential |
$72.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$97.27
|
|
|
CHG ULTRASOUND TRGT DYNAMIC MICROBUBBLE EA ADDL LES
|
Professional
|
Both
|
$712.39
|
|
|
Service Code
|
HCPCS 76979
|
| Min. Negotiated Rate |
$98.74 |
| Max. Negotiated Rate |
$317.38 |
| Rate for Payer: Cash Price |
$165.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$141.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$126.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$126.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$134.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$141.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$134.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$141.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$141.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$105.80
|
| Rate for Payer: Healthfirst Commercial |
$141.06
|
| Rate for Payer: Healthfirst Essential Plan |
$317.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$134.01
|
| Rate for Payer: Healthfirst QHP |
$141.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$98.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$141.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$119.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$98.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$141.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$105.80
|
| Rate for Payer: SOMOS Essential |
$105.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$141.06
|
|
|
CHG ULTRASOUND TRGT DYNAMIC MICROBUBBLE EA ADDL LES
|
Professional
|
Both
|
$161.98
|
|
|
Service Code
|
HCPCS 76979 26
|
| Min. Negotiated Rate |
$30.65 |
| Max. Negotiated Rate |
$98.53 |
| Rate for Payer: Cash Price |
$43.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$43.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.84
|
| Rate for Payer: Healthfirst Commercial |
$43.79
|
| Rate for Payer: Healthfirst Essential Plan |
$98.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.60
|
| Rate for Payer: Healthfirst QHP |
$43.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$43.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.84
|
| Rate for Payer: SOMOS Essential |
$32.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.79
|
|
|
CHG URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM
|
Professional
|
Both
|
$874.13
|
|
|
Service Code
|
HCPCS 78740
|
| Min. Negotiated Rate |
$169.59 |
| Max. Negotiated Rate |
$545.11 |
| Rate for Payer: Cash Price |
$246.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$242.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$218.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$218.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$230.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$242.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$230.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$242.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$242.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$181.70
|
| Rate for Payer: Healthfirst Commercial |
$242.27
|
| Rate for Payer: Healthfirst Essential Plan |
$545.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$230.16
|
| Rate for Payer: Healthfirst QHP |
$242.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$169.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$242.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$205.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$169.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$242.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$181.70
|
| Rate for Payer: SOMOS Essential |
$181.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$242.27
|
|
|
CHG URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM
|
Professional
|
Both
|
$771.37
|
|
|
Service Code
|
HCPCS 78740 TC
|
| Min. Negotiated Rate |
$149.27 |
| Max. Negotiated Rate |
$479.79 |
| Rate for Payer: Cash Price |
$218.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$213.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$191.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$191.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$202.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$213.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$202.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$213.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$213.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$159.93
|
| Rate for Payer: Healthfirst Commercial |
$213.24
|
| Rate for Payer: Healthfirst Essential Plan |
$479.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$202.58
|
| Rate for Payer: Healthfirst QHP |
$213.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$149.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$213.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$181.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$149.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$213.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$159.93
|
| Rate for Payer: SOMOS Essential |
$159.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$213.24
|
|
|
CHG URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM
|
Professional
|
Both
|
$102.73
|
|
|
Service Code
|
HCPCS 78740 26
|
| Min. Negotiated Rate |
$20.31 |
| Max. Negotiated Rate |
$65.30 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.77
|
| Rate for Payer: Healthfirst Commercial |
$29.02
|
| Rate for Payer: Healthfirst Essential Plan |
$65.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.57
|
| Rate for Payer: Healthfirst QHP |
$29.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.77
|
| Rate for Payer: SOMOS Essential |
$21.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.02
|
|
|
CHG URETHROCYSTOGRAPHY RETROGRADE RS&I
|
Professional
|
Both
|
$64.05
|
|
|
Service Code
|
HCPCS 74450 26
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$37.44 |
| Rate for Payer: Cash Price |
$16.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.48
|
| Rate for Payer: Healthfirst Commercial |
$16.64
|
| Rate for Payer: Healthfirst Essential Plan |
$37.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.81
|
| Rate for Payer: Healthfirst QHP |
$16.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$14.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.48
|
| Rate for Payer: SOMOS Essential |
$12.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.64
|
|
|
CHG URETHROCYSTOGRAPHY VOIDING RS&I
|
Professional
|
Both
|
$61.32
|
|
|
Service Code
|
HCPCS 74455 26
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$37.44 |
| Rate for Payer: Cash Price |
$16.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.48
|
| Rate for Payer: Healthfirst Commercial |
$16.64
|
| Rate for Payer: Healthfirst Essential Plan |
$37.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.81
|
| Rate for Payer: Healthfirst QHP |
$16.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$14.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.48
|
| Rate for Payer: SOMOS Essential |
$12.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.64
|
|
|
CHG URETHROCYSTOGRAPHY VOIDING RS&I
|
Professional
|
Both
|
$387.98
|
|
|
Service Code
|
HCPCS 74455 TC
|
| Min. Negotiated Rate |
$70.26 |
| Max. Negotiated Rate |
$225.83 |
| Rate for Payer: Cash Price |
$104.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$100.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$90.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$90.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$95.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$100.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$95.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$75.28
|
| Rate for Payer: Healthfirst Commercial |
$100.37
|
| Rate for Payer: Healthfirst Essential Plan |
$225.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$95.35
|
| Rate for Payer: Healthfirst QHP |
$100.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$70.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$100.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$85.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$70.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$100.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$75.28
|
| Rate for Payer: SOMOS Essential |
$75.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$100.37
|
|
|
CHG URETHROCYSTOGRAPHY VOIDING RS&I
|
Professional
|
Both
|
$449.30
|
|
|
Service Code
|
HCPCS 74455
|
| Min. Negotiated Rate |
$81.91 |
| Max. Negotiated Rate |
$263.30 |
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$117.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$105.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$105.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$111.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$117.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$111.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$117.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$117.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$87.77
|
| Rate for Payer: Healthfirst Commercial |
$117.02
|
| Rate for Payer: Healthfirst Essential Plan |
$263.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$111.17
|
| Rate for Payer: Healthfirst QHP |
$117.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$81.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$117.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$99.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$81.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$117.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$87.77
|
| Rate for Payer: SOMOS Essential |
$87.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$117.02
|
|
|
CHG URINARY BLADDER RESIDUAL STUDY
|
Professional
|
Both
|
$264.36
|
|
|
Service Code
|
HCPCS 78730 TC
|
| Min. Negotiated Rate |
$47.98 |
| Max. Negotiated Rate |
$154.24 |
| Rate for Payer: Cash Price |
$72.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$68.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$61.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$65.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$68.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$65.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$68.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$68.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51.41
|
| Rate for Payer: Healthfirst Commercial |
$68.55
|
| Rate for Payer: Healthfirst Essential Plan |
$154.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$65.12
|
| Rate for Payer: Healthfirst QHP |
$68.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$47.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$68.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$58.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$47.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$68.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$51.41
|
| Rate for Payer: SOMOS Essential |
$51.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$68.55
|
|
|
CHG URINARY BLADDER RESIDUAL STUDY
|
Professional
|
Both
|
$291.76
|
|
|
Service Code
|
HCPCS 78730
|
| Min. Negotiated Rate |
$53.50 |
| Max. Negotiated Rate |
$171.97 |
| Rate for Payer: Cash Price |
$80.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$76.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$68.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$68.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$72.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$76.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$72.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.32
|
| Rate for Payer: Healthfirst Commercial |
$76.43
|
| Rate for Payer: Healthfirst Essential Plan |
$171.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$72.61
|
| Rate for Payer: Healthfirst QHP |
$76.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$53.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$76.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$64.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$53.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$76.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$57.32
|
| Rate for Payer: SOMOS Essential |
$57.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$76.43
|
|
|
CHG URINARY BLADDER RESIDUAL STUDY
|
Professional
|
Both
|
$27.41
|
|
|
Service Code
|
HCPCS 78730 26
|
| Min. Negotiated Rate |
$5.52 |
| Max. Negotiated Rate |
$17.73 |
| Rate for Payer: Cash Price |
$7.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.91
|
| Rate for Payer: Healthfirst Commercial |
$7.88
|
| Rate for Payer: Healthfirst Essential Plan |
$17.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.49
|
| Rate for Payer: Healthfirst QHP |
$7.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$5.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$7.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$6.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$5.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5.91
|
| Rate for Payer: SOMOS Essential |
$5.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.88
|
|
|
CHG URINE ALBUMIN QUANTITATIVE
|
Professional
|
Both
|
$14.45
|
|
|
Service Code
|
HCPCS 82043
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$13.01 |
| Rate for Payer: Cash Price |
$5.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.33
|
| Rate for Payer: Healthfirst Commercial |
$5.78
|
| Rate for Payer: Healthfirst Essential Plan |
$13.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.49
|
| Rate for Payer: Healthfirst QHP |
$5.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$4.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$5.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$4.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$4.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2.31
|
| Rate for Payer: SOMOS Essential |
$2.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.78
|
|
|
CHG URINE ALBUMIN SEMIQUANTITATIVE
|
Professional
|
Both
|
$24.92
|
|
|
Service Code
|
HCPCS 82044
|
| Min. Negotiated Rate |
$2.49 |
| Max. Negotiated Rate |
$14.02 |
| Rate for Payer: Cash Price |
$6.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.67
|
| Rate for Payer: Healthfirst Commercial |
$6.23
|
| Rate for Payer: Healthfirst Essential Plan |
$14.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.92
|
| Rate for Payer: Healthfirst QHP |
$6.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$4.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$6.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$5.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$4.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2.49
|
| Rate for Payer: SOMOS Essential |
$2.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.23
|
|
