|
CHG URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS
|
Professional
|
Both
|
$21.52
|
|
|
Service Code
|
HCPCS 81025
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$19.37 |
| Rate for Payer: Cash Price |
$8.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.46
|
| Rate for Payer: Healthfirst Commercial |
$8.61
|
| Rate for Payer: Healthfirst Essential Plan |
$19.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.18
|
| Rate for Payer: Healthfirst QHP |
$8.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.44
|
| Rate for Payer: SOMOS Essential |
$3.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.61
|
|
|
CHG URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY
|
Professional
|
Both
|
$5.62
|
|
|
Service Code
|
HCPCS 81003
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$5.06 |
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$2.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.69
|
| Rate for Payer: Healthfirst Commercial |
$2.25
|
| Rate for Payer: Healthfirst Essential Plan |
$5.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.14
|
| Rate for Payer: Healthfirst QHP |
$2.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.90
|
| Rate for Payer: SOMOS Essential |
$0.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.25
|
|
|
CHG URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP
|
Professional
|
Both
|
$8.70
|
|
|
Service Code
|
HCPCS 81002
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$7.83 |
| Rate for Payer: Cash Price |
$3.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.61
|
| Rate for Payer: Healthfirst Commercial |
$3.48
|
| Rate for Payer: Healthfirst Essential Plan |
$7.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.31
|
| Rate for Payer: Healthfirst QHP |
$3.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.39
|
| Rate for Payer: SOMOS Essential |
$1.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.48
|
|
|
CHG UROGRAPHY INFUSION DRIP &/BOLUS TECHNIQUE
|
Professional
|
Both
|
$515.80
|
|
|
Service Code
|
HCPCS 74410 TC
|
| Min. Negotiated Rate |
$94.88 |
| Max. Negotiated Rate |
$304.96 |
| Rate for Payer: Cash Price |
$140.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$135.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$121.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$121.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$128.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$135.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$128.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$135.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$135.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$101.66
|
| Rate for Payer: Healthfirst Commercial |
$135.54
|
| Rate for Payer: Healthfirst Essential Plan |
$304.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$128.76
|
| Rate for Payer: Healthfirst QHP |
$135.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$94.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$135.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$115.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$94.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$135.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$101.66
|
| Rate for Payer: SOMOS Essential |
$101.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$135.54
|
|
|
CHG UROGRAPHY INFUSION DRIP &/BOLUS TECHNIQUE
|
Professional
|
Both
|
$607.08
|
|
|
Service Code
|
HCPCS 74410
|
| Min. Negotiated Rate |
$112.45 |
| Max. Negotiated Rate |
$361.44 |
| Rate for Payer: Cash Price |
$165.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$160.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$144.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$144.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$152.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$160.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$152.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$160.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$160.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$120.48
|
| Rate for Payer: Healthfirst Commercial |
$160.64
|
| Rate for Payer: Healthfirst Essential Plan |
$361.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$152.61
|
| Rate for Payer: Healthfirst QHP |
$160.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$112.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$160.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$136.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$112.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$160.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$120.48
|
| Rate for Payer: SOMOS Essential |
$120.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$160.64
|
|
|
CHG UROGRAPHY INFUSION DRIP &/BOLUS TECHNIQUE
|
Professional
|
Both
|
$91.28
|
|
|
Service Code
|
HCPCS 74410 26
|
| Min. Negotiated Rate |
$17.57 |
| Max. Negotiated Rate |
$56.48 |
| Rate for Payer: Cash Price |
$25.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.82
|
| Rate for Payer: Healthfirst Commercial |
$25.10
|
| Rate for Payer: Healthfirst Essential Plan |
$56.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23.84
|
| Rate for Payer: Healthfirst QHP |
$25.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$25.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$21.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18.82
|
| Rate for Payer: SOMOS Essential |
$18.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.10
|
|
|
CHG UROGRAPHY IV W/WO KUB W/WO TOMOGRAPHY
|
Professional
|
Both
|
$96.74
|
|
|
Service Code
|
HCPCS 74400 26
|
| Min. Negotiated Rate |
$17.30 |
| Max. Negotiated Rate |
$55.60 |
| Rate for Payer: Cash Price |
$25.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.53
|
| Rate for Payer: Healthfirst Commercial |
$24.71
|
| Rate for Payer: Healthfirst Essential Plan |
$55.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23.47
|
| Rate for Payer: Healthfirst QHP |
$24.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$24.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$21.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18.53
|
| Rate for Payer: SOMOS Essential |
$18.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.71
|
|
|
CHG UROGRAPHY IV W/WO KUB W/WO TOMOGRAPHY
|
Professional
|
Both
|
$491.33
|
|
|
Service Code
|
HCPCS 74400 TC
|
| Min. Negotiated Rate |
$89.71 |
| Max. Negotiated Rate |
$288.36 |
| Rate for Payer: Cash Price |
$132.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$128.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$115.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$115.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$121.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$128.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$121.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$128.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$128.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$96.12
|
| Rate for Payer: Healthfirst Commercial |
$128.16
|
| Rate for Payer: Healthfirst Essential Plan |
$288.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$121.75
|
| Rate for Payer: Healthfirst QHP |
$128.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$89.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$128.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$108.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$89.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$128.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$96.12
|
| Rate for Payer: SOMOS Essential |
$96.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$128.16
|
|
|
CHG UROGRAPHY IV W/WO KUB W/WO TOMOGRAPHY
|
Professional
|
Both
|
$588.11
|
|
|
Service Code
|
HCPCS 74400
|
| Min. Negotiated Rate |
$107.02 |
| Max. Negotiated Rate |
$343.98 |
| Rate for Payer: Cash Price |
$158.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$152.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$137.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$137.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$145.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$152.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$145.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$152.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$152.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$114.66
|
| Rate for Payer: Healthfirst Commercial |
$152.88
|
| Rate for Payer: Healthfirst Essential Plan |
$343.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$145.24
|
| Rate for Payer: Healthfirst QHP |
$152.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$107.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$152.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$129.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$107.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$152.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$114.66
|
| Rate for Payer: SOMOS Essential |
$114.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$152.88
|
|
|
CHG UROGRAPHY NFS DRIP &/BOLUS W/NEPHROTOMOGRAPHY
|
Professional
|
Both
|
$667.45
|
|
|
Service Code
|
HCPCS 74415
|
| Min. Negotiated Rate |
$121.03 |
| Max. Negotiated Rate |
$389.02 |
| Rate for Payer: Cash Price |
$176.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$172.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$155.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$155.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$164.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$172.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$164.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$172.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$172.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$129.68
|
| Rate for Payer: Healthfirst Commercial |
$172.90
|
| Rate for Payer: Healthfirst Essential Plan |
$389.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$164.25
|
| Rate for Payer: Healthfirst QHP |
$172.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$121.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$172.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$146.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$121.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$172.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$129.68
|
| Rate for Payer: SOMOS Essential |
$129.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$172.90
|
|
|
CHG UROGRAPHY NFS DRIP &/BOLUS W/NEPHROTOMOGRAPHY
|
Professional
|
Both
|
$92.72
|
|
|
Service Code
|
HCPCS 74415 26
|
| Min. Negotiated Rate |
$17.73 |
| Max. Negotiated Rate |
$56.99 |
| Rate for Payer: Cash Price |
$25.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.00
|
| Rate for Payer: Healthfirst Commercial |
$25.33
|
| Rate for Payer: Healthfirst Essential Plan |
$56.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24.06
|
| Rate for Payer: Healthfirst QHP |
$25.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$25.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$21.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19.00
|
| Rate for Payer: SOMOS Essential |
$19.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.33
|
|
|
CHG UROGRAPHY NFS DRIP &/BOLUS W/NEPHROTOMOGRAPHY
|
Professional
|
Both
|
$574.74
|
|
|
Service Code
|
HCPCS 74415 TC
|
| Min. Negotiated Rate |
$103.30 |
| Max. Negotiated Rate |
$332.03 |
| Rate for Payer: Cash Price |
$151.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$132.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$132.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$147.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$110.68
|
| Rate for Payer: Healthfirst Commercial |
$147.57
|
| Rate for Payer: Healthfirst Essential Plan |
$332.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$140.19
|
| Rate for Payer: Healthfirst QHP |
$147.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$103.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$147.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$125.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$103.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$110.68
|
| Rate for Payer: SOMOS Essential |
$110.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.57
|
|
|
CHG UROGRAPHY RETROGRADE WITH/WO KUB
|
Professional
|
Both
|
$96.46
|
|
|
Service Code
|
HCPCS 74420 26
|
| Min. Negotiated Rate |
$18.56 |
| Max. Negotiated Rate |
$59.67 |
| Rate for Payer: Cash Price |
$26.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.89
|
| Rate for Payer: Healthfirst Commercial |
$26.52
|
| Rate for Payer: Healthfirst Essential Plan |
$59.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.19
|
| Rate for Payer: Healthfirst QHP |
$26.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19.89
|
| Rate for Payer: SOMOS Essential |
$19.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.52
|
|
|
CHG UROGRAPHY RETROGRADE WITH/WO KUB
|
Professional
|
Both
|
$326.34
|
|
|
Service Code
|
HCPCS 74420
|
| Min. Negotiated Rate |
$62.48 |
| Max. Negotiated Rate |
$200.81 |
| Rate for Payer: Cash Price |
$90.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$89.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$80.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$80.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$89.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$84.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$89.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$89.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$66.94
|
| Rate for Payer: Healthfirst Commercial |
$89.25
|
| Rate for Payer: Healthfirst Essential Plan |
$200.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$84.79
|
| Rate for Payer: Healthfirst QHP |
$89.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$62.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$89.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$75.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$62.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$89.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$66.94
|
| Rate for Payer: SOMOS Essential |
$66.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$89.25
|
|
|
CHG UROGRAPHY RETROGRADE WITH/WO KUB
|
Professional
|
Both
|
$229.85
|
|
|
Service Code
|
HCPCS 74420 TC
|
| Min. Negotiated Rate |
$43.90 |
| Max. Negotiated Rate |
$141.12 |
| Rate for Payer: Cash Price |
$63.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$56.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$56.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$59.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$59.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$62.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.04
|
| Rate for Payer: Healthfirst Commercial |
$62.72
|
| Rate for Payer: Healthfirst Essential Plan |
$141.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$59.58
|
| Rate for Payer: Healthfirst QHP |
$62.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$43.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$62.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$53.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$43.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.04
|
| Rate for Payer: SOMOS Essential |
$47.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.72
|
|
|
CHG US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA
|
Professional
|
Both
|
$107.14
|
|
|
Service Code
|
HCPCS 76706 26
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$63.41 |
| Rate for Payer: Cash Price |
$28.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.14
|
| Rate for Payer: Healthfirst Commercial |
$28.18
|
| Rate for Payer: Healthfirst Essential Plan |
$63.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.77
|
| Rate for Payer: Healthfirst QHP |
$28.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.14
|
| Rate for Payer: SOMOS Essential |
$21.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.18
|
|
|
CHG US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA
|
Professional
|
Both
|
$457.77
|
|
|
Service Code
|
HCPCS 76706
|
| Min. Negotiated Rate |
$85.91 |
| Max. Negotiated Rate |
$276.14 |
| Rate for Payer: Cash Price |
$124.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$122.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$110.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$110.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$116.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$122.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$116.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$122.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$122.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$92.05
|
| Rate for Payer: Healthfirst Commercial |
$122.73
|
| Rate for Payer: Healthfirst Essential Plan |
$276.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$116.59
|
| Rate for Payer: Healthfirst QHP |
$122.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$85.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$122.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$104.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$85.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$122.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$92.05
|
| Rate for Payer: SOMOS Essential |
$92.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$122.73
|
|
|
CHG US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA
|
Professional
|
Both
|
$350.60
|
|
|
Service Code
|
HCPCS 76706 TC
|
| Min. Negotiated Rate |
$66.19 |
| Max. Negotiated Rate |
$212.74 |
| Rate for Payer: Cash Price |
$95.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$94.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$85.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$85.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$89.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$94.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$89.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$94.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$94.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$70.91
|
| Rate for Payer: Healthfirst Commercial |
$94.55
|
| Rate for Payer: Healthfirst Essential Plan |
$212.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$89.82
|
| Rate for Payer: Healthfirst QHP |
$94.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$66.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$94.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$80.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$66.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$94.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$70.91
|
| Rate for Payer: SOMOS Essential |
$70.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$94.55
|
|
|
CHG US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION
|
Professional
|
Both
|
$496.06
|
|
|
Service Code
|
HCPCS 76700
|
| Min. Negotiated Rate |
$92.50 |
| Max. Negotiated Rate |
$297.34 |
| Rate for Payer: Cash Price |
$134.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$132.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$118.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$118.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$125.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$132.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$125.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$132.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$132.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$99.11
|
| Rate for Payer: Healthfirst Commercial |
$132.15
|
| Rate for Payer: Healthfirst Essential Plan |
$297.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.54
|
| Rate for Payer: Healthfirst QHP |
$132.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$92.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$132.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$112.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$92.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$132.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$99.11
|
| Rate for Payer: SOMOS Essential |
$99.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$132.15
|
|
|
CHG US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION
|
Professional
|
Both
|
$154.07
|
|
|
Service Code
|
HCPCS 76700 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 US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION
|
Professional
|
Both
|
$341.99
|
|
|
Service Code
|
HCPCS 76700 TC
|
| Min. Negotiated Rate |
$63.36 |
| Max. Negotiated Rate |
$203.65 |
| Rate for Payer: Cash Price |
$93.20
|
| 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 US ABDOMINAL REAL TIME W/IMAGE LIMITED
|
Professional
|
Both
|
$376.53
|
|
|
Service Code
|
HCPCS 76705
|
| Min. Negotiated Rate |
$69.48 |
| Max. Negotiated Rate |
$223.34 |
| Rate for Payer: Cash Price |
$100.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$99.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$89.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$89.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$94.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$99.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$94.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$99.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$99.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$74.44
|
| Rate for Payer: Healthfirst Commercial |
$99.26
|
| Rate for Payer: Healthfirst Essential Plan |
$223.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$94.30
|
| Rate for Payer: Healthfirst QHP |
$99.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$69.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$99.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$84.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$69.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$99.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$74.44
|
| Rate for Payer: SOMOS Essential |
$74.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$99.26
|
|
|
CHG US ABDOMINAL REAL TIME W/IMAGE LIMITED
|
Professional
|
Both
|
$261.49
|
|
|
Service Code
|
HCPCS 76705 TC
|
| Min. Negotiated Rate |
$48.25 |
| Max. Negotiated Rate |
$155.09 |
| Rate for Payer: Cash Price |
$70.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$68.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$62.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$65.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$68.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$65.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$68.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$68.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51.70
|
| Rate for Payer: Healthfirst Commercial |
$68.93
|
| Rate for Payer: Healthfirst Essential Plan |
$155.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$65.48
|
| Rate for Payer: Healthfirst QHP |
$68.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$48.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$68.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$58.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$48.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$68.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$51.70
|
| Rate for Payer: SOMOS Essential |
$51.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$68.93
|
|
|
CHG US ABDOMINAL REAL TIME W/IMAGE LIMITED
|
Professional
|
Both
|
$115.05
|
|
|
Service Code
|
HCPCS 76705 26
|
| Min. Negotiated Rate |
$21.23 |
| Max. Negotiated Rate |
$68.24 |
| Rate for Payer: Cash Price |
$30.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$27.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$28.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$30.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.75
|
| Rate for Payer: Healthfirst Commercial |
$30.33
|
| Rate for Payer: Healthfirst Essential Plan |
$68.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.81
|
| Rate for Payer: Healthfirst QHP |
$30.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$30.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$25.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.75
|
| Rate for Payer: SOMOS Essential |
$22.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.33
|
|
|
CHG US BONE DENSITY MEAS & INTERP PERIPH ANY METHO
|
Professional
|
Both
|
$31.85
|
|
|
Service Code
|
HCPCS 76977
|
| Min. Negotiated Rate |
$6.15 |
| Max. Negotiated Rate |
$19.75 |
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.58
|
| Rate for Payer: Healthfirst Commercial |
$8.78
|
| Rate for Payer: Healthfirst Essential Plan |
$19.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.34
|
| Rate for Payer: Healthfirst QHP |
$8.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.58
|
| Rate for Payer: SOMOS Essential |
$6.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.78
|
|
