|
CHG US BONE DENSITY MEAS & INTERP PERIPH ANY METHO
|
Professional
|
Both
|
$19.99
|
|
|
Service Code
|
HCPCS 76977 TC
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$12.73 |
| Rate for Payer: Cash Price |
$5.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.25
|
| Rate for Payer: Healthfirst Commercial |
$5.66
|
| Rate for Payer: Healthfirst Essential Plan |
$12.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.38
|
| Rate for Payer: Healthfirst QHP |
$5.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$5.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$4.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4.25
|
| Rate for Payer: SOMOS Essential |
$4.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.66
|
|
|
CHG US BONE DENSITY MEAS & INTERP PERIPH ANY METHO
|
Professional
|
Both
|
$11.87
|
|
|
Service Code
|
HCPCS 76977 26
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$7.02 |
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Healthfirst Commercial |
$3.12
|
| Rate for Payer: Healthfirst Essential Plan |
$7.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.96
|
| Rate for Payer: Healthfirst QHP |
$3.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2.34
|
| Rate for Payer: SOMOS Essential |
$2.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.12
|
|
|
CHG US BREAST UNI REAL TIME WITH IMAGE COMPLETE
|
Professional
|
Both
|
$440.06
|
|
|
Service Code
|
HCPCS 76641
|
| Min. Negotiated Rate |
$81.72 |
| Max. Negotiated Rate |
$262.67 |
| Rate for Payer: Cash Price |
$118.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$116.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$105.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$105.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$110.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$116.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$110.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$116.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$116.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$87.56
|
| Rate for Payer: Healthfirst Commercial |
$116.74
|
| Rate for Payer: Healthfirst Essential Plan |
$262.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$110.90
|
| Rate for Payer: Healthfirst QHP |
$116.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$81.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$116.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$99.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$81.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$116.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$87.56
|
| Rate for Payer: SOMOS Essential |
$87.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$116.74
|
|
|
CHG US BREAST UNI REAL TIME WITH IMAGE COMPLETE
|
Professional
|
Both
|
$141.19
|
|
|
Service Code
|
HCPCS 76641 26
|
| Min. Negotiated Rate |
$26.67 |
| Max. Negotiated Rate |
$85.72 |
| Rate for Payer: Cash Price |
$38.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.57
|
| Rate for Payer: Healthfirst Commercial |
$38.10
|
| Rate for Payer: Healthfirst Essential Plan |
$85.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.20
|
| Rate for Payer: Healthfirst QHP |
$38.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.57
|
| Rate for Payer: SOMOS Essential |
$28.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.10
|
|
|
CHG US BREAST UNI REAL TIME WITH IMAGE COMPLETE
|
Professional
|
Both
|
$298.87
|
|
|
Service Code
|
HCPCS 76641 TC
|
| Min. Negotiated Rate |
$55.05 |
| Max. Negotiated Rate |
$176.94 |
| Rate for Payer: Cash Price |
$80.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$78.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$70.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$70.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$74.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$78.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$74.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$78.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$78.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$58.98
|
| Rate for Payer: Healthfirst Commercial |
$78.64
|
| Rate for Payer: Healthfirst Essential Plan |
$176.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$74.71
|
| Rate for Payer: Healthfirst QHP |
$78.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$55.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$78.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$66.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$55.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$78.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$58.98
|
| Rate for Payer: SOMOS Essential |
$58.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$78.64
|
|
|
CHG US BREAST UNI REAL TIME WITH IMAGE LIMITED
|
Professional
|
Both
|
$361.90
|
|
|
Service Code
|
HCPCS 76642
|
| Min. Negotiated Rate |
$67.74 |
| Max. Negotiated Rate |
$217.73 |
| Rate for Payer: Cash Price |
$98.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$96.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$87.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$87.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$91.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$96.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$91.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$96.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$96.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.58
|
| Rate for Payer: Healthfirst Commercial |
$96.77
|
| Rate for Payer: Healthfirst Essential Plan |
$217.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$91.93
|
| Rate for Payer: Healthfirst QHP |
$96.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$67.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$96.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$82.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$67.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$96.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$72.58
|
| Rate for Payer: SOMOS Essential |
$72.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$96.77
|
|
|
CHG US BREAST UNI REAL TIME WITH IMAGE LIMITED
|
Professional
|
Both
|
$229.85
|
|
|
Service Code
|
HCPCS 76642 TC
|
| Min. Negotiated Rate |
$42.82 |
| Max. Negotiated Rate |
$137.63 |
| Rate for Payer: Cash Price |
$62.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$61.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$55.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$55.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$58.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$61.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$58.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$61.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.88
|
| Rate for Payer: Healthfirst Commercial |
$61.17
|
| Rate for Payer: Healthfirst Essential Plan |
$137.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$58.11
|
| Rate for Payer: Healthfirst QHP |
$61.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$42.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$61.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$51.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$42.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$61.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$45.88
|
| Rate for Payer: SOMOS Essential |
$45.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$61.17
|
|
|
CHG US BREAST UNI REAL TIME WITH IMAGE LIMITED
|
Professional
|
Both
|
$132.06
|
|
|
Service Code
|
HCPCS 76642 26
|
| Min. Negotiated Rate |
$24.92 |
| Max. Negotiated Rate |
$80.10 |
| Rate for Payer: Cash Price |
$35.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.70
|
| Rate for Payer: Healthfirst Commercial |
$35.60
|
| Rate for Payer: Healthfirst Essential Plan |
$80.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.82
|
| Rate for Payer: Healthfirst QHP |
$35.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.70
|
| Rate for Payer: SOMOS Essential |
$26.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.60
|
|
|
CHG US CHEST REAL TIME W/IMAGE DOCUMENTATION
|
Professional
|
Both
|
$112.14
|
|
|
Service Code
|
HCPCS 76604 26
|
| Min. Negotiated Rate |
$20.68 |
| Max. Negotiated Rate |
$66.49 |
| Rate for Payer: Cash Price |
$29.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$28.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.16
|
| Rate for Payer: Healthfirst Commercial |
$29.55
|
| Rate for Payer: Healthfirst Essential Plan |
$66.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.07
|
| Rate for Payer: Healthfirst QHP |
$29.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$25.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.16
|
| Rate for Payer: SOMOS Essential |
$22.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.55
|
|
|
CHG US CHEST REAL TIME W/IMAGE DOCUMENTATION
|
Professional
|
Both
|
$239.96
|
|
|
Service Code
|
HCPCS 76604
|
| Min. Negotiated Rate |
$46.12 |
| Max. Negotiated Rate |
$148.23 |
| Rate for Payer: Cash Price |
$65.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$65.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$59.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$59.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$65.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$49.41
|
| Rate for Payer: Healthfirst Commercial |
$65.88
|
| Rate for Payer: Healthfirst Essential Plan |
$148.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.59
|
| Rate for Payer: Healthfirst QHP |
$65.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$46.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$65.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$56.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$46.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$65.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$49.41
|
| Rate for Payer: SOMOS Essential |
$49.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.88
|
|
|
CHG US CHEST REAL TIME W/IMAGE DOCUMENTATION
|
Professional
|
Both
|
$127.79
|
|
|
Service Code
|
HCPCS 76604 TC
|
| Min. Negotiated Rate |
$25.43 |
| Max. Negotiated Rate |
$81.74 |
| Rate for Payer: Cash Price |
$35.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$36.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.25
|
| Rate for Payer: Healthfirst Commercial |
$36.33
|
| Rate for Payer: Healthfirst Essential Plan |
$81.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.51
|
| Rate for Payer: Healthfirst QHP |
$36.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$36.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.25
|
| Rate for Payer: SOMOS Essential |
$27.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.33
|
|
|
CHG US CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL
|
Professional
|
Both
|
$388.50
|
|
|
Service Code
|
HCPCS 76936 26
|
| Min. Negotiated Rate |
$72.83 |
| Max. Negotiated Rate |
$234.11 |
| Rate for Payer: Cash Price |
$104.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$104.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$93.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$93.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$98.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$104.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$98.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$104.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$104.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$78.04
|
| Rate for Payer: Healthfirst Commercial |
$104.05
|
| Rate for Payer: Healthfirst Essential Plan |
$234.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$98.85
|
| Rate for Payer: Healthfirst QHP |
$104.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$72.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$104.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$88.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$72.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$104.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$78.04
|
| Rate for Payer: SOMOS Essential |
$78.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$104.05
|
|
|
CHG US CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL
|
Professional
|
Both
|
$723.94
|
|
|
Service Code
|
HCPCS 76936 TC
|
| Min. Negotiated Rate |
$134.71 |
| Max. Negotiated Rate |
$432.99 |
| Rate for Payer: Cash Price |
$199.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$192.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$173.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$173.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$182.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$192.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$182.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$192.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$192.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$144.33
|
| Rate for Payer: Healthfirst Commercial |
$192.44
|
| Rate for Payer: Healthfirst Essential Plan |
$432.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$182.82
|
| Rate for Payer: Healthfirst QHP |
$192.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$134.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$192.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$163.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$134.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$192.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$144.33
|
| Rate for Payer: SOMOS Essential |
$144.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$192.44
|
|
|
CHG US CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL
|
Professional
|
Both
|
$1,112.44
|
|
|
Service Code
|
HCPCS 76936
|
| Min. Negotiated Rate |
$207.54 |
| Max. Negotiated Rate |
$667.10 |
| Rate for Payer: Cash Price |
$303.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$296.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$266.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$266.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$281.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$296.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$281.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$296.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$296.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$222.37
|
| Rate for Payer: Healthfirst Commercial |
$296.49
|
| Rate for Payer: Healthfirst Essential Plan |
$667.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$281.67
|
| Rate for Payer: Healthfirst QHP |
$296.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$207.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$296.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$252.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$207.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$296.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$222.37
|
| Rate for Payer: SOMOS Essential |
$222.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$296.49
|
|
|
CHG US COMPL JOINT R-T W/IMAGE DOCUMENTATION
|
Professional
|
Both
|
$221.27
|
|
|
Service Code
|
HCPCS 76881
|
| Min. Negotiated Rate |
$41.53 |
| Max. Negotiated Rate |
$133.49 |
| Rate for Payer: Cash Price |
$60.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$59.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$53.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$56.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$59.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$56.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.50
|
| Rate for Payer: Healthfirst Commercial |
$59.33
|
| Rate for Payer: Healthfirst Essential Plan |
$133.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$56.36
|
| Rate for Payer: Healthfirst QHP |
$59.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$41.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$59.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$50.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$41.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$59.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$44.50
|
| Rate for Payer: SOMOS Essential |
$44.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$59.33
|
|
|
CHG US COMPL JOINT R-T W/IMAGE DOCUMENTATION
|
Professional
|
Both
|
$172.55
|
|
|
Service Code
|
HCPCS 76881 26
|
| Min. Negotiated Rate |
$32.67 |
| Max. Negotiated Rate |
$105.01 |
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$42.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$44.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$44.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.00
|
| Rate for Payer: Healthfirst Commercial |
$46.67
|
| Rate for Payer: Healthfirst Essential Plan |
$105.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.34
|
| Rate for Payer: Healthfirst QHP |
$46.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$46.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35.00
|
| Rate for Payer: SOMOS Essential |
$35.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.67
|
|
|
CHG US COMPL JOINT R-T W/IMAGE DOCUMENTATION
|
Professional
|
Both
|
$48.72
|
|
|
Service Code
|
HCPCS 76881 TC
|
| Min. Negotiated Rate |
$8.86 |
| Max. Negotiated Rate |
$28.46 |
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.49
|
| Rate for Payer: Healthfirst Commercial |
$12.65
|
| Rate for Payer: Healthfirst Essential Plan |
$28.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.02
|
| Rate for Payer: Healthfirst QHP |
$12.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$12.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$10.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.49
|
| Rate for Payer: SOMOS Essential |
$9.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.65
|
|
|
CHG US ENDOMYOCARDIAL BIOPSY RS&I
|
Professional
|
Both
|
$152.95
|
|
|
Service Code
|
HCPCS 76932 26
|
| Min. Negotiated Rate |
$27.77 |
| Max. Negotiated Rate |
$89.26 |
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$39.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.75
|
| Rate for Payer: Healthfirst Commercial |
$39.67
|
| Rate for Payer: Healthfirst Essential Plan |
$89.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.69
|
| Rate for Payer: Healthfirst QHP |
$39.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$39.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.75
|
| Rate for Payer: SOMOS Essential |
$29.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.67
|
|
|
CHG US FETAL NUCHAL TRANSLUCENCY 1ST GESTATION
|
Professional
|
Both
|
$224.88
|
|
|
Service Code
|
HCPCS 76813 26
|
| Min. Negotiated Rate |
$41.98 |
| Max. Negotiated Rate |
$134.93 |
| Rate for Payer: Cash Price |
$60.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$59.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$53.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$56.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$59.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$56.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.98
|
| Rate for Payer: Healthfirst Commercial |
$59.97
|
| Rate for Payer: Healthfirst Essential Plan |
$134.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$56.97
|
| Rate for Payer: Healthfirst QHP |
$59.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$41.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$59.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$50.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$41.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$59.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$44.98
|
| Rate for Payer: SOMOS Essential |
$44.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$59.97
|
|
|
CHG US FETAL NUCHAL TRANSLUCENCY 1ST GESTATION
|
Professional
|
Both
|
$265.79
|
|
|
Service Code
|
HCPCS 76813 TC
|
| Min. Negotiated Rate |
$47.44 |
| Max. Negotiated Rate |
$152.48 |
| Rate for Payer: Cash Price |
$71.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$67.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$60.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$67.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$50.83
|
| Rate for Payer: Healthfirst Commercial |
$67.77
|
| Rate for Payer: Healthfirst Essential Plan |
$152.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$64.38
|
| Rate for Payer: Healthfirst QHP |
$67.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$47.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$67.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$57.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$47.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$67.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$50.83
|
| Rate for Payer: SOMOS Essential |
$50.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$67.77
|
|
|
CHG US FETAL NUCHAL TRANSLUCENCY 1ST GESTATION
|
Professional
|
Both
|
$490.67
|
|
|
Service Code
|
HCPCS 76813
|
| Min. Negotiated Rate |
$89.42 |
| Max. Negotiated Rate |
$287.42 |
| Rate for Payer: Cash Price |
$132.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$114.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$114.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$121.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$121.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$127.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$95.81
|
| Rate for Payer: Healthfirst Commercial |
$127.74
|
| Rate for Payer: Healthfirst Essential Plan |
$287.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$121.35
|
| Rate for Payer: Healthfirst QHP |
$127.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$89.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$127.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$108.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$89.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$95.81
|
| Rate for Payer: SOMOS Essential |
$95.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.74
|
|
|
CHG US FETAL NUCHAL TRANSLUCENCY EA ADDL GESTATION
|
Professional
|
Both
|
$123.48
|
|
|
Service Code
|
HCPCS 76814 TC
|
| Min. Negotiated Rate |
$22.17 |
| Max. Negotiated Rate |
$71.26 |
| Rate for Payer: Cash Price |
$33.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.75
|
| Rate for Payer: Healthfirst Commercial |
$31.67
|
| Rate for Payer: Healthfirst Essential Plan |
$71.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.09
|
| Rate for Payer: Healthfirst QHP |
$31.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$31.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.75
|
| Rate for Payer: SOMOS Essential |
$23.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.67
|
|
|
CHG US FETAL NUCHAL TRANSLUCENCY EA ADDL GESTATION
|
Professional
|
Both
|
$307.58
|
|
|
Service Code
|
HCPCS 76814
|
| Min. Negotiated Rate |
$57.23 |
| Max. Negotiated Rate |
$183.96 |
| Rate for Payer: Cash Price |
$83.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$81.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$73.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$77.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$61.32
|
| Rate for Payer: Healthfirst Commercial |
$81.76
|
| Rate for Payer: Healthfirst Essential Plan |
$183.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$77.67
|
| Rate for Payer: Healthfirst QHP |
$81.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$57.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$81.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$69.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$57.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$61.32
|
| Rate for Payer: SOMOS Essential |
$61.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.76
|
|
|
CHG US FETAL NUCHAL TRANSLUCENCY EA ADDL GESTATION
|
Professional
|
Both
|
$184.10
|
|
|
Service Code
|
HCPCS 76814 26
|
| Min. Negotiated Rate |
$35.06 |
| Max. Negotiated Rate |
$112.70 |
| Rate for Payer: Cash Price |
$50.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$50.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$45.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$45.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$47.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$50.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$47.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$37.57
|
| Rate for Payer: Healthfirst Commercial |
$50.09
|
| Rate for Payer: Healthfirst Essential Plan |
$112.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.59
|
| Rate for Payer: Healthfirst QHP |
$50.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$35.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$50.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$42.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$35.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$50.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$37.57
|
| Rate for Payer: SOMOS Essential |
$37.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.09
|
|
|
CHG US GUIDANCE AMNIOCENTESIS IMG S&I
|
Professional
|
Both
|
$71.89
|
|
|
Service Code
|
HCPCS 76946 26
|
| Min. Negotiated Rate |
$13.67 |
| Max. Negotiated Rate |
$43.94 |
| Rate for Payer: Cash Price |
$19.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.65
|
| Rate for Payer: Healthfirst Commercial |
$19.53
|
| Rate for Payer: Healthfirst Essential Plan |
$43.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.55
|
| Rate for Payer: Healthfirst QHP |
$19.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$14.65
|
| Rate for Payer: SOMOS Essential |
$14.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.53
|
|
