|
CHG US GUIDANCE AMNIOCENTESIS IMG S&I
|
Professional
|
Both
|
$64.54
|
|
|
Service Code
|
HCPCS 76946 TC
|
| Min. Negotiated Rate |
$12.66 |
| Max. Negotiated Rate |
$40.70 |
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.57
|
| Rate for Payer: Healthfirst Commercial |
$18.09
|
| Rate for Payer: Healthfirst Essential Plan |
$40.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.19
|
| Rate for Payer: Healthfirst QHP |
$18.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$12.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$18.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$15.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$12.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$13.57
|
| Rate for Payer: SOMOS Essential |
$13.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.09
|
|
|
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
|
|
|
CHG US GUIDANCE ASPIRATION OVA IMG S&I
|
Professional
|
Both
|
$212.63
|
|
|
Service Code
|
HCPCS 76948 TC
|
| Min. Negotiated Rate |
$39.56 |
| Max. Negotiated Rate |
$127.15 |
| Rate for Payer: Cash Price |
$58.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$56.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$50.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$50.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$53.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$56.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$53.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.38
|
| Rate for Payer: Healthfirst Commercial |
$56.51
|
| Rate for Payer: Healthfirst Essential Plan |
$127.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$53.68
|
| Rate for Payer: Healthfirst QHP |
$56.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$39.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$56.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$48.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$39.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$56.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$42.38
|
| Rate for Payer: SOMOS Essential |
$42.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56.51
|
|
|
CHG US GUIDANCE ASPIRATION OVA IMG S&I
|
Professional
|
Both
|
$124.04
|
|
|
Service Code
|
HCPCS 76948 26
|
| Min. Negotiated Rate |
$23.65 |
| Max. Negotiated Rate |
$76.03 |
| Rate for Payer: Cash Price |
$34.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.34
|
| Rate for Payer: Healthfirst Commercial |
$33.79
|
| Rate for Payer: Healthfirst Essential Plan |
$76.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.10
|
| Rate for Payer: Healthfirst QHP |
$33.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$33.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.34
|
| Rate for Payer: SOMOS Essential |
$25.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.79
|
|
|
CHG US GUIDANCE ASPIRATION OVA IMG S&I
|
Professional
|
Both
|
$336.63
|
|
|
Service Code
|
HCPCS 76948
|
| Min. Negotiated Rate |
$63.21 |
| Max. Negotiated Rate |
$203.18 |
| Rate for Payer: Cash Price |
$92.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$90.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$81.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$81.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$85.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$90.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$85.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$90.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67.72
|
| Rate for Payer: Healthfirst Commercial |
$90.30
|
| Rate for Payer: Healthfirst Essential Plan |
$203.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$85.78
|
| Rate for Payer: Healthfirst QHP |
$90.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$63.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$90.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$76.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$63.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$90.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$67.72
|
| Rate for Payer: SOMOS Essential |
$67.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$90.30
|
|
|
CHG US GUIDANCE CHORIONIC VILLUS SAMPLING IMG S&I
|
Professional
|
Both
|
$124.04
|
|
|
Service Code
|
HCPCS 76945 26
|
| Min. Negotiated Rate |
$23.65 |
| Max. Negotiated Rate |
$76.03 |
| Rate for Payer: Cash Price |
$34.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.34
|
| Rate for Payer: Healthfirst Commercial |
$33.79
|
| Rate for Payer: Healthfirst Essential Plan |
$76.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.10
|
| Rate for Payer: Healthfirst QHP |
$33.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$33.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.34
|
| Rate for Payer: SOMOS Essential |
$25.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.79
|
|
|
CHG US GUIDANCE INTERSTITIAL RADIOELMENT APPLICATION
|
Professional
|
Both
|
$265.02
|
|
|
Service Code
|
HCPCS 76965 26
|
| Min. Negotiated Rate |
$51.44 |
| Max. Negotiated Rate |
$165.33 |
| Rate for Payer: Cash Price |
$73.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$73.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$66.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$66.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$69.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$73.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$69.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$55.11
|
| Rate for Payer: Healthfirst Commercial |
$73.48
|
| Rate for Payer: Healthfirst Essential Plan |
$165.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.81
|
| Rate for Payer: Healthfirst QHP |
$73.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$51.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$73.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$62.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$51.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$73.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$55.11
|
| Rate for Payer: SOMOS Essential |
$55.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$73.48
|
|
|
CHG US GUIDANCE INTERSTITIAL RADIOELMENT APPLICATION
|
Professional
|
Both
|
$382.76
|
|
|
Service Code
|
HCPCS 76965
|
| Min. Negotiated Rate |
$74.42 |
| Max. Negotiated Rate |
$239.20 |
| Rate for Payer: Cash Price |
$106.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$106.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$95.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$95.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$100.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$106.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$100.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$106.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$79.73
|
| Rate for Payer: Healthfirst Commercial |
$106.31
|
| Rate for Payer: Healthfirst Essential Plan |
$239.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$100.99
|
| Rate for Payer: Healthfirst QHP |
$106.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$74.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$106.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$90.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$74.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$106.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$79.73
|
| Rate for Payer: SOMOS Essential |
$79.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$106.31
|
|
|
CHG US GUIDANCE INTERSTITIAL RADIOELMENT APPLICATION
|
Professional
|
Both
|
$117.74
|
|
|
Service Code
|
HCPCS 76965 TC
|
| Min. Negotiated Rate |
$22.99 |
| Max. Negotiated Rate |
$73.89 |
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.63
|
| Rate for Payer: Healthfirst Commercial |
$32.84
|
| Rate for Payer: Healthfirst Essential Plan |
$73.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.20
|
| Rate for Payer: Healthfirst QHP |
$32.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.63
|
| Rate for Payer: SOMOS Essential |
$24.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.84
|
|
|
CHG US GUIDANCE NEEDLE PLACEMENT IMG S&I
|
Professional
|
Both
|
$122.19
|
|
|
Service Code
|
HCPCS 76942 26
|
| Min. Negotiated Rate |
$22.89 |
| Max. Negotiated Rate |
$73.58 |
| Rate for Payer: Cash Price |
$32.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.52
|
| Rate for Payer: Healthfirst Commercial |
$32.70
|
| Rate for Payer: Healthfirst Essential Plan |
$73.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.07
|
| Rate for Payer: Healthfirst QHP |
$32.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.52
|
| Rate for Payer: SOMOS Essential |
$24.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.70
|
|
|
CHG US GUIDANCE NEEDLE PLACEMENT IMG S&I
|
Professional
|
Both
|
$244.23
|
|
|
Service Code
|
HCPCS 76942
|
| Min. Negotiated Rate |
$46.69 |
| Max. Negotiated Rate |
$150.07 |
| Rate for Payer: Cash Price |
$66.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$66.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$60.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$63.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$66.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$63.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$66.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$66.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$50.02
|
| Rate for Payer: Healthfirst Commercial |
$66.70
|
| Rate for Payer: Healthfirst Essential Plan |
$150.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$63.37
|
| Rate for Payer: Healthfirst QHP |
$66.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$46.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$66.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$56.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$46.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$66.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$50.02
|
| Rate for Payer: SOMOS Essential |
$50.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$66.70
|
|
|
CHG US GUIDANCE NEEDLE PLACEMENT IMG S&I
|
Professional
|
Both
|
$122.05
|
|
|
Service Code
|
HCPCS 76942 TC
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Cash Price |
$33.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.50
|
| Rate for Payer: Healthfirst Commercial |
$34.00
|
| Rate for Payer: Healthfirst Essential Plan |
$76.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.30
|
| Rate for Payer: Healthfirst QHP |
$34.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.50
|
| Rate for Payer: SOMOS Essential |
$25.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.00
|
|
|
CHG US INFT HIPS R-T IMG DYNAMIC REQ PHYS/QHP MANJ
|
Professional
|
Both
|
$142.45
|
|
|
Service Code
|
HCPCS 76885 26
|
| Min. Negotiated Rate |
$26.91 |
| Max. Negotiated Rate |
$86.51 |
| Rate for Payer: Cash Price |
$38.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.84
|
| Rate for Payer: Healthfirst Commercial |
$38.45
|
| Rate for Payer: Healthfirst Essential Plan |
$86.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.53
|
| Rate for Payer: Healthfirst QHP |
$38.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.84
|
| Rate for Payer: SOMOS Essential |
$28.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.45
|
|
|
CHG US INFT HIPS R-T IMG DYNAMIC REQ PHYS/QHP MANJ
|
Professional
|
Both
|
$372.05
|
|
|
Service Code
|
HCPCS 76885 TC
|
| Min. Negotiated Rate |
$81.29 |
| Max. Negotiated Rate |
$261.29 |
| Rate for Payer: Cash Price |
$119.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$116.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$104.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$104.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$110.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$116.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$110.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$116.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$116.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$87.10
|
| Rate for Payer: Healthfirst Commercial |
$116.13
|
| Rate for Payer: Healthfirst Essential Plan |
$261.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$110.32
|
| Rate for Payer: Healthfirst QHP |
$116.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$81.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$116.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$98.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$81.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$116.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$87.10
|
| Rate for Payer: SOMOS Essential |
$87.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$116.13
|
|
|
CHG US INFT HIPS R-T IMG DYNAMIC REQ PHYS/QHP MANJ
|
Professional
|
Both
|
$514.47
|
|
|
Service Code
|
HCPCS 76885
|
| Min. Negotiated Rate |
$108.21 |
| Max. Negotiated Rate |
$347.81 |
| Rate for Payer: Cash Price |
$158.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$154.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$139.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$139.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$146.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$154.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$146.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$154.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$154.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$115.94
|
| Rate for Payer: Healthfirst Commercial |
$154.58
|
| Rate for Payer: Healthfirst Essential Plan |
$347.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$146.85
|
| Rate for Payer: Healthfirst QHP |
$154.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$108.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$154.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$131.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$108.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$154.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$115.94
|
| Rate for Payer: SOMOS Essential |
$115.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$154.58
|
|
|
CHG US INFT HIPS R-T IMG LMTD STATIC PHYS/QHP MANJ
|
Professional
|
Both
|
$432.01
|
|
|
Service Code
|
HCPCS 76886
|
| Min. Negotiated Rate |
$79.45 |
| Max. Negotiated Rate |
$255.38 |
| Rate for Payer: Cash Price |
$115.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$113.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$102.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$102.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$107.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$113.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$107.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$113.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$113.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$85.12
|
| Rate for Payer: Healthfirst Commercial |
$113.50
|
| Rate for Payer: Healthfirst Essential Plan |
$255.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$107.83
|
| Rate for Payer: Healthfirst QHP |
$113.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$79.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$113.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$96.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$79.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$113.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$85.12
|
| Rate for Payer: SOMOS Essential |
$85.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$113.50
|
|
|
CHG US INFT HIPS R-T IMG LMTD STATIC PHYS/QHP MANJ
|
Professional
|
Both
|
$121.66
|
|
|
Service Code
|
HCPCS 76886 26
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$72.31 |
| Rate for Payer: Cash Price |
$32.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.11
|
| Rate for Payer: Healthfirst Commercial |
$32.14
|
| Rate for Payer: Healthfirst Essential Plan |
$72.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.53
|
| Rate for Payer: Healthfirst QHP |
$32.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.11
|
| Rate for Payer: SOMOS Essential |
$24.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.14
|
|
|
CHG US INFT HIPS R-T IMG LMTD STATIC PHYS/QHP MANJ
|
Professional
|
Both
|
$310.35
|
|
|
Service Code
|
HCPCS 76886 TC
|
| Min. Negotiated Rate |
$56.95 |
| Max. Negotiated Rate |
$183.06 |
| Rate for Payer: Cash Price |
$83.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$81.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$73.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$77.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$61.02
|
| Rate for Payer: Healthfirst Commercial |
$81.36
|
| Rate for Payer: Healthfirst Essential Plan |
$183.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$77.29
|
| Rate for Payer: Healthfirst QHP |
$81.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$56.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$81.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$69.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$56.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$61.02
|
| Rate for Payer: SOMOS Essential |
$61.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.36
|
|
|
CHG US INTRAUTERINE FTL TFUJ/CORDOCNTS IMG S&I
|
Professional
|
Both
|
$253.54
|
|
|
Service Code
|
HCPCS 76941 26
|
| Min. Negotiated Rate |
$47.74 |
| Max. Negotiated Rate |
$153.45 |
| Rate for Payer: Cash Price |
$69.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$68.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$61.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$68.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$68.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$68.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51.15
|
| Rate for Payer: Healthfirst Commercial |
$68.20
|
| Rate for Payer: Healthfirst Essential Plan |
$153.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$64.79
|
| Rate for Payer: Healthfirst QHP |
$68.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$47.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$68.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$57.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$47.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$68.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$51.15
|
| Rate for Payer: SOMOS Essential |
$51.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$68.20
|
|
|
CHG US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG
|
Professional
|
Both
|
$174.86
|
|
|
Service Code
|
HCPCS 76882
|
| Min. Negotiated Rate |
$51.13 |
| Max. Negotiated Rate |
$164.36 |
| Rate for Payer: Cash Price |
$72.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$73.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$65.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$69.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$73.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$69.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.79
|
| Rate for Payer: Healthfirst Commercial |
$73.05
|
| Rate for Payer: Healthfirst Essential Plan |
$164.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.40
|
| Rate for Payer: Healthfirst QHP |
$73.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$51.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$73.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$62.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$51.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$73.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$54.79
|
| Rate for Payer: SOMOS Essential |
$54.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$73.05
|
|
|
CHG US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG
|
Professional
|
Both
|
$41.55
|
|
|
Service Code
|
HCPCS 76882 TC
|
| Min. Negotiated Rate |
$25.97 |
| Max. Negotiated Rate |
$83.47 |
| Rate for Payer: Cash Price |
$36.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.82
|
| Rate for Payer: Healthfirst Commercial |
$37.10
|
| Rate for Payer: Healthfirst Essential Plan |
$83.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.24
|
| Rate for Payer: Healthfirst QHP |
$37.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$31.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.82
|
| Rate for Payer: SOMOS Essential |
$27.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.10
|
|
|
CHG US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG
|
Professional
|
Both
|
$133.32
|
|
|
Service Code
|
HCPCS 76882 26
|
| Min. Negotiated Rate |
$25.16 |
| Max. Negotiated Rate |
$80.89 |
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.96
|
| Rate for Payer: Healthfirst Commercial |
$35.95
|
| Rate for Payer: Healthfirst Essential Plan |
$80.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.15
|
| Rate for Payer: Healthfirst QHP |
$35.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.96
|
| Rate for Payer: SOMOS Essential |
$26.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.95
|
|
|
CHG US &MNTR PARENCHYMAL TISSUE ABLATION
|
Professional
|
Both
|
$422.14
|
|
|
Service Code
|
HCPCS 76940 26
|
| Min. Negotiated Rate |
$79.91 |
| Max. Negotiated Rate |
$256.84 |
| Rate for Payer: Cash Price |
$113.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$114.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$102.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$102.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$108.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$114.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$108.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$114.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$114.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$85.61
|
| Rate for Payer: Healthfirst Commercial |
$114.15
|
| Rate for Payer: Healthfirst Essential Plan |
$256.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$108.44
|
| Rate for Payer: Healthfirst QHP |
$114.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$79.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$114.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$97.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$79.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$114.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$85.61
|
| Rate for Payer: SOMOS Essential |
$85.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$114.15
|
|
|
CHG US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY
|
Professional
|
Both
|
$64.54
|
|
|
Service Code
|
HCPCS 76883 TC
|
| Min. Negotiated Rate |
$12.39 |
| Max. Negotiated Rate |
$39.83 |
| Rate for Payer: Cash Price |
$17.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.28
|
| Rate for Payer: Healthfirst Commercial |
$17.70
|
| Rate for Payer: Healthfirst Essential Plan |
$39.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.82
|
| Rate for Payer: Healthfirst QHP |
$17.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$12.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$17.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$15.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$12.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$13.28
|
| Rate for Payer: SOMOS Essential |
$13.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.70
|
|
|
CHG US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY
|
Professional
|
Both
|
$231.21
|
|
|
Service Code
|
HCPCS 76883 26
|
| Min. Negotiated Rate |
$43.84 |
| Max. Negotiated Rate |
$140.92 |
| Rate for Payer: Cash Price |
$63.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$56.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$56.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$59.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$59.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$62.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$46.97
|
| Rate for Payer: Healthfirst Commercial |
$62.63
|
| Rate for Payer: Healthfirst Essential Plan |
$140.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$59.50
|
| Rate for Payer: Healthfirst QHP |
$62.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$43.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$62.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$53.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$43.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$46.97
|
| Rate for Payer: SOMOS Essential |
$46.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.63
|
|
