|
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 PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U
|
Professional
|
Both
|
$93.98
|
|
|
Service Code
|
HCPCS 76857 26
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$57.26 |
| Rate for Payer: Cash Price |
$25.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.09
|
| Rate for Payer: Healthfirst Commercial |
$25.45
|
| Rate for Payer: Healthfirst Essential Plan |
$57.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24.18
|
| Rate for Payer: Healthfirst QHP |
$25.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$25.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$21.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19.09
|
| Rate for Payer: SOMOS Essential |
$19.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.45
|
|
|
CHG US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U
|
Professional
|
Both
|
$110.57
|
|
|
Service Code
|
HCPCS 76857 TC
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$70.38 |
| Rate for Payer: Cash Price |
$31.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.46
|
| Rate for Payer: Healthfirst Commercial |
$31.28
|
| Rate for Payer: Healthfirst Essential Plan |
$70.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.72
|
| Rate for Payer: Healthfirst QHP |
$31.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$31.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.46
|
| Rate for Payer: SOMOS Essential |
$23.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.28
|
|
|
CHG US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U
|
Professional
|
Both
|
$204.51
|
|
|
Service Code
|
HCPCS 76857
|
| Min. Negotiated Rate |
$39.71 |
| Max. Negotiated Rate |
$127.64 |
| Rate for Payer: Cash Price |
$56.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$56.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$51.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$51.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$53.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$56.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$53.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.55
|
| Rate for Payer: Healthfirst Commercial |
$56.73
|
| Rate for Payer: Healthfirst Essential Plan |
$127.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$53.89
|
| Rate for Payer: Healthfirst QHP |
$56.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$39.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$56.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$48.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$39.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$56.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$42.55
|
| Rate for Payer: SOMOS Essential |
$42.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56.73
|
|
|
CHG US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE
|
Professional
|
Both
|
$450.84
|
|
|
Service Code
|
HCPCS 76856
|
| Min. Negotiated Rate |
$84.01 |
| Max. Negotiated Rate |
$270.05 |
| Rate for Payer: Cash Price |
$122.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$120.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$108.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$114.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$120.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$114.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$120.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$90.02
|
| Rate for Payer: Healthfirst Commercial |
$120.02
|
| Rate for Payer: Healthfirst Essential Plan |
$270.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$114.02
|
| Rate for Payer: Healthfirst QHP |
$120.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$84.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$120.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$102.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$84.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$120.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$90.02
|
| Rate for Payer: SOMOS Essential |
$90.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$120.02
|
|
|
CHG US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE
|
Professional
|
Both
|
$133.32
|
|
|
Service Code
|
HCPCS 76856 26
|
| Min. Negotiated Rate |
$24.73 |
| Max. Negotiated Rate |
$79.49 |
| Rate for Payer: Cash Price |
$35.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.50
|
| Rate for Payer: Healthfirst Commercial |
$35.33
|
| Rate for Payer: Healthfirst Essential Plan |
$79.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.56
|
| Rate for Payer: Healthfirst QHP |
$35.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.50
|
| Rate for Payer: SOMOS Essential |
$26.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.33
|
|
|
CHG US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE
|
Professional
|
Both
|
$317.56
|
|
|
Service Code
|
HCPCS 76856 TC
|
| Min. Negotiated Rate |
$59.28 |
| Max. Negotiated Rate |
$190.55 |
| Rate for Payer: Cash Price |
$86.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$84.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$76.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$76.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$80.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$84.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$80.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$84.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$84.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$63.52
|
| Rate for Payer: Healthfirst Commercial |
$84.69
|
| Rate for Payer: Healthfirst Essential Plan |
$190.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$80.46
|
| Rate for Payer: Healthfirst QHP |
$84.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$59.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$84.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$71.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$59.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$84.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$63.52
|
| Rate for Payer: SOMOS Essential |
$63.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$84.69
|
|
|
CHG US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT
|
Professional
|
Both
|
$308.91
|
|
|
Service Code
|
HCPCS 76801 TC
|
| Min. Negotiated Rate |
$56.95 |
| Max. Negotiated Rate |
$183.06 |
| Rate for Payer: Cash Price |
$83.93
|
| 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 PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT
|
Professional
|
Both
|
$188.13
|
|
|
Service Code
|
HCPCS 76801 26
|
| Min. Negotiated Rate |
$35.66 |
| Max. Negotiated Rate |
$114.61 |
| Rate for Payer: Cash Price |
$51.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$50.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$45.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$45.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$48.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$50.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$48.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.20
|
| Rate for Payer: Healthfirst Commercial |
$50.94
|
| Rate for Payer: Healthfirst Essential Plan |
$114.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$48.39
|
| Rate for Payer: Healthfirst QHP |
$50.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$35.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$50.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$43.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$35.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$50.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$38.20
|
| Rate for Payer: SOMOS Essential |
$38.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.94
|
|
|
CHG US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT
|
Professional
|
Both
|
$497.04
|
|
|
Service Code
|
HCPCS 76801
|
| Min. Negotiated Rate |
$92.60 |
| Max. Negotiated Rate |
$297.65 |
| Rate for Payer: Cash Price |
$135.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$132.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$119.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$119.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$125.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$132.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$125.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$132.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$132.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$99.22
|
| Rate for Payer: Healthfirst Commercial |
$132.29
|
| Rate for Payer: Healthfirst Essential Plan |
$297.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.68
|
| Rate for Payer: Healthfirst QHP |
$132.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$92.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$132.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$112.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$92.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$132.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$99.22
|
| Rate for Payer: SOMOS Essential |
$99.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$132.29
|
|
|
CHG US PREGNANT UTERUS LIMITED 1/> FETUSES
|
Professional
|
Both
|
$346.64
|
|
|
Service Code
|
HCPCS 76815
|
| Min. Negotiated Rate |
$64.41 |
| Max. Negotiated Rate |
$207.04 |
| Rate for Payer: Cash Price |
$93.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$92.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$82.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$82.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$87.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$92.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$87.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.02
|
| Rate for Payer: Healthfirst Commercial |
$92.02
|
| Rate for Payer: Healthfirst Essential Plan |
$207.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$87.42
|
| Rate for Payer: Healthfirst QHP |
$92.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$92.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$78.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$92.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.02
|
| Rate for Payer: SOMOS Essential |
$69.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$92.02
|
|
|
CHG US PREGNANT UTERUS LIMITED 1/> FETUSES
|
Professional
|
Both
|
$219.80
|
|
|
Service Code
|
HCPCS 76815 TC
|
| Min. Negotiated Rate |
$40.91 |
| Max. Negotiated Rate |
$131.51 |
| Rate for Payer: Cash Price |
$59.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$58.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$52.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$52.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$55.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$58.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$55.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$58.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$58.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.84
|
| Rate for Payer: Healthfirst Commercial |
$58.45
|
| Rate for Payer: Healthfirst Essential Plan |
$131.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$55.53
|
| Rate for Payer: Healthfirst QHP |
$58.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$40.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$58.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$49.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$40.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$58.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$43.84
|
| Rate for Payer: SOMOS Essential |
$43.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$58.45
|
|
|
CHG US PREGNANT UTERUS LIMITED 1/> FETUSES
|
Professional
|
Both
|
$126.84
|
|
|
Service Code
|
HCPCS 76815 26
|
| Min. Negotiated Rate |
$23.49 |
| Max. Negotiated Rate |
$75.51 |
| Rate for Payer: Cash Price |
$33.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.17
|
| Rate for Payer: Healthfirst Commercial |
$33.56
|
| Rate for Payer: Healthfirst Essential Plan |
$75.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.88
|
| Rate for Payer: Healthfirst QHP |
$33.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$33.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.17
|
| Rate for Payer: SOMOS Essential |
$25.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.56
|
|
|
CHG US PREG UTERUS 14 WK TRANSABDL EACH GESTATION
|
Professional
|
Both
|
$92.02
|
|
|
Service Code
|
HCPCS 76802 TC
|
| Min. Negotiated Rate |
$16.85 |
| Max. Negotiated Rate |
$54.16 |
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.05
|
| Rate for Payer: Healthfirst Commercial |
$24.07
|
| Rate for Payer: Healthfirst Essential Plan |
$54.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.87
|
| Rate for Payer: Healthfirst QHP |
$24.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$16.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$24.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$20.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$16.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18.05
|
| Rate for Payer: SOMOS Essential |
$18.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.07
|
|
|
CHG US PREG UTERUS 14 WK TRANSABDL EACH GESTATION
|
Professional
|
Both
|
$160.90
|
|
|
Service Code
|
HCPCS 76802 26
|
| Min. Negotiated Rate |
$29.74 |
| Max. Negotiated Rate |
$95.58 |
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$42.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$42.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$40.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.86
|
| Rate for Payer: Healthfirst Commercial |
$42.48
|
| Rate for Payer: Healthfirst Essential Plan |
$95.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.36
|
| Rate for Payer: Healthfirst QHP |
$42.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$42.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$36.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$42.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31.86
|
| Rate for Payer: SOMOS Essential |
$31.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.48
|
|
|
CHG US PREG UTERUS 14 WK TRANSABDL EACH GESTATION
|
Professional
|
Both
|
$252.91
|
|
|
Service Code
|
HCPCS 76802
|
| Min. Negotiated Rate |
$46.59 |
| Max. Negotiated Rate |
$149.74 |
| Rate for Payer: Cash Price |
$67.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$66.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$59.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$59.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$63.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$66.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$63.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$66.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$66.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$49.91
|
| Rate for Payer: Healthfirst Commercial |
$66.55
|
| Rate for Payer: Healthfirst Essential Plan |
$149.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$63.22
|
| Rate for Payer: Healthfirst QHP |
$66.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$46.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$66.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$56.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$46.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$66.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$49.91
|
| Rate for Payer: SOMOS Essential |
$49.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$66.55
|
|
|
CHG US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO
|
Professional
|
Both
|
$369.29
|
|
|
Service Code
|
HCPCS 76810
|
| Min. Negotiated Rate |
$67.86 |
| Max. Negotiated Rate |
$218.12 |
| Rate for Payer: Cash Price |
$99.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$96.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$87.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$87.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$92.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$96.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$92.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$96.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$96.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.70
|
| Rate for Payer: Healthfirst Commercial |
$96.94
|
| Rate for Payer: Healthfirst Essential Plan |
$218.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$92.09
|
| Rate for Payer: Healthfirst QHP |
$96.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$67.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$96.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$82.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$67.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$96.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$72.70
|
| Rate for Payer: SOMOS Essential |
$72.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$96.94
|
|
|
CHG US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO
|
Professional
|
Both
|
$180.99
|
|
|
Service Code
|
HCPCS 76810 TC
|
| Min. Negotiated Rate |
$33.04 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$42.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$44.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$44.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.40
|
| Rate for Payer: Healthfirst Commercial |
$47.20
|
| Rate for Payer: Healthfirst Essential Plan |
$106.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.84
|
| Rate for Payer: Healthfirst QHP |
$47.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$47.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$40.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35.40
|
| Rate for Payer: SOMOS Essential |
$35.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.20
|
|
|
CHG US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO
|
Professional
|
Both
|
$188.30
|
|
|
Service Code
|
HCPCS 76810 26
|
| Min. Negotiated Rate |
$34.83 |
| Max. Negotiated Rate |
$111.94 |
| Rate for Payer: Cash Price |
$50.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$49.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$44.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$44.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$47.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$49.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$47.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$37.31
|
| Rate for Payer: Healthfirst Commercial |
$49.75
|
| Rate for Payer: Healthfirst Essential Plan |
$111.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.26
|
| Rate for Payer: Healthfirst QHP |
$49.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$49.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$42.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$49.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$37.31
|
| Rate for Payer: SOMOS Essential |
$37.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$49.75
|
|
|
CHG US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION
|
Professional
|
Both
|
$575.96
|
|
|
Service Code
|
HCPCS 76805
|
| Min. Negotiated Rate |
$107.17 |
| Max. Negotiated Rate |
$344.48 |
| Rate for Payer: Cash Price |
$156.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$153.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$137.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$137.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$145.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$153.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$145.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$153.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$153.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$114.83
|
| Rate for Payer: Healthfirst Commercial |
$153.10
|
| Rate for Payer: Healthfirst Essential Plan |
$344.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$145.44
|
| Rate for Payer: Healthfirst QHP |
$153.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$107.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$153.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$130.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$107.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$153.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$114.83
|
| Rate for Payer: SOMOS Essential |
$114.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$153.10
|
|
|
CHG US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION
|
Professional
|
Both
|
$189.56
|
|
|
Service Code
|
HCPCS 76805 26
|
| Min. Negotiated Rate |
$35.93 |
| Max. Negotiated Rate |
$115.49 |
| Rate for Payer: Cash Price |
$51.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$51.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$46.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$46.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$48.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$51.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$48.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.50
|
| Rate for Payer: Healthfirst Commercial |
$51.33
|
| Rate for Payer: Healthfirst Essential Plan |
$115.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$48.76
|
| Rate for Payer: Healthfirst QHP |
$51.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$35.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$51.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$43.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$35.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$51.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$38.50
|
| Rate for Payer: SOMOS Essential |
$38.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$51.33
|
|
|
CHG US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION
|
Professional
|
Both
|
$386.40
|
|
|
Service Code
|
HCPCS 76805 TC
|
| Min. Negotiated Rate |
$71.24 |
| Max. Negotiated Rate |
$228.98 |
| Rate for Payer: Cash Price |
$105.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$101.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$91.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$91.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$96.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$101.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$96.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$101.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$101.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$76.33
|
| Rate for Payer: Healthfirst Commercial |
$101.77
|
| Rate for Payer: Healthfirst Essential Plan |
$228.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$96.68
|
| Rate for Payer: Healthfirst QHP |
$101.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$71.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$101.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$86.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$71.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$101.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$76.33
|
| Rate for Payer: SOMOS Essential |
$76.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$101.77
|
|
|
CHG US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT
|
Professional
|
Both
|
$801.43
|
|
|
Service Code
|
HCPCS 76812
|
| Min. Negotiated Rate |
$149.58 |
| Max. Negotiated Rate |
$480.80 |
| Rate for Payer: Cash Price |
$219.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$213.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$192.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$192.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$203.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$213.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$203.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$213.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$213.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$160.27
|
| Rate for Payer: Healthfirst Commercial |
$213.69
|
| Rate for Payer: Healthfirst Essential Plan |
$480.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$203.01
|
| Rate for Payer: Healthfirst QHP |
$213.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$149.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$213.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$181.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$149.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$213.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$160.27
|
| Rate for Payer: SOMOS Essential |
$160.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$213.69
|
|
|
CHG US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT
|
Professional
|
Both
|
$333.06
|
|
|
Service Code
|
HCPCS 76812 26
|
| Min. Negotiated Rate |
$63.40 |
| Max. Negotiated Rate |
$203.78 |
| Rate for Payer: Cash Price |
$91.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$90.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$81.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$81.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$86.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$90.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$86.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$90.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67.93
|
| Rate for Payer: Healthfirst Commercial |
$90.57
|
| Rate for Payer: Healthfirst Essential Plan |
$203.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$86.04
|
| Rate for Payer: Healthfirst QHP |
$90.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$63.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$90.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$76.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$63.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$90.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$67.93
|
| Rate for Payer: SOMOS Essential |
$67.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$90.57
|
|
|
CHG US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT
|
Professional
|
Both
|
$468.34
|
|
|
Service Code
|
HCPCS 76812 TC
|
| Min. Negotiated Rate |
$86.18 |
| Max. Negotiated Rate |
$277.02 |
| Rate for Payer: Cash Price |
$127.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$123.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$110.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$110.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$116.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$123.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$116.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$123.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$123.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$92.34
|
| Rate for Payer: Healthfirst Commercial |
$123.12
|
| Rate for Payer: Healthfirst Essential Plan |
$277.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$116.96
|
| Rate for Payer: Healthfirst QHP |
$123.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$86.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$123.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$104.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$86.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$123.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$92.34
|
| Rate for Payer: SOMOS Essential |
$92.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$123.12
|
|
