|
CHG US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS
|
Professional
|
Both
|
$159.36
|
|
|
Service Code
|
HCPCS 76816 26
|
| Min. Negotiated Rate |
$30.33 |
| Max. Negotiated Rate |
$97.49 |
| Rate for Payer: Cash Price |
$43.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$43.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.50
|
| Rate for Payer: Healthfirst Commercial |
$43.33
|
| Rate for Payer: Healthfirst Essential Plan |
$97.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.16
|
| Rate for Payer: Healthfirst QHP |
$43.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$43.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$36.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.50
|
| Rate for Payer: SOMOS Essential |
$32.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.33
|
|
|
CHG US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS
|
Professional
|
Both
|
$301.74
|
|
|
Service Code
|
HCPCS 76816 TC
|
| Min. Negotiated Rate |
$55.86 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Cash Price |
$82.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$79.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$71.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$71.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$75.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$79.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$75.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$79.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$59.85
|
| Rate for Payer: Healthfirst Commercial |
$79.80
|
| Rate for Payer: Healthfirst Essential Plan |
$179.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$75.81
|
| Rate for Payer: Healthfirst QHP |
$79.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$55.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$79.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$67.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$55.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$79.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$59.85
|
| Rate for Payer: SOMOS Essential |
$59.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$79.80
|
|
|
CHG US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS
|
Professional
|
Both
|
$461.09
|
|
|
Service Code
|
HCPCS 76816
|
| Min. Negotiated Rate |
$86.19 |
| Max. Negotiated Rate |
$277.04 |
| Rate for Payer: Cash Price |
$126.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$123.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$110.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$110.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$116.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$123.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$116.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$123.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$123.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$92.35
|
| Rate for Payer: Healthfirst Commercial |
$123.13
|
| Rate for Payer: Healthfirst Essential Plan |
$277.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$116.97
|
| Rate for Payer: Healthfirst QHP |
$123.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$86.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$123.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$104.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$86.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$123.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$92.35
|
| Rate for Payer: SOMOS Essential |
$92.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$123.13
|
|
|
CHG US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG
|
Professional
|
Both
|
$145.15
|
|
|
Service Code
|
HCPCS 76817 26
|
| Min. Negotiated Rate |
$26.99 |
| Max. Negotiated Rate |
$86.76 |
| Rate for Payer: Cash Price |
$39.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.92
|
| Rate for Payer: Healthfirst Commercial |
$38.56
|
| Rate for Payer: Healthfirst Essential Plan |
$86.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.63
|
| Rate for Payer: Healthfirst QHP |
$38.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.92
|
| Rate for Payer: SOMOS Essential |
$28.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.56
|
|
|
CHG US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG
|
Professional
|
Both
|
$248.54
|
|
|
Service Code
|
HCPCS 76817 TC
|
| Min. Negotiated Rate |
$46.08 |
| Max. Negotiated Rate |
$148.12 |
| Rate for Payer: Cash Price |
$67.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$65.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$59.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$59.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$65.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$49.37
|
| Rate for Payer: Healthfirst Commercial |
$65.83
|
| Rate for Payer: Healthfirst Essential Plan |
$148.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.54
|
| Rate for Payer: Healthfirst QHP |
$65.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$46.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$65.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$55.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$46.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$65.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$49.37
|
| Rate for Payer: SOMOS Essential |
$49.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.83
|
|
|
CHG US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG
|
Professional
|
Both
|
$393.68
|
|
|
Service Code
|
HCPCS 76817
|
| Min. Negotiated Rate |
$73.07 |
| Max. Negotiated Rate |
$234.88 |
| Rate for Payer: Cash Price |
$106.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$104.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$93.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$93.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$99.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$104.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$99.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$104.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$104.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$78.29
|
| Rate for Payer: Healthfirst Commercial |
$104.39
|
| Rate for Payer: Healthfirst Essential Plan |
$234.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$99.17
|
| Rate for Payer: Healthfirst QHP |
$104.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$73.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$104.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$88.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$73.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$104.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$78.29
|
| Rate for Payer: SOMOS Essential |
$78.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$104.39
|
|
|
CHG US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION
|
Professional
|
Both
|
$377.51
|
|
|
Service Code
|
HCPCS 76811 TC
|
| Min. Negotiated Rate |
$72.48 |
| Max. Negotiated Rate |
$232.99 |
| Rate for Payer: Cash Price |
$104.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$103.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$93.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$93.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$98.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$103.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$98.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$103.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$77.66
|
| Rate for Payer: Healthfirst Commercial |
$103.55
|
| Rate for Payer: Healthfirst Essential Plan |
$232.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$98.37
|
| Rate for Payer: Healthfirst QHP |
$103.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$72.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$103.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$88.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$72.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$103.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$77.66
|
| Rate for Payer: SOMOS Essential |
$77.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$103.55
|
|
|
CHG US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION
|
Professional
|
Both
|
$355.29
|
|
|
Service Code
|
HCPCS 76811 26
|
| Min. Negotiated Rate |
$67.38 |
| Max. Negotiated Rate |
$216.59 |
| Rate for Payer: Cash Price |
$97.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$96.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$86.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$86.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$91.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$96.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$91.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$96.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$96.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.19
|
| Rate for Payer: Healthfirst Commercial |
$96.26
|
| Rate for Payer: Healthfirst Essential Plan |
$216.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$91.45
|
| Rate for Payer: Healthfirst QHP |
$96.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$67.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$96.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$81.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$67.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$96.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$72.19
|
| Rate for Payer: SOMOS Essential |
$72.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$96.26
|
|
|
CHG US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION
|
Professional
|
Both
|
$732.80
|
|
|
Service Code
|
HCPCS 76811
|
| Min. Negotiated Rate |
$139.87 |
| Max. Negotiated Rate |
$449.57 |
| Rate for Payer: Cash Price |
$202.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$199.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$179.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$179.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$189.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$199.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$189.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$199.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$199.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$149.86
|
| Rate for Payer: Healthfirst Commercial |
$199.81
|
| Rate for Payer: Healthfirst Essential Plan |
$449.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$189.82
|
| Rate for Payer: Healthfirst QHP |
$199.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$139.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$199.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$169.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$139.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$199.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$149.86
|
| Rate for Payer: SOMOS Essential |
$149.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$199.81
|
|
|
CHG US, RETROPERITNL ABD, LTD
|
Professional
|
Both
|
$250.22
|
|
|
Service Code
|
HCPCS 76775
|
| Min. Negotiated Rate |
$48.32 |
| Max. Negotiated Rate |
$155.32 |
| Rate for Payer: Cash Price |
$68.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$69.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$62.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$65.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$69.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$65.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$69.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$69.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51.77
|
| Rate for Payer: Healthfirst Commercial |
$69.03
|
| Rate for Payer: Healthfirst Essential Plan |
$155.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$65.58
|
| Rate for Payer: Healthfirst QHP |
$69.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$48.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$69.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$58.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$48.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$69.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$51.77
|
| Rate for Payer: SOMOS Essential |
$51.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$69.03
|
|
|
CHG US, RETROPERITNL ABD, LTD
|
Professional
|
Both
|
$112.35
|
|
|
Service Code
|
HCPCS 76775 26
|
| Min. Negotiated Rate |
$20.99 |
| Max. Negotiated Rate |
$67.48 |
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$28.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.49
|
| Rate for Payer: Healthfirst Commercial |
$29.99
|
| Rate for Payer: Healthfirst Essential Plan |
$67.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.49
|
| Rate for Payer: Healthfirst QHP |
$29.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$25.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.49
|
| Rate for Payer: SOMOS Essential |
$22.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.99
|
|
|
CHG US, RETROPERITNL ABD, LTD
|
Professional
|
Both
|
$137.87
|
|
|
Service Code
|
HCPCS 76775 TC
|
| Min. Negotiated Rate |
$27.34 |
| Max. Negotiated Rate |
$87.86 |
| Rate for Payer: Cash Price |
$38.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$39.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.29
|
| Rate for Payer: Healthfirst Commercial |
$39.05
|
| Rate for Payer: Healthfirst Essential Plan |
$87.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.10
|
| Rate for Payer: Healthfirst QHP |
$39.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$39.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.29
|
| Rate for Payer: SOMOS Essential |
$29.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.05
|
|
|
CHG US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE
|
Professional
|
Both
|
$141.02
|
|
|
Service Code
|
HCPCS 76770 26
|
| Min. Negotiated Rate |
$26.64 |
| Max. Negotiated Rate |
$85.64 |
| Rate for Payer: Cash Price |
$38.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.55
|
| Rate for Payer: Healthfirst Commercial |
$38.06
|
| Rate for Payer: Healthfirst Essential Plan |
$85.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.16
|
| Rate for Payer: Healthfirst QHP |
$38.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.55
|
| Rate for Payer: SOMOS Essential |
$28.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.06
|
|
|
CHG US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE
|
Professional
|
Both
|
$321.86
|
|
|
Service Code
|
HCPCS 76770 TC
|
| Min. Negotiated Rate |
$59.83 |
| Max. Negotiated Rate |
$192.31 |
| Rate for Payer: Cash Price |
$87.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$85.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$76.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$76.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$81.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$85.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$81.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.10
|
| Rate for Payer: Healthfirst Commercial |
$85.47
|
| Rate for Payer: Healthfirst Essential Plan |
$192.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$81.20
|
| Rate for Payer: Healthfirst QHP |
$85.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$59.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$85.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$72.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$59.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$85.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$64.10
|
| Rate for Payer: SOMOS Essential |
$64.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$85.47
|
|
|
CHG US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE
|
Professional
|
Both
|
$462.88
|
|
|
Service Code
|
HCPCS 76770
|
| Min. Negotiated Rate |
$86.46 |
| Max. Negotiated Rate |
$277.92 |
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$123.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$111.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$111.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$117.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$123.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$117.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$123.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$123.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$92.64
|
| Rate for Payer: Healthfirst Commercial |
$123.52
|
| Rate for Payer: Healthfirst Essential Plan |
$277.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$117.34
|
| Rate for Payer: Healthfirst QHP |
$123.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$86.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$123.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$104.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$86.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$123.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$92.64
|
| Rate for Payer: SOMOS Essential |
$92.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$123.52
|
|
|
CHG US SCROTUM & CONTENTS
|
Professional
|
Both
|
$307.48
|
|
|
Service Code
|
HCPCS 76870 TC
|
| Min. Negotiated Rate |
$57.11 |
| Max. Negotiated Rate |
$183.56 |
| Rate for Payer: Cash Price |
$83.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$81.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$73.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$77.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$61.19
|
| Rate for Payer: Healthfirst Commercial |
$81.58
|
| Rate for Payer: Healthfirst Essential Plan |
$183.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$77.50
|
| Rate for Payer: Healthfirst QHP |
$81.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$57.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$81.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$69.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$57.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$61.19
|
| Rate for Payer: SOMOS Essential |
$61.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.58
|
|
|
CHG US SCROTUM & CONTENTS
|
Professional
|
Both
|
$431.66
|
|
|
Service Code
|
HCPCS 76870
|
| Min. Negotiated Rate |
$80.09 |
| Max. Negotiated Rate |
$257.42 |
| Rate for Payer: Cash Price |
$115.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$114.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$102.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$102.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$108.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$114.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$108.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$114.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$114.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$85.81
|
| Rate for Payer: Healthfirst Commercial |
$114.41
|
| Rate for Payer: Healthfirst Essential Plan |
$257.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$108.69
|
| Rate for Payer: Healthfirst QHP |
$114.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$80.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$114.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$97.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$80.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$114.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$85.81
|
| Rate for Payer: SOMOS Essential |
$85.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$114.41
|
|
|
CHG US SCROTUM & CONTENTS
|
Professional
|
Both
|
$124.18
|
|
|
Service Code
|
HCPCS 76870 26
|
| Min. Negotiated Rate |
$22.98 |
| Max. Negotiated Rate |
$73.87 |
| Rate for Payer: Cash Price |
$32.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.62
|
| Rate for Payer: Healthfirst Commercial |
$32.83
|
| Rate for Payer: Healthfirst Essential Plan |
$73.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.19
|
| Rate for Payer: Healthfirst QHP |
$32.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.83
|
| 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) |
$22.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.62
|
| Rate for Payer: SOMOS Essential |
$24.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.83
|
|
|
CHG US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM
|
Professional
|
Both
|
$477.68
|
|
|
Service Code
|
HCPCS 76536
|
| Min. Negotiated Rate |
$88.21 |
| Max. Negotiated Rate |
$283.55 |
| Rate for Payer: Cash Price |
$128.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$126.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$113.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$113.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$119.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$126.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$119.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$94.52
|
| Rate for Payer: Healthfirst Commercial |
$126.02
|
| Rate for Payer: Healthfirst Essential Plan |
$283.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$119.72
|
| Rate for Payer: Healthfirst QHP |
$126.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$88.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$126.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$107.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$88.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$126.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$94.52
|
| Rate for Payer: SOMOS Essential |
$94.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$126.02
|
|
|
CHG US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM
|
Professional
|
Both
|
$111.27
|
|
|
Service Code
|
HCPCS 76536 26
|
| Min. Negotiated Rate |
$20.51 |
| Max. Negotiated Rate |
$65.92 |
| Rate for Payer: Cash Price |
$29.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.98
|
| Rate for Payer: Healthfirst Commercial |
$29.30
|
| Rate for Payer: Healthfirst Essential Plan |
$65.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.84
|
| Rate for Payer: Healthfirst QHP |
$29.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.98
|
| Rate for Payer: SOMOS Essential |
$21.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.30
|
|
|
CHG US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM
|
Professional
|
Both
|
$366.42
|
|
|
Service Code
|
HCPCS 76536 TC
|
| Min. Negotiated Rate |
$67.70 |
| Max. Negotiated Rate |
$217.62 |
| Rate for Payer: Cash Price |
$99.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$96.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$87.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$87.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$91.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$96.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$91.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$96.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$96.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.54
|
| Rate for Payer: Healthfirst Commercial |
$96.72
|
| Rate for Payer: Healthfirst Essential Plan |
$217.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$91.88
|
| Rate for Payer: Healthfirst QHP |
$96.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$67.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$96.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$82.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$67.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$96.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$72.54
|
| Rate for Payer: SOMOS Essential |
$72.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$96.72
|
|
|
CHG US TRANSRCT PRSTATE VOL BRACHYTX PLNNING SPX
|
Professional
|
Both
|
$733.53
|
|
|
Service Code
|
HCPCS 76873
|
| Min. Negotiated Rate |
$138.77 |
| Max. Negotiated Rate |
$446.04 |
| Rate for Payer: Cash Price |
$202.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$198.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$178.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$178.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$188.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$198.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$188.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$198.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$198.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$148.68
|
| Rate for Payer: Healthfirst Commercial |
$198.24
|
| Rate for Payer: Healthfirst Essential Plan |
$446.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$188.33
|
| Rate for Payer: Healthfirst QHP |
$198.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$138.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$198.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$168.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$138.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$198.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$148.68
|
| Rate for Payer: SOMOS Essential |
$148.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$198.24
|
|
|
CHG US TRANSRCT PRSTATE VOL BRACHYTX PLNNING SPX
|
Professional
|
Both
|
$429.52
|
|
|
Service Code
|
HCPCS 76873 TC
|
| Min. Negotiated Rate |
$81.02 |
| Max. Negotiated Rate |
$260.42 |
| Rate for Payer: Cash Price |
$118.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$115.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$104.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$104.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$109.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$115.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$109.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$115.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$115.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$86.81
|
| Rate for Payer: Healthfirst Commercial |
$115.74
|
| Rate for Payer: Healthfirst Essential Plan |
$260.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$109.95
|
| Rate for Payer: Healthfirst QHP |
$115.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$81.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$115.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$98.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$81.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$115.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$86.81
|
| Rate for Payer: SOMOS Essential |
$86.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$115.74
|
|
|
CHG US TRANSRCT PRSTATE VOL BRACHYTX PLNNING SPX
|
Professional
|
Both
|
$303.98
|
|
|
Service Code
|
HCPCS 76873 26
|
| Min. Negotiated Rate |
$57.74 |
| Max. Negotiated Rate |
$185.60 |
| Rate for Payer: Cash Price |
$83.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$82.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$74.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$74.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$78.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$82.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$78.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$82.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$61.87
|
| Rate for Payer: Healthfirst Commercial |
$82.49
|
| Rate for Payer: Healthfirst Essential Plan |
$185.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$78.37
|
| Rate for Payer: Healthfirst QHP |
$82.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$57.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$82.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$70.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$57.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$82.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$61.87
|
| Rate for Payer: SOMOS Essential |
$61.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$82.49
|
|
|
CHG US TRANSRECTAL
|
Professional
|
Both
|
$126.39
|
|
|
Service Code
|
HCPCS 76872 26
|
| Min. Negotiated Rate |
$24.30 |
| Max. Negotiated Rate |
$78.10 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.03
|
| Rate for Payer: Healthfirst Commercial |
$34.71
|
| Rate for Payer: Healthfirst Essential Plan |
$78.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.97
|
| Rate for Payer: Healthfirst QHP |
$34.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.03
|
| Rate for Payer: SOMOS Essential |
$26.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.71
|
|
