|
CHG US TRANSRECTAL
|
Professional
|
Both
|
$580.51
|
|
|
Service Code
|
HCPCS 76872
|
| Min. Negotiated Rate |
$158.57 |
| Max. Negotiated Rate |
$509.69 |
| Rate for Payer: Cash Price |
$235.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$226.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$203.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$203.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$215.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$226.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$215.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$226.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$226.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$169.90
|
| Rate for Payer: Healthfirst Commercial |
$226.53
|
| Rate for Payer: Healthfirst Essential Plan |
$509.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$215.20
|
| Rate for Payer: Healthfirst QHP |
$226.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$158.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$226.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$192.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$158.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$226.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$169.90
|
| Rate for Payer: SOMOS Essential |
$169.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$226.53
|
|
|
CHG US TRANSRECTAL
|
Professional
|
Both
|
$454.13
|
|
|
Service Code
|
HCPCS 76872 TC
|
| Min. Negotiated Rate |
$134.27 |
| Max. Negotiated Rate |
$431.60 |
| Rate for Payer: Cash Price |
$200.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$191.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$172.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$172.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$182.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$191.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$182.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$191.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$143.87
|
| Rate for Payer: Healthfirst Commercial |
$191.82
|
| Rate for Payer: Healthfirst Essential Plan |
$431.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$182.23
|
| Rate for Payer: Healthfirst QHP |
$191.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$134.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$191.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$163.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$134.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$191.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$143.87
|
| Rate for Payer: SOMOS Essential |
$143.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$191.82
|
|
|
CHG US TRANSVAGINAL
|
Professional
|
Both
|
$512.68
|
|
|
Service Code
|
HCPCS 76830
|
| Min. Negotiated Rate |
$94.61 |
| Max. Negotiated Rate |
$304.11 |
| Rate for Payer: Cash Price |
$138.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$135.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$121.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$121.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$128.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$135.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$128.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$135.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$135.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$101.37
|
| Rate for Payer: Healthfirst Commercial |
$135.16
|
| Rate for Payer: Healthfirst Essential Plan |
$304.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$128.40
|
| Rate for Payer: Healthfirst QHP |
$135.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$94.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$135.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$114.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$94.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$135.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$101.37
|
| Rate for Payer: SOMOS Essential |
$101.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$135.16
|
|
|
CHG US TRANSVAGINAL
|
Professional
|
Both
|
$134.75
|
|
|
Service Code
|
HCPCS 76830 26
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Cash Price |
$35.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.79
|
| Rate for Payer: Healthfirst Commercial |
$35.72
|
| Rate for Payer: Healthfirst Essential Plan |
$80.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.93
|
| Rate for Payer: Healthfirst QHP |
$35.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.79
|
| Rate for Payer: SOMOS Essential |
$26.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.72
|
|
|
CHG US TRANSVAGINAL
|
Professional
|
Both
|
$377.93
|
|
|
Service Code
|
HCPCS 76830 TC
|
| Min. Negotiated Rate |
$69.61 |
| Max. Negotiated Rate |
$223.74 |
| Rate for Payer: Cash Price |
$103.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$99.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$89.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$89.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$94.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$99.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$94.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$99.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$99.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$74.58
|
| Rate for Payer: Healthfirst Commercial |
$99.44
|
| Rate for Payer: Healthfirst Essential Plan |
$223.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$94.47
|
| Rate for Payer: Healthfirst QHP |
$99.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$69.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$99.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$84.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$69.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$99.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$74.58
|
| Rate for Payer: SOMOS Essential |
$74.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$99.44
|
|
|
CHG US TRNSPLNT KIDNEY REAL TIME W/IMAGE DOCMTN
|
Professional
|
Both
|
$144.94
|
|
|
Service Code
|
HCPCS 76776 26
|
| Min. Negotiated Rate |
$27.39 |
| Max. Negotiated Rate |
$88.04 |
| Rate for Payer: Cash Price |
$39.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$39.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.35
|
| Rate for Payer: Healthfirst Commercial |
$39.13
|
| Rate for Payer: Healthfirst Essential Plan |
$88.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.17
|
| Rate for Payer: Healthfirst QHP |
$39.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$39.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.35
|
| Rate for Payer: SOMOS Essential |
$29.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.13
|
|
|
CHG US TRNSPLNT KIDNEY REAL TIME W/IMAGE DOCMTN
|
Professional
|
Both
|
$489.90
|
|
|
Service Code
|
HCPCS 76776 TC
|
| Min. Negotiated Rate |
$90.26 |
| Max. Negotiated Rate |
$290.12 |
| Rate for Payer: Cash Price |
$132.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$128.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$116.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$116.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$122.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$128.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$122.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$128.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$128.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$96.70
|
| Rate for Payer: Healthfirst Commercial |
$128.94
|
| Rate for Payer: Healthfirst Essential Plan |
$290.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$122.49
|
| Rate for Payer: Healthfirst QHP |
$128.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$90.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$128.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$109.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$90.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$128.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$96.70
|
| Rate for Payer: SOMOS Essential |
$96.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$128.94
|
|
|
CHG US TRNSPLNT KIDNEY REAL TIME W/IMAGE DOCMTN
|
Professional
|
Both
|
$634.87
|
|
|
Service Code
|
HCPCS 76776
|
| Min. Negotiated Rate |
$117.65 |
| Max. Negotiated Rate |
$378.16 |
| Rate for Payer: Cash Price |
$171.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$168.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$151.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$151.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$159.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$168.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$159.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$168.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$168.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$126.05
|
| Rate for Payer: Healthfirst Commercial |
$168.07
|
| Rate for Payer: Healthfirst Essential Plan |
$378.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$159.67
|
| Rate for Payer: Healthfirst QHP |
$168.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$117.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$168.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$142.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$117.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$168.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$126.05
|
| Rate for Payer: SOMOS Essential |
$126.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$168.07
|
|
|
CHG US VASC ACCESS SITS VSL PATENCY NDL ENTRY
|
Professional
|
Both
|
$60.03
|
|
|
Service Code
|
HCPCS 76937 26
|
| Min. Negotiated Rate |
$10.28 |
| Max. Negotiated Rate |
$33.03 |
| Rate for Payer: Cash Price |
$15.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.01
|
| Rate for Payer: Healthfirst Commercial |
$14.68
|
| Rate for Payer: Healthfirst Essential Plan |
$33.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.95
|
| Rate for Payer: Healthfirst QHP |
$14.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$10.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$14.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$12.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$11.01
|
| Rate for Payer: SOMOS Essential |
$11.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.68
|
|
|
CHG US VASC ACCESS SITS VSL PATENCY NDL ENTRY
|
Professional
|
Both
|
$169.26
|
|
|
Service Code
|
HCPCS 76937
|
| Min. Negotiated Rate |
$30.81 |
| Max. Negotiated Rate |
$99.05 |
| Rate for Payer: Cash Price |
$44.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$44.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$44.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.02
|
| Rate for Payer: Healthfirst Commercial |
$44.02
|
| Rate for Payer: Healthfirst Essential Plan |
$99.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.82
|
| Rate for Payer: Healthfirst QHP |
$44.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$44.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$44.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$33.02
|
| Rate for Payer: SOMOS Essential |
$33.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44.02
|
|
|
CHG US VASC ACCESS SITS VSL PATENCY NDL ENTRY
|
Professional
|
Both
|
$109.24
|
|
|
Service Code
|
HCPCS 76937 TC
|
| Min. Negotiated Rate |
$20.54 |
| Max. Negotiated Rate |
$66.02 |
| Rate for Payer: Cash Price |
$29.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.00
|
| Rate for Payer: Healthfirst Commercial |
$29.34
|
| Rate for Payer: Healthfirst Essential Plan |
$66.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.87
|
| Rate for Payer: Healthfirst QHP |
$29.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.00
|
| Rate for Payer: SOMOS Essential |
$22.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.34
|
|
|
CHG VASOGRAPY VESICULOGRAPY/EPIDIDYMOGRAPY RS&I
|
Professional
|
Both
|
$415.31
|
|
|
Service Code
|
HCPCS 74440
|
| Min. Negotiated Rate |
$76.87 |
| Max. Negotiated Rate |
$247.07 |
| Rate for Payer: Cash Price |
$113.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$109.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$98.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$98.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$104.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$109.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$104.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$109.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$82.36
|
| Rate for Payer: Healthfirst Commercial |
$109.81
|
| Rate for Payer: Healthfirst Essential Plan |
$247.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$104.32
|
| Rate for Payer: Healthfirst QHP |
$109.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$76.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$109.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$93.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$76.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$109.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$82.36
|
| Rate for Payer: SOMOS Essential |
$82.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$109.81
|
|
|
CHG VASOGRAPY VESICULOGRAPY/EPIDIDYMOGRAPY RS&I
|
Professional
|
Both
|
$346.29
|
|
|
Service Code
|
HCPCS 74440 TC
|
| Min. Negotiated Rate |
$63.47 |
| Max. Negotiated Rate |
$204.01 |
| Rate for Payer: Cash Price |
$94.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$90.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$81.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$81.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$86.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$90.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$86.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$90.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$68.00
|
| Rate for Payer: Healthfirst Commercial |
$90.67
|
| Rate for Payer: Healthfirst Essential Plan |
$204.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$86.14
|
| Rate for Payer: Healthfirst QHP |
$90.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$63.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$90.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$77.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$63.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$90.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$68.00
|
| Rate for Payer: SOMOS Essential |
$68.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$90.67
|
|
|
CHG VASOGRAPY VESICULOGRAPY/EPIDIDYMOGRAPY RS&I
|
Professional
|
Both
|
$69.02
|
|
|
Service Code
|
HCPCS 74440 26
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Cash Price |
$18.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.36
|
| Rate for Payer: Healthfirst Commercial |
$19.14
|
| Rate for Payer: Healthfirst Essential Plan |
$43.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.18
|
| Rate for Payer: Healthfirst QHP |
$19.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$14.36
|
| Rate for Payer: SOMOS Essential |
$14.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.14
|
|
|
CHG VENOGRAPHY ADRENAL BILATERAL SELECTIVE RS&I
|
Professional
|
Both
|
$383.53
|
|
|
Service Code
|
HCPCS 75842 TC
|
| Min. Negotiated Rate |
$72.60 |
| Max. Negotiated Rate |
$233.35 |
| Rate for Payer: Cash Price |
$104.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$103.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$93.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$93.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$98.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$103.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$98.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$103.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$77.78
|
| Rate for Payer: Healthfirst Commercial |
$103.71
|
| Rate for Payer: Healthfirst Essential Plan |
$233.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$98.52
|
| Rate for Payer: Healthfirst QHP |
$103.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$72.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$103.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$88.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$72.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$103.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$77.78
|
| Rate for Payer: SOMOS Essential |
$77.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$103.71
|
|
|
CHG VENOGRAPHY ADRENAL BILATERAL SELECTIVE RS&I
|
Professional
|
Both
|
$671.09
|
|
|
Service Code
|
HCPCS 75842
|
| Min. Negotiated Rate |
$126.50 |
| Max. Negotiated Rate |
$406.60 |
| Rate for Payer: Cash Price |
$182.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$180.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$162.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$162.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$171.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$180.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$171.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$180.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$180.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$135.53
|
| Rate for Payer: Healthfirst Commercial |
$180.71
|
| Rate for Payer: Healthfirst Essential Plan |
$406.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$171.67
|
| Rate for Payer: Healthfirst QHP |
$180.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$126.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$180.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$153.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$126.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$180.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$135.53
|
| Rate for Payer: SOMOS Essential |
$135.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$180.71
|
|
|
CHG VENOGRAPHY ADRENAL BILATERAL SELECTIVE RS&I
|
Professional
|
Both
|
$287.56
|
|
|
Service Code
|
HCPCS 75842 26
|
| Min. Negotiated Rate |
$53.90 |
| Max. Negotiated Rate |
$173.25 |
| Rate for Payer: Cash Price |
$77.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$77.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$69.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$69.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$73.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$77.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$73.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.75
|
| Rate for Payer: Healthfirst Commercial |
$77.00
|
| Rate for Payer: Healthfirst Essential Plan |
$173.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$73.15
|
| Rate for Payer: Healthfirst QHP |
$77.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$53.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$77.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$65.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$53.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$77.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$57.75
|
| Rate for Payer: SOMOS Essential |
$57.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$77.00
|
|
|
CHG VENOGRAPHY ADRENAL UNILATERAL SELECTIVE RS&I
|
Professional
|
Both
|
$547.05
|
|
|
Service Code
|
HCPCS 75840
|
| Min. Negotiated Rate |
$101.98 |
| Max. Negotiated Rate |
$327.78 |
| Rate for Payer: Cash Price |
$148.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$145.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$131.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$131.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$138.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$145.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$138.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$145.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$145.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$109.26
|
| Rate for Payer: Healthfirst Commercial |
$145.68
|
| Rate for Payer: Healthfirst Essential Plan |
$327.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$138.40
|
| Rate for Payer: Healthfirst QHP |
$145.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$101.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$145.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$123.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$101.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$145.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$109.26
|
| Rate for Payer: SOMOS Essential |
$109.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$145.68
|
|
|
CHG VENOGRAPHY ADRENAL UNILATERAL SELECTIVE RS&I
|
Professional
|
Both
|
$219.59
|
|
|
Service Code
|
HCPCS 75840 26
|
| Min. Negotiated Rate |
$41.07 |
| Max. Negotiated Rate |
$132.01 |
| Rate for Payer: Cash Price |
$59.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$58.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$52.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$52.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$55.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$58.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$55.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$58.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$58.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.00
|
| Rate for Payer: Healthfirst Commercial |
$58.67
|
| Rate for Payer: Healthfirst Essential Plan |
$132.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$55.74
|
| Rate for Payer: Healthfirst QHP |
$58.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$41.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$58.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$49.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$41.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$58.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$44.00
|
| Rate for Payer: SOMOS Essential |
$44.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$58.67
|
|
|
CHG VENOGRAPHY ADRENAL UNILATERAL SELECTIVE RS&I
|
Professional
|
Both
|
$327.46
|
|
|
Service Code
|
HCPCS 75840 TC
|
| Min. Negotiated Rate |
$60.91 |
| Max. Negotiated Rate |
$195.79 |
| Rate for Payer: Cash Price |
$88.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$87.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$78.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$78.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$82.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$87.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$82.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$87.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$87.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$65.27
|
| Rate for Payer: Healthfirst Commercial |
$87.02
|
| Rate for Payer: Healthfirst Essential Plan |
$195.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$82.67
|
| Rate for Payer: Healthfirst QHP |
$87.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$60.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$87.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$73.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$60.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$87.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$65.27
|
| Rate for Payer: SOMOS Essential |
$65.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$87.02
|
|
|
CHG VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$267.23
|
|
|
Service Code
|
HCPCS 75825 TC
|
| Min. Negotiated Rate |
$49.88 |
| Max. Negotiated Rate |
$160.34 |
| Rate for Payer: Cash Price |
$72.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$71.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$64.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$64.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$67.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$71.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$67.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$71.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$71.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$53.45
|
| Rate for Payer: Healthfirst Commercial |
$71.26
|
| Rate for Payer: Healthfirst Essential Plan |
$160.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$67.70
|
| Rate for Payer: Healthfirst QHP |
$71.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$49.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$71.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$60.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$49.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$71.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$53.45
|
| Rate for Payer: SOMOS Essential |
$53.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$71.26
|
|
|
CHG VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$490.00
|
|
|
Service Code
|
HCPCS 75825
|
| Min. Negotiated Rate |
$92.02 |
| Max. Negotiated Rate |
$295.76 |
| Rate for Payer: Cash Price |
$132.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$131.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$118.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$118.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$124.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$131.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$124.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$131.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$131.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$98.59
|
| Rate for Payer: Healthfirst Commercial |
$131.45
|
| Rate for Payer: Healthfirst Essential Plan |
$295.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$124.88
|
| Rate for Payer: Healthfirst QHP |
$131.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$92.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$131.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$111.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$92.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$131.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$98.59
|
| Rate for Payer: SOMOS Essential |
$98.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$131.45
|
|
|
CHG VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$222.78
|
|
|
Service Code
|
HCPCS 75825 26
|
| Min. Negotiated Rate |
$42.13 |
| Max. Negotiated Rate |
$135.43 |
| Rate for Payer: Cash Price |
$59.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$60.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$54.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$54.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$57.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$60.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$57.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.14
|
| Rate for Payer: Healthfirst Commercial |
$60.19
|
| Rate for Payer: Healthfirst Essential Plan |
$135.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$57.18
|
| Rate for Payer: Healthfirst QHP |
$60.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$42.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$60.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$51.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$42.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$60.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$45.14
|
| Rate for Payer: SOMOS Essential |
$45.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$60.19
|
|
|
CHG VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$287.35
|
|
|
Service Code
|
HCPCS 75827 TC
|
| Min. Negotiated Rate |
$52.87 |
| Max. Negotiated Rate |
$169.94 |
| Rate for Payer: Cash Price |
$78.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$75.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$67.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$67.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$71.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$75.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$71.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$56.65
|
| Rate for Payer: Healthfirst Commercial |
$75.53
|
| Rate for Payer: Healthfirst Essential Plan |
$169.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$71.75
|
| Rate for Payer: Healthfirst QHP |
$75.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$52.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$75.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$64.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$52.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$75.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$56.65
|
| Rate for Payer: SOMOS Essential |
$56.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$75.53
|
|
|
CHG VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$225.65
|
|
|
Service Code
|
HCPCS 75827 26
|
| Min. Negotiated Rate |
$41.54 |
| Max. Negotiated Rate |
$133.51 |
| Rate for Payer: Cash Price |
$60.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$59.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$53.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$56.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$59.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$56.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.51
|
| Rate for Payer: Healthfirst Commercial |
$59.34
|
| Rate for Payer: Healthfirst Essential Plan |
$133.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$56.37
|
| Rate for Payer: Healthfirst QHP |
$59.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$41.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$59.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$50.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$41.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$59.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$44.51
|
| Rate for Payer: SOMOS Essential |
$44.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$59.34
|
|
