|
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
|
|
|
CHG VENOGRAPHY EPIDURAL RS&I
|
Professional
|
Both
|
$219.59
|
|
|
Service Code
|
HCPCS 75872 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 EPIDURAL RS&I
|
Professional
|
Both
|
$327.46
|
|
|
Service Code
|
HCPCS 75872 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 EPIDURAL RS&I
|
Professional
|
Both
|
$547.05
|
|
|
Service Code
|
HCPCS 75872
|
| 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 EXTREMITY BILATERAL RS&I
|
Professional
|
Both
|
$278.57
|
|
|
Service Code
|
HCPCS 75822 26
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$170.35 |
| Rate for Payer: Cash Price |
$76.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$75.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$68.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$68.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$71.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$75.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$71.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$56.78
|
| Rate for Payer: Healthfirst Commercial |
$75.71
|
| Rate for Payer: Healthfirst Essential Plan |
$170.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$71.92
|
| Rate for Payer: Healthfirst QHP |
$75.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$53.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$75.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$64.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$53.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$75.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$56.78
|
| Rate for Payer: SOMOS Essential |
$56.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$75.71
|
|
|
CHG VENOGRAPHY EXTREMITY BILATERAL RS&I
|
Professional
|
Both
|
$561.61
|
|
|
Service Code
|
HCPCS 75822
|
| Min. Negotiated Rate |
$105.87 |
| Max. Negotiated Rate |
$340.29 |
| Rate for Payer: Cash Price |
$153.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$151.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$136.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$136.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$143.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$151.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$143.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$151.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$151.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$113.43
|
| Rate for Payer: Healthfirst Commercial |
$151.24
|
| Rate for Payer: Healthfirst Essential Plan |
$340.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$143.68
|
| Rate for Payer: Healthfirst QHP |
$151.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$105.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$151.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$128.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$105.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$151.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$113.43
|
| Rate for Payer: SOMOS Essential |
$113.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$151.24
|
|
|
CHG VENOGRAPHY EXTREMITY BILATERAL RS&I
|
Professional
|
Both
|
$283.05
|
|
|
Service Code
|
HCPCS 75822 TC
|
| Min. Negotiated Rate |
$52.87 |
| Max. Negotiated Rate |
$169.94 |
| Rate for Payer: Cash Price |
$77.64
|
| 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 EXTREMITY UNILATERAL RS&I
|
Professional
|
Both
|
$261.49
|
|
|
Service Code
|
HCPCS 75820 TC
|
| Min. Negotiated Rate |
$47.44 |
| Max. Negotiated Rate |
$152.48 |
| Rate for Payer: Cash Price |
$70.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$67.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$60.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$67.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$50.83
|
| Rate for Payer: Healthfirst Commercial |
$67.77
|
| Rate for Payer: Healthfirst Essential Plan |
$152.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$64.38
|
| Rate for Payer: Healthfirst QHP |
$67.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$47.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$67.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$57.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$47.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$67.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$50.83
|
| Rate for Payer: SOMOS Essential |
$50.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$67.77
|
|
|
CHG VENOGRAPHY EXTREMITY UNILATERAL RS&I
|
Professional
|
Both
|
$200.83
|
|
|
Service Code
|
HCPCS 75820 26
|
| Min. Negotiated Rate |
$37.04 |
| Max. Negotiated Rate |
$119.07 |
| Rate for Payer: Cash Price |
$54.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.69
|
| Rate for Payer: Healthfirst Commercial |
$52.92
|
| Rate for Payer: Healthfirst Essential Plan |
$119.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.27
|
| Rate for Payer: Healthfirst QHP |
$52.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.69
|
| Rate for Payer: SOMOS Essential |
$39.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.92
|
|
|
CHG VENOGRAPHY EXTREMITY UNILATERAL RS&I
|
Professional
|
Both
|
$462.32
|
|
|
Service Code
|
HCPCS 75820
|
| Min. Negotiated Rate |
$84.48 |
| Max. Negotiated Rate |
$271.55 |
| Rate for Payer: Cash Price |
$124.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$120.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$108.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$114.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$120.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$114.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$120.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$90.52
|
| Rate for Payer: Healthfirst Commercial |
$120.69
|
| Rate for Payer: Healthfirst Essential Plan |
$271.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$114.66
|
| Rate for Payer: Healthfirst QHP |
$120.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$84.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$120.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$102.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$84.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$120.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$90.52
|
| Rate for Payer: SOMOS Essential |
$90.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$120.69
|
|
|
CHG VENOGRAPHY ORBITAL RS&I
|
Professional
|
Both
|
$326.03
|
|
|
Service Code
|
HCPCS 75880 TC
|
| Min. Negotiated Rate |
$60.91 |
| Max. Negotiated Rate |
$195.79 |
| Rate for Payer: Cash Price |
$88.48
|
| 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 ORBITAL RS&I
|
Professional
|
Both
|
$462.04
|
|
|
Service Code
|
HCPCS 75880
|
| Min. Negotiated Rate |
$86.59 |
| Max. Negotiated Rate |
$278.32 |
| Rate for Payer: Cash Price |
$125.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$123.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$111.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$111.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$117.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$123.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$117.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$123.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$123.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$92.78
|
| Rate for Payer: Healthfirst Commercial |
$123.70
|
| Rate for Payer: Healthfirst Essential Plan |
$278.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$117.52
|
| Rate for Payer: Healthfirst QHP |
$123.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$86.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$123.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$105.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$86.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$123.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$92.78
|
| Rate for Payer: SOMOS Essential |
$92.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$123.70
|
|
|
CHG VENOGRAPHY ORBITAL RS&I
|
Professional
|
Both
|
$136.01
|
|
|
Service Code
|
HCPCS 75880 26
|
| Min. Negotiated Rate |
$25.68 |
| Max. Negotiated Rate |
$82.53 |
| Rate for Payer: Cash Price |
$36.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$36.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.51
|
| Rate for Payer: Healthfirst Commercial |
$36.68
|
| Rate for Payer: Healthfirst Essential Plan |
$82.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.85
|
| Rate for Payer: Healthfirst QHP |
$36.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$36.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$31.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.51
|
| Rate for Payer: SOMOS Essential |
$27.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.68
|
|
|
CHG VENOGRAPHY RENAL BILATERAL SELECTIVE RS&I
|
Professional
|
Both
|
$338.98
|
|
|
Service Code
|
HCPCS 75833 TC
|
| Min. Negotiated Rate |
$64.45 |
| Max. Negotiated Rate |
$207.16 |
| Rate for Payer: Cash Price |
$93.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$92.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$82.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$82.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$87.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$92.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$87.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.05
|
| Rate for Payer: Healthfirst Commercial |
$92.07
|
| Rate for Payer: Healthfirst Essential Plan |
$207.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$87.47
|
| Rate for Payer: Healthfirst QHP |
$92.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$92.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$78.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$92.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.05
|
| Rate for Payer: SOMOS Essential |
$69.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$92.07
|
|
|
CHG VENOGRAPHY RENAL BILATERAL SELECTIVE RS&I
|
Professional
|
Both
|
$630.91
|
|
|
Service Code
|
HCPCS 75833
|
| Min. Negotiated Rate |
$118.76 |
| Max. Negotiated Rate |
$381.74 |
| Rate for Payer: Cash Price |
$172.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$169.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$152.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$152.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$161.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$169.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$161.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$127.25
|
| Rate for Payer: Healthfirst Commercial |
$169.66
|
| Rate for Payer: Healthfirst Essential Plan |
$381.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$161.18
|
| Rate for Payer: Healthfirst QHP |
$169.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$118.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$169.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$144.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$118.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$169.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$127.25
|
| Rate for Payer: SOMOS Essential |
$127.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$169.66
|
|
|
CHG VENOGRAPHY RENAL BILATERAL SELECTIVE RS&I
|
Professional
|
Both
|
$291.94
|
|
|
Service Code
|
HCPCS 75833 26
|
| Min. Negotiated Rate |
$54.31 |
| Max. Negotiated Rate |
$174.58 |
| Rate for Payer: Cash Price |
$78.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$77.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$69.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$69.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$73.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$77.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$73.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$58.19
|
| Rate for Payer: Healthfirst Commercial |
$77.59
|
| Rate for Payer: Healthfirst Essential Plan |
$174.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$73.71
|
| Rate for Payer: Healthfirst QHP |
$77.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$54.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$77.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$65.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$54.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$77.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$58.19
|
| Rate for Payer: SOMOS Essential |
$58.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$77.59
|
|
|
CHG VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I
|
Professional
|
Both
|
$213.26
|
|
|
Service Code
|
HCPCS 75831 26
|
| Min. Negotiated Rate |
$39.10 |
| Max. Negotiated Rate |
$125.69 |
| Rate for Payer: Cash Price |
$56.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$55.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$50.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$50.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$53.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$55.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$53.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.90
|
| Rate for Payer: Healthfirst Commercial |
$55.86
|
| Rate for Payer: Healthfirst Essential Plan |
$125.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$53.07
|
| Rate for Payer: Healthfirst QHP |
$55.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$39.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$55.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$47.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$39.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$55.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$41.90
|
| Rate for Payer: SOMOS Essential |
$41.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.86
|
|
|
CHG VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I
|
Professional
|
Both
|
$513.42
|
|
|
Service Code
|
HCPCS 75831
|
| Min. Negotiated Rate |
$95.67 |
| Max. Negotiated Rate |
$307.51 |
| Rate for Payer: Cash Price |
$138.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$136.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$123.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$123.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$129.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$136.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$129.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$136.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$136.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$102.50
|
| Rate for Payer: Healthfirst Commercial |
$136.67
|
| Rate for Payer: Healthfirst Essential Plan |
$307.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$129.84
|
| Rate for Payer: Healthfirst QHP |
$136.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$95.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$136.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$116.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$95.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$136.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$102.50
|
| Rate for Payer: SOMOS Essential |
$102.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$136.67
|
|
|
CHG VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I
|
Professional
|
Both
|
$300.16
|
|
|
Service Code
|
HCPCS 75831 TC
|
| Min. Negotiated Rate |
$56.57 |
| Max. Negotiated Rate |
$181.82 |
| Rate for Payer: Cash Price |
$81.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$80.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$72.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$72.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$76.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$80.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$76.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.61
|
| Rate for Payer: Healthfirst Commercial |
$80.81
|
| Rate for Payer: Healthfirst Essential Plan |
$181.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$76.77
|
| Rate for Payer: Healthfirst QHP |
$80.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$56.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$80.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$68.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$56.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$80.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$60.61
|
| Rate for Payer: SOMOS Essential |
$60.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$80.81
|
|
|
CHG VENOGRAPHY SUPERIOR SAGITTAL SINUS RS&I
|
Professional
|
Both
|
$680.51
|
|
|
Service Code
|
HCPCS 75870
|
| Min. Negotiated Rate |
$133.90 |
| Max. Negotiated Rate |
$430.40 |
| Rate for Payer: Cash Price |
$182.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$191.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$172.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$172.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$181.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$191.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$181.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$191.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$143.47
|
| Rate for Payer: Healthfirst Commercial |
$191.29
|
| Rate for Payer: Healthfirst Essential Plan |
$430.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$181.73
|
| Rate for Payer: Healthfirst QHP |
$191.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$133.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$191.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$162.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$133.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$191.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$143.47
|
| Rate for Payer: SOMOS Essential |
$143.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$191.29
|
|
|
CHG VENOGRAPHY SUPERIOR SAGITTAL SINUS RS&I
|
Professional
|
Both
|
$426.65
|
|
|
Service Code
|
HCPCS 75870 TC
|
| Min. Negotiated Rate |
$85.36 |
| Max. Negotiated Rate |
$274.39 |
| Rate for Payer: Cash Price |
$115.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$121.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$109.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$109.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$115.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$121.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$115.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$121.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$121.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$91.46
|
| Rate for Payer: Healthfirst Commercial |
$121.95
|
| Rate for Payer: Healthfirst Essential Plan |
$274.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$115.85
|
| Rate for Payer: Healthfirst QHP |
$121.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$85.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$121.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$103.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$85.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$121.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$91.46
|
| Rate for Payer: SOMOS Essential |
$91.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$121.95
|
|
|
CHG VENOGRAPHY SUPERIOR SAGITTAL SINUS RS&I
|
Professional
|
Both
|
$253.86
|
|
|
Service Code
|
HCPCS 75870 26
|
| Min. Negotiated Rate |
$48.53 |
| Max. Negotiated Rate |
$155.99 |
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$69.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$62.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$65.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$69.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$65.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$69.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$69.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$52.00
|
| Rate for Payer: Healthfirst Commercial |
$69.33
|
| Rate for Payer: Healthfirst Essential Plan |
$155.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$65.86
|
| Rate for Payer: Healthfirst QHP |
$69.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$48.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$69.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$58.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$48.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$69.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$52.00
|
| Rate for Payer: SOMOS Essential |
$52.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$69.33
|
|
|
CHG VENOGRAPHY VENOUS SINUS/JUGULAR CATH RS&I
|
Professional
|
Both
|
$220.47
|
|
|
Service Code
|
HCPCS 75860 26
|
| Min. Negotiated Rate |
$41.60 |
| Max. Negotiated Rate |
$133.72 |
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$59.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$53.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$56.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$59.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$56.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.57
|
| Rate for Payer: Healthfirst Commercial |
$59.43
|
| Rate for Payer: Healthfirst Essential Plan |
$133.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$56.46
|
| Rate for Payer: Healthfirst QHP |
$59.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$41.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$59.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$50.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$41.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$59.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$44.57
|
| Rate for Payer: SOMOS Essential |
$44.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$59.43
|
|
|
CHG VENOGRAPHY VENOUS SINUS/JUGULAR CATH RS&I
|
Professional
|
Both
|
$317.42
|
|
|
Service Code
|
HCPCS 75860 TC
|
| Min. Negotiated Rate |
$59.83 |
| Max. Negotiated Rate |
$192.31 |
| Rate for Payer: Cash Price |
$86.52
|
| 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 VENOGRAPHY VENOUS SINUS/JUGULAR CATH RS&I
|
Professional
|
Both
|
$537.88
|
|
|
Service Code
|
HCPCS 75860
|
| Min. Negotiated Rate |
$101.42 |
| Max. Negotiated Rate |
$326.00 |
| Rate for Payer: Cash Price |
$145.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$144.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$130.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$130.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$137.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$144.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$137.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$144.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$144.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$108.67
|
| Rate for Payer: Healthfirst Commercial |
$144.89
|
| Rate for Payer: Healthfirst Essential Plan |
$326.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$137.65
|
| Rate for Payer: Healthfirst QHP |
$144.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$101.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$144.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$123.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$101.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$144.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$108.67
|
| Rate for Payer: SOMOS Essential |
$108.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$144.89
|
|
