|
CHG VENOUS SAMPLING THRU CATH W/WO ANGIOGRAPHY RS&
|
Professional
|
Both
|
$343.28
|
|
|
Service Code
|
HCPCS 75893 TC
|
| Min. Negotiated Rate |
$65.81 |
| Max. Negotiated Rate |
$211.52 |
| Rate for Payer: Cash Price |
$94.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$94.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$84.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$84.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$89.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$94.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$89.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$94.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$94.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$70.51
|
| Rate for Payer: Healthfirst Commercial |
$94.01
|
| Rate for Payer: Healthfirst Essential Plan |
$211.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$89.31
|
| Rate for Payer: Healthfirst QHP |
$94.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$65.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$94.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$79.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$65.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$94.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$70.51
|
| Rate for Payer: SOMOS Essential |
$70.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$94.01
|
|
|
CHG VENOUS SAMPLING THRU CATH W/WO ANGIOGRAPHY RS&
|
Professional
|
Both
|
$444.85
|
|
|
Service Code
|
HCPCS 75893
|
| Min. Negotiated Rate |
$85.18 |
| Max. Negotiated Rate |
$273.78 |
| Rate for Payer: Cash Price |
$123.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$121.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$109.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$109.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$115.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$121.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$115.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$121.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$121.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$91.26
|
| Rate for Payer: Healthfirst Commercial |
$121.68
|
| Rate for Payer: Healthfirst Essential Plan |
$273.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$115.60
|
| Rate for Payer: Healthfirst QHP |
$121.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$85.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$121.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$103.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$85.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$121.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$91.26
|
| Rate for Payer: SOMOS Essential |
$91.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$121.68
|
|
|
CHG VENOUS SAMPLING THRU CATH W/WO ANGIOGRAPHY RS&
|
Professional
|
Both
|
$101.57
|
|
|
Service Code
|
HCPCS 75893 26
|
| Min. Negotiated Rate |
$19.37 |
| Max. Negotiated Rate |
$62.26 |
| Rate for Payer: Cash Price |
$28.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.75
|
| Rate for Payer: Healthfirst Commercial |
$27.67
|
| Rate for Payer: Healthfirst Essential Plan |
$62.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.29
|
| Rate for Payer: Healthfirst QHP |
$27.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$27.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.75
|
| Rate for Payer: SOMOS Essential |
$20.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.67
|
|
|
CHG VENOUS THROMBOSIS IMAGING VENOGRAM BILATERAL
|
Professional
|
Both
|
$834.68
|
|
|
Service Code
|
HCPCS 78458
|
| Min. Negotiated Rate |
$153.69 |
| Max. Negotiated Rate |
$493.99 |
| Rate for Payer: Cash Price |
$225.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$219.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$197.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$197.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$208.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$219.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$208.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$219.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$219.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$164.66
|
| Rate for Payer: Healthfirst Commercial |
$219.55
|
| Rate for Payer: Healthfirst Essential Plan |
$493.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$208.57
|
| Rate for Payer: Healthfirst QHP |
$219.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$153.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$219.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$186.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$153.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$219.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$164.66
|
| Rate for Payer: SOMOS Essential |
$164.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$219.55
|
|
|
CHG VENOUS THROMBOSIS IMAGING VENOGRAM BILATERAL
|
Professional
|
Both
|
$663.57
|
|
|
Service Code
|
HCPCS 78458 TC
|
| Min. Negotiated Rate |
$121.28 |
| Max. Negotiated Rate |
$389.83 |
| Rate for Payer: Cash Price |
$178.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$173.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$155.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$155.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$164.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$173.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$164.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$173.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$173.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$129.94
|
| Rate for Payer: Healthfirst Commercial |
$173.26
|
| Rate for Payer: Healthfirst Essential Plan |
$389.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$164.60
|
| Rate for Payer: Healthfirst QHP |
$173.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$121.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$173.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$147.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$121.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$173.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$129.94
|
| Rate for Payer: SOMOS Essential |
$129.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$173.26
|
|
|
CHG VENOUS THROMBOSIS IMAGING VENOGRAM BILATERAL
|
Professional
|
Both
|
$171.12
|
|
|
Service Code
|
HCPCS 78458 26
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$104.15 |
| Rate for Payer: Cash Price |
$47.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.72
|
| Rate for Payer: Healthfirst Commercial |
$46.29
|
| Rate for Payer: Healthfirst Essential Plan |
$104.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43.98
|
| Rate for Payer: Healthfirst QHP |
$46.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$46.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$34.72
|
| Rate for Payer: SOMOS Essential |
$34.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.29
|
|
|
CHG VENOUS THROMBOSIS IMAGING VENOGRAM UNILATERAL
|
Professional
|
Both
|
$527.00
|
|
|
Service Code
|
HCPCS 78457 TC
|
| Min. Negotiated Rate |
$98.73 |
| Max. Negotiated Rate |
$317.34 |
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$141.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$126.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$126.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$133.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$141.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$133.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$141.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$141.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$105.78
|
| Rate for Payer: Healthfirst Commercial |
$141.04
|
| Rate for Payer: Healthfirst Essential Plan |
$317.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.99
|
| Rate for Payer: Healthfirst QHP |
$141.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$98.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$141.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$119.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$98.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$141.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$105.78
|
| Rate for Payer: SOMOS Essential |
$105.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$141.04
|
|
|
CHG VENOUS THROMBOSIS IMAGING VENOGRAM UNILATERAL
|
Professional
|
Both
|
$157.75
|
|
|
Service Code
|
HCPCS 78457 26
|
| Min. Negotiated Rate |
$28.81 |
| Max. Negotiated Rate |
$92.61 |
| Rate for Payer: Cash Price |
$41.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$41.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$39.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.87
|
| Rate for Payer: Healthfirst Commercial |
$41.16
|
| Rate for Payer: Healthfirst Essential Plan |
$92.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.10
|
| Rate for Payer: Healthfirst QHP |
$41.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$41.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$30.87
|
| Rate for Payer: SOMOS Essential |
$30.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.16
|
|
|
CHG VENOUS THROMBOSIS IMAGING VENOGRAM UNILATERAL
|
Professional
|
Both
|
$684.74
|
|
|
Service Code
|
HCPCS 78457
|
| Min. Negotiated Rate |
$127.55 |
| Max. Negotiated Rate |
$409.97 |
| Rate for Payer: Cash Price |
$183.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$182.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$163.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$163.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$173.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$182.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$173.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$182.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$182.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$136.66
|
| Rate for Payer: Healthfirst Commercial |
$182.21
|
| Rate for Payer: Healthfirst Essential Plan |
$409.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$173.10
|
| Rate for Payer: Healthfirst QHP |
$182.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$127.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$182.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$154.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$127.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$182.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$136.66
|
| Rate for Payer: SOMOS Essential |
$136.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$182.21
|
|
|
CHG VERTEBRAL FRACTURE ASSESSMENT VIA DXA
|
Professional
|
Both
|
$141.75
|
|
|
Service Code
|
HCPCS 77086
|
| Min. Negotiated Rate |
$27.79 |
| Max. Negotiated Rate |
$89.33 |
| Rate for Payer: Cash Price |
$39.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$39.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.77
|
| Rate for Payer: Healthfirst Commercial |
$39.70
|
| Rate for Payer: Healthfirst Essential Plan |
$89.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.72
|
| Rate for Payer: Healthfirst QHP |
$39.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$39.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.77
|
| Rate for Payer: SOMOS Essential |
$29.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.70
|
|
|
CHG VERTEBRAL FRACTURE ASSESSMENT VIA DXA
|
Professional
|
Both
|
$32.66
|
|
|
Service Code
|
HCPCS 77086 26
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$19.80 |
| Rate for Payer: Cash Price |
$8.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.60
|
| Rate for Payer: Healthfirst Commercial |
$8.80
|
| Rate for Payer: Healthfirst Essential Plan |
$19.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.36
|
| Rate for Payer: Healthfirst QHP |
$8.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.60
|
| Rate for Payer: SOMOS Essential |
$6.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.80
|
|
|
CHG VERTEBRAL FRACTURE ASSESSMENT VIA DXA
|
Professional
|
Both
|
$109.10
|
|
|
Service Code
|
HCPCS 77086 TC
|
| Min. Negotiated Rate |
$21.62 |
| Max. Negotiated Rate |
$69.50 |
| Rate for Payer: Cash Price |
$30.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$27.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$30.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.17
|
| Rate for Payer: Healthfirst Commercial |
$30.89
|
| Rate for Payer: Healthfirst Essential Plan |
$69.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.35
|
| Rate for Payer: Healthfirst QHP |
$30.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$30.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.17
|
| Rate for Payer: SOMOS Essential |
$23.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.89
|
|
|
CHG WHOLE BLOOD VOLUME DETERM PLASMA&RED CELL VOLU
|
Professional
|
Both
|
$424.97
|
|
|
Service Code
|
HCPCS 78122
|
| Min. Negotiated Rate |
$80.56 |
| Max. Negotiated Rate |
$258.95 |
| Rate for Payer: Cash Price |
$114.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$115.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$103.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$103.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$109.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$115.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$109.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$115.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$115.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$86.32
|
| Rate for Payer: Healthfirst Commercial |
$115.09
|
| Rate for Payer: Healthfirst Essential Plan |
$258.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$109.34
|
| Rate for Payer: Healthfirst QHP |
$115.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$80.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$115.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$97.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$80.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$115.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$86.32
|
| Rate for Payer: SOMOS Essential |
$86.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$115.09
|
|
|
CHG WHOLE BLOOD VOLUME DETERM PLASMA&RED CELL VOLU
|
Professional
|
Both
|
$81.97
|
|
|
Service Code
|
HCPCS 78122 26
|
| Min. Negotiated Rate |
$15.52 |
| Max. Negotiated Rate |
$49.88 |
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$19.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.63
|
| Rate for Payer: Healthfirst Commercial |
$22.17
|
| Rate for Payer: Healthfirst Essential Plan |
$49.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.06
|
| Rate for Payer: Healthfirst QHP |
$22.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$15.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$22.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$18.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$16.63
|
| Rate for Payer: SOMOS Essential |
$16.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.17
|
|
|
CHG WHOLE BLOOD VOLUME DETERM PLASMA&RED CELL VOLU
|
Professional
|
Both
|
$343.00
|
|
|
Service Code
|
HCPCS 78122 TC
|
| Min. Negotiated Rate |
$65.04 |
| Max. Negotiated Rate |
$209.05 |
| Rate for Payer: Cash Price |
$92.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$92.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$83.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$83.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$88.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$92.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$88.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.68
|
| Rate for Payer: Healthfirst Commercial |
$92.91
|
| Rate for Payer: Healthfirst Essential Plan |
$209.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$88.26
|
| Rate for Payer: Healthfirst QHP |
$92.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$65.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$92.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$78.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$65.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$92.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.68
|
| Rate for Payer: SOMOS Essential |
$69.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$92.91
|
|
|
CHILDHOOD BEHAVIORAL DIAGNOSES
|
Facility
|
OP
|
$218.26
|
|
|
Service Code
|
EAPG 00829
|
| Min. Negotiated Rate |
$157.37 |
| Max. Negotiated Rate |
$218.26 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$157.37
|
| Rate for Payer: Healthfirst Commercial |
$218.26
|
|
|
CHILD PREVENTIVE MEDICINE
|
Facility
|
OP
|
$222.15
|
|
|
Service Code
|
EAPG 00877
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$222.15 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$162.00
|
| Rate for Payer: Healthfirst Commercial |
$222.15
|
|
|
CHLORAMBUCIL 2 MG PO TABS
|
Facility
|
IP
|
$316.80
|
|
|
Service Code
|
NDC 6978461025
|
| Hospital Charge Code |
6978461025
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$158.40
|
|
|
CHLORAMBUCIL 2 MG PO TABS
|
Facility
|
OP
|
$316.80
|
|
|
Service Code
|
NDC 6978461025
|
| Hospital Charge Code |
6978461025
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$110.88 |
| Max. Negotiated Rate |
$253.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$174.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$158.40
|
| Rate for Payer: Aetna Government |
$158.40
|
| Rate for Payer: Brighton Health Commercial |
$237.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$253.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$215.42
|
| Rate for Payer: EmblemHealth Commercial |
$158.40
|
| Rate for Payer: Group Health Inc Commercial |
$158.40
|
| Rate for Payer: Group Health Inc Medicare |
$110.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$158.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$158.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$205.92
|
|
|
CHLORDIAZEPOXIDE HCL 10 MG PO CAPS
|
Facility
|
IP
|
$0.40
|
|
|
Service Code
|
NDC 0555003302
|
| Hospital Charge Code |
0555003302
|
|
Hospital Revenue Code
|
635
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.20
|
|
|
CHLORDIAZEPOXIDE HCL 10 MG PO CAPS
|
Facility
|
OP
|
$0.62
|
|
|
Service Code
|
NDC 5107937520
|
| Hospital Charge Code |
5107937520
|
|
Hospital Revenue Code
|
635
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.31
|
| Rate for Payer: Aetna Government |
$0.31
|
| Rate for Payer: Brighton Health Commercial |
$0.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.42
|
| Rate for Payer: EmblemHealth Commercial |
$0.31
|
| Rate for Payer: Group Health Inc Commercial |
$0.31
|
| Rate for Payer: Group Health Inc Medicare |
$0.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.40
|
|
|
CHLORDIAZEPOXIDE HCL 10 MG PO CAPS
|
Facility
|
OP
|
$0.62
|
|
|
Service Code
|
NDC 5107937501
|
| Hospital Charge Code |
5107937501
|
|
Hospital Revenue Code
|
635
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.31
|
| Rate for Payer: Aetna Government |
$0.31
|
| Rate for Payer: Brighton Health Commercial |
$0.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.42
|
| Rate for Payer: EmblemHealth Commercial |
$0.31
|
| Rate for Payer: Group Health Inc Commercial |
$0.31
|
| Rate for Payer: Group Health Inc Medicare |
$0.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.40
|
|
|
CHLORDIAZEPOXIDE HCL 10 MG PO CAPS
|
Facility
|
OP
|
$0.40
|
|
|
Service Code
|
NDC 0555003302
|
| Hospital Charge Code |
0555003302
|
|
Hospital Revenue Code
|
635
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.20
|
| Rate for Payer: Aetna Government |
$0.20
|
| Rate for Payer: Brighton Health Commercial |
$0.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.27
|
| Rate for Payer: EmblemHealth Commercial |
$0.20
|
| Rate for Payer: Group Health Inc Commercial |
$0.20
|
| Rate for Payer: Group Health Inc Medicare |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.26
|
|
|
CHLORDIAZEPOXIDE HCL 10 MG PO CAPS
|
Facility
|
IP
|
$0.62
|
|
|
Service Code
|
NDC 5107937501
|
| Hospital Charge Code |
5107937501
|
|
Hospital Revenue Code
|
635
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.31
|
|
|
CHLORDIAZEPOXIDE HCL 10 MG PO CAPS
|
Facility
|
IP
|
$0.62
|
|
|
Service Code
|
NDC 5107937520
|
| Hospital Charge Code |
5107937520
|
|
Hospital Revenue Code
|
635
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.31
|
|
