|
CHG 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION
|
Professional
|
$151.59
|
|
|
Service Code
|
HCPCS 76377 26
|
| Min. Negotiated Rate |
$30.32 |
| Max. Negotiated Rate |
$238.64 |
| Rate for Payer: Cash Price |
$41.68
|
| Rate for Payer: Cash Price |
$41.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.14
|
| Rate for Payer: Healthfirst QHP |
$43.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$43.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$36.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$113.69
|
| Rate for Payer: SOMOS Essential |
$113.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.31
|
|
|
CHG 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION
|
Professional
|
$166.60
|
|
|
Service Code
|
HCPCS 76377 TC
|
| Min. Negotiated Rate |
$30.32 |
| Max. Negotiated Rate |
$238.64 |
| Rate for Payer: Cash Price |
$48.40
|
| Rate for Payer: Cash Price |
$48.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$42.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$45.22
|
| Rate for Payer: Healthfirst QHP |
$47.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$47.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$40.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$124.95
|
| Rate for Payer: SOMOS Essential |
$124.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.60
|
|
|
CHG 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION
|
Professional
|
$318.19
|
|
|
Service Code
|
HCPCS 76377
|
| Min. Negotiated Rate |
$30.32 |
| Max. Negotiated Rate |
$238.64 |
| Rate for Payer: Cash Price |
$90.08
|
| Rate for Payer: Cash Price |
$90.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$81.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$81.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$86.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$90.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$86.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$90.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$68.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$86.36
|
| Rate for Payer: Healthfirst QHP |
$90.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$63.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$90.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$77.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$63.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$90.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$238.64
|
| Rate for Payer: SOMOS Essential |
$238.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$90.91
|
|
|
CHG 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION
|
Professional
|
$64.54
|
|
|
Service Code
|
HCPCS 76376 TC
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$76.81 |
| Rate for Payer: Cash Price |
$18.70
|
| Rate for Payer: Cash Price |
$18.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.52
|
| Rate for Payer: Healthfirst QHP |
$18.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$12.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$18.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$15.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$12.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$48.40
|
| Rate for Payer: SOMOS Essential |
$48.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.44
|
|
|
CHG 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION
|
Professional
|
$102.41
|
|
|
Service Code
|
HCPCS 76376
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$76.81 |
| Rate for Payer: Cash Price |
$29.05
|
| Rate for Payer: Cash Price |
$29.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.80
|
| Rate for Payer: Healthfirst QHP |
$29.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$76.81
|
| Rate for Payer: SOMOS Essential |
$76.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.26
|
|
|
CHG 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION
|
Professional
|
$37.84
|
|
|
Service Code
|
HCPCS 76376 26
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$76.81 |
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.27
|
| Rate for Payer: Healthfirst QHP |
$10.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$7.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$10.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$9.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.38
|
| Rate for Payer: SOMOS Essential |
$28.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.81
|
|
|
CHG ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING
|
Professional
|
$1,389.33
|
|
|
Service Code
|
HCPCS 78278
|
| Min. Negotiated Rate |
$36.76 |
| Max. Negotiated Rate |
$1,042.00 |
| Rate for Payer: Cash Price |
$373.83
|
| Rate for Payer: Cash Price |
$373.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$357.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$357.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$377.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$396.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$377.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$396.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$396.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$297.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$377.10
|
| Rate for Payer: Healthfirst QHP |
$396.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$277.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$396.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$337.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$277.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$396.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,042.00
|
| Rate for Payer: SOMOS Essential |
$1,042.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$396.95
|
|
|
CHG ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING
|
Professional
|
$183.82
|
|
|
Service Code
|
HCPCS 78278 26
|
| Min. Negotiated Rate |
$36.76 |
| Max. Negotiated Rate |
$1,042.00 |
| Rate for Payer: Cash Price |
$50.62
|
| Rate for Payer: Cash Price |
$50.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.89
|
| Rate for Payer: Healthfirst QHP |
$52.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$137.86
|
| Rate for Payer: SOMOS Essential |
$137.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.52
|
|
|
CHG ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING
|
Professional
|
$1,205.51
|
|
|
Service Code
|
HCPCS 78278 TC
|
| Min. Negotiated Rate |
$36.76 |
| Max. Negotiated Rate |
$1,042.00 |
| Rate for Payer: Cash Price |
$323.21
|
| Rate for Payer: Cash Price |
$323.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$309.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$309.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$327.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$344.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$327.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$344.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$344.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$258.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$327.21
|
| Rate for Payer: Healthfirst QHP |
$344.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$241.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$344.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$292.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$241.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$344.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$904.13
|
| Rate for Payer: SOMOS Essential |
$904.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$344.43
|
|
|
CHG ACUTE VENOUS THROMBOSIS IMAGING PEPTIDE
|
Professional
|
$1,242.50
|
|
|
Service Code
|
HCPCS 78456
|
| Min. Negotiated Rate |
$37.02 |
| Max. Negotiated Rate |
$931.88 |
| Rate for Payer: Cash Price |
$337.56
|
| Rate for Payer: Cash Price |
$337.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$319.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$319.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$337.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$355.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$337.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$355.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$355.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$266.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$337.25
|
| Rate for Payer: Healthfirst QHP |
$355.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$248.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$355.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$301.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$248.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$355.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$931.88
|
| Rate for Payer: SOMOS Essential |
$931.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$355.00
|
|
|
CHG ACUTE VENOUS THROMBOSIS IMAGING PEPTIDE
|
Professional
|
$1,057.46
|
|
|
Service Code
|
HCPCS 78456 TC
|
| Min. Negotiated Rate |
$37.02 |
| Max. Negotiated Rate |
$931.88 |
| Rate for Payer: Cash Price |
$287.45
|
| Rate for Payer: Cash Price |
$287.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$271.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$271.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$287.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$302.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$287.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$302.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$302.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$226.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$287.02
|
| Rate for Payer: Healthfirst QHP |
$302.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$211.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$302.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$256.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$211.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$302.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$793.10
|
| Rate for Payer: SOMOS Essential |
$793.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$302.13
|
|
|
CHG ACUTE VENOUS THROMBOSIS IMAGING PEPTIDE
|
Professional
|
$185.08
|
|
|
Service Code
|
HCPCS 78456 26
|
| Min. Negotiated Rate |
$37.02 |
| Max. Negotiated Rate |
$931.88 |
| Rate for Payer: Cash Price |
$50.11
|
| Rate for Payer: Cash Price |
$50.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.24
|
| Rate for Payer: Healthfirst QHP |
$52.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$138.81
|
| Rate for Payer: SOMOS Essential |
$138.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.88
|
|
|
CHG ADRENAL IMAGING CORTEX &/MEDULLA
|
Professional
|
$1,644.97
|
|
|
Service Code
|
HCPCS 78075 TC
|
| Min. Negotiated Rate |
$28.49 |
| Max. Negotiated Rate |
$1,340.56 |
| Rate for Payer: Cash Price |
$438.96
|
| Rate for Payer: Cash Price |
$438.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$422.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$422.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$446.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$469.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$446.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$469.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$469.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$352.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$446.49
|
| Rate for Payer: Healthfirst QHP |
$469.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$328.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$469.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$399.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$328.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$469.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,233.73
|
| Rate for Payer: SOMOS Essential |
$1,233.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$469.99
|
|
|
CHG ADRENAL IMAGING CORTEX &/MEDULLA
|
Professional
|
$142.45
|
|
|
Service Code
|
HCPCS 78075 26
|
| Min. Negotiated Rate |
$28.49 |
| Max. Negotiated Rate |
$1,340.56 |
| Rate for Payer: Cash Price |
$38.52
|
| Rate for Payer: Cash Price |
$38.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.66
|
| Rate for Payer: Healthfirst QHP |
$40.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$40.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$106.84
|
| Rate for Payer: SOMOS Essential |
$106.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.70
|
|
|
CHG ADRENAL IMAGING CORTEX &/MEDULLA
|
Professional
|
$1,787.42
|
|
|
Service Code
|
HCPCS 78075
|
| Min. Negotiated Rate |
$28.49 |
| Max. Negotiated Rate |
$1,340.56 |
| Rate for Payer: Cash Price |
$477.49
|
| Rate for Payer: Cash Price |
$477.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$459.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$459.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$485.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$510.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$485.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$510.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$510.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$383.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$485.16
|
| Rate for Payer: Healthfirst QHP |
$510.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$357.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$510.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$434.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$357.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$510.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,340.56
|
| Rate for Payer: SOMOS Essential |
$1,340.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$510.69
|
|
|
CHG ANGIOGRAPHY ADRENAL BILATERAL SLCTV RS&I
|
Professional
|
$713.51
|
|
|
Service Code
|
HCPCS 75733
|
| Min. Negotiated Rate |
$47.94 |
| Max. Negotiated Rate |
$535.13 |
| Rate for Payer: Cash Price |
$199.22
|
| Rate for Payer: Cash Price |
$199.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$183.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$183.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$193.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$203.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$193.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$203.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$203.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$152.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$193.67
|
| Rate for Payer: Healthfirst QHP |
$203.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$142.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$203.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$173.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$142.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$203.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$535.13
|
| Rate for Payer: SOMOS Essential |
$535.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$203.86
|
|
|
CHG ANGIOGRAPHY ADRENAL BILATERAL SLCTV RS&I
|
Professional
|
$239.72
|
|
|
Service Code
|
HCPCS 75733 26
|
| Min. Negotiated Rate |
$47.94 |
| Max. Negotiated Rate |
$535.13 |
| Rate for Payer: Cash Price |
$65.87
|
| Rate for Payer: Cash Price |
$65.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$61.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$65.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$68.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$65.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$68.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$68.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$65.07
|
| Rate for Payer: Healthfirst QHP |
$68.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$47.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$68.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$58.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$47.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$68.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$179.79
|
| Rate for Payer: SOMOS Essential |
$179.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$68.49
|
|
|
CHG ANGIOGRAPHY ADRENAL BILATERAL SLCTV RS&I
|
Professional
|
$473.83
|
|
|
Service Code
|
HCPCS 75733 TC
|
| Min. Negotiated Rate |
$47.94 |
| Max. Negotiated Rate |
$535.13 |
| Rate for Payer: Cash Price |
$133.35
|
| Rate for Payer: Cash Price |
$133.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$121.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$121.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$128.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$135.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$128.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$135.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$135.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$101.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$128.61
|
| Rate for Payer: Healthfirst QHP |
$135.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$94.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$135.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$115.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$94.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$135.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$355.37
|
| Rate for Payer: SOMOS Essential |
$355.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$135.38
|
|
|
CHG ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RS&I
|
Professional
|
$432.15
|
|
|
Service Code
|
HCPCS 75731 TC
|
| Min. Negotiated Rate |
$43.92 |
| Max. Negotiated Rate |
$488.78 |
| Rate for Payer: Cash Price |
$118.58
|
| Rate for Payer: Cash Price |
$118.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$111.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$111.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$117.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$123.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$117.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$123.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$123.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$92.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$117.30
|
| Rate for Payer: Healthfirst QHP |
$123.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$86.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$123.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$104.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$86.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$123.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$324.11
|
| Rate for Payer: SOMOS Essential |
$324.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$123.47
|
|
|
CHG ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RS&I
|
Professional
|
$219.59
|
|
|
Service Code
|
HCPCS 75731 26
|
| Min. Negotiated Rate |
$43.92 |
| Max. Negotiated Rate |
$488.78 |
| Rate for Payer: Cash Price |
$59.23
|
| Rate for Payer: Cash Price |
$59.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$56.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$56.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$59.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$59.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$62.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$59.60
|
| Rate for Payer: Healthfirst QHP |
$62.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$43.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$62.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$53.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$43.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$164.69
|
| Rate for Payer: SOMOS Essential |
$164.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.74
|
|
|
CHG ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RS&I
|
Professional
|
$651.70
|
|
|
Service Code
|
HCPCS 75731
|
| Min. Negotiated Rate |
$43.92 |
| Max. Negotiated Rate |
$488.78 |
| Rate for Payer: Cash Price |
$177.80
|
| Rate for Payer: Cash Price |
$177.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$167.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$167.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$176.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$186.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$176.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$186.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$186.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$139.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$176.89
|
| Rate for Payer: Healthfirst QHP |
$186.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$130.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$186.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$158.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$130.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$186.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$488.78
|
| Rate for Payer: SOMOS Essential |
$488.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$186.20
|
|
|
CHG ANGIOGRAPHY EXTREMITY BILATERAL RS&I
|
Professional
|
$311.68
|
|
|
Service Code
|
HCPCS 75716 TC
|
| Min. Negotiated Rate |
$62.34 |
| Max. Negotiated Rate |
$518.07 |
| Rate for Payer: Cash Price |
$85.34
|
| Rate for Payer: Cash Price |
$85.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$80.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$80.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$89.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$84.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$89.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$89.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$66.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$84.60
|
| Rate for Payer: Healthfirst QHP |
$89.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$62.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$89.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$75.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$62.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$89.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$233.76
|
| Rate for Payer: SOMOS Essential |
$233.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$89.05
|
|
|
CHG ANGIOGRAPHY EXTREMITY BILATERAL RS&I
|
Professional
|
$379.09
|
|
|
Service Code
|
HCPCS 75716 26
|
| Min. Negotiated Rate |
$62.34 |
| Max. Negotiated Rate |
$518.07 |
| Rate for Payer: Cash Price |
$103.06
|
| Rate for Payer: Cash Price |
$103.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$97.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$97.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$102.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$108.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$102.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$108.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$108.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$81.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$102.89
|
| Rate for Payer: Healthfirst QHP |
$108.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$75.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$108.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$92.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$75.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$108.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$284.32
|
| Rate for Payer: SOMOS Essential |
$284.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$108.31
|
|
|
CHG ANGIOGRAPHY EXTREMITY BILATERAL RS&I
|
Professional
|
$690.76
|
|
|
Service Code
|
HCPCS 75716
|
| Min. Negotiated Rate |
$62.34 |
| Max. Negotiated Rate |
$518.07 |
| Rate for Payer: Cash Price |
$188.40
|
| Rate for Payer: Cash Price |
$188.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$177.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$177.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$187.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$197.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$187.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$197.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$197.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$148.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$187.49
|
| Rate for Payer: Healthfirst QHP |
$197.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$138.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$197.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$167.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$138.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$197.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$518.07
|
| Rate for Payer: SOMOS Essential |
$518.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$197.36
|
|
|
CHG ANGIOGRAPHY EXTREMITY UNILATERAL RS&I
|
Professional
|
$645.68
|
|
|
Service Code
|
HCPCS 75710
|
| Min. Negotiated Rate |
$60.03 |
| Max. Negotiated Rate |
$484.26 |
| Rate for Payer: Cash Price |
$174.90
|
| Rate for Payer: Cash Price |
$174.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$166.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$166.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$175.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$184.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$175.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$184.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$184.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$138.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$175.26
|
| Rate for Payer: Healthfirst QHP |
$184.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$129.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$184.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$156.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$129.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$184.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$484.26
|
| Rate for Payer: SOMOS Essential |
$484.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$184.48
|
|
