|
CHG CARD-VASC HEMODYNAM W/WO PHARM/EXER 1/MLT DETERM
|
Professional
|
$82.11
|
|
|
Service Code
|
HCPCS 78414 26
|
| Min. Negotiated Rate |
$16.42 |
| Max. Negotiated Rate |
$1,002.68 |
| Rate for Payer: Cash Price |
$22.61
|
| Rate for Payer: Cash Price |
$22.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$23.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.29
|
| Rate for Payer: Healthfirst QHP |
$23.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$16.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$23.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$19.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$16.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$61.58
|
| Rate for Payer: SOMOS Essential |
$61.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.46
|
|
|
CHG CARD-VASC HEMODYNAM W/WO PHARM/EXER 1/MLT DETERM
|
Professional
|
$1,336.90
|
|
|
Service Code
|
HCPCS 78414
|
| Min. Negotiated Rate |
$16.42 |
| Max. Negotiated Rate |
$1,002.68 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,002.68
|
| Rate for Payer: SOMOS Essential |
$1,002.68
|
|
|
CHG CARD-VASC HEMODYNAM W/WO PHARM/EXER 1/MLT DETERM
|
Professional
|
$1,254.79
|
|
|
Service Code
|
HCPCS 78414 TC
|
| Min. Negotiated Rate |
$16.42 |
| Max. Negotiated Rate |
$1,002.68 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$941.09
|
| Rate for Payer: SOMOS Essential |
$941.09
|
|
|
CHG CELL ENUMERATION IMMUNE SELECTJ & ID PHYS INTERP
|
Professional
|
$130.69
|
|
|
Service Code
|
HCPCS 86153 26
|
| Min. Negotiated Rate |
$26.14 |
| Max. Negotiated Rate |
$98.02 |
| Rate for Payer: Cash Price |
$35.92
|
| Rate for Payer: Cash Price |
$35.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.47
|
| Rate for Payer: Healthfirst QHP |
$37.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$31.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$98.02
|
| Rate for Payer: SOMOS Essential |
$98.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.34
|
|
|
CHG CEPHALOGRAM ORTHODONTIC
|
Professional
|
$35.81
|
|
|
Service Code
|
HCPCS 70350 TC
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$52.42 |
| Rate for Payer: Cash Price |
$10.06
|
| Rate for Payer: Cash Price |
$10.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.72
|
| Rate for Payer: Healthfirst QHP |
$10.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$7.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$10.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.86
|
| Rate for Payer: SOMOS Essential |
$26.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.23
|
|
|
CHG CEPHALOGRAM ORTHODONTIC
|
Professional
|
$34.09
|
|
|
Service Code
|
HCPCS 70350 26
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$52.42 |
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.25
|
| Rate for Payer: Healthfirst QHP |
$9.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.57
|
| Rate for Payer: SOMOS Essential |
$25.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.74
|
|
|
CHG CEPHALOGRAM ORTHODONTIC
|
Professional
|
$69.90
|
|
|
Service Code
|
HCPCS 70350
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$52.42 |
| Rate for Payer: Cash Price |
$19.36
|
| Rate for Payer: Cash Price |
$19.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.97
|
| Rate for Payer: Healthfirst QHP |
$19.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$52.42
|
| Rate for Payer: SOMOS Essential |
$52.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.97
|
|
|
CHG CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY
|
Professional
|
$129.19
|
|
|
Service Code
|
HCPCS 78630 26
|
| Min. Negotiated Rate |
$25.84 |
| Max. Negotiated Rate |
$1,011.78 |
| Rate for Payer: Cash Price |
$34.24
|
| Rate for Payer: Cash Price |
$34.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.06
|
| Rate for Payer: Healthfirst QHP |
$36.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$36.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$31.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$96.89
|
| Rate for Payer: SOMOS Essential |
$96.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.91
|
|
|
CHG CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY
|
Professional
|
$1,219.89
|
|
|
Service Code
|
HCPCS 78630 TC
|
| Min. Negotiated Rate |
$25.84 |
| Max. Negotiated Rate |
$1,011.78 |
| Rate for Payer: Cash Price |
$327.53
|
| Rate for Payer: Cash Price |
$327.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$313.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$313.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$331.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$348.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$331.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$348.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$348.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$261.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$331.11
|
| Rate for Payer: Healthfirst QHP |
$348.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$243.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$348.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$296.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$243.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$348.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$914.92
|
| Rate for Payer: SOMOS Essential |
$914.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$348.54
|
|
|
CHG CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY
|
Professional
|
$1,349.04
|
|
|
Service Code
|
HCPCS 78630
|
| Min. Negotiated Rate |
$25.84 |
| Max. Negotiated Rate |
$1,011.78 |
| Rate for Payer: Cash Price |
$361.76
|
| Rate for Payer: Cash Price |
$361.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$346.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$346.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$366.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$385.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$366.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$385.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$385.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$289.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$366.17
|
| Rate for Payer: Healthfirst QHP |
$385.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$269.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$385.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$327.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$269.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$385.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,011.78
|
| Rate for Payer: SOMOS Essential |
$1,011.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$385.44
|
|
|
CHG CEREBROSPINAL FLUID FLOW W/O MATL SHUNT EVALTJ
|
Professional
|
$1,186.82
|
|
|
Service Code
|
HCPCS 78645 TC
|
| Min. Negotiated Rate |
$20.54 |
| Max. Negotiated Rate |
$967.16 |
| Rate for Payer: Cash Price |
$318.88
|
| Rate for Payer: Cash Price |
$318.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$305.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$305.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$322.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$339.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$322.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$339.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$339.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$254.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$322.14
|
| Rate for Payer: Healthfirst QHP |
$339.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$237.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$339.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$288.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$237.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$339.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$890.12
|
| Rate for Payer: SOMOS Essential |
$890.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$339.09
|
|
|
CHG CEREBROSPINAL FLUID FLOW W/O MATL SHUNT EVALTJ
|
Professional
|
$1,289.54
|
|
|
Service Code
|
HCPCS 78645
|
| Min. Negotiated Rate |
$20.54 |
| Max. Negotiated Rate |
$967.16 |
| Rate for Payer: Cash Price |
$347.71
|
| Rate for Payer: Cash Price |
$347.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$331.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$331.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$350.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$368.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$350.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$368.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$368.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$276.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$350.02
|
| Rate for Payer: Healthfirst QHP |
$368.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$257.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$368.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$313.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$257.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$368.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$967.16
|
| Rate for Payer: SOMOS Essential |
$967.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$368.44
|
|
|
CHG CEREBROSPINAL FLUID FLOW W/O MATL SHUNT EVALTJ
|
Professional
|
$102.73
|
|
|
Service Code
|
HCPCS 78645 26
|
| Min. Negotiated Rate |
$20.54 |
| Max. Negotiated Rate |
$967.16 |
| Rate for Payer: Cash Price |
$28.83
|
| Rate for Payer: Cash Price |
$28.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.88
|
| Rate for Payer: Healthfirst QHP |
$29.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$77.05
|
| Rate for Payer: SOMOS Essential |
$77.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.35
|
|
|
CHG CEREBROSPINAL FLUID FLOW W/O MATL VENTRICLGRAPHY
|
Professional
|
$118.97
|
|
|
Service Code
|
HCPCS 78635 26
|
| Min. Negotiated Rate |
$23.79 |
| Max. Negotiated Rate |
$1,014.93 |
| Rate for Payer: Cash Price |
$31.79
|
| Rate for Payer: Cash Price |
$31.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.29
|
| Rate for Payer: Healthfirst QHP |
$33.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$33.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$89.23
|
| Rate for Payer: SOMOS Essential |
$89.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.99
|
|
|
CHG CEREBROSPINAL FLUID FLOW W/O MATL VENTRICLGRAPHY
|
Professional
|
$1,234.24
|
|
|
Service Code
|
HCPCS 78635 TC
|
| Min. Negotiated Rate |
$23.79 |
| Max. Negotiated Rate |
$1,014.93 |
| Rate for Payer: Cash Price |
$331.46
|
| Rate for Payer: Cash Price |
$331.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$317.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$317.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$335.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$352.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$335.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$352.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$264.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$335.01
|
| Rate for Payer: Healthfirst QHP |
$352.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$246.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$352.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$299.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$246.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$352.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$925.68
|
| Rate for Payer: SOMOS Essential |
$925.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$352.64
|
|
|
CHG CEREBROSPINAL FLUID FLOW W/O MATL VENTRICLGRAPHY
|
Professional
|
$1,353.24
|
|
|
Service Code
|
HCPCS 78635
|
| Min. Negotiated Rate |
$23.79 |
| Max. Negotiated Rate |
$1,014.93 |
| Rate for Payer: Cash Price |
$363.25
|
| Rate for Payer: Cash Price |
$363.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$347.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$347.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$367.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$386.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$367.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$386.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$386.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$289.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$367.31
|
| Rate for Payer: Healthfirst QHP |
$386.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$270.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$386.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$328.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$270.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$386.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,014.93
|
| Rate for Payer: SOMOS Essential |
$1,014.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$386.64
|
|
|
CHG CEREBROSPINAL FLUID LEAK DETECTION&LOCALIZATIO
|
Professional
|
$1,081.96
|
|
|
Service Code
|
HCPCS 78650
|
| Min. Negotiated Rate |
$18.70 |
| Max. Negotiated Rate |
$811.47 |
| Rate for Payer: Cash Price |
$290.88
|
| Rate for Payer: Cash Price |
$290.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$278.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$278.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$293.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$309.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$293.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$309.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$309.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$231.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$293.67
|
| Rate for Payer: Healthfirst QHP |
$309.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$216.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$309.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$262.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$216.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$309.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$811.47
|
| Rate for Payer: SOMOS Essential |
$811.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$309.13
|
|
|
CHG CEREBROSPINAL FLUID LEAK DETECTION&LOCALIZATIO
|
Professional
|
$93.52
|
|
|
Service Code
|
HCPCS 78650 26
|
| Min. Negotiated Rate |
$18.70 |
| Max. Negotiated Rate |
$811.47 |
| Rate for Payer: Cash Price |
$25.83
|
| Rate for Payer: Cash Price |
$25.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.38
|
| Rate for Payer: Healthfirst QHP |
$26.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$70.14
|
| Rate for Payer: SOMOS Essential |
$70.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.72
|
|
|
CHG CEREBROSPINAL FLUID LEAK DETECTION&LOCALIZATIO
|
Professional
|
$988.44
|
|
|
Service Code
|
HCPCS 78650 TC
|
| Min. Negotiated Rate |
$18.70 |
| Max. Negotiated Rate |
$811.47 |
| Rate for Payer: Cash Price |
$265.05
|
| Rate for Payer: Cash Price |
$265.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$254.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$254.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$268.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$282.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$268.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$282.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$282.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$211.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$268.29
|
| Rate for Payer: Healthfirst QHP |
$282.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$197.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$282.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$240.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$197.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$282.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$741.33
|
| Rate for Payer: SOMOS Essential |
$741.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$282.41
|
|
|
CHG CHANGE PRQ TUBE/DRAINAGE CATH W CONTRAST RS&I
|
Professional
|
$255.75
|
|
|
Service Code
|
HCPCS 75984 TC
|
| Min. Negotiated Rate |
$29.88 |
| Max. Negotiated Rate |
$303.85 |
| Rate for Payer: Cash Price |
$68.60
|
| Rate for Payer: Cash Price |
$68.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$65.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$69.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$73.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$69.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.42
|
| Rate for Payer: Healthfirst QHP |
$73.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$51.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$73.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$62.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$51.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$73.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$191.81
|
| Rate for Payer: SOMOS Essential |
$191.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$73.07
|
|
|
CHG CHANGE PRQ TUBE/DRAINAGE CATH W CONTRAST RS&I
|
Professional
|
$149.42
|
|
|
Service Code
|
HCPCS 75984 26
|
| Min. Negotiated Rate |
$29.88 |
| Max. Negotiated Rate |
$303.85 |
| Rate for Payer: Cash Price |
$41.74
|
| Rate for Payer: Cash Price |
$41.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$42.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$40.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.56
|
| Rate for Payer: Healthfirst QHP |
$42.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$42.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$36.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$42.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$112.06
|
| Rate for Payer: SOMOS Essential |
$112.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.69
|
|
|
CHG CHANGE PRQ TUBE/DRAINAGE CATH W CONTRAST RS&I
|
Professional
|
$405.13
|
|
|
Service Code
|
HCPCS 75984
|
| Min. Negotiated Rate |
$29.88 |
| Max. Negotiated Rate |
$303.85 |
| Rate for Payer: Cash Price |
$110.34
|
| Rate for Payer: Cash Price |
$110.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$104.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$104.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$109.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$115.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$109.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$115.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$115.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$86.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$109.96
|
| Rate for Payer: Healthfirst QHP |
$115.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$81.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$115.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$98.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$81.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$115.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$303.85
|
| Rate for Payer: SOMOS Essential |
$303.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$115.75
|
|
|
CHG CHOLANGIOGRAPHY&/PANCREATOGRAPHY NTRAOP RS&I
|
Professional
|
$207.62
|
|
|
Service Code
|
HCPCS 74300 TC
|
| Min. Negotiated Rate |
$10.73 |
| Max. Negotiated Rate |
$195.96 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$155.72
|
| Rate for Payer: SOMOS Essential |
$155.72
|
|
|
CHG CHOLANGIOGRAPHY&/PANCREATOGRAPHY NTRAOP RS&I
|
Professional
|
$53.66
|
|
|
Service Code
|
HCPCS 74300 26
|
| Min. Negotiated Rate |
$10.73 |
| Max. Negotiated Rate |
$195.96 |
| Rate for Payer: Cash Price |
$14.60
|
| Rate for Payer: Cash Price |
$14.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.56
|
| Rate for Payer: Healthfirst QHP |
$15.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$10.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$15.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$13.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.24
|
| Rate for Payer: SOMOS Essential |
$40.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.33
|
|
|
CHG CHOLANGIOGRAPHY&/PANCREATOGRAPHY NTRAOP RS&I
|
Professional
|
$261.28
|
|
|
Service Code
|
HCPCS 74300
|
| Min. Negotiated Rate |
$10.73 |
| Max. Negotiated Rate |
$195.96 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$195.96
|
| Rate for Payer: SOMOS Essential |
$195.96
|
|
