|
CHG CHOLANGIO&/PANCREATOGRAPHY ADDL SET INTRAOP RS
|
Professional
|
$115.08
|
|
|
Service Code
|
HCPCS 74301 TC
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$116.71 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$86.31
|
| Rate for Payer: SOMOS Essential |
$86.31
|
|
|
CHG CHOLANGIO&/PANCREATOGRAPHY ADDL SET INTRAOP RS
|
Professional
|
$40.53
|
|
|
Service Code
|
HCPCS 74301 26
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$116.71 |
| Rate for Payer: Cash Price |
$10.70
|
| Rate for Payer: Cash Price |
$10.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.00
|
| Rate for Payer: Healthfirst QHP |
$11.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$11.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$9.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$30.40
|
| Rate for Payer: SOMOS Essential |
$30.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.58
|
|
|
CHG CHOLANGIO&/PANCREATOGRAPHY ADDL SET INTRAOP RS
|
Professional
|
$155.61
|
|
|
Service Code
|
HCPCS 74301
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$116.71 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$116.71
|
| Rate for Payer: SOMOS Essential |
$116.71
|
|
|
CHG CHOLECYSTOGRAPHY ORAL CONTRST
|
Professional
|
$62.79
|
|
|
Service Code
|
HCPCS 74290 26
|
| Min. Negotiated Rate |
$12.56 |
| Max. Negotiated Rate |
$280.96 |
| Rate for Payer: Cash Price |
$16.73
|
| Rate for Payer: Cash Price |
$16.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.04
|
| Rate for Payer: Healthfirst QHP |
$17.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$12.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$17.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$15.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$12.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.09
|
| Rate for Payer: SOMOS Essential |
$47.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.94
|
|
|
CHG CHOLECYSTOGRAPHY ORAL CONTRST
|
Professional
|
$374.61
|
|
|
Service Code
|
HCPCS 74290
|
| Min. Negotiated Rate |
$12.56 |
| Max. Negotiated Rate |
$280.96 |
| Rate for Payer: Cash Price |
$99.48
|
| Rate for Payer: Cash Price |
$99.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$96.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$96.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$101.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$101.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$107.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$101.68
|
| Rate for Payer: Healthfirst QHP |
$107.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$74.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$107.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$90.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$74.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$107.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$280.96
|
| Rate for Payer: SOMOS Essential |
$280.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$107.03
|
|
|
CHG CHOLECYSTOGRAPHY ORAL CONTRST
|
Professional
|
$311.82
|
|
|
Service Code
|
HCPCS 74290 TC
|
| Min. Negotiated Rate |
$12.56 |
| Max. Negotiated Rate |
$280.96 |
| Rate for Payer: Cash Price |
$82.75
|
| Rate for Payer: Cash Price |
$82.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$80.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$80.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$89.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$84.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$89.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$89.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$66.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$84.64
|
| Rate for Payer: Healthfirst QHP |
$89.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$62.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$89.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$75.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$62.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$89.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$233.86
|
| Rate for Payer: SOMOS Essential |
$233.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$89.09
|
|
|
CHG CINERADIOGRAPY/VIDRADIOGRAPY ROUTINE EXAMINATION
|
Professional
|
$210.56
|
|
|
Service Code
|
HCPCS 76125
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$157.92 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$157.92
|
| Rate for Payer: SOMOS Essential |
$157.92
|
|
|
CHG CINERADIOGRAPY/VIDRADIOGRAPY ROUTINE EXAMINATION
|
Professional
|
$50.93
|
|
|
Service Code
|
HCPCS 76125 26
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$157.92 |
| Rate for Payer: Cash Price |
$14.60
|
| Rate for Payer: Cash Price |
$14.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.82
|
| Rate for Payer: Healthfirst QHP |
$14.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$10.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$14.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$12.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$38.20
|
| Rate for Payer: SOMOS Essential |
$38.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.55
|
|
|
CHG CINERADIOGRAPY/VIDRADIOGRAPY ROUTINE EXAMINATION
|
Professional
|
$159.64
|
|
|
Service Code
|
HCPCS 76125 TC
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$157.92 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$119.73
|
| Rate for Payer: SOMOS Essential |
$119.73
|
|
|
CHG CINERADIOGRAPY/VIDRADIOGRAPY XCPT WHERE SPEC
|
Professional
|
$425.36
|
|
|
Service Code
|
HCPCS 76120 TC
|
| Min. Negotiated Rate |
$16.02 |
| Max. Negotiated Rate |
$379.10 |
| Rate for Payer: Cash Price |
$116.93
|
| Rate for Payer: Cash Price |
$116.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$109.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$109.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$115.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$121.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$115.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$121.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$121.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$91.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$115.45
|
| Rate for Payer: Healthfirst QHP |
$121.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$85.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$121.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$103.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$85.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$121.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$319.02
|
| Rate for Payer: SOMOS Essential |
$319.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$121.53
|
|
|
CHG CINERADIOGRAPY/VIDRADIOGRAPY XCPT WHERE SPEC
|
Professional
|
$505.47
|
|
|
Service Code
|
HCPCS 76120
|
| Min. Negotiated Rate |
$16.02 |
| Max. Negotiated Rate |
$379.10 |
| Rate for Payer: Cash Price |
$138.35
|
| Rate for Payer: Cash Price |
$138.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$129.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$129.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$137.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$144.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$137.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$144.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$144.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$108.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$137.20
|
| Rate for Payer: Healthfirst QHP |
$144.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$101.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$144.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$122.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$101.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$144.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$379.10
|
| Rate for Payer: SOMOS Essential |
$379.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$144.42
|
|
|
CHG CINERADIOGRAPY/VIDRADIOGRAPY XCPT WHERE SPEC
|
Professional
|
$80.12
|
|
|
Service Code
|
HCPCS 76120 26
|
| Min. Negotiated Rate |
$16.02 |
| Max. Negotiated Rate |
$379.10 |
| Rate for Payer: Cash Price |
$21.42
|
| Rate for Payer: Cash Price |
$21.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.75
|
| Rate for Payer: Healthfirst QHP |
$22.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$16.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$22.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$19.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$16.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$60.09
|
| Rate for Payer: SOMOS Essential |
$60.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.89
|
|
|
CHG CISTERNOGRAPHY POSITIVE CONTRAST RS&I
|
Professional
|
$228.73
|
|
|
Service Code
|
HCPCS 70015 26
|
| Min. Negotiated Rate |
$45.74 |
| Max. Negotiated Rate |
$535.84 |
| Rate for Payer: Cash Price |
$61.76
|
| Rate for Payer: Cash Price |
$61.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$58.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$65.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$49.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.08
|
| Rate for Payer: Healthfirst QHP |
$65.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$65.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$55.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$65.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$171.55
|
| Rate for Payer: SOMOS Essential |
$171.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.35
|
|
|
CHG CISTERNOGRAPHY POSITIVE CONTRAST RS&I
|
Professional
|
$714.46
|
|
|
Service Code
|
HCPCS 70015
|
| Min. Negotiated Rate |
$45.74 |
| Max. Negotiated Rate |
$535.84 |
| Rate for Payer: Cash Price |
$192.05
|
| Rate for Payer: Cash Price |
$192.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$183.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$183.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$193.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$204.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$193.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$204.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$204.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$153.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$193.92
|
| Rate for Payer: Healthfirst QHP |
$204.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$142.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$204.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$173.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$142.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$204.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$535.84
|
| Rate for Payer: SOMOS Essential |
$535.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$204.13
|
|
|
CHG CISTERNOGRAPHY POSITIVE CONTRAST RS&I
|
Professional
|
$485.73
|
|
|
Service Code
|
HCPCS 70015 TC
|
| Min. Negotiated Rate |
$45.74 |
| Max. Negotiated Rate |
$535.84 |
| Rate for Payer: Cash Price |
$130.29
|
| Rate for Payer: Cash Price |
$130.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$124.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$124.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$138.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$138.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$138.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$104.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$131.84
|
| Rate for Payer: Healthfirst QHP |
$138.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$97.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$138.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$117.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$97.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$138.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$364.30
|
| Rate for Payer: SOMOS Essential |
$364.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$138.78
|
|
|
CHG CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I
|
Professional
|
$638.02
|
|
|
Service Code
|
HCPCS 74330 TC
|
| Min. Negotiated Rate |
$22.54 |
| Max. Negotiated Rate |
$563.04 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$478.52
|
| Rate for Payer: SOMOS Essential |
$478.52
|
|
|
CHG CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I
|
Professional
|
$750.72
|
|
|
Service Code
|
HCPCS 74330
|
| Min. Negotiated Rate |
$22.54 |
| Max. Negotiated Rate |
$563.04 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$563.04
|
| Rate for Payer: SOMOS Essential |
$563.04
|
|
|
CHG CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I
|
Professional
|
$112.70
|
|
|
Service Code
|
HCPCS 74330 26
|
| Min. Negotiated Rate |
$22.54 |
| Max. Negotiated Rate |
$563.04 |
| Rate for Payer: Cash Price |
$29.66
|
| Rate for Payer: Cash Price |
$29.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.59
|
| Rate for Payer: Healthfirst QHP |
$32.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$84.52
|
| Rate for Payer: SOMOS Essential |
$84.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.20
|
|
|
CHG COAGJ/FBRNLYS ASSAY WHOLE BLOOD ADDITIVE PER DAY
|
Professional
|
$77.70
|
|
|
Service Code
|
HCPCS 85396
|
| Min. Negotiated Rate |
$15.54 |
| Max. Negotiated Rate |
$58.28 |
| Rate for Payer: Cash Price |
$21.23
|
| Rate for Payer: Cash Price |
$21.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$19.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.09
|
| Rate for Payer: Healthfirst QHP |
$22.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$15.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$22.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$18.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$58.28
|
| Rate for Payer: SOMOS Essential |
$58.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.20
|
|
|
CHG COAGULATION TIME ACTIVATED
|
Professional
|
$17.12
|
|
|
Service Code
|
HCPCS 85347
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$12.84 |
| Rate for Payer: Cash Price |
$4.28
|
| Rate for Payer: Cash Price |
$4.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.07
|
| Rate for Payer: Healthfirst QHP |
$4.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.84
|
| Rate for Payer: SOMOS Essential |
$12.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.28
|
|
|
CHG COMPREHENSIVE METABOLIC PANEL
|
Professional
|
$26.40
|
|
|
Service Code
|
HCPCS 80053
|
| Min. Negotiated Rate |
$7.39 |
| Max. Negotiated Rate |
$19.80 |
| Rate for Payer: Cash Price |
$10.56
|
| Rate for Payer: Cash Price |
$10.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.03
|
| Rate for Payer: Healthfirst QHP |
$10.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$7.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$10.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19.80
|
| Rate for Payer: SOMOS Essential |
$19.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.56
|
|
|
CHG COMPUTED TOMOGRAPHY THORAX LW DOSE LNG CA SCR C-
|
Professional
|
$602.91
|
|
|
Service Code
|
HCPCS 71271
|
| Min. Negotiated Rate |
$41.55 |
| Max. Negotiated Rate |
$452.18 |
| Rate for Payer: Cash Price |
$163.30
|
| Rate for Payer: Cash Price |
$163.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$155.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$155.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$163.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$172.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$163.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$172.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$172.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$129.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$163.65
|
| Rate for Payer: Healthfirst QHP |
$172.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$120.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$172.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$146.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$120.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$172.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$452.18
|
| Rate for Payer: SOMOS Essential |
$452.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$172.26
|
|
|
CHG COMPUTED TOMOGRAPHY THORAX LW DOSE LNG CA SCR C-
|
Professional
|
$207.76
|
|
|
Service Code
|
HCPCS 71271 26
|
| Min. Negotiated Rate |
$41.55 |
| Max. Negotiated Rate |
$452.18 |
| Rate for Payer: Cash Price |
$56.35
|
| Rate for Payer: Cash Price |
$56.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$53.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$56.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$59.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$56.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$56.39
|
| Rate for Payer: Healthfirst QHP |
$59.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$41.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$59.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$50.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$41.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$59.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$155.82
|
| Rate for Payer: SOMOS Essential |
$155.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$59.36
|
|
|
CHG COMPUTED TOMOGRAPHY THORAX LW DOSE LNG CA SCR C-
|
Professional
|
$395.19
|
|
|
Service Code
|
HCPCS 71271 TC
|
| Min. Negotiated Rate |
$41.55 |
| Max. Negotiated Rate |
$452.18 |
| Rate for Payer: Cash Price |
$106.95
|
| Rate for Payer: Cash Price |
$106.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$101.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$101.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$107.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$112.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$107.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$112.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$84.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$107.26
|
| Rate for Payer: Healthfirst QHP |
$112.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$79.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$112.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$95.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$79.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$112.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$296.39
|
| Rate for Payer: SOMOS Essential |
$296.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$112.91
|
|
|
CHG CONSLTJ COMPRE RVW RECORD REPRT REFERRED MATRL
|
Professional
|
$526.37
|
|
|
Service Code
|
HCPCS 88325
|
| Min. Negotiated Rate |
$105.27 |
| Max. Negotiated Rate |
$394.78 |
| Rate for Payer: Cash Price |
$144.22
|
| Rate for Payer: Cash Price |
$144.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$135.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$135.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$142.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$150.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$142.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$112.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$142.87
|
| Rate for Payer: Healthfirst QHP |
$150.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$105.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$150.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$127.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$105.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$150.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$394.78
|
| Rate for Payer: SOMOS Essential |
$394.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$150.39
|
|
