|
CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/O CONTRAST
|
Professional
|
$912.59
|
|
|
Service Code
|
HCPCS 74261
|
| Min. Negotiated Rate |
$91.70 |
| Max. Negotiated Rate |
$684.44 |
| Rate for Payer: Cash Price |
$494.26
|
| Rate for Payer: Cash Price |
$494.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$476.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$476.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$502.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$529.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$502.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$529.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$529.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$396.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$502.77
|
| Rate for Payer: Healthfirst QHP |
$529.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$370.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$529.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$449.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$370.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$529.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$684.44
|
| Rate for Payer: SOMOS Essential |
$684.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$529.23
|
|
|
CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/O CONTRAST
|
Professional
|
$454.13
|
|
|
Service Code
|
HCPCS 74261 TC
|
| Min. Negotiated Rate |
$91.70 |
| Max. Negotiated Rate |
$684.44 |
| Rate for Payer: Cash Price |
$370.05
|
| Rate for Payer: Cash Price |
$370.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$358.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$358.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$378.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$398.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$378.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$398.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$398.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$298.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$378.32
|
| Rate for Payer: Healthfirst QHP |
$398.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$278.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$398.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$338.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$278.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$398.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$340.60
|
| Rate for Payer: SOMOS Essential |
$340.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$398.23
|
|
|
CHG CT GUIDANCE &MONITORING VISC TISS ABLATION
|
Professional
|
$2,672.39
|
|
|
Service Code
|
HCPCS 77013
|
| Min. Negotiated Rate |
$146.98 |
| Max. Negotiated Rate |
$2,004.29 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,004.29
|
| Rate for Payer: SOMOS Essential |
$2,004.29
|
|
|
CHG CT GUIDANCE &MONITORING VISC TISS ABLATION
|
Professional
|
$1,937.50
|
|
|
Service Code
|
HCPCS 77013 TC
|
| Min. Negotiated Rate |
$146.98 |
| Max. Negotiated Rate |
$2,004.29 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,453.12
|
| Rate for Payer: SOMOS Essential |
$1,453.12
|
|
|
CHG CT GUIDANCE &MONITORING VISC TISS ABLATION
|
Professional
|
$734.90
|
|
|
Service Code
|
HCPCS 77013 26
|
| Min. Negotiated Rate |
$146.98 |
| Max. Negotiated Rate |
$2,004.29 |
| Rate for Payer: Cash Price |
$199.19
|
| Rate for Payer: Cash Price |
$199.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$188.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$188.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$199.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$209.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$199.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$157.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$199.47
|
| Rate for Payer: Healthfirst QHP |
$209.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$146.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$209.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$178.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$146.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$209.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$551.18
|
| Rate for Payer: SOMOS Essential |
$551.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$209.97
|
|
|
CHG CT GUIDANCE NEEDLE PLACEMENT
|
Professional
|
$596.02
|
|
|
Service Code
|
HCPCS 77012
|
| Min. Negotiated Rate |
$56.85 |
| Max. Negotiated Rate |
$447.02 |
| Rate for Payer: Cash Price |
$159.55
|
| Rate for Payer: Cash Price |
$159.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$153.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$153.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$161.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$170.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$161.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$170.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$170.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$127.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$161.78
|
| Rate for Payer: Healthfirst QHP |
$170.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$119.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$170.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$144.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$119.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$170.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$447.02
|
| Rate for Payer: SOMOS Essential |
$447.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$170.29
|
|
|
CHG CT GUIDANCE NEEDLE PLACEMENT
|
Professional
|
$311.82
|
|
|
Service Code
|
HCPCS 77012 TC
|
| Min. Negotiated Rate |
$56.85 |
| Max. Negotiated Rate |
$447.02 |
| Rate for Payer: Cash Price |
$83.53
|
| Rate for Payer: Cash Price |
$83.53
|
| 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 CT GUIDANCE NEEDLE PLACEMENT
|
Professional
|
$284.24
|
|
|
Service Code
|
HCPCS 77012 26
|
| Min. Negotiated Rate |
$56.85 |
| Max. Negotiated Rate |
$447.02 |
| Rate for Payer: Cash Price |
$76.02
|
| Rate for Payer: Cash Price |
$76.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$73.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$77.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$77.15
|
| Rate for Payer: Healthfirst QHP |
$81.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$56.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$81.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$69.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$56.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$213.18
|
| Rate for Payer: SOMOS Essential |
$213.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.21
|
|
|
CHG CT GUIDANCE RADIATION THERAPY FLDS PLACEMENT
|
Professional
|
$180.67
|
|
|
Service Code
|
HCPCS 77014 26
|
| Min. Negotiated Rate |
$36.13 |
| Max. Negotiated Rate |
$382.28 |
| Rate for Payer: Cash Price |
$49.43
|
| Rate for Payer: Cash Price |
$49.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$46.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$46.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$51.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.04
|
| Rate for Payer: Healthfirst QHP |
$51.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$51.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$43.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$51.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$135.50
|
| Rate for Payer: SOMOS Essential |
$135.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$51.62
|
|
|
CHG CT GUIDANCE RADIATION THERAPY FLDS PLACEMENT
|
Professional
|
$329.04
|
|
|
Service Code
|
HCPCS 77014 TC
|
| Min. Negotiated Rate |
$36.13 |
| Max. Negotiated Rate |
$382.28 |
| Rate for Payer: Cash Price |
$89.04
|
| Rate for Payer: Cash Price |
$89.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$84.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$84.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$89.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$94.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$89.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$94.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$94.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$70.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$89.31
|
| Rate for Payer: Healthfirst QHP |
$94.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$65.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$94.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$79.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$65.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$94.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$246.78
|
| Rate for Payer: SOMOS Essential |
$246.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$94.01
|
|
|
CHG CT GUIDANCE RADIATION THERAPY FLDS PLACEMENT
|
Professional
|
$509.71
|
|
|
Service Code
|
HCPCS 77014
|
| Min. Negotiated Rate |
$36.13 |
| Max. Negotiated Rate |
$382.28 |
| Rate for Payer: Cash Price |
$138.47
|
| Rate for Payer: Cash Price |
$138.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$131.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$131.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$138.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$145.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$138.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$145.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$145.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$109.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$138.35
|
| Rate for Payer: Healthfirst QHP |
$145.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$101.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$145.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$123.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$101.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$145.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$382.28
|
| Rate for Payer: SOMOS Essential |
$382.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$145.63
|
|
|
CHG CT GUIDANCE STEREOTACTIC LOCALIZATION
|
Professional
|
$955.29
|
|
|
Service Code
|
HCPCS 77011
|
| Min. Negotiated Rate |
$50.21 |
| Max. Negotiated Rate |
$716.47 |
| Rate for Payer: Cash Price |
$257.65
|
| Rate for Payer: Cash Price |
$257.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$245.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$245.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$259.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$272.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$259.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$272.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$272.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$204.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$259.29
|
| Rate for Payer: Healthfirst QHP |
$272.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$191.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$272.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$232.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$191.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$272.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$716.47
|
| Rate for Payer: SOMOS Essential |
$716.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$272.94
|
|
|
CHG CT GUIDANCE STEREOTACTIC LOCALIZATION
|
Professional
|
$704.24
|
|
|
Service Code
|
HCPCS 77011 TC
|
| Min. Negotiated Rate |
$50.21 |
| Max. Negotiated Rate |
$716.47 |
| Rate for Payer: Cash Price |
$189.63
|
| Rate for Payer: Cash Price |
$189.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$181.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$181.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$191.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$201.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$191.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$201.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$201.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$150.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$191.15
|
| Rate for Payer: Healthfirst QHP |
$201.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$140.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$201.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$171.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$140.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$201.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$528.18
|
| Rate for Payer: SOMOS Essential |
$528.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$201.21
|
|
|
CHG CT GUIDANCE STEREOTACTIC LOCALIZATION
|
Professional
|
$251.06
|
|
|
Service Code
|
HCPCS 77011 26
|
| Min. Negotiated Rate |
$50.21 |
| Max. Negotiated Rate |
$716.47 |
| Rate for Payer: Cash Price |
$68.03
|
| Rate for Payer: Cash Price |
$68.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$64.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$64.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$68.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$71.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$68.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$71.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$71.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$53.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$68.14
|
| Rate for Payer: Healthfirst QHP |
$71.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$50.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$71.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$60.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$50.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$71.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$188.30
|
| Rate for Payer: SOMOS Essential |
$188.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$71.73
|
|
|
CHG CT HEAD/BRAIN W/CONTRAST MATERIAL
|
Professional
|
$431.10
|
|
|
Service Code
|
HCPCS 70460 TC
|
| Min. Negotiated Rate |
$43.38 |
| Max. Negotiated Rate |
$485.99 |
| Rate for Payer: Cash Price |
$116.93
|
| Rate for Payer: Cash Price |
$116.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$110.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$110.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$117.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$123.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$117.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$123.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$123.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$92.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$117.01
|
| Rate for Payer: Healthfirst QHP |
$123.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$86.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$123.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$104.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$86.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$123.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$323.32
|
| Rate for Payer: SOMOS Essential |
$323.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$123.17
|
|
|
CHG CT HEAD/BRAIN W/CONTRAST MATERIAL
|
Professional
|
$216.90
|
|
|
Service Code
|
HCPCS 70460 26
|
| Min. Negotiated Rate |
$43.38 |
| Max. Negotiated Rate |
$485.99 |
| Rate for Payer: Cash Price |
$58.88
|
| Rate for Payer: Cash Price |
$58.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$55.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$55.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$58.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$61.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$58.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$61.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$46.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$58.87
|
| Rate for Payer: Healthfirst QHP |
$61.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$43.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$61.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$52.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$43.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$61.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$162.68
|
| Rate for Payer: SOMOS Essential |
$162.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$61.97
|
|
|
CHG CT HEAD/BRAIN W/CONTRAST MATERIAL
|
Professional
|
$647.99
|
|
|
Service Code
|
HCPCS 70460
|
| Min. Negotiated Rate |
$43.38 |
| Max. Negotiated Rate |
$485.99 |
| Rate for Payer: Cash Price |
$175.81
|
| Rate for Payer: Cash Price |
$175.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$166.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$166.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$175.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$185.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$175.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$185.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$185.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$138.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$175.88
|
| Rate for Payer: Healthfirst QHP |
$185.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$129.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$185.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$157.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$129.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$185.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$485.99
|
| Rate for Payer: SOMOS Essential |
$485.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$185.14
|
|
|
CHG CT HEAD/BRAIN W/O CONTRAST MATERIAL
|
Professional
|
$161.98
|
|
|
Service Code
|
HCPCS 70450 26
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$347.79 |
| Rate for Payer: Cash Price |
$43.93
|
| Rate for Payer: Cash Price |
$43.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43.97
|
| Rate for Payer: Healthfirst QHP |
$46.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$46.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$121.48
|
| Rate for Payer: SOMOS Essential |
$121.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.28
|
|
|
CHG CT HEAD/BRAIN W/O CONTRAST MATERIAL
|
Professional
|
$463.72
|
|
|
Service Code
|
HCPCS 70450
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$347.79 |
| Rate for Payer: Cash Price |
$125.50
|
| Rate for Payer: Cash Price |
$125.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$119.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$119.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$125.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$132.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$125.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$132.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$132.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$99.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.87
|
| Rate for Payer: Healthfirst QHP |
$132.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$92.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$132.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$112.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$92.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$132.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$347.79
|
| Rate for Payer: SOMOS Essential |
$347.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$132.49
|
|
|
CHG CT HEAD/BRAIN W/O CONTRAST MATERIAL
|
Professional
|
$301.74
|
|
|
Service Code
|
HCPCS 70450 TC
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$347.79 |
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$77.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$77.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$81.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$86.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$81.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$81.90
|
| Rate for Payer: Healthfirst QHP |
$86.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$60.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$86.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$73.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$60.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$86.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$226.30
|
| Rate for Payer: SOMOS Essential |
$226.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$86.21
|
|
|
CHG CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL
|
Professional
|
$764.44
|
|
|
Service Code
|
HCPCS 70470
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$573.33 |
| Rate for Payer: Cash Price |
$206.31
|
| Rate for Payer: Cash Price |
$206.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$196.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$207.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$218.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$207.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$218.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$218.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$163.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$207.49
|
| Rate for Payer: Healthfirst QHP |
$218.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$152.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$218.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$185.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$152.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$218.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$573.33
|
| Rate for Payer: SOMOS Essential |
$573.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$218.41
|
|
|
CHG CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL
|
Professional
|
$244.34
|
|
|
Service Code
|
HCPCS 70470 26
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$573.33 |
| Rate for Payer: Cash Price |
$66.35
|
| Rate for Payer: Cash Price |
$66.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$62.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$66.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$69.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$66.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$69.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$69.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$52.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$66.32
|
| Rate for Payer: Healthfirst QHP |
$69.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$48.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$69.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$59.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$48.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$69.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$183.26
|
| Rate for Payer: SOMOS Essential |
$183.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$69.81
|
|
|
CHG CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL
|
Professional
|
$520.10
|
|
|
Service Code
|
HCPCS 70470 TC
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$573.33 |
| Rate for Payer: Cash Price |
$139.96
|
| Rate for Payer: Cash Price |
$139.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$133.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$141.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$148.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$141.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$148.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$148.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$111.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$141.17
|
| Rate for Payer: Healthfirst QHP |
$148.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$104.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$148.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$126.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$104.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$148.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$390.08
|
| Rate for Payer: SOMOS Essential |
$390.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$148.60
|
|
|
CHG CT HEART C+ CARDIAC STRUX&MORPH CGEN HRT DS
|
Professional
|
$1,252.97
|
|
|
Service Code
|
HCPCS 75573
|
| Min. Negotiated Rate |
$96.32 |
| Max. Negotiated Rate |
$939.73 |
| Rate for Payer: Cash Price |
$359.45
|
| Rate for Payer: Cash Price |
$359.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$338.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$338.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$357.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$376.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$357.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$376.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$376.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$282.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$357.65
|
| Rate for Payer: Healthfirst QHP |
$376.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$263.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$376.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$320.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$263.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$376.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$939.73
|
| Rate for Payer: SOMOS Essential |
$939.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$376.47
|
|
|
CHG CT HEART C+ CARDIAC STRUX&MORPH CGEN HRT DS
|
Professional
|
$481.60
|
|
|
Service Code
|
HCPCS 75573 26
|
| Min. Negotiated Rate |
$96.32 |
| Max. Negotiated Rate |
$939.73 |
| Rate for Payer: Cash Price |
$131.01
|
| Rate for Payer: Cash Price |
$131.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$123.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$123.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$130.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$137.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$130.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$137.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$137.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$103.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$130.72
|
| Rate for Payer: Healthfirst QHP |
$137.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$96.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$137.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$116.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$96.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$137.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$361.20
|
| Rate for Payer: SOMOS Essential |
$361.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$137.60
|
|
