|
CHG CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD EA EVAL
|
Professional
|
$84.11
|
|
|
Service Code
|
HCPCS 88177 26
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$88.94 |
| Rate for Payer: Cash Price |
$23.13
|
| Rate for Payer: Cash Price |
$23.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.83
|
| Rate for Payer: Healthfirst QHP |
$24.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$16.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$24.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$20.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$16.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$63.08
|
| Rate for Payer: SOMOS Essential |
$63.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.03
|
|
|
CHG CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD EA EVAL
|
Professional
|
$34.51
|
|
|
Service Code
|
HCPCS 88177 TC
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$88.94 |
| Rate for Payer: Cash Price |
$9.82
|
| Rate for Payer: Cash Price |
$9.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.37
|
| Rate for Payer: Healthfirst QHP |
$9.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.88
|
| Rate for Payer: SOMOS Essential |
$25.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.86
|
|
|
CHG CYTP FLU BR/WA XCPT C/V FILTER METH ONLY INTERPJ
|
Professional
|
$219.80
|
|
|
Service Code
|
HCPCS 88106 TC
|
| Min. Negotiated Rate |
$14.99 |
| Max. Negotiated Rate |
$221.06 |
| Rate for Payer: Cash Price |
$62.94
|
| Rate for Payer: Cash Price |
$62.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$56.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$56.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$59.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$59.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$62.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$59.66
|
| Rate for Payer: Healthfirst QHP |
$62.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$43.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$62.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$53.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$43.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$164.85
|
| Rate for Payer: SOMOS Essential |
$164.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.80
|
|
|
CHG CYTP FLU BR/WA XCPT C/V FILTER METH ONLY INTERPJ
|
Professional
|
$74.97
|
|
|
Service Code
|
HCPCS 88106 26
|
| Min. Negotiated Rate |
$14.99 |
| Max. Negotiated Rate |
$221.06 |
| Rate for Payer: Cash Price |
$20.21
|
| Rate for Payer: Cash Price |
$20.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$19.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$20.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20.35
|
| Rate for Payer: Healthfirst QHP |
$21.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$21.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$18.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$14.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$56.23
|
| Rate for Payer: SOMOS Essential |
$56.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.42
|
|
|
CHG CYTP FLU BR/WA XCPT C/V FILTER METH ONLY INTERPJ
|
Professional
|
$294.74
|
|
|
Service Code
|
HCPCS 88106
|
| Min. Negotiated Rate |
$14.99 |
| Max. Negotiated Rate |
$221.06 |
| Rate for Payer: Cash Price |
$83.15
|
| Rate for Payer: Cash Price |
$83.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$75.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$75.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$80.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$84.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$80.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$84.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$84.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$63.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$80.00
|
| Rate for Payer: Healthfirst QHP |
$84.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$58.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$84.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$71.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$58.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$84.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$221.06
|
| Rate for Payer: SOMOS Essential |
$221.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$84.21
|
|
|
CHG CYTP FLU WASHGS/BRUSHINGS XCPT C/V SMRS INTERPJ
|
Professional
|
$185.15
|
|
|
Service Code
|
HCPCS 88104 TC
|
| Min. Negotiated Rate |
$20.90 |
| Max. Negotiated Rate |
$217.24 |
| Rate for Payer: Cash Price |
$58.23
|
| Rate for Payer: Cash Price |
$58.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.26
|
| Rate for Payer: Healthfirst QHP |
$52.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$138.86
|
| Rate for Payer: SOMOS Essential |
$138.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.90
|
|
|
CHG CYTP FLU WASHGS/BRUSHINGS XCPT C/V SMRS INTERPJ
|
Professional
|
$104.51
|
|
|
Service Code
|
HCPCS 88104 26
|
| Min. Negotiated Rate |
$20.90 |
| Max. Negotiated Rate |
$217.24 |
| Rate for Payer: Cash Price |
$29.19
|
| Rate for Payer: Cash Price |
$29.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$28.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.37
|
| Rate for Payer: Healthfirst QHP |
$29.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$25.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$78.38
|
| Rate for Payer: SOMOS Essential |
$78.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.86
|
|
|
CHG CYTP FLU WASHGS/BRUSHINGS XCPT C/V SMRS INTERPJ
|
Professional
|
$289.66
|
|
|
Service Code
|
HCPCS 88104
|
| Min. Negotiated Rate |
$20.90 |
| Max. Negotiated Rate |
$217.24 |
| Rate for Payer: Cash Price |
$87.42
|
| Rate for Payer: Cash Price |
$87.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$74.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$74.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$78.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$82.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$78.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$82.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$62.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$78.62
|
| Rate for Payer: Healthfirst QHP |
$82.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$57.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$82.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$70.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$57.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$82.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$217.24
|
| Rate for Payer: SOMOS Essential |
$217.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$82.76
|
|
|
CHG CYTP INSITU HYBRID URINE SPEC 3-5 PROBES EA MNL
|
Professional
|
$2,547.20
|
|
|
Service Code
|
HCPCS 88120
|
| Min. Negotiated Rate |
$44.67 |
| Max. Negotiated Rate |
$1,910.40 |
| Rate for Payer: Cash Price |
$679.17
|
| Rate for Payer: Cash Price |
$679.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$654.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$654.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$691.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$727.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$691.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$727.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$727.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$545.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$691.38
|
| Rate for Payer: Healthfirst QHP |
$727.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$509.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$727.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$618.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$509.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$727.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,910.40
|
| Rate for Payer: SOMOS Essential |
$1,910.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$727.77
|
|
|
CHG CYTP INSITU HYBRID URINE SPEC 3-5 PROBES EA MNL
|
Professional
|
$2,323.86
|
|
|
Service Code
|
HCPCS 88120 TC
|
| Min. Negotiated Rate |
$44.67 |
| Max. Negotiated Rate |
$1,910.40 |
| Rate for Payer: Cash Price |
$617.99
|
| Rate for Payer: Cash Price |
$617.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$597.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$597.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$630.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$663.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$630.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$663.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$663.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$497.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$630.76
|
| Rate for Payer: Healthfirst QHP |
$663.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$464.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$663.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$564.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$464.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$663.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,742.90
|
| Rate for Payer: SOMOS Essential |
$1,742.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$663.96
|
|
|
CHG CYTP INSITU HYBRID URINE SPEC 3-5 PROBES EA MNL
|
Professional
|
$223.34
|
|
|
Service Code
|
HCPCS 88120 26
|
| Min. Negotiated Rate |
$44.67 |
| Max. Negotiated Rate |
$1,910.40 |
| Rate for Payer: Cash Price |
$61.17
|
| Rate for Payer: Cash Price |
$61.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$57.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$57.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$60.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$63.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$60.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.62
|
| Rate for Payer: Healthfirst QHP |
$63.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$44.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$63.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$54.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$44.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$63.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$167.50
|
| Rate for Payer: SOMOS Essential |
$167.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$63.81
|
|
|
CHG CYTP INSITU HYBRID URNE SPEC 3-5 PROBES CPTR EA
|
Professional
|
$1,785.14
|
|
|
Service Code
|
HCPCS 88121
|
| Min. Negotiated Rate |
$37.07 |
| Max. Negotiated Rate |
$1,338.86 |
| Rate for Payer: Cash Price |
$490.82
|
| Rate for Payer: Cash Price |
$490.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$459.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$459.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$484.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$510.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$484.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$510.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$510.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$382.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$484.54
|
| Rate for Payer: Healthfirst QHP |
$510.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$357.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$510.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$433.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$357.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$510.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,338.86
|
| Rate for Payer: SOMOS Essential |
$1,338.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$510.04
|
|
|
CHG CYTP INSITU HYBRID URNE SPEC 3-5 PROBES CPTR EA
|
Professional
|
$1,599.78
|
|
|
Service Code
|
HCPCS 88121 TC
|
| Min. Negotiated Rate |
$37.07 |
| Max. Negotiated Rate |
$1,338.86 |
| Rate for Payer: Cash Price |
$439.76
|
| Rate for Payer: Cash Price |
$439.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$411.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$411.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$434.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$457.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$434.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$457.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$457.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$342.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$434.23
|
| Rate for Payer: Healthfirst QHP |
$457.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$319.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$457.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$388.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$319.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$457.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,199.84
|
| Rate for Payer: SOMOS Essential |
$1,199.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$457.08
|
|
|
CHG CYTP INSITU HYBRID URNE SPEC 3-5 PROBES CPTR EA
|
Professional
|
$185.36
|
|
|
Service Code
|
HCPCS 88121 26
|
| Min. Negotiated Rate |
$37.07 |
| Max. Negotiated Rate |
$1,338.86 |
| Rate for Payer: Cash Price |
$51.06
|
| Rate for Payer: Cash Price |
$51.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.31
|
| Rate for Payer: Healthfirst QHP |
$52.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$45.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$139.02
|
| Rate for Payer: SOMOS Essential |
$139.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.96
|
|
|
CHG CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V
|
Professional
|
$105.95
|
|
|
Service Code
|
HCPCS 88112 26
|
| Min. Negotiated Rate |
$21.19 |
| Max. Negotiated Rate |
$208.72 |
| Rate for Payer: Cash Price |
$29.19
|
| Rate for Payer: Cash Price |
$29.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$27.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$28.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$30.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.76
|
| Rate for Payer: Healthfirst QHP |
$30.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$30.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$25.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$79.46
|
| Rate for Payer: SOMOS Essential |
$79.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.27
|
|
|
CHG CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V
|
Professional
|
$278.29
|
|
|
Service Code
|
HCPCS 88112
|
| Min. Negotiated Rate |
$21.19 |
| Max. Negotiated Rate |
$208.72 |
| Rate for Payer: Cash Price |
$78.15
|
| Rate for Payer: Cash Price |
$78.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$71.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$71.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$75.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$79.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$75.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$79.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$59.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$75.53
|
| Rate for Payer: Healthfirst QHP |
$79.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$55.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$79.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$67.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$55.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$79.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$208.72
|
| Rate for Payer: SOMOS Essential |
$208.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$79.51
|
|
|
CHG CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V
|
Professional
|
$172.38
|
|
|
Service Code
|
HCPCS 88112 TC
|
| Min. Negotiated Rate |
$21.19 |
| Max. Negotiated Rate |
$208.72 |
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$44.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$44.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$46.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$49.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$46.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.79
|
| Rate for Payer: Healthfirst QHP |
$49.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$49.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$49.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$129.28
|
| Rate for Payer: SOMOS Essential |
$129.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$49.25
|
|
|
CHG CYTP SMRS ANY OTH SRC EXTND STD > 5 SLIDES
|
Professional
|
$347.59
|
|
|
Service Code
|
HCPCS 88162 TC
|
| Min. Negotiated Rate |
$30.22 |
| Max. Negotiated Rate |
$374.04 |
| Rate for Payer: Cash Price |
$107.58
|
| Rate for Payer: Cash Price |
$107.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$89.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$89.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$94.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$99.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$94.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$99.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$99.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$74.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$94.34
|
| Rate for Payer: Healthfirst QHP |
$99.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$69.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$99.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$84.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$69.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$99.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$260.69
|
| Rate for Payer: SOMOS Essential |
$260.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$99.31
|
|
|
CHG CYTP SMRS ANY OTH SRC EXTND STD > 5 SLIDES
|
Professional
|
$498.72
|
|
|
Service Code
|
HCPCS 88162
|
| Min. Negotiated Rate |
$30.22 |
| Max. Negotiated Rate |
$374.04 |
| Rate for Payer: Cash Price |
$149.24
|
| Rate for Payer: Cash Price |
$149.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$128.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$128.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$135.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$142.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$135.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$142.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$142.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$106.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$135.37
|
| Rate for Payer: Healthfirst QHP |
$142.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$99.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$142.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$121.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$99.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$142.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$374.04
|
| Rate for Payer: SOMOS Essential |
$374.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$142.49
|
|
|
CHG CYTP SMRS ANY OTH SRC EXTND STD > 5 SLIDES
|
Professional
|
$151.10
|
|
|
Service Code
|
HCPCS 88162 26
|
| Min. Negotiated Rate |
$30.22 |
| Max. Negotiated Rate |
$374.04 |
| Rate for Payer: Cash Price |
$41.67
|
| Rate for Payer: Cash Price |
$41.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.01
|
| Rate for Payer: Healthfirst QHP |
$43.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$43.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$36.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$113.32
|
| Rate for Payer: SOMOS Essential |
$113.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.17
|
|
|
CHG CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ
|
Professional
|
$98.42
|
|
|
Service Code
|
HCPCS 88161 26
|
| Min. Negotiated Rate |
$19.68 |
| Max. Negotiated Rate |
$242.86 |
| Rate for Payer: Cash Price |
$26.71
|
| Rate for Payer: Cash Price |
$26.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.71
|
| Rate for Payer: Healthfirst QHP |
$28.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$73.82
|
| Rate for Payer: SOMOS Essential |
$73.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.12
|
|
|
CHG CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ
|
Professional
|
$323.82
|
|
|
Service Code
|
HCPCS 88161
|
| Min. Negotiated Rate |
$19.68 |
| Max. Negotiated Rate |
$242.86 |
| Rate for Payer: Cash Price |
$94.36
|
| Rate for Payer: Cash Price |
$94.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$83.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$83.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$87.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$92.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$87.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$87.89
|
| Rate for Payer: Healthfirst QHP |
$92.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$92.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$78.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$92.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$242.86
|
| Rate for Payer: SOMOS Essential |
$242.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$92.52
|
|
|
CHG CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ
|
Professional
|
$225.40
|
|
|
Service Code
|
HCPCS 88161 TC
|
| Min. Negotiated Rate |
$19.68 |
| Max. Negotiated Rate |
$242.86 |
| Rate for Payer: Cash Price |
$67.66
|
| Rate for Payer: Cash Price |
$67.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$57.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$57.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$61.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$64.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$61.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.18
|
| Rate for Payer: Healthfirst QHP |
$64.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$64.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$54.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$64.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$169.05
|
| Rate for Payer: SOMOS Essential |
$169.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$64.40
|
|
|
CHG CYTP SMRS ANY OTH SRC SCR&INTERPJ
|
Professional
|
$216.79
|
|
|
Service Code
|
HCPCS 88160 TC
|
| Min. Negotiated Rate |
$19.97 |
| Max. Negotiated Rate |
$237.49 |
| Rate for Payer: Cash Price |
$65.30
|
| Rate for Payer: Cash Price |
$65.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$55.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$55.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$58.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$61.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$58.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$61.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$46.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$58.84
|
| Rate for Payer: Healthfirst QHP |
$61.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$43.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$61.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$52.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$43.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$61.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$162.59
|
| Rate for Payer: SOMOS Essential |
$162.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$61.94
|
|
|
CHG CYTP SMRS ANY OTH SRC SCR&INTERPJ
|
Professional
|
$99.86
|
|
|
Service Code
|
HCPCS 88160 26
|
| Min. Negotiated Rate |
$19.97 |
| Max. Negotiated Rate |
$237.49 |
| Rate for Payer: Cash Price |
$27.10
|
| Rate for Payer: Cash Price |
$27.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.10
|
| Rate for Payer: Healthfirst QHP |
$28.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$74.90
|
| Rate for Payer: SOMOS Essential |
$74.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.53
|
|
