|
CHG DISKOGRAPY CERVICAL/THORACIC RS&I
|
Professional
|
$220.92
|
|
|
Service Code
|
HCPCS 72285 26
|
| Min. Negotiated Rate |
$44.18 |
| Max. Negotiated Rate |
$404.93 |
| Rate for Payer: Cash Price |
$60.64
|
| Rate for Payer: Cash Price |
$60.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$56.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$56.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$59.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$63.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$59.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$59.96
|
| Rate for Payer: Healthfirst QHP |
$63.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$44.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$63.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$53.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$44.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$63.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$165.69
|
| Rate for Payer: SOMOS Essential |
$165.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$63.12
|
|
|
CHG DISKOGRAPY LUMBAR RS&I
|
Professional
|
$159.46
|
|
|
Service Code
|
HCPCS 72295 26
|
| Min. Negotiated Rate |
$31.89 |
| Max. Negotiated Rate |
$352.36 |
| Rate for Payer: Cash Price |
$43.24
|
| Rate for Payer: Cash Price |
$43.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$45.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43.28
|
| Rate for Payer: Healthfirst QHP |
$45.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$45.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$38.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$119.60
|
| Rate for Payer: SOMOS Essential |
$119.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.56
|
|
|
CHG DISKOGRAPY LUMBAR RS&I
|
Professional
|
$469.81
|
|
|
Service Code
|
HCPCS 72295
|
| Min. Negotiated Rate |
$31.89 |
| Max. Negotiated Rate |
$352.36 |
| Rate for Payer: Cash Price |
$128.73
|
| Rate for Payer: Cash Price |
$128.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$120.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$120.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$127.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$134.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$127.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$134.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$134.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$100.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$127.52
|
| Rate for Payer: Healthfirst QHP |
$134.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$93.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$134.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$114.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$93.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$134.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$352.36
|
| Rate for Payer: SOMOS Essential |
$352.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$134.23
|
|
|
CHG DISKOGRAPY LUMBAR RS&I
|
Professional
|
$310.35
|
|
|
Service Code
|
HCPCS 72295 TC
|
| Min. Negotiated Rate |
$31.89 |
| Max. Negotiated Rate |
$352.36 |
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$79.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$79.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$88.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$84.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$88.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$66.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$84.24
|
| Rate for Payer: Healthfirst QHP |
$88.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$62.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$88.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$75.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$62.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$88.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$232.76
|
| Rate for Payer: SOMOS Essential |
$232.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$88.67
|
|
|
CHG DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT
|
Professional
|
$100.49
|
|
|
Service Code
|
HCPCS 76828 TC
|
| Min. Negotiated Rate |
$20.10 |
| Max. Negotiated Rate |
$152.67 |
| Rate for Payer: Cash Price |
$26.95
|
| Rate for Payer: Cash Price |
$26.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.27
|
| Rate for Payer: Healthfirst QHP |
$28.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$75.37
|
| Rate for Payer: SOMOS Essential |
$75.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.71
|
|
|
CHG DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT
|
Professional
|
$103.08
|
|
|
Service Code
|
HCPCS 76828 26
|
| Min. Negotiated Rate |
$20.10 |
| Max. Negotiated Rate |
$152.67 |
| Rate for Payer: Cash Price |
$28.41
|
| Rate for Payer: Cash Price |
$28.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.98
|
| Rate for Payer: Healthfirst QHP |
$29.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$25.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$77.31
|
| Rate for Payer: SOMOS Essential |
$77.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.45
|
|
|
CHG DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT
|
Professional
|
$203.56
|
|
|
Service Code
|
HCPCS 76828
|
| Min. Negotiated Rate |
$20.10 |
| Max. Negotiated Rate |
$152.67 |
| Rate for Payer: Cash Price |
$55.36
|
| Rate for Payer: Cash Price |
$55.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$52.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$52.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$55.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$58.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$55.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$58.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$58.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$55.25
|
| Rate for Payer: Healthfirst QHP |
$58.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$40.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$58.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$49.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$40.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$58.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$152.67
|
| Rate for Payer: SOMOS Essential |
$152.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$58.16
|
|
|
CHG DOPPLER ECHO FETAL SPECTRAL DISPLAY COMPLETE
|
Professional
|
$109.73
|
|
|
Service Code
|
HCPCS 76827 26
|
| Min. Negotiated Rate |
$21.94 |
| Max. Negotiated Rate |
$220.22 |
| Rate for Payer: Cash Price |
$30.12
|
| Rate for Payer: Cash Price |
$30.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.78
|
| Rate for Payer: Healthfirst QHP |
$31.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$31.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$82.30
|
| Rate for Payer: SOMOS Essential |
$82.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.35
|
|
|
CHG DOPPLER ECHO FETAL SPECTRAL DISPLAY COMPLETE
|
Professional
|
$183.86
|
|
|
Service Code
|
HCPCS 76827 TC
|
| Min. Negotiated Rate |
$21.94 |
| Max. Negotiated Rate |
$220.22 |
| Rate for Payer: Cash Price |
$50.53
|
| Rate for Payer: Cash Price |
$50.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.90
|
| Rate for Payer: Healthfirst QHP |
$52.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$137.90
|
| Rate for Payer: SOMOS Essential |
$137.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.53
|
|
|
CHG DOPPLER ECHO FETAL SPECTRAL DISPLAY COMPLETE
|
Professional
|
$293.62
|
|
|
Service Code
|
HCPCS 76827
|
| Min. Negotiated Rate |
$21.94 |
| Max. Negotiated Rate |
$220.22 |
| Rate for Payer: Cash Price |
$80.65
|
| Rate for Payer: Cash Price |
$80.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$75.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$75.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$79.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$83.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$79.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$62.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$79.70
|
| Rate for Payer: Healthfirst QHP |
$83.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$58.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$83.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$71.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$58.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$83.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$220.22
|
| Rate for Payer: SOMOS Essential |
$220.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$83.89
|
|
|
CHG DOPPLER VELOCIMETRY FETAL MIDDLE CEREBRAL ART
|
Professional
|
$241.36
|
|
|
Service Code
|
HCPCS 76821 TC
|
| Min. Negotiated Rate |
$26.39 |
| Max. Negotiated Rate |
$279.98 |
| Rate for Payer: Cash Price |
$66.25
|
| Rate for Payer: Cash Price |
$66.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$62.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$65.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$68.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$65.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$68.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$68.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$65.51
|
| Rate for Payer: Healthfirst QHP |
$68.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$48.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$68.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$58.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$48.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$68.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$181.02
|
| Rate for Payer: SOMOS Essential |
$181.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$68.96
|
|
|
CHG DOPPLER VELOCIMETRY FETAL MIDDLE CEREBRAL ART
|
Professional
|
$131.95
|
|
|
Service Code
|
HCPCS 76821 26
|
| Min. Negotiated Rate |
$26.39 |
| Max. Negotiated Rate |
$279.98 |
| Rate for Payer: Cash Price |
$36.27
|
| Rate for Payer: Cash Price |
$36.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.82
|
| Rate for Payer: Healthfirst QHP |
$37.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$98.96
|
| Rate for Payer: SOMOS Essential |
$98.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.70
|
|
|
CHG DOPPLER VELOCIMETRY FETAL MIDDLE CEREBRAL ART
|
Professional
|
$373.31
|
|
|
Service Code
|
HCPCS 76821
|
| Min. Negotiated Rate |
$26.39 |
| Max. Negotiated Rate |
$279.98 |
| Rate for Payer: Cash Price |
$102.52
|
| Rate for Payer: Cash Price |
$102.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$95.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$95.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$101.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$106.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$101.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$106.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$101.33
|
| Rate for Payer: Healthfirst QHP |
$106.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$74.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$106.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$90.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$74.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$106.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$279.98
|
| Rate for Payer: SOMOS Essential |
$279.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$106.66
|
|
|
CHG DOPPLER VELOCIMETRY FETAL UMBILICAL ARTERY
|
Professional
|
$92.68
|
|
|
Service Code
|
HCPCS 76820 26
|
| Min. Negotiated Rate |
$18.54 |
| Max. Negotiated Rate |
$139.47 |
| Rate for Payer: Cash Price |
$25.53
|
| Rate for Payer: Cash Price |
$25.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.16
|
| Rate for Payer: Healthfirst QHP |
$26.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.51
|
| Rate for Payer: SOMOS Essential |
$69.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.48
|
|
|
CHG DOPPLER VELOCIMETRY FETAL UMBILICAL ARTERY
|
Professional
|
$93.31
|
|
|
Service Code
|
HCPCS 76820 TC
|
| Min. Negotiated Rate |
$18.54 |
| Max. Negotiated Rate |
$139.47 |
| Rate for Payer: Cash Price |
$25.38
|
| Rate for Payer: Cash Price |
$25.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.33
|
| Rate for Payer: Healthfirst QHP |
$26.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.98
|
| Rate for Payer: SOMOS Essential |
$69.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.66
|
|
|
CHG DOPPLER VELOCIMETRY FETAL UMBILICAL ARTERY
|
Professional
|
$185.96
|
|
|
Service Code
|
HCPCS 76820
|
| Min. Negotiated Rate |
$18.54 |
| Max. Negotiated Rate |
$139.47 |
| Rate for Payer: Cash Price |
$50.91
|
| Rate for Payer: Cash Price |
$50.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$53.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.47
|
| Rate for Payer: Healthfirst QHP |
$53.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$53.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$45.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$53.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$139.47
|
| Rate for Payer: SOMOS Essential |
$139.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.13
|
|
|
CHG DRUG SCREEN QUANTITATIVE LIDOCAINE
|
Professional
|
$37.00
|
|
|
Service Code
|
HCPCS 80176
|
| Min. Negotiated Rate |
$10.28 |
| Max. Negotiated Rate |
$27.75 |
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.96
|
| Rate for Payer: Healthfirst QHP |
$14.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$10.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$14.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$12.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.75
|
| Rate for Payer: SOMOS Essential |
$27.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.69
|
|
|
CHG DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL
|
Professional
|
$94.75
|
|
|
Service Code
|
HCPCS 77081 TC
|
| Min. Negotiated Rate |
$7.85 |
| Max. Negotiated Rate |
$100.52 |
| Rate for Payer: Cash Price |
$26.56
|
| Rate for Payer: Cash Price |
$26.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.72
|
| Rate for Payer: Healthfirst QHP |
$27.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$27.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$71.06
|
| Rate for Payer: SOMOS Essential |
$71.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.07
|
|
|
CHG DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL
|
Professional
|
$39.27
|
|
|
Service Code
|
HCPCS 77081 26
|
| Min. Negotiated Rate |
$7.85 |
| Max. Negotiated Rate |
$100.52 |
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.66
|
| Rate for Payer: Healthfirst QHP |
$11.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$7.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$11.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$9.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.45
|
| Rate for Payer: SOMOS Essential |
$29.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.22
|
|
|
CHG DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL
|
Professional
|
$134.02
|
|
|
Service Code
|
HCPCS 77081
|
| Min. Negotiated Rate |
$7.85 |
| Max. Negotiated Rate |
$100.52 |
| Rate for Payer: Cash Price |
$36.91
|
| Rate for Payer: Cash Price |
$36.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.38
|
| Rate for Payer: Healthfirst QHP |
$38.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$100.52
|
| Rate for Payer: SOMOS Essential |
$100.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.29
|
|
|
CHG DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL
|
Professional
|
$162.79
|
|
|
Service Code
|
HCPCS 77080
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$122.09 |
| Rate for Payer: Cash Price |
$45.55
|
| Rate for Payer: Cash Price |
$45.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$44.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$44.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.18
|
| Rate for Payer: Healthfirst QHP |
$46.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$46.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$122.09
|
| Rate for Payer: SOMOS Essential |
$122.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.51
|
|
|
CHG DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL
|
Professional
|
$124.92
|
|
|
Service Code
|
HCPCS 77080 TC
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$122.09 |
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.91
|
| Rate for Payer: Healthfirst QHP |
$35.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$93.69
|
| Rate for Payer: SOMOS Essential |
$93.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.69
|
|
|
CHG DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL
|
Professional
|
$37.84
|
|
|
Service Code
|
HCPCS 77080 26
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$122.09 |
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.27
|
| Rate for Payer: Healthfirst QHP |
$10.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$7.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$10.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$9.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.38
|
| Rate for Payer: SOMOS Essential |
$28.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.81
|
|
|
CHG DXA BONE DENSITY STUDY AXIAL SKELETON
|
Professional
|
$219.87
|
|
|
Service Code
|
HCPCS 77085
|
| Min. Negotiated Rate |
$11.52 |
| Max. Negotiated Rate |
$164.90 |
| Rate for Payer: Cash Price |
$62.24
|
| Rate for Payer: Cash Price |
$62.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$56.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$56.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$59.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$59.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$62.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$59.68
|
| Rate for Payer: Healthfirst QHP |
$62.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$43.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$62.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$53.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$43.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$164.90
|
| Rate for Payer: SOMOS Essential |
$164.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.82
|
|
|
CHG DXA BONE DENSITY STUDY AXIAL SKELETON
|
Professional
|
$57.58
|
|
|
Service Code
|
HCPCS 77085 26
|
| Min. Negotiated Rate |
$11.52 |
| Max. Negotiated Rate |
$164.90 |
| Rate for Payer: Cash Price |
$15.41
|
| Rate for Payer: Cash Price |
$15.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.63
|
| Rate for Payer: Healthfirst QHP |
$16.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$13.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$43.18
|
| Rate for Payer: SOMOS Essential |
$43.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.45
|
|
