|
CHG DXA BONE DENSITY STUDY AXIAL SKELETON
|
Professional
|
$162.30
|
|
|
Service Code
|
HCPCS 77085 TC
|
| Min. Negotiated Rate |
$11.52 |
| Max. Negotiated Rate |
$164.90 |
| Rate for Payer: Cash Price |
$46.83
|
| Rate for Payer: Cash Price |
$46.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$44.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$44.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.05
|
| Rate for Payer: Healthfirst QHP |
$46.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$46.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$121.72
|
| Rate for Payer: SOMOS Essential |
$121.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.37
|
|
|
CHG DX OPHTHALMIC US ANT SEGMENT IMMERSION UNI/BI
|
Professional
|
$313.50
|
|
|
Service Code
|
HCPCS 76513
|
| Min. Negotiated Rate |
$25.35 |
| Max. Negotiated Rate |
$235.12 |
| Rate for Payer: Cash Price |
$86.22
|
| Rate for Payer: Cash Price |
$86.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$80.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$80.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$85.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$89.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$85.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$89.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$89.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$85.09
|
| Rate for Payer: Healthfirst QHP |
$89.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$62.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$89.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$76.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$62.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$89.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$235.12
|
| Rate for Payer: SOMOS Essential |
$235.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$89.57
|
|
|
CHG DX OPHTHALMIC US ANT SEGMENT IMMERSION UNI/BI
|
Professional
|
$126.77
|
|
|
Service Code
|
HCPCS 76513 26
|
| Min. Negotiated Rate |
$25.35 |
| Max. Negotiated Rate |
$235.12 |
| Rate for Payer: Cash Price |
$34.91
|
| Rate for Payer: Cash Price |
$34.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.41
|
| Rate for Payer: Healthfirst QHP |
$36.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$36.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$95.08
|
| Rate for Payer: SOMOS Essential |
$95.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.22
|
|
|
CHG DX OPHTHALMIC US ANT SEGMENT IMMERSION UNI/BI
|
Professional
|
$186.73
|
|
|
Service Code
|
HCPCS 76513 TC
|
| Min. Negotiated Rate |
$25.35 |
| Max. Negotiated Rate |
$235.12 |
| Rate for Payer: Cash Price |
$51.31
|
| Rate for Payer: Cash Price |
$51.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$48.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$48.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$53.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.68
|
| Rate for Payer: Healthfirst QHP |
$53.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$53.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$45.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$53.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$140.05
|
| Rate for Payer: SOMOS Essential |
$140.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.35
|
|
|
CHG ECHOENCEPHALOGRAPHY REAL TIME IMAGING
|
Professional
|
$362.11
|
|
|
Service Code
|
HCPCS 76506 TC
|
| Min. Negotiated Rate |
$24.58 |
| Max. Negotiated Rate |
$363.77 |
| Rate for Payer: Cash Price |
$97.29
|
| Rate for Payer: Cash Price |
$97.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$93.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$93.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$98.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$103.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$98.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$103.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$77.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$98.29
|
| Rate for Payer: Healthfirst QHP |
$103.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$72.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$103.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$87.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$72.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$103.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$271.58
|
| Rate for Payer: SOMOS Essential |
$271.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$103.46
|
|
|
CHG ECHOENCEPHALOGRAPHY REAL TIME IMAGING
|
Professional
|
$122.92
|
|
|
Service Code
|
HCPCS 76506 26
|
| Min. Negotiated Rate |
$24.58 |
| Max. Negotiated Rate |
$363.77 |
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Cash Price |
$34.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.36
|
| Rate for Payer: Healthfirst QHP |
$35.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$92.19
|
| Rate for Payer: SOMOS Essential |
$92.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.12
|
|
|
CHG ECHOENCEPHALOGRAPHY REAL TIME IMAGING
|
Professional
|
$485.03
|
|
|
Service Code
|
HCPCS 76506
|
| Min. Negotiated Rate |
$24.58 |
| Max. Negotiated Rate |
$363.77 |
| Rate for Payer: Cash Price |
$132.05
|
| Rate for Payer: Cash Price |
$132.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$124.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$124.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$138.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$138.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$138.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$103.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$131.65
|
| Rate for Payer: Healthfirst QHP |
$138.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$97.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$138.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$117.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$97.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$138.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$363.77
|
| Rate for Payer: SOMOS Essential |
$363.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$138.58
|
|
|
CHG ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING
|
Professional
|
$1,110.80
|
|
|
Service Code
|
HCPCS 76825
|
| Min. Negotiated Rate |
$62.13 |
| Max. Negotiated Rate |
$833.10 |
| Rate for Payer: Cash Price |
$302.70
|
| Rate for Payer: Cash Price |
$302.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$285.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$285.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$301.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$317.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$301.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$317.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$317.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$238.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$301.50
|
| Rate for Payer: Healthfirst QHP |
$317.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$222.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$317.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$269.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$222.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$317.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$833.10
|
| Rate for Payer: SOMOS Essential |
$833.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$317.37
|
|
|
CHG ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING
|
Professional
|
$310.66
|
|
|
Service Code
|
HCPCS 76825 26
|
| Min. Negotiated Rate |
$62.13 |
| Max. Negotiated Rate |
$833.10 |
| Rate for Payer: Cash Price |
$85.49
|
| Rate for Payer: Cash Price |
$85.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$79.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$79.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$88.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$84.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$88.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$66.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$84.32
|
| Rate for Payer: Healthfirst QHP |
$88.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$62.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$88.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$75.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$62.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$88.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$233.00
|
| Rate for Payer: SOMOS Essential |
$233.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$88.76
|
|
|
CHG ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING
|
Professional
|
$800.14
|
|
|
Service Code
|
HCPCS 76825 TC
|
| Min. Negotiated Rate |
$62.13 |
| Max. Negotiated Rate |
$833.10 |
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$205.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$205.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$217.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$228.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$217.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$228.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$228.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$171.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$217.18
|
| Rate for Payer: Healthfirst QHP |
$228.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$160.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$228.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$194.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$160.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$228.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$600.10
|
| Rate for Payer: SOMOS Essential |
$600.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$228.61
|
|
|
CHG ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD
|
Professional
|
$512.93
|
|
|
Service Code
|
HCPCS 76826 TC
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$500.17 |
| Rate for Payer: Cash Price |
$139.56
|
| Rate for Payer: Cash Price |
$139.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$131.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$131.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$139.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$146.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$139.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$146.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$146.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$109.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$139.22
|
| Rate for Payer: Healthfirst QHP |
$146.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$102.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$146.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$124.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$102.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$146.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$384.70
|
| Rate for Payer: SOMOS Essential |
$384.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$146.55
|
|
|
CHG ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD
|
Professional
|
$154.00
|
|
|
Service Code
|
HCPCS 76826 26
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$500.17 |
| Rate for Payer: Cash Price |
$42.38
|
| Rate for Payer: Cash Price |
$42.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$44.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.80
|
| Rate for Payer: Healthfirst QHP |
$44.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$44.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$44.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$115.50
|
| Rate for Payer: SOMOS Essential |
$115.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44.00
|
|
|
CHG ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD
|
Professional
|
$666.89
|
|
|
Service Code
|
HCPCS 76826
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$500.17 |
| Rate for Payer: Cash Price |
$181.94
|
| Rate for Payer: Cash Price |
$181.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$171.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$171.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$181.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$190.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$181.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$190.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$190.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$142.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$181.01
|
| Rate for Payer: Healthfirst QHP |
$190.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$133.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$190.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$161.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$133.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$190.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$500.17
|
| Rate for Payer: SOMOS Essential |
$500.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$190.54
|
|
|
CHG ELECTRON MICROSCOPY DIAGNOSTIC
|
Professional
|
$1,715.25
|
|
|
Service Code
|
HCPCS 88348 TC
|
| Min. Negotiated Rate |
$59.33 |
| Max. Negotiated Rate |
$1,508.93 |
| Rate for Payer: Cash Price |
$485.40
|
| Rate for Payer: Cash Price |
$485.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$441.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$441.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$465.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$490.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$465.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$490.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$490.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$367.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$465.57
|
| Rate for Payer: Healthfirst QHP |
$490.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$343.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$490.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$416.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$343.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$490.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,286.44
|
| Rate for Payer: SOMOS Essential |
$1,286.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$490.07
|
|
|
CHG ELECTRON MICROSCOPY DIAGNOSTIC
|
Professional
|
$296.66
|
|
|
Service Code
|
HCPCS 88348 26
|
| Min. Negotiated Rate |
$59.33 |
| Max. Negotiated Rate |
$1,508.93 |
| Rate for Payer: Cash Price |
$81.41
|
| Rate for Payer: Cash Price |
$81.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$76.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$76.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$80.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$84.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$80.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$84.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$84.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$63.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$80.52
|
| Rate for Payer: Healthfirst QHP |
$84.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$59.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$84.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$72.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$59.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$84.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$222.50
|
| Rate for Payer: SOMOS Essential |
$222.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$84.76
|
|
|
CHG ELECTRON MICROSCOPY DIAGNOSTIC
|
Professional
|
$2,011.91
|
|
|
Service Code
|
HCPCS 88348
|
| Min. Negotiated Rate |
$59.33 |
| Max. Negotiated Rate |
$1,508.93 |
| Rate for Payer: Cash Price |
$566.81
|
| Rate for Payer: Cash Price |
$566.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$517.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$517.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$546.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$574.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$546.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$574.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$574.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$431.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$546.09
|
| Rate for Payer: Healthfirst QHP |
$574.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$402.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$574.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$488.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$402.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$574.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,508.93
|
| Rate for Payer: SOMOS Essential |
$1,508.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$574.83
|
|
|
CHG ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I
|
Professional
|
$638.02
|
|
|
Service Code
|
HCPCS 74328 TC
|
| Min. Negotiated Rate |
$18.33 |
| Max. Negotiated Rate |
$547.26 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$478.52
|
| Rate for Payer: SOMOS Essential |
$478.52
|
|
|
CHG ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I
|
Professional
|
$91.67
|
|
|
Service Code
|
HCPCS 74328 26
|
| Min. Negotiated Rate |
$18.33 |
| Max. Negotiated Rate |
$547.26 |
| Rate for Payer: Cash Price |
$25.11
|
| Rate for Payer: Cash Price |
$25.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24.88
|
| Rate for Payer: Healthfirst QHP |
$26.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$68.75
|
| Rate for Payer: SOMOS Essential |
$68.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.19
|
|
|
CHG ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I
|
Professional
|
$729.68
|
|
|
Service Code
|
HCPCS 74328
|
| Min. Negotiated Rate |
$18.33 |
| Max. Negotiated Rate |
$547.26 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$547.26
|
| Rate for Payer: SOMOS Essential |
$547.26
|
|
|
CHG ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS RS&I
|
Professional
|
$93.10
|
|
|
Service Code
|
HCPCS 74329 26
|
| Min. Negotiated Rate |
$18.62 |
| Max. Negotiated Rate |
$465.50 |
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.27
|
| Rate for Payer: Healthfirst QHP |
$26.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.82
|
| Rate for Payer: SOMOS Essential |
$69.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.60
|
|
|
CHG ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS RS&I
|
Professional
|
$527.56
|
|
|
Service Code
|
HCPCS 74329 TC
|
| Min. Negotiated Rate |
$18.62 |
| Max. Negotiated Rate |
$465.50 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$395.67
|
| Rate for Payer: SOMOS Essential |
$395.67
|
|
|
CHG ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS RS&I
|
Professional
|
$620.66
|
|
|
Service Code
|
HCPCS 74329
|
| Min. Negotiated Rate |
$18.62 |
| Max. Negotiated Rate |
$465.50 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$465.50
|
| Rate for Payer: SOMOS Essential |
$465.50
|
|
|
CHG ESOPHAGEAL MOTILITY
|
Professional
|
$860.65
|
|
|
Service Code
|
HCPCS 78258
|
| Min. Negotiated Rate |
$27.05 |
| Max. Negotiated Rate |
$645.49 |
| Rate for Payer: Cash Price |
$231.37
|
| Rate for Payer: Cash Price |
$231.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$221.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$221.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$233.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$245.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$233.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$245.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$245.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$184.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$233.60
|
| Rate for Payer: Healthfirst QHP |
$245.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$172.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$245.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$209.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$172.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$245.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$645.49
|
| Rate for Payer: SOMOS Essential |
$645.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$245.90
|
|
|
CHG ESOPHAGEAL MOTILITY
|
Professional
|
$135.24
|
|
|
Service Code
|
HCPCS 78258 26
|
| Min. Negotiated Rate |
$27.05 |
| Max. Negotiated Rate |
$645.49 |
| Rate for Payer: Cash Price |
$35.93
|
| Rate for Payer: Cash Price |
$35.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.71
|
| Rate for Payer: Healthfirst QHP |
$38.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$101.43
|
| Rate for Payer: SOMOS Essential |
$101.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.64
|
|
|
CHG ESOPHAGEAL MOTILITY
|
Professional
|
$725.38
|
|
|
Service Code
|
HCPCS 78258 TC
|
| Min. Negotiated Rate |
$27.05 |
| Max. Negotiated Rate |
$645.49 |
| Rate for Payer: Cash Price |
$195.43
|
| Rate for Payer: Cash Price |
$195.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$186.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$186.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$196.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$207.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$196.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$207.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$207.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$155.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$196.89
|
| Rate for Payer: Healthfirst QHP |
$207.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$145.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$207.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$176.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$145.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$207.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$544.04
|
| Rate for Payer: SOMOS Essential |
$544.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$207.25
|
|
