|
CHG EVASC RPR DESCND THORCIC AORTA CELIAC ORIG RS&I
|
Professional
|
$1,240.37
|
|
|
Service Code
|
HCPCS 75957 26
|
| Min. Negotiated Rate |
$248.07 |
| Max. Negotiated Rate |
$2,713.04 |
| Rate for Payer: Cash Price |
$331.01
|
| Rate for Payer: Cash Price |
$331.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$318.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$318.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$336.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$354.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$336.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$354.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$354.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$265.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$336.67
|
| Rate for Payer: Healthfirst QHP |
$354.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$248.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$354.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$301.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$248.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$354.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$930.28
|
| Rate for Payer: SOMOS Essential |
$930.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$354.39
|
|
|
CHG EVASC RPR DESCND THORCIC AORTA CELIAC ORIG RS&I
|
Professional
|
$2,377.03
|
|
|
Service Code
|
HCPCS 75957 TC
|
| Min. Negotiated Rate |
$248.07 |
| Max. Negotiated Rate |
$2,713.04 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,782.77
|
| Rate for Payer: SOMOS Essential |
$1,782.77
|
|
|
CHG EVASC RPR DESCND THORCIC AORTA CELIAC ORIG RS&I
|
Professional
|
$3,617.39
|
|
|
Service Code
|
HCPCS 75957
|
| Min. Negotiated Rate |
$248.07 |
| Max. Negotiated Rate |
$2,713.04 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,713.04
|
| Rate for Payer: SOMOS Essential |
$2,713.04
|
|
|
CHG EVASC RPR DESCND THORCIC AORTA SUBCLAV ORIG RS&I
|
Professional
|
$1,446.48
|
|
|
Service Code
|
HCPCS 75956 26
|
| Min. Negotiated Rate |
$289.30 |
| Max. Negotiated Rate |
$3,168.80 |
| Rate for Payer: Cash Price |
$385.24
|
| Rate for Payer: Cash Price |
$385.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$371.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$371.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$392.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$413.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$392.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$413.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$413.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$309.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$392.62
|
| Rate for Payer: Healthfirst QHP |
$413.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$289.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$413.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$351.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$289.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$413.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,084.86
|
| Rate for Payer: SOMOS Essential |
$1,084.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$413.28
|
|
|
CHG EVASC RPR DESCND THORCIC AORTA SUBCLAV ORIG RS&I
|
Professional
|
$2,778.58
|
|
|
Service Code
|
HCPCS 75956 TC
|
| Min. Negotiated Rate |
$289.30 |
| Max. Negotiated Rate |
$3,168.80 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,083.94
|
| Rate for Payer: SOMOS Essential |
$2,083.94
|
|
|
CHG EVASC RPR DESCND THORCIC AORTA SUBCLAV ORIG RS&I
|
Professional
|
$4,225.06
|
|
|
Service Code
|
HCPCS 75956
|
| Min. Negotiated Rate |
$289.30 |
| Max. Negotiated Rate |
$3,168.80 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,168.80
|
| Rate for Payer: SOMOS Essential |
$3,168.80
|
|
|
CHG FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING
|
Professional
|
$491.51
|
|
|
Service Code
|
HCPCS 76818
|
| Min. Negotiated Rate |
$40.28 |
| Max. Negotiated Rate |
$368.63 |
| Rate for Payer: Cash Price |
$136.41
|
| Rate for Payer: Cash Price |
$136.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$126.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$126.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$133.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$140.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$133.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$140.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$140.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$105.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.41
|
| Rate for Payer: Healthfirst QHP |
$140.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$98.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$140.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$119.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$98.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$140.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$368.63
|
| Rate for Payer: SOMOS Essential |
$368.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$140.43
|
|
|
CHG FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING
|
Professional
|
$290.08
|
|
|
Service Code
|
HCPCS 76818 TC
|
| Min. Negotiated Rate |
$40.28 |
| Max. Negotiated Rate |
$368.63 |
| Rate for Payer: Cash Price |
$82.43
|
| Rate for Payer: Cash Price |
$82.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$74.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$74.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$78.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$82.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$78.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$82.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$62.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$78.74
|
| Rate for Payer: Healthfirst QHP |
$82.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$58.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$82.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$70.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$58.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$82.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$217.56
|
| Rate for Payer: SOMOS Essential |
$217.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$82.88
|
|
|
CHG FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING
|
Professional
|
$201.39
|
|
|
Service Code
|
HCPCS 76818 26
|
| Min. Negotiated Rate |
$40.28 |
| Max. Negotiated Rate |
$368.63 |
| Rate for Payer: Cash Price |
$53.98
|
| Rate for Payer: Cash Price |
$53.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$51.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$51.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$54.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$57.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$54.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$54.66
|
| Rate for Payer: Healthfirst QHP |
$57.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$40.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$57.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$48.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$40.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$57.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$151.04
|
| Rate for Payer: SOMOS Essential |
$151.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$57.54
|
|
|
CHG FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING
|
Professional
|
$208.29
|
|
|
Service Code
|
HCPCS 76819 TC
|
| Min. Negotiated Rate |
$28.72 |
| Max. Negotiated Rate |
$263.92 |
| Rate for Payer: Cash Price |
$59.01
|
| Rate for Payer: Cash Price |
$59.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$53.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$56.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$59.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$56.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$56.53
|
| Rate for Payer: Healthfirst QHP |
$59.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$41.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$59.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$50.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$41.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$59.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$156.22
|
| Rate for Payer: SOMOS Essential |
$156.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$59.51
|
|
|
CHG FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING
|
Professional
|
$143.61
|
|
|
Service Code
|
HCPCS 76819 26
|
| Min. Negotiated Rate |
$28.72 |
| Max. Negotiated Rate |
$263.92 |
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.98
|
| Rate for Payer: Healthfirst QHP |
$41.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$41.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$107.71
|
| Rate for Payer: SOMOS Essential |
$107.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.03
|
|
|
CHG FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING
|
Professional
|
$351.89
|
|
|
Service Code
|
HCPCS 76819
|
| Min. Negotiated Rate |
$28.72 |
| Max. Negotiated Rate |
$263.92 |
| Rate for Payer: Cash Price |
$98.51
|
| Rate for Payer: Cash Price |
$98.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$90.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$90.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$95.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$100.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$95.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$75.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$95.51
|
| Rate for Payer: Healthfirst QHP |
$100.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$70.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$100.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$85.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$70.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$100.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$263.92
|
| Rate for Payer: SOMOS Essential |
$263.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$100.54
|
|
|
CHG FETAL MRI W/PLACNTL MATRNL PLVC IMG EA ADDL GES
|
Professional
|
$517.37
|
|
|
Service Code
|
HCPCS 74713 TC
|
| Min. Negotiated Rate |
$71.36 |
| Max. Negotiated Rate |
$655.65 |
| Rate for Payer: Cash Price |
$138.54
|
| Rate for Payer: Cash Price |
$138.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$133.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$147.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$110.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$140.43
|
| Rate for Payer: Healthfirst QHP |
$147.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$103.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$147.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$125.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$103.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$388.03
|
| Rate for Payer: SOMOS Essential |
$388.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.82
|
|
|
CHG FETAL MRI W/PLACNTL MATRNL PLVC IMG EA ADDL GES
|
Professional
|
$874.20
|
|
|
Service Code
|
HCPCS 74713
|
| Min. Negotiated Rate |
$71.36 |
| Max. Negotiated Rate |
$655.65 |
| Rate for Payer: Cash Price |
$234.62
|
| Rate for Payer: Cash Price |
$234.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$224.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$224.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$237.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$249.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$237.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$249.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$249.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$187.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$237.28
|
| Rate for Payer: Healthfirst QHP |
$249.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$174.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$249.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$212.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$174.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$249.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$655.65
|
| Rate for Payer: SOMOS Essential |
$655.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$249.77
|
|
|
CHG FETAL MRI W/PLACNTL MATRNL PLVC IMG EA ADDL GES
|
Professional
|
$356.83
|
|
|
Service Code
|
HCPCS 74713 26
|
| Min. Negotiated Rate |
$71.36 |
| Max. Negotiated Rate |
$655.65 |
| Rate for Payer: Cash Price |
$96.08
|
| Rate for Payer: Cash Price |
$96.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$91.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$91.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$96.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$101.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$96.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$101.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$101.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$76.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$96.85
|
| Rate for Payer: Healthfirst QHP |
$101.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$71.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$101.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$86.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$71.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$101.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$267.62
|
| Rate for Payer: SOMOS Essential |
$267.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$101.95
|
|
|
CHG FETAL MRI W/PLACNTL MATRNL PLVC IMG SING/1ST GES
|
Professional
|
$1,573.29
|
|
|
Service Code
|
HCPCS 74712
|
| Min. Negotiated Rate |
$115.79 |
| Max. Negotiated Rate |
$1,179.97 |
| Rate for Payer: Cash Price |
$486.02
|
| Rate for Payer: Cash Price |
$486.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$466.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$466.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$492.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$518.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$492.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$518.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$518.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$388.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$492.55
|
| Rate for Payer: Healthfirst QHP |
$518.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$362.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$518.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$440.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$362.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$518.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,179.97
|
| Rate for Payer: SOMOS Essential |
$1,179.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$518.47
|
|
|
CHG FETAL MRI W/PLACNTL MATRNL PLVC IMG SING/1ST GES
|
Professional
|
$994.32
|
|
|
Service Code
|
HCPCS 74712 TC
|
| Min. Negotiated Rate |
$115.79 |
| Max. Negotiated Rate |
$1,179.97 |
| Rate for Payer: Cash Price |
$329.97
|
| Rate for Payer: Cash Price |
$329.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$317.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$317.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$335.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$353.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$335.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$353.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$353.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$264.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$335.40
|
| Rate for Payer: Healthfirst QHP |
$353.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$247.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$353.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$300.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$247.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$353.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$745.74
|
| Rate for Payer: SOMOS Essential |
$745.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$353.05
|
|
|
CHG FETAL MRI W/PLACNTL MATRNL PLVC IMG SING/1ST GES
|
Professional
|
$578.94
|
|
|
Service Code
|
HCPCS 74712 26
|
| Min. Negotiated Rate |
$115.79 |
| Max. Negotiated Rate |
$1,179.97 |
| Rate for Payer: Cash Price |
$156.05
|
| Rate for Payer: Cash Price |
$156.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$148.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$148.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$157.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$165.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$157.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$165.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$124.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$157.14
|
| Rate for Payer: Healthfirst QHP |
$165.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$115.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$165.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$140.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$115.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$165.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$434.20
|
| Rate for Payer: SOMOS Essential |
$434.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$165.41
|
|
|
CHG FIBRINOLYSINS/COAGULOPATHY SCREEN INTERP&REPOR
|
Professional
|
$141.09
|
|
|
Service Code
|
HCPCS 85390 26
|
| Min. Negotiated Rate |
$28.22 |
| Max. Negotiated Rate |
$105.82 |
| Rate for Payer: Cash Price |
$38.80
|
| Rate for Payer: Cash Price |
$38.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.29
|
| Rate for Payer: Healthfirst QHP |
$40.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$40.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$105.82
|
| Rate for Payer: SOMOS Essential |
$105.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.31
|
|
|
CHG FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS
|
Professional
|
$529.87
|
|
|
Service Code
|
HCPCS 88182 TC
|
| Min. Negotiated Rate |
$29.90 |
| Max. Negotiated Rate |
$509.54 |
| Rate for Payer: Cash Price |
$154.41
|
| Rate for Payer: Cash Price |
$154.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$136.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$136.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$143.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$151.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$143.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$151.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$151.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$113.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$143.82
|
| Rate for Payer: Healthfirst QHP |
$151.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$105.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$151.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$128.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$105.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$151.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$397.40
|
| Rate for Payer: SOMOS Essential |
$397.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$151.39
|
|
|
CHG FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS
|
Professional
|
$679.39
|
|
|
Service Code
|
HCPCS 88182
|
| Min. Negotiated Rate |
$29.90 |
| Max. Negotiated Rate |
$509.54 |
| Rate for Payer: Cash Price |
$194.85
|
| Rate for Payer: Cash Price |
$194.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$174.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$174.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$184.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$194.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$184.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$194.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$194.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$145.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$184.40
|
| Rate for Payer: Healthfirst QHP |
$194.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$135.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$194.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$164.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$135.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$194.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$509.54
|
| Rate for Payer: SOMOS Essential |
$509.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$194.11
|
|
|
CHG FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS
|
Professional
|
$149.49
|
|
|
Service Code
|
HCPCS 88182 26
|
| Min. Negotiated Rate |
$29.90 |
| Max. Negotiated Rate |
$509.54 |
| Rate for Payer: Cash Price |
$40.44
|
| Rate for Payer: Cash Price |
$40.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$42.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$40.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.57
|
| Rate for Payer: Healthfirst QHP |
$42.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$42.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$36.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$42.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$112.12
|
| Rate for Payer: SOMOS Essential |
$112.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.71
|
|
|
CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY 1ST
|
Professional
|
$321.72
|
|
|
Service Code
|
HCPCS 88184
|
| Min. Negotiated Rate |
$64.34 |
| Max. Negotiated Rate |
$241.29 |
| Rate for Payer: Cash Price |
$92.41
|
| Rate for Payer: Cash Price |
$92.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$82.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$82.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$87.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$91.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$87.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$91.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$68.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$87.32
|
| Rate for Payer: Healthfirst QHP |
$91.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$91.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$78.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$91.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$241.29
|
| Rate for Payer: SOMOS Essential |
$241.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$91.92
|
|
|
CHG FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA
|
Professional
|
$102.06
|
|
|
Service Code
|
HCPCS 88185
|
| Min. Negotiated Rate |
$20.41 |
| Max. Negotiated Rate |
$76.54 |
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.70
|
| Rate for Payer: Healthfirst QHP |
$29.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$76.54
|
| Rate for Payer: SOMOS Essential |
$76.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.16
|
|
|
CHG FLOW CYTOMETRY INTERPJ 2-8 MARKERS
|
Professional
|
$141.02
|
|
|
Service Code
|
HCPCS 88187
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$105.76 |
| Rate for Payer: Cash Price |
$38.68
|
| Rate for Payer: Cash Price |
$38.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.28
|
| Rate for Payer: Healthfirst QHP |
$40.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$40.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$105.76
|
| Rate for Payer: SOMOS Essential |
$105.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.29
|
|
