|
CHG FLOW CYTOMETRY INTERPJ 9-15 MARKERS
|
Professional
|
$247.21
|
|
|
Service Code
|
HCPCS 88188
|
| Min. Negotiated Rate |
$49.44 |
| Max. Negotiated Rate |
$185.41 |
| Rate for Payer: Cash Price |
$67.21
|
| Rate for Payer: Cash Price |
$67.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$63.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$63.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$67.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$67.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$70.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$52.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$67.10
|
| Rate for Payer: Healthfirst QHP |
$70.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$49.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$70.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$60.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$49.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$185.41
|
| Rate for Payer: SOMOS Essential |
$185.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.63
|
|
|
CHG FLOW CYTOMETRY INTERPRETATION 16/> MARKERS
|
Professional
|
$332.57
|
|
|
Service Code
|
HCPCS 88189
|
| Min. Negotiated Rate |
$66.51 |
| Max. Negotiated Rate |
$249.43 |
| Rate for Payer: Cash Price |
$90.62
|
| Rate for Payer: Cash Price |
$90.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$85.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$85.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$90.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$95.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$90.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$95.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$95.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$71.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$90.27
|
| Rate for Payer: Healthfirst QHP |
$95.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$66.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$95.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$80.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$66.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$95.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$249.43
|
| Rate for Payer: SOMOS Essential |
$249.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$95.02
|
|
|
CHG FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY
|
Professional
|
$69.20
|
|
|
Service Code
|
HCPCS 86255 26
|
| Min. Negotiated Rate |
$13.84 |
| Max. Negotiated Rate |
$51.90 |
| Rate for Payer: Cash Price |
$19.03
|
| Rate for Payer: Cash Price |
$19.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.78
|
| Rate for Payer: Healthfirst QHP |
$19.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$51.90
|
| Rate for Payer: SOMOS Essential |
$51.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.77
|
|
|
CHG FLUORESCENT NONNFCT AGT ANTB TITER EA ANTIBODY
|
Professional
|
$69.20
|
|
|
Service Code
|
HCPCS 86256 26
|
| Min. Negotiated Rate |
$13.84 |
| Max. Negotiated Rate |
$51.90 |
| Rate for Payer: Cash Price |
$19.03
|
| Rate for Payer: Cash Price |
$19.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.78
|
| Rate for Payer: Healthfirst QHP |
$19.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$51.90
|
| Rate for Payer: SOMOS Essential |
$51.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.77
|
|
|
CHG FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON
|
Professional
|
$116.27
|
|
|
Service Code
|
HCPCS 77003 26
|
| Min. Negotiated Rate |
$23.25 |
| Max. Negotiated Rate |
$339.39 |
| Rate for Payer: Cash Price |
$31.68
|
| Rate for Payer: Cash Price |
$31.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.56
|
| Rate for Payer: Healthfirst QHP |
$33.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$33.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$87.20
|
| Rate for Payer: SOMOS Essential |
$87.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.22
|
|
|
CHG FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON
|
Professional
|
$452.52
|
|
|
Service Code
|
HCPCS 77003
|
| Min. Negotiated Rate |
$23.25 |
| Max. Negotiated Rate |
$339.39 |
| Rate for Payer: Cash Price |
$122.68
|
| Rate for Payer: Cash Price |
$122.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$116.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$116.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$122.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$129.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$122.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$129.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$129.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$96.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$122.83
|
| Rate for Payer: Healthfirst QHP |
$129.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$90.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$129.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$109.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$90.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$129.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$339.39
|
| Rate for Payer: SOMOS Essential |
$339.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$129.29
|
|
|
CHG FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON
|
Professional
|
$336.25
|
|
|
Service Code
|
HCPCS 77003 TC
|
| Min. Negotiated Rate |
$23.25 |
| Max. Negotiated Rate |
$339.39 |
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$86.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$86.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$91.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$96.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$91.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$96.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$96.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$91.27
|
| Rate for Payer: Healthfirst QHP |
$96.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$67.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$96.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$81.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$67.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$96.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$252.19
|
| Rate for Payer: SOMOS Essential |
$252.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$96.07
|
|
|
CHG FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT
|
Professional
|
$359.24
|
|
|
Service Code
|
HCPCS 77001 TC
|
| Min. Negotiated Rate |
$14.87 |
| Max. Negotiated Rate |
$325.18 |
| Rate for Payer: Cash Price |
$95.71
|
| Rate for Payer: Cash Price |
$95.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$92.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$92.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$97.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$102.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$97.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$102.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$102.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$76.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$97.51
|
| Rate for Payer: Healthfirst QHP |
$102.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$71.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$102.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$87.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$71.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$102.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$269.43
|
| Rate for Payer: SOMOS Essential |
$269.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$102.64
|
|
|
CHG FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT
|
Professional
|
$433.58
|
|
|
Service Code
|
HCPCS 77001
|
| Min. Negotiated Rate |
$14.87 |
| Max. Negotiated Rate |
$325.18 |
| Rate for Payer: Cash Price |
$115.79
|
| Rate for Payer: Cash Price |
$115.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$111.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$111.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$117.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$123.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$117.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$123.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$123.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$92.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$117.69
|
| Rate for Payer: Healthfirst QHP |
$123.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$86.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$123.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$105.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$86.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$123.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$325.18
|
| Rate for Payer: SOMOS Essential |
$325.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$123.88
|
|
|
CHG FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT
|
Professional
|
$74.34
|
|
|
Service Code
|
HCPCS 77001 26
|
| Min. Negotiated Rate |
$14.87 |
| Max. Negotiated Rate |
$325.18 |
| Rate for Payer: Cash Price |
$20.08
|
| Rate for Payer: Cash Price |
$20.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$19.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$20.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20.18
|
| Rate for Payer: Healthfirst QHP |
$21.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$21.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$18.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$14.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$55.76
|
| Rate for Payer: SOMOS Essential |
$55.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.24
|
|
|
CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON
|
Professional
|
$110.22
|
|
|
Service Code
|
HCPCS 77002 26
|
| Min. Negotiated Rate |
$22.04 |
| Max. Negotiated Rate |
$374.72 |
| Rate for Payer: Cash Price |
$29.35
|
| Rate for Payer: Cash Price |
$29.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.92
|
| Rate for Payer: Healthfirst QHP |
$31.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$31.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$82.66
|
| Rate for Payer: SOMOS Essential |
$82.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.49
|
|
|
CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON
|
Professional
|
$499.63
|
|
|
Service Code
|
HCPCS 77002
|
| Min. Negotiated Rate |
$22.04 |
| Max. Negotiated Rate |
$374.72 |
| Rate for Payer: Cash Price |
$135.28
|
| Rate for Payer: Cash Price |
$135.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$128.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$128.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$135.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$142.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$135.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$142.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$142.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$107.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$135.61
|
| Rate for Payer: Healthfirst QHP |
$142.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$99.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$142.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$121.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$99.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$142.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$374.72
|
| Rate for Payer: SOMOS Essential |
$374.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$142.75
|
|
|
CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON
|
Professional
|
$389.41
|
|
|
Service Code
|
HCPCS 77002 TC
|
| Min. Negotiated Rate |
$22.04 |
| Max. Negotiated Rate |
$374.72 |
| Rate for Payer: Cash Price |
$105.93
|
| Rate for Payer: Cash Price |
$105.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$100.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$100.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$105.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$111.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$105.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$111.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$83.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$105.70
|
| Rate for Payer: Healthfirst QHP |
$111.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$77.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$111.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$94.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$77.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$111.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$292.06
|
| Rate for Payer: SOMOS Essential |
$292.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$111.26
|
|
|
CHG FLUOROSCOPY UP TO 1 HOUR PHYSICIAN/QHP TIME
|
Professional
|
$65.77
|
|
|
Service Code
|
HCPCS 76000 26
|
| Min. Negotiated Rate |
$13.15 |
| Max. Negotiated Rate |
$140.86 |
| Rate for Payer: Cash Price |
$16.66
|
| Rate for Payer: Cash Price |
$16.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.85
|
| Rate for Payer: Healthfirst QHP |
$18.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$18.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$15.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$49.33
|
| Rate for Payer: SOMOS Essential |
$49.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.79
|
|
|
CHG FLUOROSCOPY UP TO 1 HOUR PHYSICIAN/QHP TIME
|
Professional
|
$122.05
|
|
|
Service Code
|
HCPCS 76000 TC
|
| Min. Negotiated Rate |
$13.15 |
| Max. Negotiated Rate |
$140.86 |
| Rate for Payer: Cash Price |
$33.24
|
| Rate for Payer: Cash Price |
$33.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.13
|
| Rate for Payer: Healthfirst QHP |
$34.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$91.54
|
| Rate for Payer: SOMOS Essential |
$91.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.87
|
|
|
CHG FLUOROSCOPY UP TO 1 HOUR PHYSICIAN/QHP TIME
|
Professional
|
$187.81
|
|
|
Service Code
|
HCPCS 76000
|
| Min. Negotiated Rate |
$13.15 |
| Max. Negotiated Rate |
$140.86 |
| Rate for Payer: Cash Price |
$49.90
|
| Rate for Payer: Cash Price |
$49.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$48.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$48.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$53.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.98
|
| Rate for Payer: Healthfirst QHP |
$53.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$53.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$45.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$53.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$140.86
|
| Rate for Payer: SOMOS Essential |
$140.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.66
|
|
|
CHG GASTRIC EMPTYING IMAGING STUDY
|
Professional
|
$148.72
|
|
|
Service Code
|
HCPCS 78264 26
|
| Min. Negotiated Rate |
$29.74 |
| Max. Negotiated Rate |
$990.86 |
| Rate for Payer: Cash Price |
$40.27
|
| Rate for Payer: Cash Price |
$40.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$42.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$40.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.37
|
| Rate for Payer: Healthfirst QHP |
$42.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$42.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$36.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$42.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$111.54
|
| Rate for Payer: SOMOS Essential |
$111.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.49
|
|
|
CHG GASTRIC EMPTYING IMAGING STUDY
|
Professional
|
$1,321.15
|
|
|
Service Code
|
HCPCS 78264
|
| Min. Negotiated Rate |
$29.74 |
| Max. Negotiated Rate |
$990.86 |
| Rate for Payer: Cash Price |
$354.83
|
| Rate for Payer: Cash Price |
$354.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$339.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$339.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$358.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$377.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$358.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$377.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$377.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$283.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$358.60
|
| Rate for Payer: Healthfirst QHP |
$377.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$264.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$377.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$320.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$264.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$377.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$990.86
|
| Rate for Payer: SOMOS Essential |
$990.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$377.47
|
|
|
CHG GASTRIC EMPTYING IMAGING STUDY
|
Professional
|
$1,172.43
|
|
|
Service Code
|
HCPCS 78264 TC
|
| Min. Negotiated Rate |
$29.74 |
| Max. Negotiated Rate |
$990.86 |
| Rate for Payer: Cash Price |
$314.56
|
| Rate for Payer: Cash Price |
$314.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$301.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$301.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$318.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$334.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$318.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$334.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$334.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$251.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$318.23
|
| Rate for Payer: Healthfirst QHP |
$334.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$234.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$334.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$284.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$234.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$334.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$879.32
|
| Rate for Payer: SOMOS Essential |
$879.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$334.98
|
|
|
CHG GASTRIC EMPTYNG IMAG STD W/SM BWL TRANSIT
|
Professional
|
$181.13
|
|
|
Service Code
|
HCPCS 78265 26
|
| Min. Negotiated Rate |
$36.22 |
| Max. Negotiated Rate |
$1,172.38 |
| Rate for Payer: Cash Price |
$49.25
|
| Rate for Payer: Cash Price |
$49.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$46.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$46.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$51.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.16
|
| Rate for Payer: Healthfirst QHP |
$51.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$51.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$43.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$51.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$135.85
|
| Rate for Payer: SOMOS Essential |
$135.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$51.75
|
|
|
CHG GASTRIC EMPTYNG IMAG STD W/SM BWL TRANSIT
|
Professional
|
$1,563.17
|
|
|
Service Code
|
HCPCS 78265
|
| Min. Negotiated Rate |
$36.22 |
| Max. Negotiated Rate |
$1,172.38 |
| Rate for Payer: Cash Price |
$421.18
|
| Rate for Payer: Cash Price |
$421.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$401.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$401.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$424.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$446.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$424.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$446.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$446.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$334.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$424.29
|
| Rate for Payer: Healthfirst QHP |
$446.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$312.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$446.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$379.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$312.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$446.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,172.38
|
| Rate for Payer: SOMOS Essential |
$1,172.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$446.62
|
|
|
CHG GASTRIC EMPTYNG IMAG STD W/SM BWL TRANSIT
|
Professional
|
$1,382.05
|
|
|
Service Code
|
HCPCS 78265 TC
|
| Min. Negotiated Rate |
$36.22 |
| Max. Negotiated Rate |
$1,172.38 |
| Rate for Payer: Cash Price |
$371.93
|
| Rate for Payer: Cash Price |
$371.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$355.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$355.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$375.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$394.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$375.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$394.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$394.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$296.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$375.13
|
| Rate for Payer: Healthfirst QHP |
$394.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$276.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$394.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$335.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$276.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$394.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,036.54
|
| Rate for Payer: SOMOS Essential |
$1,036.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$394.87
|
|
|
CHG GASTRIC MUCOSA IMAGING
|
Professional
|
$104.97
|
|
|
Service Code
|
HCPCS 78261 26
|
| Min. Negotiated Rate |
$20.99 |
| Max. Negotiated Rate |
$602.28 |
| Rate for Payer: Cash Price |
$29.01
|
| Rate for Payer: Cash Price |
$29.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$28.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.49
|
| Rate for Payer: Healthfirst QHP |
$29.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$25.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$78.73
|
| Rate for Payer: SOMOS Essential |
$78.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.99
|
|
|
CHG GASTRIC MUCOSA IMAGING
|
Professional
|
$698.08
|
|
|
Service Code
|
HCPCS 78261 TC
|
| Min. Negotiated Rate |
$20.99 |
| Max. Negotiated Rate |
$602.28 |
| Rate for Payer: Cash Price |
$187.02
|
| Rate for Payer: Cash Price |
$187.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$179.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$179.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$189.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$199.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$189.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$199.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$199.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$149.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$189.48
|
| Rate for Payer: Healthfirst QHP |
$199.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$139.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$199.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$169.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$139.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$199.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$523.56
|
| Rate for Payer: SOMOS Essential |
$523.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$199.45
|
|
|
CHG GASTRIC MUCOSA IMAGING
|
Professional
|
$803.04
|
|
|
Service Code
|
HCPCS 78261
|
| Min. Negotiated Rate |
$20.99 |
| Max. Negotiated Rate |
$602.28 |
| Rate for Payer: Cash Price |
$216.03
|
| Rate for Payer: Cash Price |
$216.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$206.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$206.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$217.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$229.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$217.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$229.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$229.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$172.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$217.97
|
| Rate for Payer: Healthfirst QHP |
$229.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$160.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$229.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$195.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$160.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$229.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$602.28
|
| Rate for Payer: SOMOS Essential |
$602.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$229.44
|
|
