|
CHG HYPERTHERMIA INTERSTIAL PROBE 5/> APPLICATORS
|
Professional
|
$388.92
|
|
|
Service Code
|
HCPCS 77615 26
|
| Min. Negotiated Rate |
$77.78 |
| Max. Negotiated Rate |
$3,479.52 |
| Rate for Payer: Cash Price |
$107.29
|
| Rate for Payer: Cash Price |
$107.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$100.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$100.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$105.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$111.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$105.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$111.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$83.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$105.56
|
| Rate for Payer: Healthfirst QHP |
$111.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$77.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$111.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$94.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$77.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$111.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$291.69
|
| Rate for Payer: SOMOS Essential |
$291.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$111.12
|
|
|
CHG HYPERTHERMIA INTERSTIAL PROBE 5/> APPLICATORS
|
Professional
|
$4,639.36
|
|
|
Service Code
|
HCPCS 77615
|
| Min. Negotiated Rate |
$77.78 |
| Max. Negotiated Rate |
$3,479.52 |
| Rate for Payer: Cash Price |
$1,263.80
|
| Rate for Payer: Cash Price |
$1,263.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,192.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,192.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,259.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,325.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,259.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,325.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,325.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$994.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,259.25
|
| Rate for Payer: Healthfirst QHP |
$1,325.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$927.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,325.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,126.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$927.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,325.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,479.52
|
| Rate for Payer: SOMOS Essential |
$3,479.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,325.53
|
|
|
CHG HYPERTHERMIA INTERSTIAL PROBE 5/> APPLICATORS
|
Professional
|
$4,250.44
|
|
|
Service Code
|
HCPCS 77615 TC
|
| Min. Negotiated Rate |
$77.78 |
| Max. Negotiated Rate |
$3,479.52 |
| Rate for Payer: Cash Price |
$1,156.51
|
| Rate for Payer: Cash Price |
$1,156.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,092.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,092.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,153.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,214.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,153.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,214.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,214.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$910.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,153.69
|
| Rate for Payer: Healthfirst QHP |
$1,214.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$850.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,214.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,032.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$850.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,214.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,187.83
|
| Rate for Payer: SOMOS Essential |
$3,187.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,214.41
|
|
|
CHG HYPERTHERMIA INTERSTITIAL PROBE 5/< APPLICATORS
|
Professional
|
$2,684.40
|
|
|
Service Code
|
HCPCS 77610 TC
|
| Min. Negotiated Rate |
$54.84 |
| Max. Negotiated Rate |
$2,218.96 |
| Rate for Payer: Cash Price |
$727.77
|
| Rate for Payer: Cash Price |
$727.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$690.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$690.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$728.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$766.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$728.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$766.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$766.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$575.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$728.62
|
| Rate for Payer: Healthfirst QHP |
$766.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$536.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$766.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$651.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$536.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$766.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,013.30
|
| Rate for Payer: SOMOS Essential |
$2,013.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$766.97
|
|
|
CHG HYPERTHERMIA INTERSTITIAL PROBE 5/< APPLICATORS
|
Professional
|
$2,958.62
|
|
|
Service Code
|
HCPCS 77610
|
| Min. Negotiated Rate |
$54.84 |
| Max. Negotiated Rate |
$2,218.96 |
| Rate for Payer: Cash Price |
$804.31
|
| Rate for Payer: Cash Price |
$804.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$760.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$760.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$803.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$845.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$803.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$845.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$845.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$633.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$803.05
|
| Rate for Payer: Healthfirst QHP |
$845.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$591.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$845.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$718.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$591.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$845.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,218.96
|
| Rate for Payer: SOMOS Essential |
$2,218.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$845.32
|
|
|
CHG HYPERTHERMIA INTERSTITIAL PROBE 5/< APPLICATORS
|
Professional
|
$274.19
|
|
|
Service Code
|
HCPCS 77610 26
|
| Min. Negotiated Rate |
$54.84 |
| Max. Negotiated Rate |
$2,218.96 |
| Rate for Payer: Cash Price |
$76.55
|
| Rate for Payer: Cash Price |
$76.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$70.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$70.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$74.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$78.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$74.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$78.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$78.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$58.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$74.42
|
| Rate for Payer: Healthfirst QHP |
$78.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$54.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$78.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$66.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$54.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$78.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$205.64
|
| Rate for Payer: SOMOS Essential |
$205.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$78.34
|
|
|
CHG HYPERTHERMIA INTRACAVITARY PROBES
|
Professional
|
$2,780.19
|
|
|
Service Code
|
HCPCS 77620
|
| Min. Negotiated Rate |
$74.36 |
| Max. Negotiated Rate |
$2,085.14 |
| Rate for Payer: Cash Price |
$753.93
|
| Rate for Payer: Cash Price |
$753.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$714.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$714.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$754.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$794.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$754.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$794.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$794.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$595.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$754.62
|
| Rate for Payer: Healthfirst QHP |
$794.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$556.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$794.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$675.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$556.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$794.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,085.14
|
| Rate for Payer: SOMOS Essential |
$2,085.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$794.34
|
|
|
CHG HYPERTHERMIA INTRACAVITARY PROBES
|
Professional
|
$371.81
|
|
|
Service Code
|
HCPCS 77620 26
|
| Min. Negotiated Rate |
$74.36 |
| Max. Negotiated Rate |
$2,085.14 |
| Rate for Payer: Cash Price |
$98.07
|
| Rate for Payer: Cash Price |
$98.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$95.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$95.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$100.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$106.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$100.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$106.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$79.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$100.92
|
| Rate for Payer: Healthfirst QHP |
$106.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$74.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$106.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$90.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$74.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$106.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$278.86
|
| Rate for Payer: SOMOS Essential |
$278.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$106.23
|
|
|
CHG HYPERTHERMIA INTRACAVITARY PROBES
|
Professional
|
$2,408.42
|
|
|
Service Code
|
HCPCS 77620 TC
|
| Min. Negotiated Rate |
$74.36 |
| Max. Negotiated Rate |
$2,085.14 |
| Rate for Payer: Cash Price |
$655.86
|
| Rate for Payer: Cash Price |
$655.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$619.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$619.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$653.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$688.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$653.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$688.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$688.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$516.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$653.71
|
| Rate for Payer: Healthfirst QHP |
$688.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$481.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$688.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$584.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$481.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$688.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,806.32
|
| Rate for Payer: SOMOS Essential |
$1,806.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$688.12
|
|
|
CHG HYSTEROSALPINGOGRAPHY RS&I
|
Professional
|
$73.19
|
|
|
Service Code
|
HCPCS 74740 26
|
| Min. Negotiated Rate |
$14.64 |
| Max. Negotiated Rate |
$308.15 |
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.86
|
| Rate for Payer: Healthfirst QHP |
$20.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$20.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$17.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$14.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$54.89
|
| Rate for Payer: SOMOS Essential |
$54.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.91
|
|
|
CHG HYSTEROSALPINGOGRAPHY RS&I
|
Professional
|
$410.87
|
|
|
Service Code
|
HCPCS 74740
|
| Min. Negotiated Rate |
$14.64 |
| Max. Negotiated Rate |
$308.15 |
| Rate for Payer: Cash Price |
$109.43
|
| Rate for Payer: Cash Price |
$109.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$105.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$105.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$111.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$117.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$111.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$117.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$117.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$111.52
|
| Rate for Payer: Healthfirst QHP |
$117.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$82.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$117.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$99.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$82.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$117.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$308.15
|
| Rate for Payer: SOMOS Essential |
$308.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$117.39
|
|
|
CHG HYSTEROSALPINGOGRAPHY RS&I
|
Professional
|
$337.68
|
|
|
Service Code
|
HCPCS 74740 TC
|
| Min. Negotiated Rate |
$14.64 |
| Max. Negotiated Rate |
$308.15 |
| Rate for Payer: Cash Price |
$89.43
|
| Rate for Payer: Cash Price |
$89.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$86.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$86.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$91.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$96.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$91.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$96.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$96.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$91.66
|
| Rate for Payer: Healthfirst QHP |
$96.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$67.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$96.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$82.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$67.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$96.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$253.26
|
| Rate for Payer: SOMOS Essential |
$253.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$96.48
|
|
|
CHG IAADIADOO INFLUENZA
|
Professional
|
$66.20
|
|
|
Service Code
|
HCPCS 87804
|
| Min. Negotiated Rate |
$11.58 |
| Max. Negotiated Rate |
$49.65 |
| Rate for Payer: Cash Price |
$16.55
|
| Rate for Payer: Cash Price |
$16.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.72
|
| Rate for Payer: Healthfirst QHP |
$16.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$14.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$49.65
|
| Rate for Payer: SOMOS Essential |
$49.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.55
|
|
|
CHG IAADIADOO STREPTOCOCCUS GROUP A
|
Professional
|
$41.32
|
|
|
Service Code
|
HCPCS 87880
|
| Min. Negotiated Rate |
$11.57 |
| Max. Negotiated Rate |
$30.99 |
| Rate for Payer: Cash Price |
$16.53
|
| Rate for Payer: Cash Price |
$16.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.70
|
| Rate for Payer: Healthfirst QHP |
$16.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$14.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$30.99
|
| Rate for Payer: SOMOS Essential |
$30.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.53
|
|
|
CHG IMHCHEM/IMCYTCHM 1ST SINGLE ANTB STAIN PROCEDURE
|
Professional
|
$284.48
|
|
|
Service Code
|
HCPCS 88342 TC
|
| Min. Negotiated Rate |
$26.70 |
| Max. Negotiated Rate |
$313.51 |
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$73.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$77.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$77.22
|
| Rate for Payer: Healthfirst QHP |
$81.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$56.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$81.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$69.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$56.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$213.36
|
| Rate for Payer: SOMOS Essential |
$213.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.28
|
|
|
CHG IMHCHEM/IMCYTCHM 1ST SINGLE ANTB STAIN PROCEDURE
|
Professional
|
$133.53
|
|
|
Service Code
|
HCPCS 88342 26
|
| Min. Negotiated Rate |
$26.70 |
| Max. Negotiated Rate |
$313.51 |
| Rate for Payer: Cash Price |
$36.82
|
| Rate for Payer: Cash Price |
$36.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.24
|
| Rate for Payer: Healthfirst QHP |
$38.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$100.15
|
| Rate for Payer: SOMOS Essential |
$100.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.15
|
|
|
CHG IMHCHEM/IMCYTCHM 1ST SINGLE ANTB STAIN PROCEDURE
|
Professional
|
$418.01
|
|
|
Service Code
|
HCPCS 88342
|
| Min. Negotiated Rate |
$26.70 |
| Max. Negotiated Rate |
$313.51 |
| Rate for Payer: Cash Price |
$122.32
|
| Rate for Payer: Cash Price |
$122.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$107.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$107.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$119.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$119.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$119.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$89.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$113.46
|
| Rate for Payer: Healthfirst QHP |
$119.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$83.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$119.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$101.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$83.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$119.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$313.51
|
| Rate for Payer: SOMOS Essential |
$313.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$119.43
|
|
|
CHG IMHCHEM/IMCYTCHM EA ADDL SINGLE ANTB STAIN PX
|
Professional
|
$108.82
|
|
|
Service Code
|
HCPCS 88341 26
|
| Min. Negotiated Rate |
$21.76 |
| Max. Negotiated Rate |
$270.27 |
| Rate for Payer: Cash Price |
$29.58
|
| Rate for Payer: Cash Price |
$29.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$27.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.54
|
| Rate for Payer: Healthfirst QHP |
$31.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$31.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$81.62
|
| Rate for Payer: SOMOS Essential |
$81.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.09
|
|
|
CHG IMHCHEM/IMCYTCHM EA ADDL SINGLE ANTB STAIN PX
|
Professional
|
$360.36
|
|
|
Service Code
|
HCPCS 88341
|
| Min. Negotiated Rate |
$21.76 |
| Max. Negotiated Rate |
$270.27 |
| Rate for Payer: Cash Price |
$104.63
|
| Rate for Payer: Cash Price |
$104.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$92.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$92.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$97.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$102.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$97.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$102.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$102.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$77.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$97.81
|
| Rate for Payer: Healthfirst QHP |
$102.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$72.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$102.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$87.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$72.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$102.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$270.27
|
| Rate for Payer: SOMOS Essential |
$270.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$102.96
|
|
|
CHG IMHCHEM/IMCYTCHM EA ADDL SINGLE ANTB STAIN PX
|
Professional
|
$251.55
|
|
|
Service Code
|
HCPCS 88341 TC
|
| Min. Negotiated Rate |
$21.76 |
| Max. Negotiated Rate |
$270.27 |
| Rate for Payer: Cash Price |
$75.05
|
| Rate for Payer: Cash Price |
$75.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$64.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$64.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$68.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$71.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$68.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$71.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$71.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$53.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$68.28
|
| Rate for Payer: Healthfirst QHP |
$71.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$50.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$71.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$61.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$50.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$71.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$188.66
|
| Rate for Payer: SOMOS Essential |
$188.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$71.87
|
|
|
CHG IMHCHEM/IMCYTCHM EA MULTIPLEX ANTIBODY STAIN PX
|
Professional
|
$561.93
|
|
|
Service Code
|
HCPCS 88344 TC
|
| Min. Negotiated Rate |
$29.32 |
| Max. Negotiated Rate |
$531.40 |
| Rate for Payer: Cash Price |
$160.55
|
| Rate for Payer: Cash Price |
$160.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$144.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$144.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$152.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$160.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$152.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$160.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$160.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$120.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$152.52
|
| Rate for Payer: Healthfirst QHP |
$160.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$112.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$160.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$136.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$112.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$160.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$421.45
|
| Rate for Payer: SOMOS Essential |
$421.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$160.55
|
|
|
CHG IMHCHEM/IMCYTCHM EA MULTIPLEX ANTIBODY STAIN PX
|
Professional
|
$708.54
|
|
|
Service Code
|
HCPCS 88344
|
| Min. Negotiated Rate |
$29.32 |
| Max. Negotiated Rate |
$531.40 |
| Rate for Payer: Cash Price |
$200.99
|
| Rate for Payer: Cash Price |
$200.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$182.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$182.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$192.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$202.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$192.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$202.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$202.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$151.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$192.32
|
| Rate for Payer: Healthfirst QHP |
$202.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$141.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$202.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$172.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$141.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$202.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$531.40
|
| Rate for Payer: SOMOS Essential |
$531.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$202.44
|
|
|
CHG IMHCHEM/IMCYTCHM EA MULTIPLEX ANTIBODY STAIN PX
|
Professional
|
$146.62
|
|
|
Service Code
|
HCPCS 88344 26
|
| Min. Negotiated Rate |
$29.32 |
| Max. Negotiated Rate |
$531.40 |
| Rate for Payer: Cash Price |
$40.44
|
| Rate for Payer: Cash Price |
$40.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$39.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.80
|
| Rate for Payer: Healthfirst QHP |
$41.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$41.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$35.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$109.96
|
| Rate for Payer: SOMOS Essential |
$109.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.89
|
|
|
CHG IMMUNOELECTROPHORESIS CROSSED
|
Professional
|
$85.54
|
|
|
Service Code
|
HCPCS 86327 26
|
| Min. Negotiated Rate |
$17.11 |
| Max. Negotiated Rate |
$64.16 |
| Rate for Payer: Cash Price |
$23.13
|
| Rate for Payer: Cash Price |
$23.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23.22
|
| Rate for Payer: Healthfirst QHP |
$24.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$24.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$20.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$64.16
|
| Rate for Payer: SOMOS Essential |
$64.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.44
|
|
|
CHG IMMUNOELECTROPHORESIS OTHER FLUIDS CONCENTRATION
|
Professional
|
$69.20
|
|
|
Service Code
|
HCPCS 86325 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
|
|
