|
CHG MAMMARY DUCTOGRAM OR GALACTOGRAM SINGLE
|
Professional
|
$69.27
|
|
|
Service Code
|
HCPCS 77053 26
|
| Min. Negotiated Rate |
$13.85 |
| Max. Negotiated Rate |
$170.42 |
| Rate for Payer: Cash Price |
$18.91
|
| Rate for Payer: Cash Price |
$18.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.80
|
| Rate for Payer: Healthfirst QHP |
$19.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$51.95
|
| Rate for Payer: SOMOS Essential |
$51.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.79
|
|
|
CHG MANUAL APPL STRESS PFRMD PHYS/QHP JOINT FILMS
|
Professional
|
$237.27
|
|
|
Service Code
|
HCPCS 77071
|
| Min. Negotiated Rate |
$47.45 |
| Max. Negotiated Rate |
$177.95 |
| Rate for Payer: Cash Price |
$64.65
|
| Rate for Payer: Cash Price |
$64.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$61.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$67.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$50.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$64.40
|
| Rate for Payer: Healthfirst QHP |
$67.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$47.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$67.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$57.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$47.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$67.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$177.95
|
| Rate for Payer: SOMOS Essential |
$177.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$67.79
|
|
|
CHG MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I
|
Professional
|
$77.04
|
|
|
Service Code
|
HCPCS 75902 26
|
| Min. Negotiated Rate |
$15.41 |
| Max. Negotiated Rate |
$292.72 |
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$19.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$20.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20.91
|
| Rate for Payer: Healthfirst QHP |
$22.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$15.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$22.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$18.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$57.78
|
| Rate for Payer: SOMOS Essential |
$57.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.01
|
|
|
CHG MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I
|
Professional
|
$390.29
|
|
|
Service Code
|
HCPCS 75902
|
| Min. Negotiated Rate |
$15.41 |
| Max. Negotiated Rate |
$292.72 |
| Rate for Payer: Cash Price |
$102.55
|
| Rate for Payer: Cash Price |
$102.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$100.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$100.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$105.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$111.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$105.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$111.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$83.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$105.93
|
| Rate for Payer: Healthfirst QHP |
$111.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$78.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$111.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$94.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$78.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$111.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$292.72
|
| Rate for Payer: SOMOS Essential |
$292.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$111.51
|
|
|
CHG MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I
|
Professional
|
$313.25
|
|
|
Service Code
|
HCPCS 75902 TC
|
| Min. Negotiated Rate |
$15.41 |
| Max. Negotiated Rate |
$292.72 |
| Rate for Payer: Cash Price |
$82.75
|
| Rate for Payer: Cash Price |
$82.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$80.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$80.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$85.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$89.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$85.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$89.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$89.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$85.02
|
| Rate for Payer: Healthfirst QHP |
$89.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$62.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$89.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$76.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$62.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$89.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$234.94
|
| Rate for Payer: SOMOS Essential |
$234.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$89.50
|
|
|
CHG MECHANICAL RMVL PERICATHETER OBSTR MATRL RS&I
|
Professional
|
$996.35
|
|
|
Service Code
|
HCPCS 75901
|
| Min. Negotiated Rate |
$18.49 |
| Max. Negotiated Rate |
$747.26 |
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$256.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$256.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$270.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$284.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$270.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$284.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$284.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$213.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$270.44
|
| Rate for Payer: Healthfirst QHP |
$284.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$199.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$284.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$241.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$199.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$284.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$747.26
|
| Rate for Payer: SOMOS Essential |
$747.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$284.67
|
|
|
CHG MECHANICAL RMVL PERICATHETER OBSTR MATRL RS&I
|
Professional
|
$92.44
|
|
|
Service Code
|
HCPCS 75901 26
|
| Min. Negotiated Rate |
$18.49 |
| Max. Negotiated Rate |
$747.26 |
| Rate for Payer: Cash Price |
$24.47
|
| Rate for Payer: Cash Price |
$24.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.09
|
| Rate for Payer: Healthfirst QHP |
$26.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.33
|
| Rate for Payer: SOMOS Essential |
$69.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.41
|
|
|
CHG MECHANICAL RMVL PERICATHETER OBSTR MATRL RS&I
|
Professional
|
$903.91
|
|
|
Service Code
|
HCPCS 75901 TC
|
| Min. Negotiated Rate |
$18.49 |
| Max. Negotiated Rate |
$747.26 |
| Rate for Payer: Cash Price |
$242.51
|
| Rate for Payer: Cash Price |
$242.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$232.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$232.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$245.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$258.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$245.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$258.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$258.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$193.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$245.35
|
| Rate for Payer: Healthfirst QHP |
$258.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$180.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$258.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$219.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$180.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$258.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$677.93
|
| Rate for Payer: SOMOS Essential |
$677.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$258.26
|
|
|
CHG MEDICAL PHYSICS DOSE EVAL RADIATION EXPOS W/RPRT
|
Professional
|
$3,990.60
|
|
|
Service Code
|
HCPCS 76145
|
| Min. Negotiated Rate |
$798.12 |
| Max. Negotiated Rate |
$2,992.95 |
| Rate for Payer: Cash Price |
$1,088.56
|
| Rate for Payer: Cash Price |
$1,088.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,026.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,026.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,083.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,140.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,083.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,140.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,140.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$855.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,083.16
|
| Rate for Payer: Healthfirst QHP |
$1,140.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$798.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,140.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$969.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$798.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,140.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,992.95
|
| Rate for Payer: SOMOS Essential |
$2,992.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,140.17
|
|
|
CHG MLC IMRT DESIGN & CONSTRUCTION PER IMRT PLAN
|
Professional
|
$1,946.77
|
|
|
Service Code
|
HCPCS 77338
|
| Min. Negotiated Rate |
$181.43 |
| Max. Negotiated Rate |
$1,460.08 |
| Rate for Payer: Cash Price |
$539.78
|
| Rate for Payer: Cash Price |
$539.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$500.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$500.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$528.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$556.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$528.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$556.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$556.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$417.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$528.41
|
| Rate for Payer: Healthfirst QHP |
$556.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$389.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$556.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$472.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$389.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$556.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,460.08
|
| Rate for Payer: SOMOS Essential |
$1,460.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$556.22
|
|
|
CHG MLC IMRT DESIGN & CONSTRUCTION PER IMRT PLAN
|
Professional
|
$1,039.64
|
|
|
Service Code
|
HCPCS 77338 TC
|
| Min. Negotiated Rate |
$181.43 |
| Max. Negotiated Rate |
$1,460.08 |
| Rate for Payer: Cash Price |
$290.90
|
| Rate for Payer: Cash Price |
$290.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$267.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$267.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$282.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$297.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$282.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$297.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$297.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$222.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$282.19
|
| Rate for Payer: Healthfirst QHP |
$297.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$207.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$297.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$252.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$207.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$297.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$779.73
|
| Rate for Payer: SOMOS Essential |
$779.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$297.04
|
|
|
CHG MLC IMRT DESIGN & CONSTRUCTION PER IMRT PLAN
|
Professional
|
$907.13
|
|
|
Service Code
|
HCPCS 77338 26
|
| Min. Negotiated Rate |
$181.43 |
| Max. Negotiated Rate |
$1,460.08 |
| Rate for Payer: Cash Price |
$248.88
|
| Rate for Payer: Cash Price |
$248.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$233.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$233.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$246.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$259.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$246.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$259.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$259.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$194.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$246.22
|
| Rate for Payer: Healthfirst QHP |
$259.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$181.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$259.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$220.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$181.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$259.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$680.35
|
| Rate for Payer: SOMOS Essential |
$680.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$259.18
|
|
|
CHG MORPHOMETRIC ANALYSIS SKELETAL MUSCLE
|
Professional
|
$309.19
|
|
|
Service Code
|
HCPCS 88355 26
|
| Min. Negotiated Rate |
$52.56 |
| Max. Negotiated Rate |
$428.98 |
| Rate for Payer: Cash Price |
$78.89
|
| Rate for Payer: Cash Price |
$78.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$79.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$79.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$83.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$88.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$83.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$88.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$66.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$83.92
|
| Rate for Payer: Healthfirst QHP |
$88.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$61.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$88.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$75.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$61.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$88.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$231.89
|
| Rate for Payer: SOMOS Essential |
$231.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$88.34
|
|
|
CHG MORPHOMETRIC ANALYSIS SKELETAL MUSCLE
|
Professional
|
$262.78
|
|
|
Service Code
|
HCPCS 88355 TC
|
| Min. Negotiated Rate |
$52.56 |
| Max. Negotiated Rate |
$428.98 |
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$67.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$67.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$71.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$75.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$71.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$56.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$71.33
|
| Rate for Payer: Healthfirst QHP |
$75.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$52.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$75.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$63.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$52.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$75.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$197.08
|
| Rate for Payer: SOMOS Essential |
$197.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$75.08
|
|
|
CHG MORPHOMETRIC ANALYSIS SKELETAL MUSCLE
|
Professional
|
$571.97
|
|
|
Service Code
|
HCPCS 88355
|
| Min. Negotiated Rate |
$52.56 |
| Max. Negotiated Rate |
$428.98 |
| Rate for Payer: Cash Price |
$141.44
|
| Rate for Payer: Cash Price |
$141.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$147.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$147.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$155.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$163.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$155.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$163.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$163.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$122.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$155.25
|
| Rate for Payer: Healthfirst QHP |
$163.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$114.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$163.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$138.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$114.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$163.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$428.98
|
| Rate for Payer: SOMOS Essential |
$428.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$163.42
|
|
|
CHG M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR EACH MULTIPRB
|
Professional
|
$1,122.56
|
|
|
Service Code
|
HCPCS 88374 TC
|
| Min. Negotiated Rate |
$32.47 |
| Max. Negotiated Rate |
$963.67 |
| Rate for Payer: Cash Price |
$291.39
|
| Rate for Payer: Cash Price |
$291.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$288.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$288.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$304.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$320.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$304.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$320.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$320.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$240.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$304.69
|
| Rate for Payer: Healthfirst QHP |
$320.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$224.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$320.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$272.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$224.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$320.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$841.92
|
| Rate for Payer: SOMOS Essential |
$841.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$320.73
|
|
|
CHG M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR EACH MULTIPRB
|
Professional
|
$1,284.89
|
|
|
Service Code
|
HCPCS 88374
|
| Min. Negotiated Rate |
$32.47 |
| Max. Negotiated Rate |
$963.67 |
| Rate for Payer: Cash Price |
$335.45
|
| Rate for Payer: Cash Price |
$335.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$330.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$330.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$348.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$367.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$348.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$367.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$367.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$275.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$348.75
|
| Rate for Payer: Healthfirst QHP |
$367.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$256.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$367.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$312.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$256.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$367.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$963.67
|
| Rate for Payer: SOMOS Essential |
$963.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$367.11
|
|
|
CHG M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR EACH MULTIPRB
|
Professional
|
$162.33
|
|
|
Service Code
|
HCPCS 88374 26
|
| Min. Negotiated Rate |
$32.47 |
| Max. Negotiated Rate |
$963.67 |
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$44.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$44.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.06
|
| Rate for Payer: Healthfirst QHP |
$46.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$46.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$121.75
|
| Rate for Payer: SOMOS Essential |
$121.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.38
|
|
|
CHG M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR PER SPEC EACH
|
Professional
|
$94.22
|
|
|
Service Code
|
HCPCS 88373 26
|
| Min. Negotiated Rate |
$18.84 |
| Max. Negotiated Rate |
$211.89 |
| Rate for Payer: Cash Price |
$26.12
|
| Rate for Payer: Cash Price |
$26.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.57
|
| Rate for Payer: Healthfirst QHP |
$26.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$70.66
|
| Rate for Payer: SOMOS Essential |
$70.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.92
|
|
|
CHG M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR PER SPEC EACH
|
Professional
|
$282.52
|
|
|
Service Code
|
HCPCS 88373
|
| Min. Negotiated Rate |
$18.84 |
| Max. Negotiated Rate |
$211.89 |
| Rate for Payer: Cash Price |
$77.43
|
| Rate for Payer: Cash Price |
$77.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$72.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$72.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$76.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$80.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$76.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$76.68
|
| Rate for Payer: Healthfirst QHP |
$80.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$56.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$80.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$68.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$56.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$80.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$211.89
|
| Rate for Payer: SOMOS Essential |
$211.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$80.72
|
|
|
CHG M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR PER SPEC EACH
|
Professional
|
$188.30
|
|
|
Service Code
|
HCPCS 88373 TC
|
| Min. Negotiated Rate |
$18.84 |
| Max. Negotiated Rate |
$211.89 |
| Rate for Payer: Cash Price |
$51.31
|
| Rate for Payer: Cash Price |
$51.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$48.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$48.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$51.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$53.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$51.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$51.11
|
| Rate for Payer: Healthfirst QHP |
$53.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$53.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$45.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$53.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$141.22
|
| Rate for Payer: SOMOS Essential |
$141.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.80
|
|
|
CHG M/PHMTRC ALYS ISH QUANT/SEMIQ MNL EACH MULTIPRB
|
Professional
|
$1,675.66
|
|
|
Service Code
|
HCPCS 88377
|
| Min. Negotiated Rate |
$48.26 |
| Max. Negotiated Rate |
$1,256.74 |
| Rate for Payer: Cash Price |
$460.76
|
| Rate for Payer: Cash Price |
$460.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$430.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$430.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$454.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$478.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$454.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$478.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$478.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$359.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$454.82
|
| Rate for Payer: Healthfirst QHP |
$478.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$335.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$478.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$406.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$335.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$478.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,256.74
|
| Rate for Payer: SOMOS Essential |
$1,256.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$478.76
|
|
|
CHG M/PHMTRC ALYS ISH QUANT/SEMIQ MNL EACH MULTIPRB
|
Professional
|
$1,434.34
|
|
|
Service Code
|
HCPCS 88377 TC
|
| Min. Negotiated Rate |
$48.26 |
| Max. Negotiated Rate |
$1,256.74 |
| Rate for Payer: Cash Price |
$394.02
|
| Rate for Payer: Cash Price |
$394.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$368.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$368.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$389.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$409.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$389.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$409.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$409.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$307.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$389.32
|
| Rate for Payer: Healthfirst QHP |
$409.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$286.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$409.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$348.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$286.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$409.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,075.76
|
| Rate for Payer: SOMOS Essential |
$1,075.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$409.81
|
|
|
CHG M/PHMTRC ALYS ISH QUANT/SEMIQ MNL EACH MULTIPRB
|
Professional
|
$241.33
|
|
|
Service Code
|
HCPCS 88377 26
|
| Min. Negotiated Rate |
$48.26 |
| Max. Negotiated Rate |
$1,256.74 |
| Rate for Payer: Cash Price |
$66.74
|
| Rate for Payer: Cash Price |
$66.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$62.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$65.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$68.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$65.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$68.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$68.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$65.50
|
| Rate for Payer: Healthfirst QHP |
$68.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$48.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$68.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$58.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$48.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$68.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$181.00
|
| Rate for Payer: SOMOS Essential |
$181.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$68.95
|
|
|
CHG M/PHMTRC ALYS ISH QUANT/SEMIQ MNL PER SPEC EACH
|
Professional
|
$126.35
|
|
|
Service Code
|
HCPCS 88369 26
|
| Min. Negotiated Rate |
$25.27 |
| Max. Negotiated Rate |
$384.67 |
| Rate for Payer: Cash Price |
$35.25
|
| Rate for Payer: Cash Price |
$35.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.30
|
| Rate for Payer: Healthfirst QHP |
$36.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$36.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$94.76
|
| Rate for Payer: SOMOS Essential |
$94.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.10
|
|
