|
CHG OF CYSTOSTOMY TUBE, SIMPLE
|
Facility
OP
|
$711.45
|
|
|
Service Code
|
HCPCS 51705
|
| Hospital Charge Code |
30305598
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.58 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$285.81
|
| Rate for Payer: Aetna Government |
$285.81
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$285.81
|
| Rate for Payer: Cash Price |
$285.81
|
| Rate for Payer: Cash Price |
$285.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$285.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$285.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$55.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$242.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$254.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$285.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$254.37
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$355.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$285.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$61.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$242.94
|
| Rate for Payer: Healthfirst QHP |
$285.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$285.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$285.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$285.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$228.65
|
| Rate for Payer: Wellcare Medicare |
$271.52
|
|
|
CHG OF CYSTOSTOMY TUBE, SIMPLE
|
Facility
OP
|
$711.45
|
|
|
Service Code
|
HCPCS 51705
|
| Hospital Charge Code |
30305921
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$55.58 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$285.81
|
| Rate for Payer: Aetna Government |
$285.81
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$285.81
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$285.81
|
| Rate for Payer: Cash Price |
$285.81
|
| Rate for Payer: Cash Price |
$285.81
|
| Rate for Payer: Cash Price |
$285.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$285.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$285.81
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$55.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$242.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$254.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$285.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$254.37
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$355.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$285.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$285.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$285.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$285.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$285.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$228.65
|
| Rate for Payer: Wellcare Medicare |
$271.52
|
|
|
CHG OF CYSTOSTOMY TUBE, SIMPLE
|
Facility
OP
|
$711.45
|
|
|
Service Code
|
HCPCS 51705
|
| Hospital Charge Code |
30105921
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$55.58 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$285.81
|
| Rate for Payer: Aetna Government |
$285.81
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$285.81
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$285.81
|
| Rate for Payer: Cash Price |
$285.81
|
| Rate for Payer: Cash Price |
$285.81
|
| Rate for Payer: Cash Price |
$285.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$285.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$285.81
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$55.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$242.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$254.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$285.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$254.37
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$355.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$285.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$285.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$285.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$285.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$285.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$228.65
|
| Rate for Payer: Wellcare Medicare |
$271.52
|
|
|
CHG OPH BMTRY US ECHOGRAPY A-SCAN IO LENS PWR CAL
|
Professional
|
$281.54
|
|
|
Service Code
|
HCPCS 76519
|
| Min. Negotiated Rate |
$23.85 |
| Max. Negotiated Rate |
$211.16 |
| Rate for Payer: Cash Price |
$78.24
|
| Rate for Payer: Cash Price |
$78.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$72.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$72.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$76.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$80.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$76.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$76.42
|
| Rate for Payer: Healthfirst QHP |
$80.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$56.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$80.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$68.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$56.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$80.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$211.16
|
| Rate for Payer: SOMOS Essential |
$211.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$80.44
|
|
|
CHG OPH BMTRY US ECHOGRAPY A-SCAN IO LENS PWR CAL
|
Professional
|
$119.25
|
|
|
Service Code
|
HCPCS 76519 26
|
| Min. Negotiated Rate |
$23.85 |
| Max. Negotiated Rate |
$211.16 |
| Rate for Payer: Cash Price |
$32.82
|
| Rate for Payer: Cash Price |
$32.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.37
|
| Rate for Payer: Healthfirst QHP |
$34.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$89.44
|
| Rate for Payer: SOMOS Essential |
$89.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.07
|
|
|
CHG OPH BMTRY US ECHOGRAPY A-SCAN IO LENS PWR CAL
|
Professional
|
$162.30
|
|
|
Service Code
|
HCPCS 76519 TC
|
| Min. Negotiated Rate |
$23.85 |
| Max. Negotiated Rate |
$211.16 |
| Rate for Payer: Cash Price |
$45.42
|
| Rate for Payer: Cash Price |
$45.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$44.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$44.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.05
|
| Rate for Payer: Healthfirst QHP |
$46.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$46.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$121.72
|
| Rate for Payer: SOMOS Essential |
$121.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.37
|
|
|
CHG OPHTHALMIC BIOMETRY US ECHOGRAPY A-SCAN
|
Professional
|
$88.76
|
|
|
Service Code
|
HCPCS 76516 26
|
| Min. Negotiated Rate |
$17.75 |
| Max. Negotiated Rate |
$146.26 |
| Rate for Payer: Cash Price |
$24.40
|
| Rate for Payer: Cash Price |
$24.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24.09
|
| Rate for Payer: Healthfirst QHP |
$25.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$25.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$21.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$66.57
|
| Rate for Payer: SOMOS Essential |
$66.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.36
|
|
|
CHG OPHTHALMIC BIOMETRY US ECHOGRAPY A-SCAN
|
Professional
|
$106.23
|
|
|
Service Code
|
HCPCS 76516 TC
|
| Min. Negotiated Rate |
$17.75 |
| Max. Negotiated Rate |
$146.26 |
| Rate for Payer: Cash Price |
$29.31
|
| Rate for Payer: Cash Price |
$29.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$27.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$28.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$30.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.83
|
| Rate for Payer: Healthfirst QHP |
$30.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$30.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$25.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$79.67
|
| Rate for Payer: SOMOS Essential |
$79.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.35
|
|
|
CHG OPHTHALMIC BIOMETRY US ECHOGRAPY A-SCAN
|
Professional
|
$195.02
|
|
|
Service Code
|
HCPCS 76516
|
| Min. Negotiated Rate |
$17.75 |
| Max. Negotiated Rate |
$146.26 |
| Rate for Payer: Cash Price |
$53.71
|
| Rate for Payer: Cash Price |
$53.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$50.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$50.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$52.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$55.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$52.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$52.93
|
| Rate for Payer: Healthfirst QHP |
$55.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$39.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$55.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$47.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$39.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$55.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$146.26
|
| Rate for Payer: SOMOS Essential |
$146.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.72
|
|
|
CHG OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION
|
Professional
|
$234.19
|
|
|
Service Code
|
HCPCS 76529 TC
|
| Min. Negotiated Rate |
$25.17 |
| Max. Negotiated Rate |
$270.04 |
| Rate for Payer: Cash Price |
$63.89
|
| Rate for Payer: Cash Price |
$63.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$60.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$63.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$66.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$63.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$66.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$66.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$50.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$63.56
|
| Rate for Payer: Healthfirst QHP |
$66.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$46.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$66.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$56.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$46.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$66.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$175.64
|
| Rate for Payer: SOMOS Essential |
$175.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$66.91
|
|
|
CHG OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION
|
Professional
|
$125.86
|
|
|
Service Code
|
HCPCS 76529 26
|
| Min. Negotiated Rate |
$25.17 |
| Max. Negotiated Rate |
$270.04 |
| Rate for Payer: Cash Price |
$35.04
|
| Rate for Payer: Cash Price |
$35.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.16
|
| Rate for Payer: Healthfirst QHP |
$35.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$94.40
|
| Rate for Payer: SOMOS Essential |
$94.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.96
|
|
|
CHG OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION
|
Professional
|
$360.05
|
|
|
Service Code
|
HCPCS 76529
|
| Min. Negotiated Rate |
$25.17 |
| Max. Negotiated Rate |
$270.04 |
| Rate for Payer: Cash Price |
$98.93
|
| Rate for Payer: Cash Price |
$98.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$92.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$92.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$97.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$102.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$97.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$102.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$102.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$77.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$97.73
|
| Rate for Payer: Healthfirst QHP |
$102.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$72.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$102.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$87.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$72.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$102.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$270.04
|
| Rate for Payer: SOMOS Essential |
$270.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$102.87
|
|
|
CHG OPHTHALMIC US DX B-SCAN&QUAN A-SCAN SM PT ENCTR
|
Professional
|
$285.78
|
|
|
Service Code
|
HCPCS 76510
|
| Min. Negotiated Rate |
$26.42 |
| Max. Negotiated Rate |
$214.34 |
| Rate for Payer: Cash Price |
$78.31
|
| Rate for Payer: Cash Price |
$78.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$73.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$77.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$61.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$77.57
|
| Rate for Payer: Healthfirst QHP |
$81.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$57.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$81.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$69.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$57.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$214.34
|
| Rate for Payer: SOMOS Essential |
$214.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.65
|
|
|
CHG OPHTHALMIC US DX B-SCAN&QUAN A-SCAN SM PT ENCTR
|
Professional
|
$153.65
|
|
|
Service Code
|
HCPCS 76510 26
|
| Min. Negotiated Rate |
$26.42 |
| Max. Negotiated Rate |
$214.34 |
| Rate for Payer: Cash Price |
$42.33
|
| Rate for Payer: Cash Price |
$42.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.70
|
| Rate for Payer: Healthfirst QHP |
$43.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$43.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$115.24
|
| Rate for Payer: SOMOS Essential |
$115.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.90
|
|
|
CHG OPHTHALMIC US DX B-SCAN&QUAN A-SCAN SM PT ENCTR
|
Professional
|
$132.13
|
|
|
Service Code
|
HCPCS 76510 TC
|
| Min. Negotiated Rate |
$26.42 |
| Max. Negotiated Rate |
$214.34 |
| Rate for Payer: Cash Price |
$35.99
|
| Rate for Payer: Cash Price |
$35.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.86
|
| Rate for Payer: Healthfirst QHP |
$37.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$99.10
|
| Rate for Payer: SOMOS Essential |
$99.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.75
|
|
|
CHG OPHTHALMIC US DX B-SCAN W/WO NON-QUAN A-SCAN
|
Professional
|
$197.79
|
|
|
Service Code
|
HCPCS 76512
|
| Min. Negotiated Rate |
$15.50 |
| Max. Negotiated Rate |
$148.34 |
| Rate for Payer: Cash Price |
$54.57
|
| Rate for Payer: Cash Price |
$54.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$50.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$50.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$53.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$56.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$53.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$53.68
|
| Rate for Payer: Healthfirst QHP |
$56.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$39.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$56.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$48.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$39.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$56.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$148.34
|
| Rate for Payer: SOMOS Essential |
$148.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56.51
|
|
|
CHG OPHTHALMIC US DX B-SCAN W/WO NON-QUAN A-SCAN
|
Professional
|
$120.30
|
|
|
Service Code
|
HCPCS 76512 26
|
| Min. Negotiated Rate |
$15.50 |
| Max. Negotiated Rate |
$148.34 |
| Rate for Payer: Cash Price |
$33.12
|
| Rate for Payer: Cash Price |
$33.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.65
|
| Rate for Payer: Healthfirst QHP |
$34.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$90.22
|
| Rate for Payer: SOMOS Essential |
$90.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.37
|
|
|
CHG OPHTHALMIC US DX B-SCAN W/WO NON-QUAN A-SCAN
|
Professional
|
$77.49
|
|
|
Service Code
|
HCPCS 76512 TC
|
| Min. Negotiated Rate |
$15.50 |
| Max. Negotiated Rate |
$148.34 |
| Rate for Payer: Cash Price |
$21.45
|
| Rate for Payer: Cash Price |
$21.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$19.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.03
|
| Rate for Payer: Healthfirst QHP |
$22.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$15.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$22.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$18.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$58.12
|
| Rate for Payer: SOMOS Essential |
$58.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.14
|
|
|
CHG OPHTHALMIC US DX CORNEAL PACHYMETRY UNI/BI
|
Professional
|
$48.90
|
|
|
Service Code
|
HCPCS 76514
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$36.68 |
| Rate for Payer: Cash Price |
$13.21
|
| Rate for Payer: Cash Price |
$13.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.27
|
| Rate for Payer: Healthfirst QHP |
$13.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$13.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$11.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36.68
|
| Rate for Payer: SOMOS Essential |
$36.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.97
|
|
|
CHG OPHTHALMIC US DX CORNEAL PACHYMETRY UNI/BI
|
Professional
|
$17.12
|
|
|
Service Code
|
HCPCS 76514 TC
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$36.68 |
| Rate for Payer: Cash Price |
$4.56
|
| Rate for Payer: Cash Price |
$4.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.65
|
| Rate for Payer: Healthfirst QHP |
$4.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$4.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.84
|
| Rate for Payer: SOMOS Essential |
$12.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.89
|
|
|
CHG OPHTHALMIC US DX CORNEAL PACHYMETRY UNI/BI
|
Professional
|
$31.78
|
|
|
Service Code
|
HCPCS 76514 26
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$36.68 |
| Rate for Payer: Cash Price |
$8.65
|
| Rate for Payer: Cash Price |
$8.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.63
|
| Rate for Payer: Healthfirst QHP |
$9.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.84
|
| Rate for Payer: SOMOS Essential |
$23.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.08
|
|
|
CHG OPHTHALMIC US DX QUANTITATIVE A-SCAN ONLY
|
Professional
|
$140.39
|
|
|
Service Code
|
HCPCS 76511 26
|
| Min. Negotiated Rate |
$18.95 |
| Max. Negotiated Rate |
$176.35 |
| Rate for Payer: Cash Price |
$38.66
|
| Rate for Payer: Cash Price |
$38.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.10
|
| Rate for Payer: Healthfirst QHP |
$40.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$40.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$105.29
|
| Rate for Payer: SOMOS Essential |
$105.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.11
|
|
|
CHG OPHTHALMIC US DX QUANTITATIVE A-SCAN ONLY
|
Professional
|
$235.13
|
|
|
Service Code
|
HCPCS 76511
|
| Min. Negotiated Rate |
$18.95 |
| Max. Negotiated Rate |
$176.35 |
| Rate for Payer: Cash Price |
$64.83
|
| Rate for Payer: Cash Price |
$64.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$60.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$63.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$67.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$63.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$50.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$63.82
|
| Rate for Payer: Healthfirst QHP |
$67.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$47.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$67.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$57.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$47.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$67.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$176.35
|
| Rate for Payer: SOMOS Essential |
$176.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$67.18
|
|
|
CHG OPHTHALMIC US DX QUANTITATIVE A-SCAN ONLY
|
Professional
|
$94.75
|
|
|
Service Code
|
HCPCS 76511 TC
|
| Min. Negotiated Rate |
$18.95 |
| Max. Negotiated Rate |
$176.35 |
| Rate for Payer: Cash Price |
$26.17
|
| Rate for Payer: Cash Price |
$26.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.72
|
| Rate for Payer: Healthfirst QHP |
$27.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$27.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$71.06
|
| Rate for Payer: SOMOS Essential |
$71.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.07
|
|
|
CHG ORTHOPANTOGRAM
|
Professional
|
$39.27
|
|
|
Service Code
|
HCPCS 70355 26
|
| Min. Negotiated Rate |
$7.45 |
| Max. Negotiated Rate |
$57.38 |
| Rate for Payer: Cash Price |
$10.74
|
| Rate for Payer: Cash Price |
$10.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.66
|
| Rate for Payer: Healthfirst QHP |
$11.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$7.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$11.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$9.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.45
|
| Rate for Payer: SOMOS Essential |
$29.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.22
|
|
