|
CHG SALIVARY GLAND IMAGING
|
Professional
|
$630.49
|
|
|
Service Code
|
HCPCS 78230 TC
|
| Min. Negotiated Rate |
$16.97 |
| Max. Negotiated Rate |
$536.50 |
| Rate for Payer: Cash Price |
$169.11
|
| Rate for Payer: Cash Price |
$169.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$162.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$162.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$171.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$180.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$171.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$180.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$180.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$135.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$171.13
|
| Rate for Payer: Healthfirst QHP |
$180.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$126.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$180.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$153.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$126.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$180.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$472.87
|
| Rate for Payer: SOMOS Essential |
$472.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$180.14
|
|
|
CHG SALIVARY GLAND IMAGING SERIAL IMAGES
|
Professional
|
$80.82
|
|
|
Service Code
|
HCPCS 78231 26
|
| Min. Negotiated Rate |
$16.16 |
| Max. Negotiated Rate |
$331.88 |
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$23.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.94
|
| Rate for Payer: Healthfirst QHP |
$23.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$16.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$23.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$19.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$16.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$60.62
|
| Rate for Payer: SOMOS Essential |
$60.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.09
|
|
|
CHG SALIVARY GLAND IMAGING SERIAL IMAGES
|
Professional
|
$442.51
|
|
|
Service Code
|
HCPCS 78231
|
| Min. Negotiated Rate |
$16.16 |
| Max. Negotiated Rate |
$331.88 |
| Rate for Payer: Cash Price |
$121.30
|
| Rate for Payer: Cash Price |
$121.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$113.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$113.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$120.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$126.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$120.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$94.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$120.11
|
| Rate for Payer: Healthfirst QHP |
$126.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$88.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$126.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$107.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$88.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$126.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$331.88
|
| Rate for Payer: SOMOS Essential |
$331.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$126.43
|
|
|
CHG SALIVARY GLAND IMAGING SERIAL IMAGES
|
Professional
|
$361.69
|
|
|
Service Code
|
HCPCS 78231 TC
|
| Min. Negotiated Rate |
$16.16 |
| Max. Negotiated Rate |
$331.88 |
| Rate for Payer: Cash Price |
$99.40
|
| Rate for Payer: Cash Price |
$99.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$93.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$93.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$98.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$103.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$98.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$103.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$77.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$98.17
|
| Rate for Payer: Healthfirst QHP |
$103.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$72.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$103.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$87.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$72.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$103.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$271.27
|
| Rate for Payer: SOMOS Essential |
$271.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$103.34
|
|
|
CHG SCREENING DIGITAL BREAST TOMOSYNTHESIS BI
|
Professional
|
$103.50
|
|
|
Service Code
|
HCPCS 77063 TC
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$165.93 |
| Rate for Payer: Cash Price |
$28.29
|
| Rate for Payer: Cash Price |
$28.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$28.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.09
|
| Rate for Payer: Healthfirst QHP |
$29.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$25.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$77.62
|
| Rate for Payer: SOMOS Essential |
$77.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.57
|
|
|
CHG SCREENING DIGITAL BREAST TOMOSYNTHESIS BI
|
Professional
|
$117.71
|
|
|
Service Code
|
HCPCS 77063 26
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$165.93 |
| Rate for Payer: Cash Price |
$31.05
|
| Rate for Payer: Cash Price |
$31.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.95
|
| Rate for Payer: Healthfirst QHP |
$33.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$33.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$88.28
|
| Rate for Payer: SOMOS Essential |
$88.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.63
|
|
|
CHG SCREENING DIGITAL BREAST TOMOSYNTHESIS BI
|
Professional
|
$221.24
|
|
|
Service Code
|
HCPCS 77063
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$165.93 |
| Rate for Payer: Cash Price |
$59.34
|
| Rate for Payer: Cash Price |
$59.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$56.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$56.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$60.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$63.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$60.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.05
|
| Rate for Payer: Healthfirst QHP |
$63.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$44.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$63.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$53.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$44.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$63.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$165.93
|
| Rate for Payer: SOMOS Essential |
$165.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$63.21
|
|
|
CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD
|
Professional
|
$545.86
|
|
|
Service Code
|
HCPCS 77067
|
| Min. Negotiated Rate |
$29.27 |
| Max. Negotiated Rate |
$409.40 |
| Rate for Payer: Cash Price |
$148.69
|
| Rate for Payer: Cash Price |
$148.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$140.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$140.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$148.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$155.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$148.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$155.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$155.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$116.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$148.16
|
| Rate for Payer: Healthfirst QHP |
$155.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$109.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$155.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$132.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$109.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$155.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$409.40
|
| Rate for Payer: SOMOS Essential |
$409.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$155.96
|
|
|
CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD
|
Professional
|
$399.49
|
|
|
Service Code
|
HCPCS 77067 TC
|
| Min. Negotiated Rate |
$29.27 |
| Max. Negotiated Rate |
$409.40 |
| Rate for Payer: Cash Price |
$109.07
|
| Rate for Payer: Cash Price |
$109.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$102.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$102.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$108.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$114.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$108.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$114.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$114.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$85.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$108.43
|
| Rate for Payer: Healthfirst QHP |
$114.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$79.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$114.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$97.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$79.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$114.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$299.62
|
| Rate for Payer: SOMOS Essential |
$299.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$114.14
|
|
|
CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD
|
Professional
|
$146.37
|
|
|
Service Code
|
HCPCS 77067 26
|
| Min. Negotiated Rate |
$29.27 |
| Max. Negotiated Rate |
$409.40 |
| Rate for Payer: Cash Price |
$39.62
|
| Rate for Payer: Cash Price |
$39.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$39.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.73
|
| Rate for Payer: Healthfirst QHP |
$41.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$41.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$35.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$109.78
|
| Rate for Payer: SOMOS Essential |
$109.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.82
|
|
|
CHG SHUNTOGRAM INDWELLING NONVASCULAR SHUNT RS&I
|
Professional
|
$257.18
|
|
|
Service Code
|
HCPCS 75809 TC
|
| Min. Negotiated Rate |
$19.14 |
| Max. Negotiated Rate |
$264.65 |
| Rate for Payer: Cash Price |
$70.17
|
| Rate for Payer: Cash Price |
$70.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$66.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$66.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$69.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$73.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$69.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$55.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.81
|
| Rate for Payer: Healthfirst QHP |
$73.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$51.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$73.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$62.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$51.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$73.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$192.88
|
| Rate for Payer: SOMOS Essential |
$192.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$73.48
|
|
|
CHG SHUNTOGRAM INDWELLING NONVASCULAR SHUNT RS&I
|
Professional
|
$95.69
|
|
|
Service Code
|
HCPCS 75809 26
|
| Min. Negotiated Rate |
$19.14 |
| Max. Negotiated Rate |
$264.65 |
| Rate for Payer: Cash Price |
$24.95
|
| Rate for Payer: Cash Price |
$24.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.97
|
| Rate for Payer: Healthfirst QHP |
$27.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$27.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$71.77
|
| Rate for Payer: SOMOS Essential |
$71.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.34
|
|
|
CHG SHUNTOGRAM INDWELLING NONVASCULAR SHUNT RS&I
|
Professional
|
$352.87
|
|
|
Service Code
|
HCPCS 75809
|
| Min. Negotiated Rate |
$19.14 |
| Max. Negotiated Rate |
$264.65 |
| Rate for Payer: Cash Price |
$95.12
|
| Rate for Payer: Cash Price |
$95.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$90.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$90.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$95.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$100.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$95.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$75.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$95.78
|
| Rate for Payer: Healthfirst QHP |
$100.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$70.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$100.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$85.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$70.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$100.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$264.65
|
| Rate for Payer: SOMOS Essential |
$264.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$100.82
|
|
|
CHG SIALOGRAPHY RS&I
|
Professional
|
$507.19
|
|
|
Service Code
|
HCPCS 70390
|
| Min. Negotiated Rate |
$14.64 |
| Max. Negotiated Rate |
$380.39 |
| Rate for Payer: Cash Price |
$135.37
|
| Rate for Payer: Cash Price |
$135.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$130.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$130.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$137.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$144.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$137.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$144.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$144.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$108.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$137.66
|
| Rate for Payer: Healthfirst QHP |
$144.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$101.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$144.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$123.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$101.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$144.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$380.39
|
| Rate for Payer: SOMOS Essential |
$380.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$144.91
|
|
|
CHG SIALOGRAPHY RS&I
|
Professional
|
$73.19
|
|
|
Service Code
|
HCPCS 70390 26
|
| Min. Negotiated Rate |
$14.64 |
| Max. Negotiated Rate |
$380.39 |
| Rate for Payer: Cash Price |
$19.61
|
| Rate for Payer: Cash Price |
$19.61
|
| 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 SIALOGRAPHY RS&I
|
Professional
|
$434.00
|
|
|
Service Code
|
HCPCS 70390 TC
|
| Min. Negotiated Rate |
$14.64 |
| Max. Negotiated Rate |
$380.39 |
| Rate for Payer: Cash Price |
$115.75
|
| Rate for Payer: Cash Price |
$115.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$111.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$111.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$117.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$124.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$117.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$124.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$124.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$93.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$117.80
|
| Rate for Payer: Healthfirst QHP |
$124.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$86.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$124.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$105.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$86.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$124.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$325.50
|
| Rate for Payer: SOMOS Essential |
$325.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$124.00
|
|
|
CHG SKIN TEST CANDIDA
|
Professional
|
$31.89
|
|
|
Service Code
|
HCPCS 86485
|
| Min. Negotiated Rate |
$23.92 |
| Max. Negotiated Rate |
$23.92 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.92
|
| Rate for Payer: SOMOS Essential |
$23.92
|
|
|
CHG SKIN TEST COCCIDIOIDOMYCOSIS
|
Professional
|
$336.25
|
|
|
Service Code
|
HCPCS 86490
|
| Min. Negotiated Rate |
$67.25 |
| Max. Negotiated Rate |
$252.19 |
| Rate for Payer: Cash Price |
$90.21
|
| Rate for Payer: Cash Price |
$90.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$86.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$86.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$91.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$96.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$91.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$96.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$96.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$91.27
|
| Rate for Payer: Healthfirst QHP |
$96.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$67.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$96.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$81.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$67.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$96.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$252.19
|
| Rate for Payer: SOMOS Essential |
$252.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$96.07
|
|
|
CHG SKIN TEST HISTOPLASMOSIS
|
Professional
|
$32.94
|
|
|
Service Code
|
HCPCS 86510
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$24.70 |
| Rate for Payer: Cash Price |
$9.27
|
| Rate for Payer: Cash Price |
$9.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.94
|
| Rate for Payer: Healthfirst QHP |
$9.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.70
|
| Rate for Payer: SOMOS Essential |
$24.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.41
|
|
|
CHG SKIN TEST TUBERCULOSIS INTRADERMAL
|
Professional
|
$44.42
|
|
|
Service Code
|
HCPCS 86580
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$33.32 |
| Rate for Payer: Cash Price |
$12.41
|
| Rate for Payer: Cash Price |
$12.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.06
|
| Rate for Payer: Healthfirst QHP |
$12.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$12.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$10.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$33.32
|
| Rate for Payer: SOMOS Essential |
$33.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.69
|
|
|
CHG SMR PRIM SRC SPEC STAIN BODIES/PARASITS
|
Professional
|
$69.20
|
|
|
Service Code
|
HCPCS 87207 26
|
| Min. Negotiated Rate |
$13.84 |
| Max. Negotiated Rate |
$51.90 |
| Rate for Payer: Cash Price |
$19.03
|
| Rate for Payer: Cash Price |
$19.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.78
|
| Rate for Payer: Healthfirst QHP |
$19.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$51.90
|
| Rate for Payer: SOMOS Essential |
$51.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.77
|
|
|
CHG SPEC DOSIM ONLY PRESCRIBED TREATING PHYS
|
Professional
|
$83.23
|
|
|
Service Code
|
HCPCS 77331 TC
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$200.86 |
| Rate for Payer: Cash Price |
$23.02
|
| Rate for Payer: Cash Price |
$23.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$23.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.59
|
| Rate for Payer: Healthfirst QHP |
$23.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$16.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$23.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$20.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$16.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$62.42
|
| Rate for Payer: SOMOS Essential |
$62.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.78
|
|
|
CHG SPEC DOSIM ONLY PRESCRIBED TREATING PHYS
|
Professional
|
$267.82
|
|
|
Service Code
|
HCPCS 77331
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$200.86 |
| Rate for Payer: Cash Price |
$73.94
|
| Rate for Payer: Cash Price |
$73.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$68.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$68.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$72.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$76.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$72.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$72.69
|
| Rate for Payer: Healthfirst QHP |
$76.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$53.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$76.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$65.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$53.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$76.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$200.86
|
| Rate for Payer: SOMOS Essential |
$200.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$76.52
|
|
|
CHG SPEC DOSIM ONLY PRESCRIBED TREATING PHYS
|
Professional
|
$184.59
|
|
|
Service Code
|
HCPCS 77331 26
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$200.86 |
| Rate for Payer: Cash Price |
$50.92
|
| Rate for Payer: Cash Price |
$50.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.10
|
| Rate for Payer: Healthfirst QHP |
$52.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$138.44
|
| Rate for Payer: SOMOS Essential |
$138.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.74
|
|
|
CHG SPECIAL TREATMENT PROCEDURE
|
Professional
|
$574.60
|
|
|
Service Code
|
HCPCS 77470
|
| Min. Negotiated Rate |
$28.41 |
| Max. Negotiated Rate |
$430.95 |
| Rate for Payer: Cash Price |
$160.98
|
| Rate for Payer: Cash Price |
$160.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$147.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$147.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$155.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$164.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$155.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$164.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$164.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$123.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$155.96
|
| Rate for Payer: Healthfirst QHP |
$164.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$114.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$164.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$139.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$114.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$164.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$430.95
|
| Rate for Payer: SOMOS Essential |
$430.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$164.17
|
|
