|
CHG TRANSCATHETER BIOPSY RS&I
|
Professional
|
$2,330.13
|
|
|
Service Code
|
HCPCS 75970 TC
|
| Min. Negotiated Rate |
$30.69 |
| Max. Negotiated Rate |
$1,862.68 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,747.60
|
| Rate for Payer: SOMOS Essential |
$1,747.60
|
|
|
CHG TRANSCATHETER EMBOLIZATION ANY METH RS&I
|
Professional
|
$4,877.64
|
|
|
Service Code
|
HCPCS 75894 TC
|
| Min. Negotiated Rate |
$62.28 |
| Max. Negotiated Rate |
$3,891.77 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,658.23
|
| Rate for Payer: SOMOS Essential |
$3,658.23
|
|
|
CHG TRANSCATHETER EMBOLIZATION ANY METH RS&I
|
Professional
|
$5,189.03
|
|
|
Service Code
|
HCPCS 75894
|
| Min. Negotiated Rate |
$62.28 |
| Max. Negotiated Rate |
$3,891.77 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,891.77
|
| Rate for Payer: SOMOS Essential |
$3,891.77
|
|
|
CHG TRANSCATHETER EMBOLIZATION ANY METH RS&I
|
Professional
|
$311.40
|
|
|
Service Code
|
HCPCS 75894 26
|
| Min. Negotiated Rate |
$62.28 |
| Max. Negotiated Rate |
$3,891.77 |
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$80.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$80.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$88.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$84.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$88.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$66.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$84.52
|
| Rate for Payer: Healthfirst QHP |
$88.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$62.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$88.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$75.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$62.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$88.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$233.55
|
| Rate for Payer: SOMOS Essential |
$233.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$88.97
|
|
|
CHG TRANSCERVICAL CATHJ FALLOPIAN TUBE RS&I
|
Professional
|
$118.97
|
|
|
Service Code
|
HCPCS 74742 26
|
| Min. Negotiated Rate |
$23.79 |
| Max. Negotiated Rate |
$486.73 |
| Rate for Payer: Cash Price |
$31.79
|
| Rate for Payer: Cash Price |
$31.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.29
|
| Rate for Payer: Healthfirst QHP |
$33.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$33.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$89.23
|
| Rate for Payer: SOMOS Essential |
$89.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.99
|
|
|
CHG TRANSCERVICAL CATHJ FALLOPIAN TUBE RS&I
|
Professional
|
$530.01
|
|
|
Service Code
|
HCPCS 74742 TC
|
| Min. Negotiated Rate |
$23.79 |
| Max. Negotiated Rate |
$486.73 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$397.51
|
| Rate for Payer: SOMOS Essential |
$397.51
|
|
|
CHG TRANSCERVICAL CATHJ FALLOPIAN TUBE RS&I
|
Professional
|
$648.97
|
|
|
Service Code
|
HCPCS 74742
|
| Min. Negotiated Rate |
$23.79 |
| Max. Negotiated Rate |
$486.73 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$486.73
|
| Rate for Payer: SOMOS Essential |
$486.73
|
|
|
CHG TX DEVICES DESIGN & CONSTRUCTION COMPLEX
|
Professional
|
$280.18
|
|
|
Service Code
|
HCPCS 77334 TC
|
| Min. Negotiated Rate |
$48.24 |
| Max. Negotiated Rate |
$391.05 |
| Rate for Payer: Cash Price |
$77.64
|
| Rate for Payer: Cash Price |
$77.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$72.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$72.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$76.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$80.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$76.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$76.05
|
| Rate for Payer: Healthfirst QHP |
$80.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$56.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$80.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$68.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$56.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$80.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$210.14
|
| Rate for Payer: SOMOS Essential |
$210.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$80.05
|
|
|
CHG TX DEVICES DESIGN & CONSTRUCTION COMPLEX
|
Professional
|
$241.22
|
|
|
Service Code
|
HCPCS 77334 26
|
| Min. Negotiated Rate |
$48.24 |
| Max. Negotiated Rate |
$391.05 |
| Rate for Payer: Cash Price |
$66.81
|
| Rate for Payer: Cash Price |
$66.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$62.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$65.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$68.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$65.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$68.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$68.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$65.47
|
| Rate for Payer: Healthfirst QHP |
$68.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$48.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$68.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$58.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$48.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$68.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$180.92
|
| Rate for Payer: SOMOS Essential |
$180.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$68.92
|
|
|
CHG TX DEVICES DESIGN & CONSTRUCTION COMPLEX
|
Professional
|
$521.40
|
|
|
Service Code
|
HCPCS 77334
|
| Min. Negotiated Rate |
$48.24 |
| Max. Negotiated Rate |
$391.05 |
| Rate for Payer: Cash Price |
$144.45
|
| Rate for Payer: Cash Price |
$144.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$134.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$134.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$141.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$148.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$141.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$148.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$148.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$111.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$141.52
|
| Rate for Payer: Healthfirst QHP |
$148.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$104.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$148.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$126.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$104.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$148.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$391.05
|
| Rate for Payer: SOMOS Essential |
$391.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$148.97
|
|
|
CHG TX DEVICES DESIGN & CONSTRUCTION INTERMEDIATE
|
Professional
|
$160.93
|
|
|
Service Code
|
HCPCS 77333 26
|
| Min. Negotiated Rate |
$32.19 |
| Max. Negotiated Rate |
$438.64 |
| Rate for Payer: Cash Price |
$43.36
|
| Rate for Payer: Cash Price |
$43.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$45.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43.68
|
| Rate for Payer: Healthfirst QHP |
$45.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$45.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$120.70
|
| Rate for Payer: SOMOS Essential |
$120.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.98
|
|
|
CHG TX DEVICES DESIGN & CONSTRUCTION INTERMEDIATE
|
Professional
|
$423.92
|
|
|
Service Code
|
HCPCS 77333 TC
|
| Min. Negotiated Rate |
$32.19 |
| Max. Negotiated Rate |
$438.64 |
| Rate for Payer: Cash Price |
$115.75
|
| Rate for Payer: Cash Price |
$115.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$109.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$109.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$115.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$121.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$115.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$121.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$121.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$90.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$115.06
|
| Rate for Payer: Healthfirst QHP |
$121.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$84.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$121.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$102.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$84.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$121.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$317.94
|
| Rate for Payer: SOMOS Essential |
$317.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$121.12
|
|
|
CHG TX DEVICES DESIGN & CONSTRUCTION INTERMEDIATE
|
Professional
|
$584.85
|
|
|
Service Code
|
HCPCS 77333
|
| Min. Negotiated Rate |
$32.19 |
| Max. Negotiated Rate |
$438.64 |
| Rate for Payer: Cash Price |
$159.11
|
| Rate for Payer: Cash Price |
$159.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$150.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$150.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$158.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$167.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$158.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$167.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$167.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$125.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$158.74
|
| Rate for Payer: Healthfirst QHP |
$167.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$116.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$167.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$142.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$116.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$167.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$438.64
|
| Rate for Payer: SOMOS Essential |
$438.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$167.10
|
|
|
CHG TX DEVICES DESIGN & CONSTRUCTION SIMPLE
|
Professional
|
$159.46
|
|
|
Service Code
|
HCPCS 77332
|
| Min. Negotiated Rate |
$12.62 |
| Max. Negotiated Rate |
$119.60 |
| Rate for Payer: Cash Price |
$45.08
|
| Rate for Payer: Cash Price |
$45.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$45.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43.28
|
| Rate for Payer: Healthfirst QHP |
$45.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$45.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$38.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$119.60
|
| Rate for Payer: SOMOS Essential |
$119.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.56
|
|
|
CHG TX DEVICES DESIGN & CONSTRUCTION SIMPLE
|
Professional
|
$63.11
|
|
|
Service Code
|
HCPCS 77332 TC
|
| Min. Negotiated Rate |
$12.62 |
| Max. Negotiated Rate |
$119.60 |
| Rate for Payer: Cash Price |
$18.70
|
| Rate for Payer: Cash Price |
$18.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.13
|
| Rate for Payer: Healthfirst QHP |
$18.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$12.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$18.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$15.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$12.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.33
|
| Rate for Payer: SOMOS Essential |
$47.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.03
|
|
|
CHG TX DEVICES DESIGN & CONSTRUCTION SIMPLE
|
Professional
|
$96.32
|
|
|
Service Code
|
HCPCS 77332 26
|
| Min. Negotiated Rate |
$12.62 |
| Max. Negotiated Rate |
$119.60 |
| Rate for Payer: Cash Price |
$26.37
|
| Rate for Payer: Cash Price |
$26.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.14
|
| Rate for Payer: Healthfirst QHP |
$27.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$27.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$72.24
|
| Rate for Payer: SOMOS Essential |
$72.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.52
|
|
|
CHG ULTRASONIC GUIDANCE INTRAOPERATIVE
|
Professional
|
$794.64
|
|
|
Service Code
|
HCPCS 76998
|
| Min. Negotiated Rate |
$52.79 |
| Max. Negotiated Rate |
$595.98 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$595.98
|
| Rate for Payer: SOMOS Essential |
$595.98
|
|
|
CHG ULTRASONIC GUIDANCE INTRAOPERATIVE
|
Professional
|
$263.97
|
|
|
Service Code
|
HCPCS 76998 26
|
| Min. Negotiated Rate |
$52.79 |
| Max. Negotiated Rate |
$595.98 |
| Rate for Payer: Cash Price |
$53.93
|
| Rate for Payer: Cash Price |
$53.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$67.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$67.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$71.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$75.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$71.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$56.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$71.65
|
| Rate for Payer: Healthfirst QHP |
$75.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$52.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$75.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$64.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$52.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$75.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$197.98
|
| Rate for Payer: SOMOS Essential |
$197.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$75.42
|
|
|
CHG ULTRASONIC GUIDANCE INTRAOPERATIVE
|
Professional
|
$530.67
|
|
|
Service Code
|
HCPCS 76998 TC
|
| Min. Negotiated Rate |
$52.79 |
| Max. Negotiated Rate |
$595.98 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$398.00
|
| Rate for Payer: SOMOS Essential |
$398.00
|
|
|
CHG ULTRASOUND ELASTOGRAPHY EA ADDL TAGET LESION
|
Professional
|
$260.30
|
|
|
Service Code
|
HCPCS 76983
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$195.22 |
| Rate for Payer: Cash Price |
$71.41
|
| Rate for Payer: Cash Price |
$71.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$66.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$66.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$70.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$74.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$70.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$74.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$55.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$70.65
|
| Rate for Payer: Healthfirst QHP |
$74.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$52.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$74.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$63.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$52.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$74.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$195.22
|
| Rate for Payer: SOMOS Essential |
$195.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$74.37
|
|
|
CHG ULTRASOUND ELASTOGRAPHY EA ADDL TAGET LESION
|
Professional
|
$102.31
|
|
|
Service Code
|
HCPCS 76983 26
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$195.22 |
| Rate for Payer: Cash Price |
$27.57
|
| Rate for Payer: Cash Price |
$27.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.77
|
| Rate for Payer: Healthfirst QHP |
$29.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$76.73
|
| Rate for Payer: SOMOS Essential |
$76.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.23
|
|
|
CHG ULTRASOUND ELASTOGRAPHY EA ADDL TAGET LESION
|
Professional
|
$157.99
|
|
|
Service Code
|
HCPCS 76983 TC
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$195.22 |
| Rate for Payer: Cash Price |
$43.85
|
| Rate for Payer: Cash Price |
$43.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$45.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42.88
|
| Rate for Payer: Healthfirst QHP |
$45.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$45.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$38.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$118.49
|
| Rate for Payer: SOMOS Essential |
$118.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.14
|
|
|
CHG ULTRASOUND ELASTOGRAPHY FIRST TARGET LESION
|
Professional
|
$399.53
|
|
|
Service Code
|
HCPCS 76982
|
| Min. Negotiated Rate |
$23.30 |
| Max. Negotiated Rate |
$299.65 |
| Rate for Payer: Cash Price |
$108.34
|
| Rate for Payer: Cash Price |
$108.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$102.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$102.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$108.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$114.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$108.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$114.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$114.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$85.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$108.44
|
| Rate for Payer: Healthfirst QHP |
$114.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$79.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$114.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$97.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$79.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$114.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$299.65
|
| Rate for Payer: SOMOS Essential |
$299.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$114.15
|
|
|
CHG ULTRASOUND ELASTOGRAPHY FIRST TARGET LESION
|
Professional
|
$116.48
|
|
|
Service Code
|
HCPCS 76982 26
|
| Min. Negotiated Rate |
$23.30 |
| Max. Negotiated Rate |
$299.65 |
| Rate for Payer: Cash Price |
$31.10
|
| Rate for Payer: Cash Price |
$31.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.62
|
| Rate for Payer: Healthfirst QHP |
$33.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$33.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$87.36
|
| Rate for Payer: SOMOS Essential |
$87.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.28
|
|
|
CHG ULTRASOUND ELASTOGRAPHY FIRST TARGET LESION
|
Professional
|
$283.05
|
|
|
Service Code
|
HCPCS 76982 TC
|
| Min. Negotiated Rate |
$23.30 |
| Max. Negotiated Rate |
$299.65 |
| Rate for Payer: Cash Price |
$77.25
|
| Rate for Payer: Cash Price |
$77.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$72.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$72.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$76.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$80.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$76.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$76.83
|
| Rate for Payer: Healthfirst QHP |
$80.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$56.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$80.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$68.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$56.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$80.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$212.29
|
| Rate for Payer: SOMOS Essential |
$212.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$80.87
|
|
