|
CHG ULTRASOUND ELASTOGRAPHY PARENCHYMA
|
Professional
|
$329.04
|
|
|
Service Code
|
HCPCS 76981 TC
|
| Min. Negotiated Rate |
$23.30 |
| Max. Negotiated Rate |
$334.14 |
| Rate for Payer: Cash Price |
$90.21
|
| Rate for Payer: Cash Price |
$90.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$84.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$84.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$89.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$94.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$89.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$94.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$94.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$70.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$89.31
|
| Rate for Payer: Healthfirst QHP |
$94.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$65.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$94.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$79.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$65.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$94.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$246.78
|
| Rate for Payer: SOMOS Essential |
$246.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$94.01
|
|
|
CHG ULTRASOUND ELASTOGRAPHY PARENCHYMA
|
Professional
|
$116.48
|
|
|
Service Code
|
HCPCS 76981 26
|
| Min. Negotiated Rate |
$23.30 |
| Max. Negotiated Rate |
$334.14 |
| 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 PARENCHYMA
|
Professional
|
$445.52
|
|
|
Service Code
|
HCPCS 76981
|
| Min. Negotiated Rate |
$23.30 |
| Max. Negotiated Rate |
$334.14 |
| Rate for Payer: Cash Price |
$121.31
|
| Rate for Payer: Cash Price |
$121.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$114.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$114.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$120.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$120.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$127.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$95.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$120.93
|
| Rate for Payer: Healthfirst QHP |
$127.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$89.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$127.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$108.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$89.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$334.14
|
| Rate for Payer: SOMOS Essential |
$334.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.29
|
|
|
CHG ULTRASOUND SPINAL CANAL & CONTENTS
|
Professional
|
$418.18
|
|
|
Service Code
|
HCPCS 76800 TC
|
| Min. Negotiated Rate |
$52.24 |
| Max. Negotiated Rate |
$509.54 |
| Rate for Payer: Cash Price |
$131.86
|
| Rate for Payer: Cash Price |
$131.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$107.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$107.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$119.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$119.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$119.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$89.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$113.51
|
| Rate for Payer: Healthfirst QHP |
$119.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$83.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$119.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$101.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$83.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$119.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$313.64
|
| Rate for Payer: SOMOS Essential |
$313.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$119.48
|
|
|
CHG ULTRASOUND SPINAL CANAL & CONTENTS
|
Professional
|
$679.39
|
|
|
Service Code
|
HCPCS 76800
|
| Min. Negotiated Rate |
$52.24 |
| Max. Negotiated Rate |
$509.54 |
| Rate for Payer: Cash Price |
$203.59
|
| Rate for Payer: Cash Price |
$203.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$174.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$174.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$184.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$194.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$184.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$194.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$194.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$145.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$184.40
|
| Rate for Payer: Healthfirst QHP |
$194.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$135.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$194.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$164.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$135.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$194.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$509.54
|
| Rate for Payer: SOMOS Essential |
$509.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$194.11
|
|
|
CHG ULTRASOUND SPINAL CANAL & CONTENTS
|
Professional
|
$261.21
|
|
|
Service Code
|
HCPCS 76800 26
|
| Min. Negotiated Rate |
$52.24 |
| Max. Negotiated Rate |
$509.54 |
| Rate for Payer: Cash Price |
$71.73
|
| Rate for Payer: Cash Price |
$71.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$67.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$67.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$70.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$74.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$70.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$74.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$55.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$70.90
|
| Rate for Payer: Healthfirst QHP |
$74.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$52.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$74.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$63.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$52.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$74.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$195.91
|
| Rate for Payer: SOMOS Essential |
$195.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$74.63
|
|
|
CHG ULTRASOUND TRGT DYNAMIC MICROBUBBLE 1ST LESION
|
Professional
|
$309.61
|
|
|
Service Code
|
HCPCS 76978 26
|
| Min. Negotiated Rate |
$61.92 |
| Max. Negotiated Rate |
$815.25 |
| Rate for Payer: Cash Price |
$84.29
|
| Rate for Payer: Cash Price |
$84.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$79.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$79.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$88.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$84.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$88.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$66.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$84.04
|
| Rate for Payer: Healthfirst QHP |
$88.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$61.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$88.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$75.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$61.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$88.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$232.21
|
| Rate for Payer: SOMOS Essential |
$232.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$88.46
|
|
|
CHG ULTRASOUND TRGT DYNAMIC MICROBUBBLE 1ST LESION
|
Professional
|
$1,087.00
|
|
|
Service Code
|
HCPCS 76978
|
| Min. Negotiated Rate |
$61.92 |
| Max. Negotiated Rate |
$815.25 |
| Rate for Payer: Cash Price |
$256.47
|
| Rate for Payer: Cash Price |
$256.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$295.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$310.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$295.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$310.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$310.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$232.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$295.04
|
| Rate for Payer: Healthfirst QHP |
$310.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$217.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$310.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$263.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$217.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$310.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$815.25
|
| Rate for Payer: SOMOS Essential |
$815.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$310.57
|
|
|
CHG ULTRASOUND TRGT DYNAMIC MICROBUBBLE 1ST LESION
|
Professional
|
$777.42
|
|
|
Service Code
|
HCPCS 76978 TC
|
| Min. Negotiated Rate |
$61.92 |
| Max. Negotiated Rate |
$815.25 |
| Rate for Payer: Cash Price |
$172.18
|
| Rate for Payer: Cash Price |
$172.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$199.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$199.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$211.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$222.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$211.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$222.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$222.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$166.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$211.01
|
| Rate for Payer: Healthfirst QHP |
$222.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$155.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$222.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$188.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$155.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$222.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$583.06
|
| Rate for Payer: SOMOS Essential |
$583.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$222.12
|
|
|
CHG ULTRASOUND TRGT DYNAMIC MICROBUBBLE EA ADDL LES
|
Professional
|
$712.39
|
|
|
Service Code
|
HCPCS 76979
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$534.29 |
| Rate for Payer: Cash Price |
$165.58
|
| Rate for Payer: Cash Price |
$165.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$183.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$183.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$193.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$203.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$193.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$203.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$203.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$152.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$193.36
|
| Rate for Payer: Healthfirst QHP |
$203.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$142.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$203.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$173.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$142.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$203.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$534.29
|
| Rate for Payer: SOMOS Essential |
$534.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$203.54
|
|
|
CHG ULTRASOUND TRGT DYNAMIC MICROBUBBLE EA ADDL LES
|
Professional
|
$550.41
|
|
|
Service Code
|
HCPCS 76979 TC
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$534.29 |
| Rate for Payer: Cash Price |
$121.65
|
| Rate for Payer: Cash Price |
$121.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$141.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$149.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$149.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$117.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$149.40
|
| Rate for Payer: Healthfirst QHP |
$157.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$110.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$157.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$133.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$110.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$412.81
|
| Rate for Payer: SOMOS Essential |
$412.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.26
|
|
|
CHG ULTRASOUND TRGT DYNAMIC MICROBUBBLE EA ADDL LES
|
Professional
|
$161.98
|
|
|
Service Code
|
HCPCS 76979 26
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$534.29 |
| Rate for Payer: Cash Price |
$43.93
|
| Rate for Payer: Cash Price |
$43.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43.97
|
| Rate for Payer: Healthfirst QHP |
$46.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$46.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$121.48
|
| Rate for Payer: SOMOS Essential |
$121.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.28
|
|
|
CHG URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM
|
Professional
|
$102.73
|
|
|
Service Code
|
HCPCS 78740 26
|
| Min. Negotiated Rate |
$20.54 |
| Max. Negotiated Rate |
$655.60 |
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.88
|
| Rate for Payer: Healthfirst QHP |
$29.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$77.05
|
| Rate for Payer: SOMOS Essential |
$77.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.35
|
|
|
CHG URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM
|
Professional
|
$874.13
|
|
|
Service Code
|
HCPCS 78740
|
| Min. Negotiated Rate |
$20.54 |
| Max. Negotiated Rate |
$655.60 |
| Rate for Payer: Cash Price |
$246.82
|
| Rate for Payer: Cash Price |
$246.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$224.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$224.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$237.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$249.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$237.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$249.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$249.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$187.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$237.26
|
| Rate for Payer: Healthfirst QHP |
$249.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$174.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$249.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$212.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$174.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$249.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$655.60
|
| Rate for Payer: SOMOS Essential |
$655.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$249.75
|
|
|
CHG URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM
|
Professional
|
$771.37
|
|
|
Service Code
|
HCPCS 78740 TC
|
| Min. Negotiated Rate |
$20.54 |
| Max. Negotiated Rate |
$655.60 |
| Rate for Payer: Cash Price |
$218.22
|
| Rate for Payer: Cash Price |
$218.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$198.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$198.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$209.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$220.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$209.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$220.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$220.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.37
|
| Rate for Payer: Healthfirst QHP |
$220.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$154.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$220.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$187.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$154.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$220.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$578.53
|
| Rate for Payer: SOMOS Essential |
$578.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$220.39
|
|
|
CHG URETHROCYSTOGRAPHY RETROGRADE RS&I
|
Professional
|
$359.17
|
|
|
Service Code
|
HCPCS 74450
|
| Min. Negotiated Rate |
$12.81 |
| Max. Negotiated Rate |
$269.38 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$269.38
|
| Rate for Payer: SOMOS Essential |
$269.38
|
|
|
CHG URETHROCYSTOGRAPHY RETROGRADE RS&I
|
Professional
|
$64.05
|
|
|
Service Code
|
HCPCS 74450 26
|
| Min. Negotiated Rate |
$12.81 |
| Max. Negotiated Rate |
$269.38 |
| Rate for Payer: Cash Price |
$16.85
|
| Rate for Payer: Cash Price |
$16.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.38
|
| Rate for Payer: Healthfirst QHP |
$18.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$12.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$18.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$15.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$12.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$48.04
|
| Rate for Payer: SOMOS Essential |
$48.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.30
|
|
|
CHG URETHROCYSTOGRAPHY RETROGRADE RS&I
|
Professional
|
$295.12
|
|
|
Service Code
|
HCPCS 74450 TC
|
| Min. Negotiated Rate |
$12.81 |
| Max. Negotiated Rate |
$269.38 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$221.34
|
| Rate for Payer: SOMOS Essential |
$221.34
|
|
|
CHG URETHROCYSTOGRAPHY VOIDING RS&I
|
Professional
|
$61.32
|
|
|
Service Code
|
HCPCS 74455 26
|
| Min. Negotiated Rate |
$12.26 |
| Max. Negotiated Rate |
$336.98 |
| Rate for Payer: Cash Price |
$16.85
|
| Rate for Payer: Cash Price |
$16.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.64
|
| Rate for Payer: Healthfirst QHP |
$17.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$12.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$17.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$14.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$12.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$45.99
|
| Rate for Payer: SOMOS Essential |
$45.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.52
|
|
|
CHG URETHROCYSTOGRAPHY VOIDING RS&I
|
Professional
|
$387.98
|
|
|
Service Code
|
HCPCS 74455 TC
|
| Min. Negotiated Rate |
$12.26 |
| Max. Negotiated Rate |
$336.98 |
| Rate for Payer: Cash Price |
$104.75
|
| Rate for Payer: Cash Price |
$104.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$99.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$99.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$105.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$110.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$105.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$110.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$110.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$83.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$105.31
|
| Rate for Payer: Healthfirst QHP |
$110.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$77.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$110.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$94.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$77.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$110.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$290.98
|
| Rate for Payer: SOMOS Essential |
$290.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$110.85
|
|
|
CHG URETHROCYSTOGRAPHY VOIDING RS&I
|
Professional
|
$449.30
|
|
|
Service Code
|
HCPCS 74455
|
| Min. Negotiated Rate |
$12.26 |
| Max. Negotiated Rate |
$336.98 |
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$115.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$115.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$121.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$128.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$121.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$128.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$128.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$96.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$121.95
|
| Rate for Payer: Healthfirst QHP |
$128.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$89.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$128.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$109.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$89.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$128.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$336.98
|
| Rate for Payer: SOMOS Essential |
$336.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$128.37
|
|
|
CHG URINARY BLADDER RESIDUAL STUDY
|
Professional
|
$291.76
|
|
|
Service Code
|
HCPCS 78730
|
| Min. Negotiated Rate |
$5.48 |
| Max. Negotiated Rate |
$218.82 |
| Rate for Payer: Cash Price |
$80.12
|
| Rate for Payer: Cash Price |
$80.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$75.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$75.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$79.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$83.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$79.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$62.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$79.19
|
| Rate for Payer: Healthfirst QHP |
$83.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$58.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$83.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$70.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$58.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$83.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$218.82
|
| Rate for Payer: SOMOS Essential |
$218.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$83.36
|
|
|
CHG URINARY BLADDER RESIDUAL STUDY
|
Professional
|
$27.41
|
|
|
Service Code
|
HCPCS 78730 26
|
| Min. Negotiated Rate |
$5.48 |
| Max. Negotiated Rate |
$218.82 |
| Rate for Payer: Cash Price |
$7.98
|
| Rate for Payer: Cash Price |
$7.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.44
|
| Rate for Payer: Healthfirst QHP |
$7.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$5.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$7.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$6.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$5.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.56
|
| Rate for Payer: SOMOS Essential |
$20.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.83
|
|
|
CHG URINARY BLADDER RESIDUAL STUDY
|
Professional
|
$264.36
|
|
|
Service Code
|
HCPCS 78730 TC
|
| Min. Negotiated Rate |
$5.48 |
| Max. Negotiated Rate |
$218.82 |
| Rate for Payer: Cash Price |
$72.14
|
| Rate for Payer: Cash Price |
$72.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$67.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$67.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$71.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$75.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$71.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$56.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$71.75
|
| Rate for Payer: Healthfirst QHP |
$75.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$52.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$75.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$64.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$52.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$75.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$198.27
|
| Rate for Payer: SOMOS Essential |
$198.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$75.53
|
|
|
CHG URINE ALBUMIN QUANTITATIVE
|
Professional
|
$14.45
|
|
|
Service Code
|
HCPCS 82043
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$10.84 |
| Rate for Payer: Cash Price |
$5.78
|
| Rate for Payer: Cash Price |
$5.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.49
|
| Rate for Payer: Healthfirst QHP |
$5.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$4.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$5.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$4.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$4.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$10.84
|
| Rate for Payer: SOMOS Essential |
$10.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.78
|
|
