|
CHG URINE ALBUMIN SEMIQUANTITATIVE
|
Professional
|
$24.92
|
|
|
Service Code
|
HCPCS 82044
|
| Min. Negotiated Rate |
$4.36 |
| Max. Negotiated Rate |
$18.69 |
| Rate for Payer: Cash Price |
$6.23
|
| Rate for Payer: Cash Price |
$6.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.92
|
| Rate for Payer: Healthfirst QHP |
$6.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$4.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$6.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$5.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$4.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18.69
|
| Rate for Payer: SOMOS Essential |
$18.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.23
|
|
|
CHG URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS
|
Professional
|
$21.52
|
|
|
Service Code
|
HCPCS 81025
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$16.14 |
| Rate for Payer: Cash Price |
$8.61
|
| Rate for Payer: Cash Price |
$8.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.18
|
| Rate for Payer: Healthfirst QHP |
$8.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$16.14
|
| Rate for Payer: SOMOS Essential |
$16.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.61
|
|
|
CHG URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY
|
Professional
|
$5.62
|
|
|
Service Code
|
HCPCS 81003
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$2.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.14
|
| Rate for Payer: Healthfirst QHP |
$2.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4.22
|
| Rate for Payer: SOMOS Essential |
$4.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.25
|
|
|
CHG URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP
|
Professional
|
$8.70
|
|
|
Service Code
|
HCPCS 81002
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$6.52 |
| Rate for Payer: Cash Price |
$3.48
|
| Rate for Payer: Cash Price |
$3.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.31
|
| Rate for Payer: Healthfirst QHP |
$3.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.52
|
| Rate for Payer: SOMOS Essential |
$6.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.48
|
|
|
CHG UROGRAPHY INFUSION DRIP &/BOLUS TECHNIQUE
|
Professional
|
$515.80
|
|
|
Service Code
|
HCPCS 74410 TC
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$455.31 |
| Rate for Payer: Cash Price |
$140.74
|
| Rate for Payer: Cash Price |
$140.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$132.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$132.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$147.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$110.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$140.00
|
| Rate for Payer: Healthfirst QHP |
$147.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$103.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$147.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$125.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$103.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$386.85
|
| Rate for Payer: SOMOS Essential |
$386.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.37
|
|
|
CHG UROGRAPHY INFUSION DRIP &/BOLUS TECHNIQUE
|
Professional
|
$91.28
|
|
|
Service Code
|
HCPCS 74410 26
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$455.31 |
| Rate for Payer: Cash Price |
$25.02
|
| Rate for Payer: Cash Price |
$25.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24.78
|
| Rate for Payer: Healthfirst QHP |
$26.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$68.46
|
| Rate for Payer: SOMOS Essential |
$68.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.08
|
|
|
CHG UROGRAPHY INFUSION DRIP &/BOLUS TECHNIQUE
|
Professional
|
$607.08
|
|
|
Service Code
|
HCPCS 74410
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$455.31 |
| Rate for Payer: Cash Price |
$165.76
|
| Rate for Payer: Cash Price |
$165.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$156.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$156.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$164.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$173.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$164.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$173.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$173.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$130.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$164.78
|
| Rate for Payer: Healthfirst QHP |
$173.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$121.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$173.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$147.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$121.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$173.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$455.31
|
| Rate for Payer: SOMOS Essential |
$455.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$173.45
|
|
|
CHG UROGRAPHY IV W/WO KUB W/WO TOMOGRAPHY
|
Professional
|
$491.33
|
|
|
Service Code
|
HCPCS 74400 TC
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$441.08 |
| Rate for Payer: Cash Price |
$132.49
|
| Rate for Payer: Cash Price |
$132.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$126.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$126.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$133.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$140.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$133.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$140.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$140.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$105.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.36
|
| Rate for Payer: Healthfirst QHP |
$140.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$98.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$140.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$119.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$98.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$140.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$368.50
|
| Rate for Payer: SOMOS Essential |
$368.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$140.38
|
|
|
CHG UROGRAPHY IV W/WO KUB W/WO TOMOGRAPHY
|
Professional
|
$96.74
|
|
|
Service Code
|
HCPCS 74400 26
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$441.08 |
| Rate for Payer: Cash Price |
$25.64
|
| Rate for Payer: Cash Price |
$25.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.26
|
| Rate for Payer: Healthfirst QHP |
$27.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$27.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$72.56
|
| Rate for Payer: SOMOS Essential |
$72.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.64
|
|
|
CHG UROGRAPHY IV W/WO KUB W/WO TOMOGRAPHY
|
Professional
|
$588.11
|
|
|
Service Code
|
HCPCS 74400
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$441.08 |
| Rate for Payer: Cash Price |
$158.13
|
| Rate for Payer: Cash Price |
$158.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$151.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$151.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$159.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$168.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$159.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$168.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$168.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$126.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$159.63
|
| Rate for Payer: Healthfirst QHP |
$168.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$117.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$168.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$142.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$117.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$168.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$441.08
|
| Rate for Payer: SOMOS Essential |
$441.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$168.03
|
|
|
CHG UROGRAPHY NFS DRIP &/BOLUS W/NEPHROTOMOGRAPHY
|
Professional
|
$92.72
|
|
|
Service Code
|
HCPCS 74415 26
|
| Min. Negotiated Rate |
$18.54 |
| Max. Negotiated Rate |
$500.59 |
| Rate for Payer: Cash Price |
$25.02
|
| Rate for Payer: Cash Price |
$25.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.17
|
| Rate for Payer: Healthfirst QHP |
$26.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.54
|
| Rate for Payer: SOMOS Essential |
$69.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.49
|
|
|
CHG UROGRAPHY NFS DRIP &/BOLUS W/NEPHROTOMOGRAPHY
|
Professional
|
$667.45
|
|
|
Service Code
|
HCPCS 74415
|
| Min. Negotiated Rate |
$18.54 |
| Max. Negotiated Rate |
$500.59 |
| Rate for Payer: Cash Price |
$176.76
|
| Rate for Payer: Cash Price |
$176.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$171.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$171.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$181.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$190.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$181.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$190.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$190.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$143.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$181.16
|
| Rate for Payer: Healthfirst QHP |
$190.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$133.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$190.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$162.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$133.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$190.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$500.59
|
| Rate for Payer: SOMOS Essential |
$500.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$190.70
|
|
|
CHG UROGRAPHY NFS DRIP &/BOLUS W/NEPHROTOMOGRAPHY
|
Professional
|
$574.74
|
|
|
Service Code
|
HCPCS 74415 TC
|
| Min. Negotiated Rate |
$18.54 |
| Max. Negotiated Rate |
$500.59 |
| Rate for Payer: Cash Price |
$151.74
|
| Rate for Payer: Cash Price |
$151.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$147.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$147.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$156.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$164.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$156.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$164.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$164.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$123.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$156.00
|
| Rate for Payer: Healthfirst QHP |
$164.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$114.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$164.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$139.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$114.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$164.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$431.06
|
| Rate for Payer: SOMOS Essential |
$431.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$164.21
|
|
|
CHG UROGRAPHY RETROGRADE WITH/WO KUB
|
Professional
|
$96.46
|
|
|
Service Code
|
HCPCS 74420 26
|
| Min. Negotiated Rate |
$19.29 |
| Max. Negotiated Rate |
$244.76 |
| Rate for Payer: Cash Price |
$26.46
|
| Rate for Payer: Cash Price |
$26.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.18
|
| Rate for Payer: Healthfirst QHP |
$27.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$27.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$72.34
|
| Rate for Payer: SOMOS Essential |
$72.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.56
|
|
|
CHG UROGRAPHY RETROGRADE WITH/WO KUB
|
Professional
|
$326.34
|
|
|
Service Code
|
HCPCS 74420
|
| Min. Negotiated Rate |
$19.29 |
| Max. Negotiated Rate |
$244.76 |
| Rate for Payer: Cash Price |
$90.35
|
| Rate for Payer: Cash Price |
$90.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$83.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$83.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$88.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$93.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$88.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$88.58
|
| Rate for Payer: Healthfirst QHP |
$93.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$65.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$93.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$79.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$65.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$93.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$244.76
|
| Rate for Payer: SOMOS Essential |
$244.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$93.24
|
|
|
CHG UROGRAPHY RETROGRADE WITH/WO KUB
|
Professional
|
$229.85
|
|
|
Service Code
|
HCPCS 74420 TC
|
| Min. Negotiated Rate |
$19.29 |
| Max. Negotiated Rate |
$244.76 |
| Rate for Payer: Cash Price |
$63.89
|
| Rate for Payer: Cash Price |
$63.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$59.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$59.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$65.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$49.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.39
|
| Rate for Payer: Healthfirst QHP |
$65.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$65.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$55.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$65.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$172.39
|
| Rate for Payer: SOMOS Essential |
$172.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.67
|
|
|
CHG US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA
|
Professional
|
$107.14
|
|
|
Service Code
|
HCPCS 76706 26
|
| Min. Negotiated Rate |
$21.43 |
| Max. Negotiated Rate |
$343.33 |
| Rate for Payer: Cash Price |
$28.52
|
| Rate for Payer: Cash Price |
$28.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$27.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$30.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.08
|
| Rate for Payer: Healthfirst QHP |
$30.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$30.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$80.36
|
| Rate for Payer: SOMOS Essential |
$80.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.61
|
|
|
CHG US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA
|
Professional
|
$457.77
|
|
|
Service Code
|
HCPCS 76706
|
| Min. Negotiated Rate |
$21.43 |
| Max. Negotiated Rate |
$343.33 |
| Rate for Payer: Cash Price |
$124.24
|
| Rate for Payer: Cash Price |
$124.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$117.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$117.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$124.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$130.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$124.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$98.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$124.25
|
| Rate for Payer: Healthfirst QHP |
$130.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$91.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$130.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$111.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$91.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$130.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$343.33
|
| Rate for Payer: SOMOS Essential |
$343.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.79
|
|
|
CHG US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA
|
Professional
|
$350.60
|
|
|
Service Code
|
HCPCS 76706 TC
|
| Min. Negotiated Rate |
$21.43 |
| Max. Negotiated Rate |
$343.33 |
| Rate for Payer: Cash Price |
$95.71
|
| Rate for Payer: Cash Price |
$95.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$90.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$90.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$95.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$100.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$95.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$75.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$95.16
|
| Rate for Payer: Healthfirst QHP |
$100.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$70.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$100.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$85.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$70.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$100.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$262.95
|
| Rate for Payer: SOMOS Essential |
$262.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$100.17
|
|
|
CHG US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION
|
Professional
|
$496.06
|
|
|
Service Code
|
HCPCS 76700
|
| Min. Negotiated Rate |
$30.81 |
| Max. Negotiated Rate |
$372.04 |
| Rate for Payer: Cash Price |
$134.95
|
| Rate for Payer: Cash Price |
$134.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$127.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$127.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$134.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$141.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$134.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$141.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$141.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$106.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$134.64
|
| Rate for Payer: Healthfirst QHP |
$141.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$99.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$141.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$120.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$99.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$141.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$372.04
|
| Rate for Payer: SOMOS Essential |
$372.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$141.73
|
|
|
CHG US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION
|
Professional
|
$341.99
|
|
|
Service Code
|
HCPCS 76700 TC
|
| Min. Negotiated Rate |
$30.81 |
| Max. Negotiated Rate |
$372.04 |
| Rate for Payer: Cash Price |
$93.20
|
| Rate for Payer: Cash Price |
$93.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$87.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$87.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$92.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$97.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$92.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$97.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$97.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$92.82
|
| Rate for Payer: Healthfirst QHP |
$97.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$68.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$97.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$83.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$68.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$97.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$256.49
|
| Rate for Payer: SOMOS Essential |
$256.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$97.71
|
|
|
CHG US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION
|
Professional
|
$154.07
|
|
|
Service Code
|
HCPCS 76700 26
|
| Min. Negotiated Rate |
$30.81 |
| Max. Negotiated Rate |
$372.04 |
| Rate for Payer: Cash Price |
$41.75
|
| Rate for Payer: Cash Price |
$41.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$44.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.82
|
| Rate for Payer: Healthfirst QHP |
$44.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$44.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$44.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$115.55
|
| Rate for Payer: SOMOS Essential |
$115.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44.02
|
|
|
CHG US ABDOMINAL REAL TIME W/IMAGE LIMITED
|
Professional
|
$115.05
|
|
|
Service Code
|
HCPCS 76705 26
|
| Min. Negotiated Rate |
$23.01 |
| Max. Negotiated Rate |
$282.40 |
| Rate for Payer: Cash Price |
$30.31
|
| Rate for Payer: Cash Price |
$30.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.23
|
| Rate for Payer: Healthfirst QHP |
$32.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$86.29
|
| Rate for Payer: SOMOS Essential |
$86.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.87
|
|
|
CHG US ABDOMINAL REAL TIME W/IMAGE LIMITED
|
Professional
|
$261.49
|
|
|
Service Code
|
HCPCS 76705 TC
|
| Min. Negotiated Rate |
$23.01 |
| Max. Negotiated Rate |
$282.40 |
| Rate for Payer: Cash Price |
$70.57
|
| Rate for Payer: Cash Price |
$70.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$67.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$67.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$70.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$74.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$70.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$74.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$56.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$70.97
|
| Rate for Payer: Healthfirst QHP |
$74.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$52.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$74.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$63.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$52.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$74.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$196.12
|
| Rate for Payer: SOMOS Essential |
$196.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$74.71
|
|
|
CHG US ABDOMINAL REAL TIME W/IMAGE LIMITED
|
Professional
|
$376.53
|
|
|
Service Code
|
HCPCS 76705
|
| Min. Negotiated Rate |
$23.01 |
| Max. Negotiated Rate |
$282.40 |
| Rate for Payer: Cash Price |
$100.88
|
| Rate for Payer: Cash Price |
$100.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$96.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$96.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$102.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$102.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$107.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$102.20
|
| Rate for Payer: Healthfirst QHP |
$107.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$75.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$107.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$91.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$75.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$107.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$282.40
|
| Rate for Payer: SOMOS Essential |
$282.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$107.58
|
|
