|
CHG US BONE DENSITY MEAS & INTERP PERIPH ANY METHO
|
Professional
|
$19.99
|
|
|
Service Code
|
HCPCS 76977 TC
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$23.89 |
| Rate for Payer: Cash Price |
$5.73
|
| Rate for Payer: Cash Price |
$5.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.42
|
| Rate for Payer: Healthfirst QHP |
$5.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$4.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$5.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$4.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$4.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$14.99
|
| Rate for Payer: SOMOS Essential |
$14.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.71
|
|
|
CHG US BONE DENSITY MEAS & INTERP PERIPH ANY METHO
|
Professional
|
$11.87
|
|
|
Service Code
|
HCPCS 76977 26
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$23.89 |
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.22
|
| Rate for Payer: Healthfirst QHP |
$3.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.90
|
| Rate for Payer: SOMOS Essential |
$8.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.39
|
|
|
CHG US BONE DENSITY MEAS & INTERP PERIPH ANY METHO
|
Professional
|
$31.85
|
|
|
Service Code
|
HCPCS 76977
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$23.89 |
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.64
|
| Rate for Payer: Healthfirst QHP |
$9.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.89
|
| Rate for Payer: SOMOS Essential |
$23.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.10
|
|
|
CHG US BREAST UNI REAL TIME WITH IMAGE COMPLETE
|
Professional
|
$298.87
|
|
|
Service Code
|
HCPCS 76641 TC
|
| Min. Negotiated Rate |
$28.24 |
| Max. Negotiated Rate |
$330.04 |
| Rate for Payer: Cash Price |
$80.78
|
| Rate for Payer: Cash Price |
$80.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$76.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$76.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$81.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$85.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$81.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$81.12
|
| Rate for Payer: Healthfirst QHP |
$85.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$59.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$85.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$72.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$59.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$85.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$224.15
|
| Rate for Payer: SOMOS Essential |
$224.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$85.39
|
|
|
CHG US BREAST UNI REAL TIME WITH IMAGE COMPLETE
|
Professional
|
$440.06
|
|
|
Service Code
|
HCPCS 76641
|
| Min. Negotiated Rate |
$28.24 |
| Max. Negotiated Rate |
$330.04 |
| Rate for Payer: Cash Price |
$118.96
|
| Rate for Payer: Cash Price |
$118.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$113.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$113.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$119.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$125.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$119.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$94.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$119.44
|
| Rate for Payer: Healthfirst QHP |
$125.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$88.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$125.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$106.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$88.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$125.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$330.04
|
| Rate for Payer: SOMOS Essential |
$330.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$125.73
|
|
|
CHG US BREAST UNI REAL TIME WITH IMAGE COMPLETE
|
Professional
|
$141.19
|
|
|
Service Code
|
HCPCS 76641 26
|
| Min. Negotiated Rate |
$28.24 |
| Max. Negotiated Rate |
$330.04 |
| Rate for Payer: Cash Price |
$38.18
|
| Rate for Payer: Cash Price |
$38.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.32
|
| Rate for Payer: Healthfirst QHP |
$40.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$40.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$105.89
|
| Rate for Payer: SOMOS Essential |
$105.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.34
|
|
|
CHG US BREAST UNI REAL TIME WITH IMAGE LIMITED
|
Professional
|
$361.90
|
|
|
Service Code
|
HCPCS 76642
|
| Min. Negotiated Rate |
$26.41 |
| Max. Negotiated Rate |
$271.42 |
| Rate for Payer: Cash Price |
$98.36
|
| Rate for Payer: Cash Price |
$98.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$93.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$93.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$98.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$103.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$98.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$103.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$77.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$98.23
|
| Rate for Payer: Healthfirst QHP |
$103.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$72.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$103.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$87.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$72.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$103.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$271.42
|
| Rate for Payer: SOMOS Essential |
$271.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$103.40
|
|
|
CHG US BREAST UNI REAL TIME WITH IMAGE LIMITED
|
Professional
|
$132.06
|
|
|
Service Code
|
HCPCS 76642 26
|
| Min. Negotiated Rate |
$26.41 |
| Max. Negotiated Rate |
$271.42 |
| Rate for Payer: Cash Price |
$35.65
|
| Rate for Payer: Cash Price |
$35.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.84
|
| Rate for Payer: Healthfirst QHP |
$37.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$99.04
|
| Rate for Payer: SOMOS Essential |
$99.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.73
|
|
|
CHG US BREAST UNI REAL TIME WITH IMAGE LIMITED
|
Professional
|
$229.85
|
|
|
Service Code
|
HCPCS 76642 TC
|
| Min. Negotiated Rate |
$26.41 |
| Max. Negotiated Rate |
$271.42 |
| Rate for Payer: Cash Price |
$62.71
|
| Rate for Payer: Cash Price |
$62.71
|
| 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 CHEST REAL TIME W/IMAGE DOCUMENTATION
|
Professional
|
$127.79
|
|
|
Service Code
|
HCPCS 76604 TC
|
| Min. Negotiated Rate |
$22.43 |
| Max. Negotiated Rate |
$179.97 |
| Rate for Payer: Cash Price |
$35.99
|
| Rate for Payer: Cash Price |
$35.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.68
|
| Rate for Payer: Healthfirst QHP |
$36.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$36.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$31.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$95.84
|
| Rate for Payer: SOMOS Essential |
$95.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.51
|
|
|
CHG US CHEST REAL TIME W/IMAGE DOCUMENTATION
|
Professional
|
$239.96
|
|
|
Service Code
|
HCPCS 76604
|
| Min. Negotiated Rate |
$22.43 |
| Max. Negotiated Rate |
$179.97 |
| Rate for Payer: Cash Price |
$65.51
|
| Rate for Payer: Cash Price |
$65.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$61.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$65.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$68.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$65.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$68.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$68.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$65.13
|
| Rate for Payer: Healthfirst QHP |
$68.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$47.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$68.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$58.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$47.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$68.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$179.97
|
| Rate for Payer: SOMOS Essential |
$179.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$68.56
|
|
|
CHG US CHEST REAL TIME W/IMAGE DOCUMENTATION
|
Professional
|
$112.14
|
|
|
Service Code
|
HCPCS 76604 26
|
| Min. Negotiated Rate |
$22.43 |
| Max. Negotiated Rate |
$179.97 |
| Rate for Payer: Cash Price |
$29.52
|
| Rate for Payer: Cash Price |
$29.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.44
|
| Rate for Payer: Healthfirst QHP |
$32.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$84.10
|
| Rate for Payer: SOMOS Essential |
$84.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.04
|
|
|
CHG US CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL
|
Professional
|
$723.94
|
|
|
Service Code
|
HCPCS 76936 TC
|
| Min. Negotiated Rate |
$77.70 |
| Max. Negotiated Rate |
$834.33 |
| Rate for Payer: Cash Price |
$199.13
|
| Rate for Payer: Cash Price |
$199.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$186.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$186.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$196.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$206.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$196.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$206.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$206.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$155.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$196.50
|
| Rate for Payer: Healthfirst QHP |
$206.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$144.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$206.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$175.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$144.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$206.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$542.96
|
| Rate for Payer: SOMOS Essential |
$542.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$206.84
|
|
|
CHG US CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL
|
Professional
|
$388.50
|
|
|
Service Code
|
HCPCS 76936 26
|
| Min. Negotiated Rate |
$77.70 |
| Max. Negotiated Rate |
$834.33 |
| Rate for Payer: Cash Price |
$104.54
|
| Rate for Payer: Cash Price |
$104.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$99.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$99.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$105.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$111.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$105.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$111.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$83.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$105.45
|
| Rate for Payer: Healthfirst QHP |
$111.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$77.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$111.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$94.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$77.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$111.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$291.38
|
| Rate for Payer: SOMOS Essential |
$291.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$111.00
|
|
|
CHG US CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL
|
Professional
|
$1,112.44
|
|
|
Service Code
|
HCPCS 76936
|
| Min. Negotiated Rate |
$77.70 |
| Max. Negotiated Rate |
$834.33 |
| Rate for Payer: Cash Price |
$303.67
|
| Rate for Payer: Cash Price |
$303.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$286.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$286.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$301.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$317.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$301.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$317.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$317.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$238.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$301.95
|
| Rate for Payer: Healthfirst QHP |
$317.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$222.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$317.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$270.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$222.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$317.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$834.33
|
| Rate for Payer: SOMOS Essential |
$834.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$317.84
|
|
|
CHG US COMPL JOINT R-T W/IMAGE DOCUMENTATION
|
Professional
|
$172.55
|
|
|
Service Code
|
HCPCS 76881 26
|
| Min. Negotiated Rate |
$9.74 |
| Max. Negotiated Rate |
$165.95 |
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$44.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$44.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$46.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$49.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$46.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.84
|
| Rate for Payer: Healthfirst QHP |
$49.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$49.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$49.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$129.41
|
| Rate for Payer: SOMOS Essential |
$129.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$49.30
|
|
|
CHG US COMPL JOINT R-T W/IMAGE DOCUMENTATION
|
Professional
|
$48.72
|
|
|
Service Code
|
HCPCS 76881 TC
|
| Min. Negotiated Rate |
$9.74 |
| Max. Negotiated Rate |
$165.95 |
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.22
|
| Rate for Payer: Healthfirst QHP |
$13.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$13.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$11.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36.54
|
| Rate for Payer: SOMOS Essential |
$36.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.92
|
|
|
CHG US COMPL JOINT R-T W/IMAGE DOCUMENTATION
|
Professional
|
$221.27
|
|
|
Service Code
|
HCPCS 76881
|
| Min. Negotiated Rate |
$9.74 |
| Max. Negotiated Rate |
$165.95 |
| Rate for Payer: Cash Price |
$60.45
|
| Rate for Payer: Cash Price |
$60.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$56.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$56.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$60.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$63.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$60.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.06
|
| Rate for Payer: Healthfirst QHP |
$63.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$44.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$63.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$53.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$44.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$63.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$165.95
|
| Rate for Payer: SOMOS Essential |
$165.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$63.22
|
|
|
CHG US ENDOMYOCARDIAL BIOPSY RS&I
|
Professional
|
$464.59
|
|
|
Service Code
|
HCPCS 76932
|
| Min. Negotiated Rate |
$30.59 |
| Max. Negotiated Rate |
$348.44 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$348.44
|
| Rate for Payer: SOMOS Essential |
$348.44
|
|
|
CHG US ENDOMYOCARDIAL BIOPSY RS&I
|
Professional
|
$311.64
|
|
|
Service Code
|
HCPCS 76932 TC
|
| Min. Negotiated Rate |
$30.59 |
| Max. Negotiated Rate |
$348.44 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$233.73
|
| Rate for Payer: SOMOS Essential |
$233.73
|
|
|
CHG US ENDOMYOCARDIAL BIOPSY RS&I
|
Professional
|
$152.95
|
|
|
Service Code
|
HCPCS 76932 26
|
| Min. Negotiated Rate |
$30.59 |
| Max. Negotiated Rate |
$348.44 |
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.52
|
| Rate for Payer: Healthfirst QHP |
$43.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$43.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$114.71
|
| Rate for Payer: SOMOS Essential |
$114.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.70
|
|
|
CHG US FETAL NUCHAL TRANSLUCENCY 1ST GESTATION
|
Professional
|
$265.79
|
|
|
Service Code
|
HCPCS 76813 TC
|
| Min. Negotiated Rate |
$44.98 |
| Max. Negotiated Rate |
$368.00 |
| Rate for Payer: Cash Price |
$71.35
|
| Rate for Payer: Cash Price |
$71.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$68.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$68.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$72.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$75.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$72.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$56.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$72.14
|
| Rate for Payer: Healthfirst QHP |
$75.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$53.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$75.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$64.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$53.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$75.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$199.34
|
| Rate for Payer: SOMOS Essential |
$199.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$75.94
|
|
|
CHG US FETAL NUCHAL TRANSLUCENCY 1ST GESTATION
|
Professional
|
$490.67
|
|
|
Service Code
|
HCPCS 76813
|
| Min. Negotiated Rate |
$44.98 |
| Max. Negotiated Rate |
$368.00 |
| Rate for Payer: Cash Price |
$132.06
|
| Rate for Payer: Cash Price |
$132.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$126.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$126.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$133.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$140.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$133.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$140.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$140.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$105.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.18
|
| Rate for Payer: Healthfirst QHP |
$140.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$98.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$140.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$119.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$98.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$140.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$368.00
|
| Rate for Payer: SOMOS Essential |
$368.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$140.19
|
|
|
CHG US FETAL NUCHAL TRANSLUCENCY 1ST GESTATION
|
Professional
|
$224.88
|
|
|
Service Code
|
HCPCS 76813 26
|
| Min. Negotiated Rate |
$44.98 |
| Max. Negotiated Rate |
$368.00 |
| Rate for Payer: Cash Price |
$60.71
|
| Rate for Payer: Cash Price |
$60.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$57.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$57.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$61.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$64.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$61.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.04
|
| Rate for Payer: Healthfirst QHP |
$64.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$44.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$64.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$54.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$44.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$64.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$168.66
|
| Rate for Payer: SOMOS Essential |
$168.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$64.25
|
|
|
CHG US FETAL NUCHAL TRANSLUCENCY EA ADDL GESTATION
|
Professional
|
$184.10
|
|
|
Service Code
|
HCPCS 76814 26
|
| Min. Negotiated Rate |
$24.70 |
| Max. Negotiated Rate |
$230.68 |
| Rate for Payer: Cash Price |
$50.71
|
| Rate for Payer: Cash Price |
$50.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.97
|
| Rate for Payer: Healthfirst QHP |
$52.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$138.08
|
| Rate for Payer: SOMOS Essential |
$138.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.60
|
|
