|
CHG US FETAL NUCHAL TRANSLUCENCY EA ADDL GESTATION
|
Professional
|
$307.58
|
|
|
Service Code
|
HCPCS 76814
|
| Min. Negotiated Rate |
$24.70 |
| Max. Negotiated Rate |
$230.68 |
| Rate for Payer: Cash Price |
$83.95
|
| Rate for Payer: Cash Price |
$83.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$79.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$79.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$83.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$87.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$83.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$87.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$87.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$65.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$83.49
|
| Rate for Payer: Healthfirst QHP |
$87.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$61.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$87.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$74.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$61.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$87.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$230.68
|
| Rate for Payer: SOMOS Essential |
$230.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$87.88
|
|
|
CHG US FETAL NUCHAL TRANSLUCENCY EA ADDL GESTATION
|
Professional
|
$123.48
|
|
|
Service Code
|
HCPCS 76814 TC
|
| Min. Negotiated Rate |
$24.70 |
| Max. Negotiated Rate |
$230.68 |
| Rate for Payer: Cash Price |
$33.24
|
| Rate for Payer: Cash Price |
$33.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.52
|
| Rate for Payer: Healthfirst QHP |
$35.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$92.61
|
| Rate for Payer: SOMOS Essential |
$92.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.28
|
|
|
CHG US GUIDANCE AMNIOCENTESIS IMG S&I
|
Professional
|
$64.54
|
|
|
Service Code
|
HCPCS 76946 TC
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$102.32 |
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.52
|
| Rate for Payer: Healthfirst QHP |
$18.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$12.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$18.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$15.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$12.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$48.40
|
| Rate for Payer: SOMOS Essential |
$48.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.44
|
|
|
CHG US GUIDANCE AMNIOCENTESIS IMG S&I
|
Professional
|
$71.89
|
|
|
Service Code
|
HCPCS 76946 26
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$102.32 |
| Rate for Payer: Cash Price |
$19.77
|
| Rate for Payer: Cash Price |
$19.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.51
|
| Rate for Payer: Healthfirst QHP |
$20.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$20.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$17.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$14.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$53.92
|
| Rate for Payer: SOMOS Essential |
$53.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.54
|
|
|
CHG US GUIDANCE AMNIOCENTESIS IMG S&I
|
Professional
|
$136.43
|
|
|
Service Code
|
HCPCS 76946
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$102.32 |
| Rate for Payer: Cash Price |
$38.08
|
| Rate for Payer: Cash Price |
$38.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.03
|
| Rate for Payer: Healthfirst QHP |
$38.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$102.32
|
| Rate for Payer: SOMOS Essential |
$102.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.98
|
|
|
CHG US GUIDANCE ASPIRATION OVA IMG S&I
|
Professional
|
$124.04
|
|
|
Service Code
|
HCPCS 76948 26
|
| Min. Negotiated Rate |
$24.81 |
| Max. Negotiated Rate |
$252.47 |
| Rate for Payer: Cash Price |
$34.21
|
| Rate for Payer: Cash Price |
$34.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.67
|
| Rate for Payer: Healthfirst QHP |
$35.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$93.03
|
| Rate for Payer: SOMOS Essential |
$93.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.44
|
|
|
CHG US GUIDANCE ASPIRATION OVA IMG S&I
|
Professional
|
$212.63
|
|
|
Service Code
|
HCPCS 76948 TC
|
| Min. Negotiated Rate |
$24.81 |
| Max. Negotiated Rate |
$252.47 |
| Rate for Payer: Cash Price |
$58.39
|
| Rate for Payer: Cash Price |
$58.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$54.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$54.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$57.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$60.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$57.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$57.71
|
| Rate for Payer: Healthfirst QHP |
$60.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$42.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$60.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$51.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$42.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$60.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$159.47
|
| Rate for Payer: SOMOS Essential |
$159.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$60.75
|
|
|
CHG US GUIDANCE ASPIRATION OVA IMG S&I
|
Professional
|
$336.63
|
|
|
Service Code
|
HCPCS 76948
|
| Min. Negotiated Rate |
$24.81 |
| Max. Negotiated Rate |
$252.47 |
| Rate for Payer: Cash Price |
$92.59
|
| Rate for Payer: Cash Price |
$92.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$86.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$86.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$91.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$96.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$91.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$96.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$96.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$91.37
|
| Rate for Payer: Healthfirst QHP |
$96.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$67.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$96.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$81.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$67.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$96.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$252.47
|
| Rate for Payer: SOMOS Essential |
$252.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$96.18
|
|
|
CHG US GUIDANCE CHORIONIC VILLUS SAMPLING IMG S&I
|
Professional
|
$432.36
|
|
|
Service Code
|
HCPCS 76945
|
| Min. Negotiated Rate |
$24.81 |
| Max. Negotiated Rate |
$324.27 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$324.27
|
| Rate for Payer: SOMOS Essential |
$324.27
|
|
|
CHG US GUIDANCE CHORIONIC VILLUS SAMPLING IMG S&I
|
Professional
|
$308.32
|
|
|
Service Code
|
HCPCS 76945 TC
|
| Min. Negotiated Rate |
$24.81 |
| Max. Negotiated Rate |
$324.27 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$231.24
|
| Rate for Payer: SOMOS Essential |
$231.24
|
|
|
CHG US GUIDANCE CHORIONIC VILLUS SAMPLING IMG S&I
|
Professional
|
$124.04
|
|
|
Service Code
|
HCPCS 76945 26
|
| Min. Negotiated Rate |
$24.81 |
| Max. Negotiated Rate |
$324.27 |
| Rate for Payer: Cash Price |
$34.21
|
| Rate for Payer: Cash Price |
$34.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.67
|
| Rate for Payer: Healthfirst QHP |
$35.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$93.03
|
| Rate for Payer: SOMOS Essential |
$93.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.44
|
|
|
CHG US GUIDANCE INTERSTITIAL RADIOELMENT APPLICATION
|
Professional
|
$265.02
|
|
|
Service Code
|
HCPCS 76965 26
|
| Min. Negotiated Rate |
$23.55 |
| Max. Negotiated Rate |
$287.07 |
| Rate for Payer: Cash Price |
$73.83
|
| Rate for Payer: Cash Price |
$73.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$68.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$68.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$71.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$75.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$71.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$56.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$71.93
|
| Rate for Payer: Healthfirst QHP |
$75.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$53.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$75.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$64.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$53.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$75.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$198.76
|
| Rate for Payer: SOMOS Essential |
$198.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$75.72
|
|
|
CHG US GUIDANCE INTERSTITIAL RADIOELMENT APPLICATION
|
Professional
|
$117.74
|
|
|
Service Code
|
HCPCS 76965 TC
|
| Min. Negotiated Rate |
$23.55 |
| Max. Negotiated Rate |
$287.07 |
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.96
|
| Rate for Payer: Healthfirst QHP |
$33.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$33.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$88.30
|
| Rate for Payer: SOMOS Essential |
$88.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.64
|
|
|
CHG US GUIDANCE INTERSTITIAL RADIOELMENT APPLICATION
|
Professional
|
$382.76
|
|
|
Service Code
|
HCPCS 76965
|
| Min. Negotiated Rate |
$23.55 |
| Max. Negotiated Rate |
$287.07 |
| Rate for Payer: Cash Price |
$106.67
|
| Rate for Payer: Cash Price |
$106.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$98.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$98.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$103.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$109.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$103.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$109.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$82.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$103.89
|
| Rate for Payer: Healthfirst QHP |
$109.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$76.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$109.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$92.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$76.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$109.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$287.07
|
| Rate for Payer: SOMOS Essential |
$287.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$109.36
|
|
|
CHG US GUIDANCE NEEDLE PLACEMENT IMG S&I
|
Professional
|
$122.05
|
|
|
Service Code
|
HCPCS 76942 TC
|
| Min. Negotiated Rate |
$24.41 |
| Max. Negotiated Rate |
$183.17 |
| Rate for Payer: Cash Price |
$33.63
|
| Rate for Payer: Cash Price |
$33.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.13
|
| Rate for Payer: Healthfirst QHP |
$34.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$91.54
|
| Rate for Payer: SOMOS Essential |
$91.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.87
|
|
|
CHG US GUIDANCE NEEDLE PLACEMENT IMG S&I
|
Professional
|
$244.23
|
|
|
Service Code
|
HCPCS 76942
|
| Min. Negotiated Rate |
$24.41 |
| Max. Negotiated Rate |
$183.17 |
| Rate for Payer: Cash Price |
$66.34
|
| Rate for Payer: Cash Price |
$66.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$62.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$66.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$69.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$66.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$69.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$69.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$52.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$66.29
|
| Rate for Payer: Healthfirst QHP |
$69.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$48.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$69.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$59.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$48.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$69.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$183.17
|
| Rate for Payer: SOMOS Essential |
$183.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$69.78
|
|
|
CHG US GUIDANCE NEEDLE PLACEMENT IMG S&I
|
Professional
|
$122.19
|
|
|
Service Code
|
HCPCS 76942 26
|
| Min. Negotiated Rate |
$24.41 |
| Max. Negotiated Rate |
$183.17 |
| Rate for Payer: Cash Price |
$32.71
|
| Rate for Payer: Cash Price |
$32.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.16
|
| Rate for Payer: Healthfirst QHP |
$34.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$91.64
|
| Rate for Payer: SOMOS Essential |
$91.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.91
|
|
|
CHG US INFT HIPS R-T IMG DYNAMIC REQ PHYS/QHP MANJ
|
Professional
|
$372.05
|
|
|
Service Code
|
HCPCS 76885 TC
|
| Min. Negotiated Rate |
$28.49 |
| Max. Negotiated Rate |
$385.85 |
| Rate for Payer: Cash Price |
$119.52
|
| Rate for Payer: Cash Price |
$119.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$114.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$114.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$120.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$126.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$120.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$95.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$120.49
|
| Rate for Payer: Healthfirst QHP |
$126.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$88.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$126.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$107.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$88.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$126.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$279.04
|
| Rate for Payer: SOMOS Essential |
$279.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$126.83
|
|
|
CHG US INFT HIPS R-T IMG DYNAMIC REQ PHYS/QHP MANJ
|
Professional
|
$142.45
|
|
|
Service Code
|
HCPCS 76885 26
|
| Min. Negotiated Rate |
$28.49 |
| Max. Negotiated Rate |
$385.85 |
| Rate for Payer: Cash Price |
$38.52
|
| Rate for Payer: Cash Price |
$38.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.66
|
| Rate for Payer: Healthfirst QHP |
$40.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$40.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$106.84
|
| Rate for Payer: SOMOS Essential |
$106.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.70
|
|
|
CHG US INFT HIPS R-T IMG DYNAMIC REQ PHYS/QHP MANJ
|
Professional
|
$514.47
|
|
|
Service Code
|
HCPCS 76885
|
| Min. Negotiated Rate |
$28.49 |
| Max. Negotiated Rate |
$385.85 |
| Rate for Payer: Cash Price |
$158.05
|
| Rate for Payer: Cash Price |
$158.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$150.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$150.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$159.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$167.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$159.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$167.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$167.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$125.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$159.15
|
| Rate for Payer: Healthfirst QHP |
$167.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$117.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$167.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$142.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$117.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$167.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$385.85
|
| Rate for Payer: SOMOS Essential |
$385.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$167.53
|
|
|
CHG US INFT HIPS R-T IMG LMTD STATIC PHYS/QHP MANJ
|
Professional
|
$432.01
|
|
|
Service Code
|
HCPCS 76886
|
| Min. Negotiated Rate |
$24.33 |
| Max. Negotiated Rate |
$324.01 |
| Rate for Payer: Cash Price |
$115.68
|
| Rate for Payer: Cash Price |
$115.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$111.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$111.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$117.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$123.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$117.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$123.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$123.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$92.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$117.26
|
| Rate for Payer: Healthfirst QHP |
$123.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$86.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$123.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$104.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$86.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$123.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$324.01
|
| Rate for Payer: SOMOS Essential |
$324.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$123.43
|
|
|
CHG US INFT HIPS R-T IMG LMTD STATIC PHYS/QHP MANJ
|
Professional
|
$121.66
|
|
|
Service Code
|
HCPCS 76886 26
|
| Min. Negotiated Rate |
$24.33 |
| Max. Negotiated Rate |
$324.01 |
| Rate for Payer: Cash Price |
$32.14
|
| Rate for Payer: Cash Price |
$32.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.02
|
| Rate for Payer: Healthfirst QHP |
$34.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$91.24
|
| Rate for Payer: SOMOS Essential |
$91.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.76
|
|
|
CHG US INFT HIPS R-T IMG LMTD STATIC PHYS/QHP MANJ
|
Professional
|
$310.35
|
|
|
Service Code
|
HCPCS 76886 TC
|
| Min. Negotiated Rate |
$24.33 |
| Max. Negotiated Rate |
$324.01 |
| Rate for Payer: Cash Price |
$83.53
|
| Rate for Payer: Cash Price |
$83.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$79.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$79.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$88.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$84.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$88.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$66.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$84.24
|
| Rate for Payer: Healthfirst QHP |
$88.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$62.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$88.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$75.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$62.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$88.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$232.76
|
| Rate for Payer: SOMOS Essential |
$232.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$88.67
|
|
|
CHG US INTRAUTERINE FTL TFUJ/CORDOCNTS IMG S&I
|
Professional
|
$253.54
|
|
|
Service Code
|
HCPCS 76941 26
|
| Min. Negotiated Rate |
$50.71 |
| Max. Negotiated Rate |
$421.40 |
| Rate for Payer: Cash Price |
$69.04
|
| Rate for Payer: Cash Price |
$69.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$65.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$68.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$68.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$68.82
|
| Rate for Payer: Healthfirst QHP |
$72.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$50.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$72.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$61.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$50.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$190.16
|
| Rate for Payer: SOMOS Essential |
$190.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.44
|
|
|
CHG US INTRAUTERINE FTL TFUJ/CORDOCNTS IMG S&I
|
Professional
|
$561.86
|
|
|
Service Code
|
HCPCS 76941
|
| Min. Negotiated Rate |
$50.71 |
| Max. Negotiated Rate |
$421.40 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$421.40
|
| Rate for Payer: SOMOS Essential |
$421.40
|
|
