|
CHG US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO
|
Professional
|
$369.29
|
|
|
Service Code
|
HCPCS 76810
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$276.97 |
| Rate for Payer: Cash Price |
$99.31
|
| Rate for Payer: Cash Price |
$99.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$94.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$94.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$100.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$105.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$100.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$79.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$100.23
|
| Rate for Payer: Healthfirst QHP |
$105.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$73.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$105.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$89.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$73.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$105.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$276.97
|
| Rate for Payer: SOMOS Essential |
$276.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$105.51
|
|
|
CHG US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO
|
Professional
|
$180.99
|
|
|
Service Code
|
HCPCS 76810 TC
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$276.97 |
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$46.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$46.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$51.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.12
|
| Rate for Payer: Healthfirst QHP |
$51.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$51.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$43.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$51.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$135.74
|
| Rate for Payer: SOMOS Essential |
$135.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$51.71
|
|
|
CHG US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO
|
Professional
|
$188.30
|
|
|
Service Code
|
HCPCS 76810 26
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$276.97 |
| Rate for Payer: Cash Price |
$50.36
|
| Rate for Payer: Cash Price |
$50.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$48.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$48.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$51.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$53.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$51.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$51.11
|
| Rate for Payer: Healthfirst QHP |
$53.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$53.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$45.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$53.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$141.22
|
| Rate for Payer: SOMOS Essential |
$141.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.80
|
|
|
CHG US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION
|
Professional
|
$189.56
|
|
|
Service Code
|
HCPCS 76805 26
|
| Min. Negotiated Rate |
$37.91 |
| Max. Negotiated Rate |
$431.97 |
| Rate for Payer: Cash Price |
$51.57
|
| Rate for Payer: Cash Price |
$51.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$48.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$48.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$51.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$54.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$51.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$51.45
|
| Rate for Payer: Healthfirst QHP |
$54.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$54.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$46.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$54.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$142.17
|
| Rate for Payer: SOMOS Essential |
$142.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.16
|
|
|
CHG US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION
|
Professional
|
$575.96
|
|
|
Service Code
|
HCPCS 76805
|
| Min. Negotiated Rate |
$37.91 |
| Max. Negotiated Rate |
$431.97 |
| Rate for Payer: Cash Price |
$156.94
|
| Rate for Payer: Cash Price |
$156.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$148.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$148.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$156.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$164.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$156.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$164.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$164.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$123.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$156.33
|
| Rate for Payer: Healthfirst QHP |
$164.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$115.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$164.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$139.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$115.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$164.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$431.97
|
| Rate for Payer: SOMOS Essential |
$431.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$164.56
|
|
|
CHG US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION
|
Professional
|
$386.40
|
|
|
Service Code
|
HCPCS 76805 TC
|
| Min. Negotiated Rate |
$37.91 |
| Max. Negotiated Rate |
$431.97 |
| Rate for Payer: Cash Price |
$105.38
|
| Rate for Payer: Cash Price |
$105.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$99.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$99.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$104.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$110.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$104.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$110.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$110.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$82.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$104.88
|
| Rate for Payer: Healthfirst QHP |
$110.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$77.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$110.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$93.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$77.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$110.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$289.80
|
| Rate for Payer: SOMOS Essential |
$289.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$110.40
|
|
|
CHG US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT
|
Professional
|
$801.43
|
|
|
Service Code
|
HCPCS 76812
|
| Min. Negotiated Rate |
$66.61 |
| Max. Negotiated Rate |
$601.07 |
| Rate for Payer: Cash Price |
$219.46
|
| Rate for Payer: Cash Price |
$219.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$206.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$206.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$217.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$228.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$217.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$228.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$228.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$171.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$217.53
|
| Rate for Payer: Healthfirst QHP |
$228.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$160.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$228.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$194.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$160.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$228.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$601.07
|
| Rate for Payer: SOMOS Essential |
$601.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$228.98
|
|
|
CHG US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT
|
Professional
|
$468.34
|
|
|
Service Code
|
HCPCS 76812 TC
|
| Min. Negotiated Rate |
$66.61 |
| Max. Negotiated Rate |
$601.07 |
| Rate for Payer: Cash Price |
$127.78
|
| Rate for Payer: Cash Price |
$127.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$120.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$120.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$127.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$133.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$127.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$133.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$133.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$100.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$127.12
|
| Rate for Payer: Healthfirst QHP |
$133.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$93.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$133.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$113.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$93.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$133.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$351.26
|
| Rate for Payer: SOMOS Essential |
$351.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$133.81
|
|
|
CHG US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT
|
Professional
|
$333.06
|
|
|
Service Code
|
HCPCS 76812 26
|
| Min. Negotiated Rate |
$66.61 |
| Max. Negotiated Rate |
$601.07 |
| Rate for Payer: Cash Price |
$91.69
|
| Rate for Payer: Cash Price |
$91.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$85.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$85.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$90.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$95.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$90.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$95.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$95.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$71.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$90.40
|
| Rate for Payer: Healthfirst QHP |
$95.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$66.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$95.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$80.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$66.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$95.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$249.80
|
| Rate for Payer: SOMOS Essential |
$249.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$95.16
|
|
|
CHG US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS
|
Professional
|
$159.36
|
|
|
Service Code
|
HCPCS 76816 26
|
| Min. Negotiated Rate |
$31.87 |
| Max. Negotiated Rate |
$345.82 |
| Rate for Payer: Cash Price |
$43.86
|
| Rate for Payer: Cash Price |
$43.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$45.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43.25
|
| Rate for Payer: Healthfirst QHP |
$45.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$45.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$38.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$119.52
|
| Rate for Payer: SOMOS Essential |
$119.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.53
|
|
|
CHG US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS
|
Professional
|
$461.09
|
|
|
Service Code
|
HCPCS 76816
|
| Min. Negotiated Rate |
$31.87 |
| Max. Negotiated Rate |
$345.82 |
| Rate for Payer: Cash Price |
$126.61
|
| Rate for Payer: Cash Price |
$126.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$118.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$118.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$125.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$131.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$125.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$131.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$131.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$98.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.15
|
| Rate for Payer: Healthfirst QHP |
$131.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$92.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$131.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$111.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$92.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$131.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$345.82
|
| Rate for Payer: SOMOS Essential |
$345.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$131.74
|
|
|
CHG US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS
|
Professional
|
$301.74
|
|
|
Service Code
|
HCPCS 76816 TC
|
| Min. Negotiated Rate |
$31.87 |
| Max. Negotiated Rate |
$345.82 |
| Rate for Payer: Cash Price |
$82.75
|
| Rate for Payer: Cash Price |
$82.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$77.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$77.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$81.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$86.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$81.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$81.90
|
| Rate for Payer: Healthfirst QHP |
$86.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$60.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$86.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$73.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$60.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$86.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$226.30
|
| Rate for Payer: SOMOS Essential |
$226.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$86.21
|
|
|
CHG US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG
|
Professional
|
$248.54
|
|
|
Service Code
|
HCPCS 76817 TC
|
| Min. Negotiated Rate |
$29.03 |
| Max. Negotiated Rate |
$295.26 |
| Rate for Payer: Cash Price |
$67.82
|
| Rate for Payer: Cash Price |
$67.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$63.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$63.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$67.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$71.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$67.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$71.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$71.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$53.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$67.46
|
| Rate for Payer: Healthfirst QHP |
$71.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$49.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$71.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$60.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$49.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$71.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$186.40
|
| Rate for Payer: SOMOS Essential |
$186.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$71.01
|
|
|
CHG US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG
|
Professional
|
$145.15
|
|
|
Service Code
|
HCPCS 76817 26
|
| Min. Negotiated Rate |
$29.03 |
| Max. Negotiated Rate |
$295.26 |
| Rate for Payer: Cash Price |
$39.03
|
| Rate for Payer: Cash Price |
$39.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$39.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.40
|
| Rate for Payer: Healthfirst QHP |
$41.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$41.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$35.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$108.86
|
| Rate for Payer: SOMOS Essential |
$108.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.47
|
|
|
CHG US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG
|
Professional
|
$393.68
|
|
|
Service Code
|
HCPCS 76817
|
| Min. Negotiated Rate |
$29.03 |
| Max. Negotiated Rate |
$295.26 |
| Rate for Payer: Cash Price |
$106.85
|
| Rate for Payer: Cash Price |
$106.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$101.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$101.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$106.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$112.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$106.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$112.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$84.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$106.86
|
| Rate for Payer: Healthfirst QHP |
$112.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$78.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$112.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$95.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$78.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$112.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$295.26
|
| Rate for Payer: SOMOS Essential |
$295.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$112.48
|
|
|
CHG US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION
|
Professional
|
$732.80
|
|
|
Service Code
|
HCPCS 76811
|
| Min. Negotiated Rate |
$71.06 |
| Max. Negotiated Rate |
$549.60 |
| Rate for Payer: Cash Price |
$202.27
|
| Rate for Payer: Cash Price |
$202.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$188.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$188.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$198.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$209.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$198.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$157.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$198.90
|
| Rate for Payer: Healthfirst QHP |
$209.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$146.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$209.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$177.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$146.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$209.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$549.60
|
| Rate for Payer: SOMOS Essential |
$549.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$209.37
|
|
|
CHG US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION
|
Professional
|
$377.51
|
|
|
Service Code
|
HCPCS 76811 TC
|
| Min. Negotiated Rate |
$71.06 |
| Max. Negotiated Rate |
$549.60 |
| Rate for Payer: Cash Price |
$104.82
|
| Rate for Payer: Cash Price |
$104.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$97.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$97.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$102.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$102.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$107.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$102.47
|
| Rate for Payer: Healthfirst QHP |
$107.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$75.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$107.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$91.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$75.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$107.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$283.13
|
| Rate for Payer: SOMOS Essential |
$283.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$107.86
|
|
|
CHG US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION
|
Professional
|
$355.29
|
|
|
Service Code
|
HCPCS 76811 26
|
| Min. Negotiated Rate |
$71.06 |
| Max. Negotiated Rate |
$549.60 |
| Rate for Payer: Cash Price |
$97.44
|
| Rate for Payer: Cash Price |
$97.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$91.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$91.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$96.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$101.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$96.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$101.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$101.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$76.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$96.43
|
| Rate for Payer: Healthfirst QHP |
$101.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$71.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$101.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$86.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$71.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$101.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$266.47
|
| Rate for Payer: SOMOS Essential |
$266.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$101.51
|
|
|
CHG US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE
|
Professional
|
$321.86
|
|
|
Service Code
|
HCPCS 76770 TC
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$347.16 |
| Rate for Payer: Cash Price |
$87.07
|
| Rate for Payer: Cash Price |
$87.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$82.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$82.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$87.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$91.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$87.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$91.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$68.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$87.36
|
| Rate for Payer: Healthfirst QHP |
$91.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$91.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$78.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$91.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$241.40
|
| Rate for Payer: SOMOS Essential |
$241.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$91.96
|
|
|
CHG US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE
|
Professional
|
$462.88
|
|
|
Service Code
|
HCPCS 76770
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$347.16 |
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$119.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$119.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$125.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$132.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$125.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$132.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$132.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$99.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.64
|
| Rate for Payer: Healthfirst QHP |
$132.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$92.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$132.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$112.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$92.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$132.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$347.16
|
| Rate for Payer: SOMOS Essential |
$347.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$132.25
|
|
|
CHG US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE
|
Professional
|
$141.02
|
|
|
Service Code
|
HCPCS 76770 26
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$347.16 |
| Rate for Payer: Cash Price |
$38.52
|
| Rate for Payer: Cash Price |
$38.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.28
|
| Rate for Payer: Healthfirst QHP |
$40.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$40.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$105.76
|
| Rate for Payer: SOMOS Essential |
$105.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.29
|
|
|
CHG US SCROTUM & CONTENTS
|
Professional
|
$124.18
|
|
|
Service Code
|
HCPCS 76870 26
|
| Min. Negotiated Rate |
$24.84 |
| Max. Negotiated Rate |
$323.74 |
| Rate for Payer: Cash Price |
$32.84
|
| Rate for Payer: Cash Price |
$32.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.71
|
| Rate for Payer: Healthfirst QHP |
$35.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$93.14
|
| Rate for Payer: SOMOS Essential |
$93.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.48
|
|
|
CHG US SCROTUM & CONTENTS
|
Professional
|
$307.48
|
|
|
Service Code
|
HCPCS 76870 TC
|
| Min. Negotiated Rate |
$24.84 |
| Max. Negotiated Rate |
$323.74 |
| Rate for Payer: Cash Price |
$83.14
|
| Rate for Payer: Cash Price |
$83.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$79.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$79.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$83.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$87.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$83.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$87.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$87.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$65.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$83.46
|
| Rate for Payer: Healthfirst QHP |
$87.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$61.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$87.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$74.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$61.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$87.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$230.61
|
| Rate for Payer: SOMOS Essential |
$230.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$87.85
|
|
|
CHG US SCROTUM & CONTENTS
|
Professional
|
$431.66
|
|
|
Service Code
|
HCPCS 76870
|
| Min. Negotiated Rate |
$24.84 |
| Max. Negotiated Rate |
$323.74 |
| Rate for Payer: Cash Price |
$115.98
|
| Rate for Payer: Cash Price |
$115.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$111.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$111.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$117.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$123.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$117.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$123.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$123.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$92.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$117.16
|
| Rate for Payer: Healthfirst QHP |
$123.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$86.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$123.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$104.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$86.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$123.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$323.74
|
| Rate for Payer: SOMOS Essential |
$323.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$123.33
|
|
|
CHG US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM
|
Professional
|
$111.27
|
|
|
Service Code
|
HCPCS 76536 26
|
| Min. Negotiated Rate |
$22.25 |
| Max. Negotiated Rate |
$358.26 |
| Rate for Payer: Cash Price |
$29.26
|
| Rate for Payer: Cash Price |
$29.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.20
|
| Rate for Payer: Healthfirst QHP |
$31.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$31.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$83.45
|
| Rate for Payer: SOMOS Essential |
$83.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.79
|
|
