|
CHG US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM
|
Professional
|
$477.68
|
|
|
Service Code
|
HCPCS 76536
|
| Min. Negotiated Rate |
$22.25 |
| Max. Negotiated Rate |
$358.26 |
| Rate for Payer: Cash Price |
$128.52
|
| Rate for Payer: Cash Price |
$128.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$122.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$122.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$129.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$136.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$129.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$136.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$136.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$102.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$129.66
|
| Rate for Payer: Healthfirst QHP |
$136.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$95.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$136.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$116.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$95.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$136.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$358.26
|
| Rate for Payer: SOMOS Essential |
$358.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$136.48
|
|
|
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
|
|
|
CHG US TRANSRCT PRSTATE VOL BRACHYTX PLNNING SPX
|
Professional
|
$733.53
|
|
|
Service Code
|
HCPCS 76873
|
| Min. Negotiated Rate |
$60.80 |
| Max. Negotiated Rate |
$550.15 |
| Rate for Payer: Cash Price |
$202.09
|
| Rate for Payer: Cash Price |
$202.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$188.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$188.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$199.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$209.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$199.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$157.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$199.10
|
| Rate for Payer: Healthfirst QHP |
$209.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$146.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$209.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$178.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$146.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$209.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$550.15
|
| Rate for Payer: SOMOS Essential |
$550.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$209.58
|
|
|
CHG US TRANSRCT PRSTATE VOL BRACHYTX PLNNING SPX
|
Professional
|
$429.52
|
|
|
Service Code
|
HCPCS 76873 TC
|
| Min. Negotiated Rate |
$60.80 |
| Max. Negotiated Rate |
$550.15 |
| Rate for Payer: Cash Price |
$118.74
|
| Rate for Payer: Cash Price |
$118.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$110.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$110.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$116.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$122.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$116.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$122.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$122.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$92.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$116.58
|
| Rate for Payer: Healthfirst QHP |
$122.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$85.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$122.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$104.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$85.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$122.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$322.14
|
| Rate for Payer: SOMOS Essential |
$322.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$122.72
|
|
|
CHG US TRANSRCT PRSTATE VOL BRACHYTX PLNNING SPX
|
Professional
|
$303.98
|
|
|
Service Code
|
HCPCS 76873 26
|
| Min. Negotiated Rate |
$60.80 |
| Max. Negotiated Rate |
$550.15 |
| Rate for Payer: Cash Price |
$83.35
|
| Rate for Payer: Cash Price |
$83.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$78.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$78.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$82.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$86.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$82.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$65.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$82.51
|
| Rate for Payer: Healthfirst QHP |
$86.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$60.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$86.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$73.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$60.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$86.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$227.98
|
| Rate for Payer: SOMOS Essential |
$227.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$86.85
|
|
|
CHG US TRANSRECTAL
|
Professional
|
$580.51
|
|
|
Service Code
|
HCPCS 76872
|
| Min. Negotiated Rate |
$25.28 |
| Max. Negotiated Rate |
$435.38 |
| Rate for Payer: Cash Price |
$235.21
|
| Rate for Payer: Cash Price |
$235.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$220.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$220.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$233.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$245.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$233.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$245.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$245.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$184.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$233.22
|
| Rate for Payer: Healthfirst QHP |
$245.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$171.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$245.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$208.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$171.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$245.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$435.38
|
| Rate for Payer: SOMOS Essential |
$435.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$245.50
|
|
|
CHG US TRANSRECTAL
|
Professional
|
$454.13
|
|
|
Service Code
|
HCPCS 76872 TC
|
| Min. Negotiated Rate |
$25.28 |
| Max. Negotiated Rate |
$435.38 |
| Rate for Payer: Cash Price |
$200.07
|
| Rate for Payer: Cash Price |
$200.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$188.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$188.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$198.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$209.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$198.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$157.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$198.91
|
| Rate for Payer: Healthfirst QHP |
$209.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$146.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$209.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$177.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$146.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$209.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$340.60
|
| Rate for Payer: SOMOS Essential |
$340.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$209.38
|
|
|
CHG US TRANSRECTAL
|
Professional
|
$126.39
|
|
|
Service Code
|
HCPCS 76872 26
|
| Min. Negotiated Rate |
$25.28 |
| Max. Negotiated Rate |
$435.38 |
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.30
|
| Rate for Payer: Healthfirst QHP |
$36.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$36.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$94.79
|
| Rate for Payer: SOMOS Essential |
$94.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.11
|
|
|
CHG US TRANSVAGINAL
|
Professional
|
$134.75
|
|
|
Service Code
|
HCPCS 76830 26
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$384.51 |
| Rate for Payer: Cash Price |
$35.76
|
| Rate for Payer: Cash Price |
$35.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.58
|
| Rate for Payer: Healthfirst QHP |
$38.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$101.06
|
| Rate for Payer: SOMOS Essential |
$101.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.50
|
|
|
CHG US TRANSVAGINAL
|
Professional
|
$512.68
|
|
|
Service Code
|
HCPCS 76830
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$384.51 |
| Rate for Payer: Cash Price |
$138.78
|
| Rate for Payer: Cash Price |
$138.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$131.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$131.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$139.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$146.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$139.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$146.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$146.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$109.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$139.16
|
| Rate for Payer: Healthfirst QHP |
$146.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$102.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$146.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$124.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$102.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$146.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$384.51
|
| Rate for Payer: SOMOS Essential |
$384.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$146.48
|
|
|
CHG US TRANSVAGINAL
|
Professional
|
$377.93
|
|
|
Service Code
|
HCPCS 76830 TC
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$384.51 |
| Rate for Payer: Cash Price |
$103.02
|
| Rate for Payer: Cash Price |
$103.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$97.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$97.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$102.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$102.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$107.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$102.58
|
| Rate for Payer: Healthfirst QHP |
$107.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$75.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$107.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$91.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$75.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$107.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$283.45
|
| Rate for Payer: SOMOS Essential |
$283.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$107.98
|
|
|
CHG US TRNSPLNT KIDNEY REAL TIME W/IMAGE DOCMTN
|
Professional
|
$489.90
|
|
|
Service Code
|
HCPCS 76776 TC
|
| Min. Negotiated Rate |
$28.99 |
| Max. Negotiated Rate |
$476.15 |
| Rate for Payer: Cash Price |
$132.49
|
| Rate for Payer: Cash Price |
$132.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$125.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$132.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$139.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$132.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$139.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$139.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$104.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$132.97
|
| Rate for Payer: Healthfirst QHP |
$139.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$97.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$139.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$118.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$97.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$139.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$367.42
|
| Rate for Payer: SOMOS Essential |
$367.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$139.97
|
|
|
CHG US TRNSPLNT KIDNEY REAL TIME W/IMAGE DOCMTN
|
Professional
|
$144.94
|
|
|
Service Code
|
HCPCS 76776 26
|
| Min. Negotiated Rate |
$28.99 |
| Max. Negotiated Rate |
$476.15 |
| Rate for Payer: Cash Price |
$39.22
|
| Rate for Payer: Cash Price |
$39.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$39.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.34
|
| Rate for Payer: Healthfirst QHP |
$41.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$41.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$35.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$108.70
|
| Rate for Payer: SOMOS Essential |
$108.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.41
|
|
|
CHG US TRNSPLNT KIDNEY REAL TIME W/IMAGE DOCMTN
|
Professional
|
$634.87
|
|
|
Service Code
|
HCPCS 76776
|
| Min. Negotiated Rate |
$28.99 |
| Max. Negotiated Rate |
$476.15 |
| Rate for Payer: Cash Price |
$171.71
|
| Rate for Payer: Cash Price |
$171.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$163.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$163.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$172.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$181.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$172.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$181.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$181.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$136.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$172.32
|
| Rate for Payer: Healthfirst QHP |
$181.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$126.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$181.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$154.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$126.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$181.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$476.15
|
| Rate for Payer: SOMOS Essential |
$476.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$181.39
|
|
|
CHG US VASC ACCESS SITS VSL PATENCY NDL ENTRY
|
Professional
|
$109.24
|
|
|
Service Code
|
HCPCS 76937 TC
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$126.94 |
| Rate for Payer: Cash Price |
$29.31
|
| Rate for Payer: Cash Price |
$29.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.65
|
| Rate for Payer: Healthfirst QHP |
$31.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$31.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$81.93
|
| Rate for Payer: SOMOS Essential |
$81.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.21
|
|
|
CHG US VASC ACCESS SITS VSL PATENCY NDL ENTRY
|
Professional
|
$60.03
|
|
|
Service Code
|
HCPCS 76937 26
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$126.94 |
| Rate for Payer: Cash Price |
$15.48
|
| Rate for Payer: Cash Price |
$15.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.29
|
| Rate for Payer: Healthfirst QHP |
$17.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$12.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$17.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$14.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$12.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$45.02
|
| Rate for Payer: SOMOS Essential |
$45.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.15
|
|
|
CHG US VASC ACCESS SITS VSL PATENCY NDL ENTRY
|
Professional
|
$169.26
|
|
|
Service Code
|
HCPCS 76937
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$126.94 |
| Rate for Payer: Cash Price |
$44.79
|
| Rate for Payer: Cash Price |
$44.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$48.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$45.94
|
| Rate for Payer: Healthfirst QHP |
$48.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$48.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$48.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$126.94
|
| Rate for Payer: SOMOS Essential |
$126.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$48.36
|
|
|
CHG VASOGRAPY VESICULOGRAPY/EPIDIDYMOGRAPY RS&I
|
Professional
|
$346.29
|
|
|
Service Code
|
HCPCS 74440 TC
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$311.48 |
| Rate for Payer: Cash Price |
$94.54
|
| Rate for Payer: Cash Price |
$94.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$89.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$89.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$93.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$98.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$93.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$98.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$98.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$74.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$93.99
|
| Rate for Payer: Healthfirst QHP |
$98.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$69.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$98.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$84.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$69.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$98.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$259.72
|
| Rate for Payer: SOMOS Essential |
$259.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$98.94
|
|
|
CHG VASOGRAPY VESICULOGRAPY/EPIDIDYMOGRAPY RS&I
|
Professional
|
$69.02
|
|
|
Service Code
|
HCPCS 74440 26
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$311.48 |
| Rate for Payer: Cash Price |
$18.99
|
| Rate for Payer: Cash Price |
$18.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.73
|
| Rate for Payer: Healthfirst QHP |
$19.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$51.76
|
| Rate for Payer: SOMOS Essential |
$51.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.72
|
|
|
CHG VASOGRAPY VESICULOGRAPY/EPIDIDYMOGRAPY RS&I
|
Professional
|
$415.31
|
|
|
Service Code
|
HCPCS 74440
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$311.48 |
| Rate for Payer: Cash Price |
$113.52
|
| Rate for Payer: Cash Price |
$113.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$106.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$106.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$112.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$118.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$112.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$118.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$118.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$89.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$112.73
|
| Rate for Payer: Healthfirst QHP |
$118.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$83.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$118.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$100.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$83.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$118.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$311.48
|
| Rate for Payer: SOMOS Essential |
$311.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$118.66
|
|
|
CHG VENOGRAPHY ADRENAL BILATERAL SELECTIVE RS&I
|
Professional
|
$383.53
|
|
|
Service Code
|
HCPCS 75842 TC
|
| Min. Negotiated Rate |
$57.51 |
| Max. Negotiated Rate |
$503.32 |
| Rate for Payer: Cash Price |
$104.99
|
| Rate for Payer: Cash Price |
$104.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$98.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$98.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$104.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$109.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$104.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$109.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$82.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$104.10
|
| Rate for Payer: Healthfirst QHP |
$109.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$76.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$109.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$93.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$76.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$109.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$287.65
|
| Rate for Payer: SOMOS Essential |
$287.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$109.58
|
|
|
CHG VENOGRAPHY ADRENAL BILATERAL SELECTIVE RS&I
|
Professional
|
$671.09
|
|
|
Service Code
|
HCPCS 75842
|
| Min. Negotiated Rate |
$57.51 |
| Max. Negotiated Rate |
$503.32 |
| Rate for Payer: Cash Price |
$182.78
|
| Rate for Payer: Cash Price |
$182.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$172.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$172.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$182.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$191.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$182.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$191.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$143.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$182.15
|
| Rate for Payer: Healthfirst QHP |
$191.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$134.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$191.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$162.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$134.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$191.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$503.32
|
| Rate for Payer: SOMOS Essential |
$503.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$191.74
|
|
|
CHG VENOGRAPHY ADRENAL BILATERAL SELECTIVE RS&I
|
Professional
|
$287.56
|
|
|
Service Code
|
HCPCS 75842 26
|
| Min. Negotiated Rate |
$57.51 |
| Max. Negotiated Rate |
$503.32 |
| Rate for Payer: Cash Price |
$77.79
|
| Rate for Payer: Cash Price |
$77.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$73.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$78.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$82.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$78.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$82.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$61.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$78.05
|
| Rate for Payer: Healthfirst QHP |
$82.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$57.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$82.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$69.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$57.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$82.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$215.67
|
| Rate for Payer: SOMOS Essential |
$215.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$82.16
|
|
|
CHG VENOGRAPHY ADRENAL UNILATERAL SELECTIVE RS&I
|
Professional
|
$547.05
|
|
|
Service Code
|
HCPCS 75840
|
| Min. Negotiated Rate |
$43.92 |
| Max. Negotiated Rate |
$410.29 |
| Rate for Payer: Cash Price |
$148.10
|
| Rate for Payer: Cash Price |
$148.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$140.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$140.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$148.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$156.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$148.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$156.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$156.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$117.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$148.48
|
| Rate for Payer: Healthfirst QHP |
$156.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$109.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$156.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$132.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$109.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$156.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$410.29
|
| Rate for Payer: SOMOS Essential |
$410.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$156.30
|
|
|
CHG VENOGRAPHY ADRENAL UNILATERAL SELECTIVE RS&I
|
Professional
|
$327.46
|
|
|
Service Code
|
HCPCS 75840 TC
|
| Min. Negotiated Rate |
$43.92 |
| Max. Negotiated Rate |
$410.29 |
| Rate for Payer: Cash Price |
$88.87
|
| Rate for Payer: Cash Price |
$88.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$84.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$84.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$88.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$93.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$88.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$70.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$88.88
|
| Rate for Payer: Healthfirst QHP |
$93.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$65.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$93.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$79.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$65.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$93.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$245.60
|
| Rate for Payer: SOMOS Essential |
$245.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$93.56
|
|
