|
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 CAVAL INFERIOR SERIALOGRAPHY RS&I
|
Professional
|
$222.78
|
|
|
Service Code
|
HCPCS 75825 26
|
| Min. Negotiated Rate |
$44.56 |
| Max. Negotiated Rate |
$367.50 |
| Rate for Payer: Cash Price |
$59.91
|
| Rate for Payer: Cash Price |
$59.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$57.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$57.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$60.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$63.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$60.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.47
|
| Rate for Payer: Healthfirst QHP |
$63.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$44.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$63.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$54.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$44.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$63.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$167.08
|
| Rate for Payer: SOMOS Essential |
$167.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$63.65
|
|
|
CHG VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I
|
Professional
|
$490.00
|
|
|
Service Code
|
HCPCS 75825
|
| Min. Negotiated Rate |
$44.56 |
| Max. Negotiated Rate |
$367.50 |
| Rate for Payer: Cash Price |
$132.84
|
| Rate for Payer: Cash Price |
$132.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$126.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$126.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$133.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$140.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$133.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$140.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$140.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$105.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.00
|
| Rate for Payer: Healthfirst QHP |
$140.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$98.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$140.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$119.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$98.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$140.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$367.50
|
| Rate for Payer: SOMOS Essential |
$367.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$140.00
|
|
|
CHG VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I
|
Professional
|
$267.23
|
|
|
Service Code
|
HCPCS 75825 TC
|
| Min. Negotiated Rate |
$44.56 |
| Max. Negotiated Rate |
$367.50 |
| Rate for Payer: Cash Price |
$72.92
|
| Rate for Payer: Cash Price |
$72.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$68.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$68.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$72.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$76.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$72.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$72.53
|
| Rate for Payer: Healthfirst QHP |
$76.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$53.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$76.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$64.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$53.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$76.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$200.42
|
| Rate for Payer: SOMOS Essential |
$200.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$76.35
|
|
|
CHG VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I
|
Professional
|
$225.65
|
|
|
Service Code
|
HCPCS 75827 26
|
| Min. Negotiated Rate |
$45.13 |
| Max. Negotiated Rate |
$384.75 |
| Rate for Payer: Cash Price |
$60.07
|
| Rate for Payer: Cash Price |
$60.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$58.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$61.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$64.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$61.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.25
|
| Rate for Payer: Healthfirst QHP |
$64.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$64.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$54.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$64.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$169.24
|
| Rate for Payer: SOMOS Essential |
$169.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$64.47
|
|
|
CHG VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I
|
Professional
|
$287.35
|
|
|
Service Code
|
HCPCS 75827 TC
|
| Min. Negotiated Rate |
$45.13 |
| Max. Negotiated Rate |
$384.75 |
| Rate for Payer: Cash Price |
$78.03
|
| Rate for Payer: Cash Price |
$78.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$73.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$78.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$82.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$78.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$82.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$61.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$78.00
|
| Rate for Payer: Healthfirst QHP |
$82.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$57.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$82.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$69.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$57.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$82.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$215.51
|
| Rate for Payer: SOMOS Essential |
$215.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$82.10
|
|
|
CHG VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I
|
Professional
|
$513.00
|
|
|
Service Code
|
HCPCS 75827
|
| Min. Negotiated Rate |
$45.13 |
| Max. Negotiated Rate |
$384.75 |
| Rate for Payer: Cash Price |
$138.10
|
| Rate for Payer: Cash Price |
$138.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$131.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$131.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$139.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$146.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$139.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$146.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$146.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$109.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$139.24
|
| Rate for Payer: Healthfirst QHP |
$146.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$102.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$146.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$124.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$102.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$146.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$384.75
|
| Rate for Payer: SOMOS Essential |
$384.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$146.57
|
|
|
CHG VENOGRAPHY EPIDURAL RS&I
|
Professional
|
$219.59
|
|
|
Service Code
|
HCPCS 75872 26
|
| Min. Negotiated Rate |
$43.92 |
| Max. Negotiated Rate |
$410.29 |
| Rate for Payer: Cash Price |
$59.23
|
| Rate for Payer: Cash Price |
$59.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$56.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$56.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$59.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$59.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$62.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$59.60
|
| Rate for Payer: Healthfirst QHP |
$62.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$43.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$62.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$53.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$43.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$164.69
|
| Rate for Payer: SOMOS Essential |
$164.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.74
|
|
|
CHG VENOGRAPHY EPIDURAL RS&I
|
Professional
|
$547.05
|
|
|
Service Code
|
HCPCS 75872
|
| 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 EPIDURAL RS&I
|
Professional
|
$327.46
|
|
|
Service Code
|
HCPCS 75872 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
|
|
|
CHG VENOGRAPHY EXTREMITY BILATERAL RS&I
|
Professional
|
$561.61
|
|
|
Service Code
|
HCPCS 75822
|
| Min. Negotiated Rate |
$55.71 |
| Max. Negotiated Rate |
$421.21 |
| Rate for Payer: Cash Price |
$153.89
|
| Rate for Payer: Cash Price |
$153.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$144.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$144.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$152.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$160.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$152.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$160.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$160.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$120.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$152.44
|
| Rate for Payer: Healthfirst QHP |
$160.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$112.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$160.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$136.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$112.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$160.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$421.21
|
| Rate for Payer: SOMOS Essential |
$421.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$160.46
|
|
|
CHG VENOGRAPHY EXTREMITY BILATERAL RS&I
|
Professional
|
$283.05
|
|
|
Service Code
|
HCPCS 75822 TC
|
| Min. Negotiated Rate |
$55.71 |
| Max. Negotiated Rate |
$421.21 |
| Rate for Payer: Cash Price |
$77.64
|
| Rate for Payer: Cash Price |
$77.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$72.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$72.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$76.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$80.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$76.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$76.83
|
| Rate for Payer: Healthfirst QHP |
$80.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$56.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$80.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$68.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$56.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$80.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$212.29
|
| Rate for Payer: SOMOS Essential |
$212.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$80.87
|
|
|
CHG VENOGRAPHY EXTREMITY BILATERAL RS&I
|
Professional
|
$278.57
|
|
|
Service Code
|
HCPCS 75822 26
|
| Min. Negotiated Rate |
$55.71 |
| Max. Negotiated Rate |
$421.21 |
| Rate for Payer: Cash Price |
$76.25
|
| Rate for Payer: Cash Price |
$76.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$71.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$71.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$75.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$79.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$75.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$79.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$59.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$75.61
|
| Rate for Payer: Healthfirst QHP |
$79.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$55.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$79.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$67.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$55.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$79.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$208.93
|
| Rate for Payer: SOMOS Essential |
$208.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$79.59
|
|
|
CHG VENOGRAPHY EXTREMITY UNILATERAL RS&I
|
Professional
|
$261.49
|
|
|
Service Code
|
HCPCS 75820 TC
|
| Min. Negotiated Rate |
$40.17 |
| Max. Negotiated Rate |
$346.74 |
| Rate for Payer: Cash Price |
$70.17
|
| Rate for Payer: Cash Price |
$70.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$67.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$67.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$70.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$74.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$70.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$74.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$56.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$70.97
|
| Rate for Payer: Healthfirst QHP |
$74.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$52.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$74.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$63.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$52.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$74.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$196.12
|
| Rate for Payer: SOMOS Essential |
$196.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$74.71
|
|
|
CHG VENOGRAPHY EXTREMITY UNILATERAL RS&I
|
Professional
|
$200.83
|
|
|
Service Code
|
HCPCS 75820 26
|
| Min. Negotiated Rate |
$40.17 |
| Max. Negotiated Rate |
$346.74 |
| Rate for Payer: Cash Price |
$54.20
|
| Rate for Payer: Cash Price |
$54.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$51.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$51.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$54.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$57.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$54.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$54.51
|
| Rate for Payer: Healthfirst QHP |
$57.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$40.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$57.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$48.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$40.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$57.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$150.62
|
| Rate for Payer: SOMOS Essential |
$150.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$57.38
|
|
|
CHG VENOGRAPHY EXTREMITY UNILATERAL RS&I
|
Professional
|
$462.32
|
|
|
Service Code
|
HCPCS 75820
|
| Min. Negotiated Rate |
$40.17 |
| Max. Negotiated Rate |
$346.74 |
| Rate for Payer: Cash Price |
$124.37
|
| Rate for Payer: Cash Price |
$124.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$118.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$118.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$125.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$132.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$125.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$132.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$132.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$99.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.49
|
| Rate for Payer: Healthfirst QHP |
$132.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$92.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$132.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$112.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$92.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$132.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$346.74
|
| Rate for Payer: SOMOS Essential |
$346.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$132.09
|
|
|
CHG VENOGRAPHY ORBITAL RS&I
|
Professional
|
$462.04
|
|
|
Service Code
|
HCPCS 75880
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$346.53 |
| Rate for Payer: Cash Price |
$125.22
|
| Rate for Payer: Cash Price |
$125.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$118.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$118.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$125.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$132.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$125.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$132.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$132.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$99.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.41
|
| Rate for Payer: Healthfirst QHP |
$132.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$92.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$132.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$112.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$92.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$132.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$346.53
|
| Rate for Payer: SOMOS Essential |
$346.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$132.01
|
|
|
CHG VENOGRAPHY ORBITAL RS&I
|
Professional
|
$136.01
|
|
|
Service Code
|
HCPCS 75880 26
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$346.53 |
| Rate for Payer: Cash Price |
$36.74
|
| Rate for Payer: Cash Price |
$36.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.92
|
| Rate for Payer: Healthfirst QHP |
$38.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$102.01
|
| Rate for Payer: SOMOS Essential |
$102.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.86
|
|
|
CHG VENOGRAPHY ORBITAL RS&I
|
Professional
|
$326.03
|
|
|
Service Code
|
HCPCS 75880 TC
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$346.53 |
| Rate for Payer: Cash Price |
$88.48
|
| Rate for Payer: Cash Price |
$88.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$83.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$83.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$88.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$93.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$88.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$88.49
|
| Rate for Payer: Healthfirst QHP |
$93.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$65.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$93.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$79.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$65.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$93.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$244.52
|
| Rate for Payer: SOMOS Essential |
$244.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$93.15
|
|
|
CHG VENOGRAPHY RENAL BILATERAL SELECTIVE RS&I
|
Professional
|
$291.94
|
|
|
Service Code
|
HCPCS 75833 26
|
| Min. Negotiated Rate |
$58.39 |
| Max. Negotiated Rate |
$473.18 |
| Rate for Payer: Cash Price |
$78.78
|
| Rate for Payer: Cash Price |
$78.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$75.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$75.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$79.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$83.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$79.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$62.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$79.24
|
| Rate for Payer: Healthfirst QHP |
$83.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$58.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$83.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$70.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$58.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$83.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$218.96
|
| Rate for Payer: SOMOS Essential |
$218.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$83.41
|
|
|
CHG VENOGRAPHY RENAL BILATERAL SELECTIVE RS&I
|
Professional
|
$338.98
|
|
|
Service Code
|
HCPCS 75833 TC
|
| Min. Negotiated Rate |
$58.39 |
| Max. Negotiated Rate |
$473.18 |
| Rate for Payer: Cash Price |
$93.98
|
| Rate for Payer: Cash Price |
$93.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$87.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$87.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$92.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$96.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$92.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$96.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$96.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$92.01
|
| Rate for Payer: Healthfirst QHP |
$96.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$67.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$96.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$82.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$67.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$96.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$254.24
|
| Rate for Payer: SOMOS Essential |
$254.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$96.85
|
|
|
CHG VENOGRAPHY RENAL BILATERAL SELECTIVE RS&I
|
Professional
|
$630.91
|
|
|
Service Code
|
HCPCS 75833
|
| Min. Negotiated Rate |
$58.39 |
| Max. Negotiated Rate |
$473.18 |
| Rate for Payer: Cash Price |
$172.76
|
| Rate for Payer: Cash Price |
$172.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$162.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$162.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$171.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$180.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$171.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$180.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$180.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$135.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$171.25
|
| Rate for Payer: Healthfirst QHP |
$180.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$126.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$180.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$153.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$126.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$180.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$473.18
|
| Rate for Payer: SOMOS Essential |
$473.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$180.26
|
|
|
CHG VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I
|
Professional
|
$300.16
|
|
|
Service Code
|
HCPCS 75831 TC
|
| Min. Negotiated Rate |
$42.65 |
| Max. Negotiated Rate |
$385.06 |
| Rate for Payer: Cash Price |
$81.41
|
| Rate for Payer: Cash Price |
$81.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$77.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$77.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$81.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$85.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$81.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$81.47
|
| Rate for Payer: Healthfirst QHP |
$85.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$60.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$85.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$72.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$60.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$85.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$225.12
|
| Rate for Payer: SOMOS Essential |
$225.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$85.76
|
|
|
CHG VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I
|
Professional
|
$213.26
|
|
|
Service Code
|
HCPCS 75831 26
|
| Min. Negotiated Rate |
$42.65 |
| Max. Negotiated Rate |
$385.06 |
| Rate for Payer: Cash Price |
$56.78
|
| Rate for Payer: Cash Price |
$56.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$54.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$54.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$57.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$60.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$57.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$57.88
|
| Rate for Payer: Healthfirst QHP |
$60.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$42.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$60.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$51.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$42.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$60.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$159.94
|
| Rate for Payer: SOMOS Essential |
$159.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$60.93
|
|
|
CHG VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I
|
Professional
|
$513.42
|
|
|
Service Code
|
HCPCS 75831
|
| Min. Negotiated Rate |
$42.65 |
| Max. Negotiated Rate |
$385.06 |
| Rate for Payer: Cash Price |
$138.19
|
| Rate for Payer: Cash Price |
$138.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$132.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$132.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$139.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$146.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$139.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$146.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$146.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$110.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$139.36
|
| Rate for Payer: Healthfirst QHP |
$146.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$102.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$146.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$124.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$102.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$146.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$385.06
|
| Rate for Payer: SOMOS Essential |
$385.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$146.69
|
|
