|
CHG 3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS
|
Professional
|
Both
|
$1,100.16
|
|
|
Service Code
|
HCPCS 77295 TC
|
| Min. Negotiated Rate |
$212.52 |
| Max. Negotiated Rate |
$683.10 |
| Rate for Payer: Cash Price |
$304.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$303.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$273.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$273.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$288.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$303.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$288.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$303.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$303.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$227.70
|
| Rate for Payer: Healthfirst Commercial |
$303.60
|
| Rate for Payer: Healthfirst Essential Plan |
$683.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$288.42
|
| Rate for Payer: Healthfirst QHP |
$303.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$212.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$303.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$258.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$212.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$303.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$227.70
|
| Rate for Payer: SOMOS Essential |
$227.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$303.60
|
|
|
CHG 3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS
|
Professional
|
Both
|
$2,007.29
|
|
|
Service Code
|
HCPCS 77295
|
| Min. Negotiated Rate |
$387.18 |
| Max. Negotiated Rate |
$1,244.50 |
| Rate for Payer: Cash Price |
$553.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$553.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$497.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$497.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$525.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$553.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$525.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$553.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$553.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$414.83
|
| Rate for Payer: Healthfirst Commercial |
$553.11
|
| Rate for Payer: Healthfirst Essential Plan |
$1,244.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$525.45
|
| Rate for Payer: Healthfirst QHP |
$553.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$387.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$553.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$470.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$387.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$553.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$414.83
|
| Rate for Payer: SOMOS Essential |
$414.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$553.11
|
|
|
CHG 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION
|
Professional
|
Both
|
$151.59
|
|
|
Service Code
|
HCPCS 76377 26
|
| Min. Negotiated Rate |
$28.66 |
| Max. Negotiated Rate |
$92.11 |
| Rate for Payer: Cash Price |
$41.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$40.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.70
|
| Rate for Payer: Healthfirst Commercial |
$40.94
|
| Rate for Payer: Healthfirst Essential Plan |
$92.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.89
|
| Rate for Payer: Healthfirst QHP |
$40.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$40.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$30.70
|
| Rate for Payer: SOMOS Essential |
$30.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.94
|
|
|
CHG 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION
|
Professional
|
Both
|
$318.19
|
|
|
Service Code
|
HCPCS 76377
|
| Min. Negotiated Rate |
$63.22 |
| Max. Negotiated Rate |
$203.20 |
| Rate for Payer: Cash Price |
$90.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$90.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$81.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$81.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$85.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$90.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$85.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$90.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67.73
|
| Rate for Payer: Healthfirst Commercial |
$90.31
|
| Rate for Payer: Healthfirst Essential Plan |
$203.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$85.79
|
| Rate for Payer: Healthfirst QHP |
$90.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$63.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$90.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$76.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$63.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$90.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$67.73
|
| Rate for Payer: SOMOS Essential |
$67.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$90.31
|
|
|
CHG 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION
|
Professional
|
Both
|
$166.60
|
|
|
Service Code
|
HCPCS 76377 TC
|
| Min. Negotiated Rate |
$34.56 |
| Max. Negotiated Rate |
$111.08 |
| Rate for Payer: Cash Price |
$48.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$49.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$44.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$44.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$46.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$49.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$46.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$37.03
|
| Rate for Payer: Healthfirst Commercial |
$49.37
|
| Rate for Payer: Healthfirst Essential Plan |
$111.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.90
|
| Rate for Payer: Healthfirst QHP |
$49.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$49.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$49.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$37.03
|
| Rate for Payer: SOMOS Essential |
$37.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$49.37
|
|
|
CHG 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION
|
Professional
|
Both
|
$64.54
|
|
|
Service Code
|
HCPCS 76376 TC
|
| Min. Negotiated Rate |
$13.47 |
| Max. Negotiated Rate |
$43.31 |
| Rate for Payer: Cash Price |
$18.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.44
|
| Rate for Payer: Healthfirst Commercial |
$19.25
|
| Rate for Payer: Healthfirst Essential Plan |
$43.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.29
|
| Rate for Payer: Healthfirst QHP |
$19.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$14.44
|
| Rate for Payer: SOMOS Essential |
$14.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.25
|
|
|
CHG 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION
|
Professional
|
Both
|
$37.84
|
|
|
Service Code
|
HCPCS 76376 26
|
| Min. Negotiated Rate |
$7.16 |
| Max. Negotiated Rate |
$23.02 |
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.67
|
| Rate for Payer: Healthfirst Commercial |
$10.23
|
| Rate for Payer: Healthfirst Essential Plan |
$23.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.72
|
| Rate for Payer: Healthfirst QHP |
$10.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$7.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$10.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.67
|
| Rate for Payer: SOMOS Essential |
$7.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.23
|
|
|
CHG 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION
|
Professional
|
Both
|
$102.41
|
|
|
Service Code
|
HCPCS 76376
|
| Min. Negotiated Rate |
$20.63 |
| Max. Negotiated Rate |
$66.31 |
| Rate for Payer: Cash Price |
$29.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$28.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.10
|
| Rate for Payer: Healthfirst Commercial |
$29.47
|
| Rate for Payer: Healthfirst Essential Plan |
$66.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.00
|
| Rate for Payer: Healthfirst QHP |
$29.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$25.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.10
|
| Rate for Payer: SOMOS Essential |
$22.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.47
|
|
|
CHG ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING
|
Professional
|
Both
|
$1,389.33
|
|
|
Service Code
|
HCPCS 78278
|
| Min. Negotiated Rate |
$253.01 |
| Max. Negotiated Rate |
$813.26 |
| Rate for Payer: Cash Price |
$373.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$361.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$325.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$325.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$343.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$361.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$343.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$361.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$361.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$271.09
|
| Rate for Payer: Healthfirst Commercial |
$361.45
|
| Rate for Payer: Healthfirst Essential Plan |
$813.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$343.38
|
| Rate for Payer: Healthfirst QHP |
$361.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$253.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$361.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$307.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$253.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$361.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$271.09
|
| Rate for Payer: SOMOS Essential |
$271.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$361.45
|
|
|
CHG ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING
|
Professional
|
Both
|
$183.82
|
|
|
Service Code
|
HCPCS 78278 26
|
| Min. Negotiated Rate |
$34.84 |
| Max. Negotiated Rate |
$111.98 |
| Rate for Payer: Cash Price |
$50.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$49.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$44.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$44.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$47.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$49.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$47.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$37.33
|
| Rate for Payer: Healthfirst Commercial |
$49.77
|
| Rate for Payer: Healthfirst Essential Plan |
$111.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.28
|
| Rate for Payer: Healthfirst QHP |
$49.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$49.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$42.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$49.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$37.33
|
| Rate for Payer: SOMOS Essential |
$37.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$49.77
|
|
|
CHG ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING
|
Professional
|
Both
|
$1,205.51
|
|
|
Service Code
|
HCPCS 78278 TC
|
| Min. Negotiated Rate |
$218.18 |
| Max. Negotiated Rate |
$701.28 |
| Rate for Payer: Cash Price |
$323.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$311.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$280.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$280.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$296.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$311.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$296.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$311.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$311.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$233.76
|
| Rate for Payer: Healthfirst Commercial |
$311.68
|
| Rate for Payer: Healthfirst Essential Plan |
$701.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$296.10
|
| Rate for Payer: Healthfirst QHP |
$311.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$218.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$311.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$264.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$218.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$311.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$233.76
|
| Rate for Payer: SOMOS Essential |
$233.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$311.68
|
|
|
CHG ACUTE VENOUS THROMBOSIS IMAGING PEPTIDE
|
Professional
|
Both
|
$1,242.50
|
|
|
Service Code
|
HCPCS 78456
|
| Min. Negotiated Rate |
$227.28 |
| Max. Negotiated Rate |
$730.55 |
| Rate for Payer: Cash Price |
$337.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$324.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$292.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$292.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$308.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$324.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$308.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$324.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$324.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$243.52
|
| Rate for Payer: Healthfirst Commercial |
$324.69
|
| Rate for Payer: Healthfirst Essential Plan |
$730.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$308.46
|
| Rate for Payer: Healthfirst QHP |
$324.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$227.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$324.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$275.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$227.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$324.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$243.52
|
| Rate for Payer: SOMOS Essential |
$243.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$324.69
|
|
|
CHG ACUTE VENOUS THROMBOSIS IMAGING PEPTIDE
|
Professional
|
Both
|
$1,057.46
|
|
|
Service Code
|
HCPCS 78456 TC
|
| Min. Negotiated Rate |
$192.36 |
| Max. Negotiated Rate |
$618.30 |
| Rate for Payer: Cash Price |
$287.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$274.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$247.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$247.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$261.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$274.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$261.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$274.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$274.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$206.10
|
| Rate for Payer: Healthfirst Commercial |
$274.80
|
| Rate for Payer: Healthfirst Essential Plan |
$618.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$261.06
|
| Rate for Payer: Healthfirst QHP |
$274.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$192.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$274.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$233.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$192.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$274.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$206.10
|
| Rate for Payer: SOMOS Essential |
$206.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$274.80
|
|
|
CHG ACUTE VENOUS THROMBOSIS IMAGING PEPTIDE
|
Professional
|
Both
|
$185.08
|
|
|
Service Code
|
HCPCS 78456 26
|
| Min. Negotiated Rate |
$34.92 |
| Max. Negotiated Rate |
$112.25 |
| Rate for Payer: Cash Price |
$50.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$49.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$44.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$44.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$47.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$49.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$47.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$37.42
|
| Rate for Payer: Healthfirst Commercial |
$49.89
|
| Rate for Payer: Healthfirst Essential Plan |
$112.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.40
|
| Rate for Payer: Healthfirst QHP |
$49.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$49.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$42.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$49.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$37.42
|
| Rate for Payer: SOMOS Essential |
$37.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$49.89
|
|
|
CHG ADRENAL IMAGING CORTEX &/MEDULLA
|
Professional
|
Both
|
$142.45
|
|
|
Service Code
|
HCPCS 78075 26
|
| Min. Negotiated Rate |
$26.91 |
| Max. Negotiated Rate |
$86.51 |
| Rate for Payer: Cash Price |
$38.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.84
|
| Rate for Payer: Healthfirst Commercial |
$38.45
|
| Rate for Payer: Healthfirst Essential Plan |
$86.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.53
|
| Rate for Payer: Healthfirst QHP |
$38.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.84
|
| Rate for Payer: SOMOS Essential |
$28.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.45
|
|
|
CHG ADRENAL IMAGING CORTEX &/MEDULLA
|
Professional
|
Both
|
$1,787.42
|
|
|
Service Code
|
HCPCS 78075
|
| Min. Negotiated Rate |
$322.69 |
| Max. Negotiated Rate |
$1,037.20 |
| Rate for Payer: Cash Price |
$477.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$460.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$414.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$414.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$437.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$460.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$437.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$460.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$460.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$345.74
|
| Rate for Payer: Healthfirst Commercial |
$460.98
|
| Rate for Payer: Healthfirst Essential Plan |
$1,037.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$437.93
|
| Rate for Payer: Healthfirst QHP |
$460.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$322.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$460.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$391.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$322.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$460.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$345.74
|
| Rate for Payer: SOMOS Essential |
$345.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$460.98
|
|
|
CHG ADRENAL IMAGING CORTEX &/MEDULLA
|
Professional
|
Both
|
$1,644.97
|
|
|
Service Code
|
HCPCS 78075 TC
|
| Min. Negotiated Rate |
$295.77 |
| Max. Negotiated Rate |
$950.69 |
| Rate for Payer: Cash Price |
$438.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$422.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$380.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$380.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$401.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$422.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$401.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$422.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$422.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$316.90
|
| Rate for Payer: Healthfirst Commercial |
$422.53
|
| Rate for Payer: Healthfirst Essential Plan |
$950.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$401.40
|
| Rate for Payer: Healthfirst QHP |
$422.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$295.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$422.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$359.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$295.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$422.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$316.90
|
| Rate for Payer: SOMOS Essential |
$316.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$422.53
|
|
|
CHG ANGIOGRAPHY ADRENAL BILATERAL SLCTV RS&I
|
Professional
|
Both
|
$473.83
|
|
|
Service Code
|
HCPCS 75733 TC
|
| Min. Negotiated Rate |
$92.48 |
| Max. Negotiated Rate |
$297.27 |
| Rate for Payer: Cash Price |
$133.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$132.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$118.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$118.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$125.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$132.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$125.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$132.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$132.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$99.09
|
| Rate for Payer: Healthfirst Commercial |
$132.12
|
| Rate for Payer: Healthfirst Essential Plan |
$297.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.51
|
| Rate for Payer: Healthfirst QHP |
$132.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$92.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$132.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$112.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$92.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$132.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$99.09
|
| Rate for Payer: SOMOS Essential |
$99.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$132.12
|
|
|
CHG ANGIOGRAPHY ADRENAL BILATERAL SLCTV RS&I
|
Professional
|
Both
|
$713.51
|
|
|
Service Code
|
HCPCS 75733
|
| Min. Negotiated Rate |
$138.03 |
| Max. Negotiated Rate |
$443.68 |
| Rate for Payer: Cash Price |
$199.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$197.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$177.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$177.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$187.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$197.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$187.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$197.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$197.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$147.89
|
| Rate for Payer: Healthfirst Commercial |
$197.19
|
| Rate for Payer: Healthfirst Essential Plan |
$443.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$187.33
|
| Rate for Payer: Healthfirst QHP |
$197.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$138.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$197.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$167.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$138.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$197.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$147.89
|
| Rate for Payer: SOMOS Essential |
$147.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$197.19
|
|
|
CHG ANGIOGRAPHY ADRENAL BILATERAL SLCTV RS&I
|
Professional
|
Both
|
$239.72
|
|
|
Service Code
|
HCPCS 75733 26
|
| Min. Negotiated Rate |
$45.55 |
| Max. Negotiated Rate |
$146.41 |
| Rate for Payer: Cash Price |
$65.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$65.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$58.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$61.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$65.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$61.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.80
|
| Rate for Payer: Healthfirst Commercial |
$65.07
|
| Rate for Payer: Healthfirst Essential Plan |
$146.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.82
|
| Rate for Payer: Healthfirst QHP |
$65.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$65.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$55.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$65.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$48.80
|
| Rate for Payer: SOMOS Essential |
$48.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.07
|
|
|
CHG ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RS&I
|
Professional
|
Both
|
$219.59
|
|
|
Service Code
|
HCPCS 75731 26
|
| Min. Negotiated Rate |
$41.07 |
| Max. Negotiated Rate |
$132.01 |
| Rate for Payer: Cash Price |
$59.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$58.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$52.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$52.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$55.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$58.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$55.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$58.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$58.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.00
|
| Rate for Payer: Healthfirst Commercial |
$58.67
|
| Rate for Payer: Healthfirst Essential Plan |
$132.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$55.74
|
| Rate for Payer: Healthfirst QHP |
$58.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$41.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$58.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$49.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$41.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$58.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$44.00
|
| Rate for Payer: SOMOS Essential |
$44.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$58.67
|
|
|
CHG ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RS&I
|
Professional
|
Both
|
$651.70
|
|
|
Service Code
|
HCPCS 75731
|
| Min. Negotiated Rate |
$123.61 |
| Max. Negotiated Rate |
$397.31 |
| Rate for Payer: Cash Price |
$177.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$176.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$158.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$158.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$167.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$176.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$167.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$176.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$176.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$132.44
|
| Rate for Payer: Healthfirst Commercial |
$176.58
|
| Rate for Payer: Healthfirst Essential Plan |
$397.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$167.75
|
| Rate for Payer: Healthfirst QHP |
$176.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$123.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$176.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$150.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$123.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$176.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$132.44
|
| Rate for Payer: SOMOS Essential |
$132.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$176.58
|
|
|
CHG ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RS&I
|
Professional
|
Both
|
$432.15
|
|
|
Service Code
|
HCPCS 75731 TC
|
| Min. Negotiated Rate |
$82.54 |
| Max. Negotiated Rate |
$265.30 |
| Rate for Payer: Cash Price |
$118.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$117.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$106.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$106.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$112.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$117.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$112.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$117.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$117.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.43
|
| Rate for Payer: Healthfirst Commercial |
$117.91
|
| Rate for Payer: Healthfirst Essential Plan |
$265.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$112.01
|
| Rate for Payer: Healthfirst QHP |
$117.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$82.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$117.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$100.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$82.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$117.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$88.43
|
| Rate for Payer: SOMOS Essential |
$88.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$117.91
|
|
|
CHG ANGIOGRAPHY EXTREMITY BILATERAL RS&I
|
Professional
|
Both
|
$379.09
|
|
|
Service Code
|
HCPCS 75716 26
|
| Min. Negotiated Rate |
$71.53 |
| Max. Negotiated Rate |
$229.93 |
| Rate for Payer: Cash Price |
$103.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$102.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$91.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$91.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$97.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$102.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$97.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$102.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$102.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$76.64
|
| Rate for Payer: Healthfirst Commercial |
$102.19
|
| Rate for Payer: Healthfirst Essential Plan |
$229.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$97.08
|
| Rate for Payer: Healthfirst QHP |
$102.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$71.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$102.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$86.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$71.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$102.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$76.64
|
| Rate for Payer: SOMOS Essential |
$76.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$102.19
|
|
|
CHG ANGIOGRAPHY EXTREMITY BILATERAL RS&I
|
Professional
|
Both
|
$690.76
|
|
|
Service Code
|
HCPCS 75716
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$417.87 |
| Rate for Payer: Cash Price |
$188.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$185.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$167.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$167.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$176.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$185.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$176.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$185.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$185.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$139.29
|
| Rate for Payer: Healthfirst Commercial |
$185.72
|
| Rate for Payer: Healthfirst Essential Plan |
$417.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$176.43
|
| Rate for Payer: Healthfirst QHP |
$185.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$130.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$185.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$157.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$130.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$185.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$139.29
|
| Rate for Payer: SOMOS Essential |
$139.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$185.72
|
|
