|
CHG ANGIOGRAPHY EXTREMITY BILATERAL RS&I
|
Professional
|
Both
|
$311.68
|
|
|
Service Code
|
HCPCS 75716 TC
|
| Min. Negotiated Rate |
$58.47 |
| Max. Negotiated Rate |
$187.94 |
| Rate for Payer: Cash Price |
$85.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$83.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$75.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$75.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$79.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$83.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$79.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$62.65
|
| Rate for Payer: Healthfirst Commercial |
$83.53
|
| Rate for Payer: Healthfirst Essential Plan |
$187.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$79.35
|
| Rate for Payer: Healthfirst QHP |
$83.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$58.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$83.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$71.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$58.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$83.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$62.65
|
| Rate for Payer: SOMOS Essential |
$62.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$83.53
|
|
|
CHG ANGIOGRAPHY EXTREMITY UNILATERAL RS&I
|
Professional
|
Both
|
$300.16
|
|
|
Service Code
|
HCPCS 75710 TC
|
| Min. Negotiated Rate |
$55.21 |
| Max. Negotiated Rate |
$177.46 |
| Rate for Payer: Cash Price |
$81.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$78.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$70.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$70.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$74.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$78.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$74.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$78.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$78.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$59.15
|
| Rate for Payer: Healthfirst Commercial |
$78.87
|
| Rate for Payer: Healthfirst Essential Plan |
$177.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$74.93
|
| Rate for Payer: Healthfirst QHP |
$78.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$55.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$78.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$67.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$55.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$78.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$59.15
|
| Rate for Payer: SOMOS Essential |
$59.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$78.87
|
|
|
CHG ANGIOGRAPHY EXTREMITY UNILATERAL RS&I
|
Professional
|
Both
|
$345.52
|
|
|
Service Code
|
HCPCS 75710 26
|
| Min. Negotiated Rate |
$63.95 |
| Max. Negotiated Rate |
$205.54 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$91.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$82.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$82.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$86.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$91.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$86.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$91.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$68.51
|
| Rate for Payer: Healthfirst Commercial |
$91.35
|
| Rate for Payer: Healthfirst Essential Plan |
$205.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$86.78
|
| Rate for Payer: Healthfirst QHP |
$91.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$63.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$91.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$77.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$63.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$91.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$68.51
|
| Rate for Payer: SOMOS Essential |
$68.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$91.35
|
|
|
CHG ANGIOGRAPHY EXTREMITY UNILATERAL RS&I
|
Professional
|
Both
|
$645.68
|
|
|
Service Code
|
HCPCS 75710
|
| Min. Negotiated Rate |
$119.15 |
| Max. Negotiated Rate |
$383.00 |
| Rate for Payer: Cash Price |
$174.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$170.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$153.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$153.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$161.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$170.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$161.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$170.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$170.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$127.67
|
| Rate for Payer: Healthfirst Commercial |
$170.22
|
| Rate for Payer: Healthfirst Essential Plan |
$383.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$161.71
|
| Rate for Payer: Healthfirst QHP |
$170.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$119.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$170.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$144.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$119.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$170.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$127.67
|
| Rate for Payer: SOMOS Essential |
$127.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$170.22
|
|
|
CHG ANGIOGRAPHY INTERNAL MAMMARY RS&I
|
Professional
|
Both
|
$228.80
|
|
|
Service Code
|
HCPCS 75756 26
|
| Min. Negotiated Rate |
$42.73 |
| Max. Negotiated Rate |
$137.36 |
| Rate for Payer: Cash Price |
$60.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$61.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$54.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$54.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$58.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$61.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$58.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$61.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.79
|
| Rate for Payer: Healthfirst Commercial |
$61.05
|
| Rate for Payer: Healthfirst Essential Plan |
$137.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$58.00
|
| Rate for Payer: Healthfirst QHP |
$61.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$42.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$61.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$51.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$42.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$61.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$45.79
|
| Rate for Payer: SOMOS Essential |
$45.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$61.05
|
|
|
CHG ANGIOGRAPHY INTERNAL MAMMARY RS&I
|
Professional
|
Both
|
$466.62
|
|
|
Service Code
|
HCPCS 75756 TC
|
| Min. Negotiated Rate |
$88.52 |
| Max. Negotiated Rate |
$284.51 |
| Rate for Payer: Cash Price |
$131.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$126.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$113.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$113.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$120.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$126.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$120.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$94.84
|
| Rate for Payer: Healthfirst Commercial |
$126.45
|
| Rate for Payer: Healthfirst Essential Plan |
$284.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$120.13
|
| Rate for Payer: Healthfirst QHP |
$126.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$88.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$126.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$107.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$88.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$126.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$94.84
|
| Rate for Payer: SOMOS Essential |
$94.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$126.45
|
|
|
CHG ANGIOGRAPHY INTERNAL MAMMARY RS&I
|
Professional
|
Both
|
$695.45
|
|
|
Service Code
|
HCPCS 75756
|
| Min. Negotiated Rate |
$131.25 |
| Max. Negotiated Rate |
$421.88 |
| Rate for Payer: Cash Price |
$192.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$187.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$168.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$168.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$178.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$187.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$178.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$187.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$187.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$140.62
|
| Rate for Payer: Healthfirst Commercial |
$187.50
|
| Rate for Payer: Healthfirst Essential Plan |
$421.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$178.12
|
| Rate for Payer: Healthfirst QHP |
$187.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$131.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$187.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$159.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$131.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$187.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$140.62
|
| Rate for Payer: SOMOS Essential |
$140.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$187.50
|
|
|
CHG ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I
|
Professional
|
Both
|
$612.33
|
|
|
Service Code
|
HCPCS 75736
|
| Min. Negotiated Rate |
$115.93 |
| Max. Negotiated Rate |
$372.64 |
| Rate for Payer: Cash Price |
$166.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$165.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$149.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$149.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$157.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$165.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$157.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$165.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$124.22
|
| Rate for Payer: Healthfirst Commercial |
$165.62
|
| Rate for Payer: Healthfirst Essential Plan |
$372.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$157.34
|
| Rate for Payer: Healthfirst QHP |
$165.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$115.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$165.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$140.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$115.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$165.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$124.22
|
| Rate for Payer: SOMOS Essential |
$124.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$165.62
|
|
|
CHG ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I
|
Professional
|
Both
|
$397.64
|
|
|
Service Code
|
HCPCS 75736 TC
|
| Min. Negotiated Rate |
$76.56 |
| Max. Negotiated Rate |
$246.08 |
| Rate for Payer: Cash Price |
$109.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$109.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$98.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$98.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$103.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$109.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$103.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$109.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$82.03
|
| Rate for Payer: Healthfirst Commercial |
$109.37
|
| Rate for Payer: Healthfirst Essential Plan |
$246.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$103.90
|
| Rate for Payer: Healthfirst QHP |
$109.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$76.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$109.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$92.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$76.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$109.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$82.03
|
| Rate for Payer: SOMOS Essential |
$82.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$109.37
|
|
|
CHG ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I
|
Professional
|
Both
|
$214.69
|
|
|
Service Code
|
HCPCS 75736 26
|
| Min. Negotiated Rate |
$39.38 |
| Max. Negotiated Rate |
$126.56 |
| Rate for Payer: Cash Price |
$57.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$56.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$50.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$50.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$53.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$56.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$53.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.19
|
| Rate for Payer: Healthfirst Commercial |
$56.25
|
| Rate for Payer: Healthfirst Essential Plan |
$126.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$53.44
|
| Rate for Payer: Healthfirst QHP |
$56.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$39.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$56.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$47.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$39.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$56.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$42.19
|
| Rate for Payer: SOMOS Essential |
$42.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56.25
|
|
|
CHG ANGIOGRAPHY PULMONARY BILATERAL SLCTV RS&I
|
Professional
|
Both
|
$314.55
|
|
|
Service Code
|
HCPCS 75743 TC
|
| Min. Negotiated Rate |
$58.47 |
| Max. Negotiated Rate |
$187.94 |
| Rate for Payer: Cash Price |
$85.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$83.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$75.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$75.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$79.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$83.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$79.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$62.65
|
| Rate for Payer: Healthfirst Commercial |
$83.53
|
| Rate for Payer: Healthfirst Essential Plan |
$187.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$79.35
|
| Rate for Payer: Healthfirst QHP |
$83.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$58.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$83.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$71.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$58.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$83.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$62.65
|
| Rate for Payer: SOMOS Essential |
$62.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$83.53
|
|
|
CHG ANGIOGRAPHY PULMONARY BILATERAL SLCTV RS&I
|
Professional
|
Both
|
$625.73
|
|
|
Service Code
|
HCPCS 75743
|
| Min. Negotiated Rate |
$117.70 |
| Max. Negotiated Rate |
$378.34 |
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$168.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$151.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$151.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$159.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$168.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$159.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$168.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$168.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$126.11
|
| Rate for Payer: Healthfirst Commercial |
$168.15
|
| Rate for Payer: Healthfirst Essential Plan |
$378.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$159.74
|
| Rate for Payer: Healthfirst QHP |
$168.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$117.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$168.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$142.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$117.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$168.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$126.11
|
| Rate for Payer: SOMOS Essential |
$126.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$168.15
|
|
|
CHG ANGIOGRAPHY PULMONARY BILATERAL SLCTV RS&I
|
Professional
|
Both
|
$311.19
|
|
|
Service Code
|
HCPCS 75743 26
|
| Min. Negotiated Rate |
$59.24 |
| Max. Negotiated Rate |
$190.42 |
| Rate for Payer: Cash Price |
$84.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$84.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$76.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$76.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$80.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$84.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$80.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$84.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$84.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$63.47
|
| Rate for Payer: Healthfirst Commercial |
$84.63
|
| Rate for Payer: Healthfirst Essential Plan |
$190.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$80.40
|
| Rate for Payer: Healthfirst QHP |
$84.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$59.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$84.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$71.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$59.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$84.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$63.47
|
| Rate for Payer: SOMOS Essential |
$63.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$84.63
|
|
|
CHG ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I
|
Professional
|
Both
|
$554.86
|
|
|
Service Code
|
HCPCS 75741
|
| Min. Negotiated Rate |
$102.76 |
| Max. Negotiated Rate |
$330.30 |
| Rate for Payer: Cash Price |
$149.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$146.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$132.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$132.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$139.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$146.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$139.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$146.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$146.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$110.10
|
| Rate for Payer: Healthfirst Commercial |
$146.80
|
| Rate for Payer: Healthfirst Essential Plan |
$330.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$139.46
|
| Rate for Payer: Healthfirst QHP |
$146.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$102.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$146.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$124.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$102.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$146.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$110.10
|
| Rate for Payer: SOMOS Essential |
$110.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$146.80
|
|
|
CHG ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I
|
Professional
|
Both
|
$308.77
|
|
|
Service Code
|
HCPCS 75741 TC
|
| Min. Negotiated Rate |
$57.38 |
| Max. Negotiated Rate |
$184.43 |
| Rate for Payer: Cash Price |
$83.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$81.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$73.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$77.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$61.48
|
| Rate for Payer: Healthfirst Commercial |
$81.97
|
| Rate for Payer: Healthfirst Essential Plan |
$184.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$77.87
|
| Rate for Payer: Healthfirst QHP |
$81.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$57.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$81.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$69.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$57.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$61.48
|
| Rate for Payer: SOMOS Essential |
$61.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.97
|
|
|
CHG ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I
|
Professional
|
Both
|
$246.05
|
|
|
Service Code
|
HCPCS 75741 26
|
| Min. Negotiated Rate |
$45.37 |
| Max. Negotiated Rate |
$145.84 |
| Rate for Payer: Cash Price |
$65.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$64.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$58.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$61.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$64.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$61.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.62
|
| Rate for Payer: Healthfirst Commercial |
$64.82
|
| Rate for Payer: Healthfirst Essential Plan |
$145.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.58
|
| Rate for Payer: Healthfirst QHP |
$64.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$64.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$55.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$64.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$48.62
|
| Rate for Payer: SOMOS Essential |
$48.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$64.82
|
|
|
CHG ANGIOGRAPHY SPINAL SELECTIVE RS&I
|
Professional
|
Both
|
$1,090.22
|
|
|
Service Code
|
HCPCS 75705
|
| Min. Negotiated Rate |
$210.60 |
| Max. Negotiated Rate |
$676.93 |
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$300.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$270.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$270.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$285.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$300.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$285.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$300.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$300.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$225.65
|
| Rate for Payer: Healthfirst Commercial |
$300.86
|
| Rate for Payer: Healthfirst Essential Plan |
$676.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$285.82
|
| Rate for Payer: Healthfirst QHP |
$300.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$210.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$300.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$255.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$210.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$300.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$225.65
|
| Rate for Payer: SOMOS Essential |
$225.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$300.86
|
|
|
CHG ANGIOGRAPHY SPINAL SELECTIVE RS&I
|
Professional
|
Both
|
$510.02
|
|
|
Service Code
|
HCPCS 75705 26
|
| Min. Negotiated Rate |
$96.27 |
| Max. Negotiated Rate |
$309.44 |
| Rate for Payer: Cash Price |
$135.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$137.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$123.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$123.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$130.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$137.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$130.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$137.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$137.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$103.15
|
| Rate for Payer: Healthfirst Commercial |
$137.53
|
| Rate for Payer: Healthfirst Essential Plan |
$309.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$130.65
|
| Rate for Payer: Healthfirst QHP |
$137.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$96.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$137.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$116.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$96.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$137.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$103.15
|
| Rate for Payer: SOMOS Essential |
$103.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$137.53
|
|
|
CHG ANGIOGRAPHY SPINAL SELECTIVE RS&I
|
Professional
|
Both
|
$580.20
|
|
|
Service Code
|
HCPCS 75705 TC
|
| Min. Negotiated Rate |
$114.33 |
| Max. Negotiated Rate |
$367.49 |
| Rate for Payer: Cash Price |
$160.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$163.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$147.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$147.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$155.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$163.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$155.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$163.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$163.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$122.50
|
| Rate for Payer: Healthfirst Commercial |
$163.33
|
| Rate for Payer: Healthfirst Essential Plan |
$367.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$155.16
|
| Rate for Payer: Healthfirst QHP |
$163.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$114.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$163.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$138.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$114.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$163.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$122.50
|
| Rate for Payer: SOMOS Essential |
$122.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$163.33
|
|
|
CHG ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I
|
Professional
|
Both
|
$386.65
|
|
|
Service Code
|
HCPCS 75726 26
|
| Min. Negotiated Rate |
$72.39 |
| Max. Negotiated Rate |
$232.67 |
| Rate for Payer: Cash Price |
$102.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$103.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$93.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$93.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$98.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$103.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$98.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$103.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$77.56
|
| Rate for Payer: Healthfirst Commercial |
$103.41
|
| Rate for Payer: Healthfirst Essential Plan |
$232.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$98.24
|
| Rate for Payer: Healthfirst QHP |
$103.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$72.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$103.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$87.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$72.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$103.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$77.56
|
| Rate for Payer: SOMOS Essential |
$77.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$103.41
|
|
|
CHG ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I
|
Professional
|
Both
|
$337.54
|
|
|
Service Code
|
HCPCS 75726 TC
|
| Min. Negotiated Rate |
$63.36 |
| Max. Negotiated Rate |
$203.65 |
| Rate for Payer: Cash Price |
$92.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$90.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$81.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$81.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$85.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$90.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$85.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$90.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67.88
|
| Rate for Payer: Healthfirst Commercial |
$90.51
|
| Rate for Payer: Healthfirst Essential Plan |
$203.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$85.98
|
| Rate for Payer: Healthfirst QHP |
$90.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$63.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$90.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$76.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$63.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$90.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$67.88
|
| Rate for Payer: SOMOS Essential |
$67.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$90.51
|
|
|
CHG ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I
|
Professional
|
Both
|
$724.19
|
|
|
Service Code
|
HCPCS 75726
|
| Min. Negotiated Rate |
$135.74 |
| Max. Negotiated Rate |
$436.32 |
| Rate for Payer: Cash Price |
$194.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$193.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$174.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$174.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$184.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$193.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$184.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$193.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$193.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$145.44
|
| Rate for Payer: Healthfirst Commercial |
$193.92
|
| Rate for Payer: Healthfirst Essential Plan |
$436.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$184.22
|
| Rate for Payer: Healthfirst QHP |
$193.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$135.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$193.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$164.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$135.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$193.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$145.44
|
| Rate for Payer: SOMOS Essential |
$145.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$193.92
|
|
|
CHG ANGRPH CATH F-UP STD TCAT OTHER THAN THROMBYLSIS
|
Professional
|
Both
|
$398.76
|
|
|
Service Code
|
HCPCS 75898 26
|
| Min. Negotiated Rate |
$74.39 |
| Max. Negotiated Rate |
$239.11 |
| Rate for Payer: Cash Price |
$106.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$106.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$95.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$95.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$100.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$106.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$100.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$106.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$79.70
|
| Rate for Payer: Healthfirst Commercial |
$106.27
|
| Rate for Payer: Healthfirst Essential Plan |
$239.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$100.96
|
| Rate for Payer: Healthfirst QHP |
$106.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$74.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$106.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$90.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$74.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$106.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$79.70
|
| Rate for Payer: SOMOS Essential |
$79.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$106.27
|
|
|
CHG ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I
|
Professional
|
Both
|
$214.97
|
|
|
Service Code
|
HCPCS 75746 26
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$127.28 |
| Rate for Payer: Cash Price |
$57.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$56.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$50.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$50.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$53.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$56.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$53.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.43
|
| Rate for Payer: Healthfirst Commercial |
$56.57
|
| Rate for Payer: Healthfirst Essential Plan |
$127.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$53.74
|
| Rate for Payer: Healthfirst QHP |
$56.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$39.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$56.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$48.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$39.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$56.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$42.43
|
| Rate for Payer: SOMOS Essential |
$42.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56.57
|
|
|
CHG ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I
|
Professional
|
Both
|
$572.64
|
|
|
Service Code
|
HCPCS 75746
|
| Min. Negotiated Rate |
$107.85 |
| Max. Negotiated Rate |
$346.66 |
| Rate for Payer: Cash Price |
$155.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$154.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$138.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$138.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$146.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$154.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$146.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$154.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$154.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$115.55
|
| Rate for Payer: Healthfirst Commercial |
$154.07
|
| Rate for Payer: Healthfirst Essential Plan |
$346.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$146.37
|
| Rate for Payer: Healthfirst QHP |
$154.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$107.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$154.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$130.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$107.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$154.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$115.55
|
| Rate for Payer: SOMOS Essential |
$115.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$154.07
|
|
