|
CHG ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I
|
Professional
|
Both
|
$357.67
|
|
|
Service Code
|
HCPCS 75746 TC
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$219.38 |
| Rate for Payer: Cash Price |
$98.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$97.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$87.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$87.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$92.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$97.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$92.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$97.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$97.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.12
|
| Rate for Payer: Healthfirst Commercial |
$97.50
|
| Rate for Payer: Healthfirst Essential Plan |
$219.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$92.62
|
| Rate for Payer: Healthfirst QHP |
$97.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$68.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$97.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$82.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$68.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$97.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$73.12
|
| Rate for Payer: SOMOS Essential |
$73.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$97.50
|
|
|
CHG ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I
|
Professional
|
Both
|
$188.65
|
|
|
Service Code
|
HCPCS 75774 26
|
| Min. Negotiated Rate |
$34.99 |
| Max. Negotiated Rate |
$112.48 |
| Rate for Payer: Cash Price |
$50.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$49.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$44.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$44.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$47.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$49.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$47.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$37.49
|
| Rate for Payer: Healthfirst Commercial |
$49.99
|
| Rate for Payer: Healthfirst Essential Plan |
$112.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.49
|
| Rate for Payer: Healthfirst QHP |
$49.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$49.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$42.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$49.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$37.49
|
| Rate for Payer: SOMOS Essential |
$37.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$49.99
|
|
|
CHG ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I
|
Professional
|
Both
|
$411.32
|
|
|
Service Code
|
HCPCS 75774
|
| Min. Negotiated Rate |
$76.18 |
| Max. Negotiated Rate |
$244.87 |
| Rate for Payer: Cash Price |
$111.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$108.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$97.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$97.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$103.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$108.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$103.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$108.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$108.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$81.62
|
| Rate for Payer: Healthfirst Commercial |
$108.83
|
| Rate for Payer: Healthfirst Essential Plan |
$244.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$103.39
|
| Rate for Payer: Healthfirst QHP |
$108.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$76.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$108.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$92.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$76.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$108.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$81.62
|
| Rate for Payer: SOMOS Essential |
$81.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$108.83
|
|
|
CHG ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I
|
Professional
|
Both
|
$222.67
|
|
|
Service Code
|
HCPCS 75774 TC
|
| Min. Negotiated Rate |
$41.19 |
| Max. Negotiated Rate |
$132.39 |
| Rate for Payer: Cash Price |
$60.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$58.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$52.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$52.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$55.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$58.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$55.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$58.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$58.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.13
|
| Rate for Payer: Healthfirst Commercial |
$58.84
|
| Rate for Payer: Healthfirst Essential Plan |
$132.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$55.90
|
| Rate for Payer: Healthfirst QHP |
$58.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$41.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$58.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$50.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$41.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$58.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$44.13
|
| Rate for Payer: SOMOS Essential |
$44.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$58.84
|
|
|
CHG ANTEGRADE UROGRAPHY RADIOLOGICAL SUPVJ & INTERPJ
|
Professional
|
Both
|
$491.47
|
|
|
Service Code
|
HCPCS 74425 TC
|
| Min. Negotiated Rate |
$89.28 |
| Max. Negotiated Rate |
$286.99 |
| Rate for Payer: Cash Price |
$132.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$114.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$114.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$121.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$121.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$127.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$95.66
|
| Rate for Payer: Healthfirst Commercial |
$127.55
|
| Rate for Payer: Healthfirst Essential Plan |
$286.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$121.17
|
| Rate for Payer: Healthfirst QHP |
$127.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$89.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$127.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$108.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$89.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$95.66
|
| Rate for Payer: SOMOS Essential |
$95.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.55
|
|
|
CHG ANTEGRADE UROGRAPHY RADIOLOGICAL SUPVJ & INTERPJ
|
Professional
|
Both
|
$95.24
|
|
|
Service Code
|
HCPCS 74425 26
|
| Min. Negotiated Rate |
$18.49 |
| Max. Negotiated Rate |
$59.42 |
| Rate for Payer: Cash Price |
$25.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.81
|
| Rate for Payer: Healthfirst Commercial |
$26.41
|
| Rate for Payer: Healthfirst Essential Plan |
$59.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.09
|
| Rate for Payer: Healthfirst QHP |
$26.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19.81
|
| Rate for Payer: SOMOS Essential |
$19.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.41
|
|
|
CHG ANTEGRADE UROGRAPHY RADIOLOGICAL SUPVJ & INTERPJ
|
Professional
|
Both
|
$586.71
|
|
|
Service Code
|
HCPCS 74425
|
| Min. Negotiated Rate |
$107.77 |
| Max. Negotiated Rate |
$346.41 |
| Rate for Payer: Cash Price |
$158.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$153.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$138.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$138.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$146.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$153.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$146.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$153.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$153.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$115.47
|
| Rate for Payer: Healthfirst Commercial |
$153.96
|
| Rate for Payer: Healthfirst Essential Plan |
$346.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$146.26
|
| Rate for Payer: Healthfirst QHP |
$153.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$107.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$153.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$130.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$107.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$153.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$115.47
|
| Rate for Payer: SOMOS Essential |
$115.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$153.96
|
|
|
CHG ANTISTREPTOLYSIN O TITER
|
Professional
|
Both
|
$18.00
|
|
|
Service Code
|
HCPCS 86060
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$16.43 |
| Rate for Payer: Cash Price |
$7.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.47
|
| Rate for Payer: Healthfirst Commercial |
$7.30
|
| Rate for Payer: Healthfirst Essential Plan |
$16.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.93
|
| Rate for Payer: Healthfirst QHP |
$7.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$5.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$7.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$6.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$5.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2.92
|
| Rate for Payer: SOMOS Essential |
$2.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.30
|
|
|
CHG AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I
|
Professional
|
Both
|
$278.74
|
|
|
Service Code
|
HCPCS 75630 TC
|
| Min. Negotiated Rate |
$52.22 |
| Max. Negotiated Rate |
$167.85 |
| Rate for Payer: Cash Price |
$76.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$74.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$67.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$67.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$70.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$74.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$70.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$74.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$55.95
|
| Rate for Payer: Healthfirst Commercial |
$74.60
|
| Rate for Payer: Healthfirst Essential Plan |
$167.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$70.87
|
| Rate for Payer: Healthfirst QHP |
$74.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$52.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$74.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$63.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$52.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$74.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$55.95
|
| Rate for Payer: SOMOS Essential |
$55.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$74.60
|
|
|
CHG AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I
|
Professional
|
Both
|
$664.44
|
|
|
Service Code
|
HCPCS 75630
|
| Min. Negotiated Rate |
$124.75 |
| Max. Negotiated Rate |
$400.97 |
| Rate for Payer: Cash Price |
$181.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$178.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$160.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$160.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$169.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$178.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$169.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$178.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$178.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$133.66
|
| Rate for Payer: Healthfirst Commercial |
$178.21
|
| Rate for Payer: Healthfirst Essential Plan |
$400.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$169.30
|
| Rate for Payer: Healthfirst QHP |
$178.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$124.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$178.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$151.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$124.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$178.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$133.66
|
| Rate for Payer: SOMOS Essential |
$133.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$178.21
|
|
|
CHG AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I
|
Professional
|
Both
|
$385.74
|
|
|
Service Code
|
HCPCS 75630 26
|
| Min. Negotiated Rate |
$72.53 |
| Max. Negotiated Rate |
$233.15 |
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$103.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$93.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$93.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$98.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$103.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$98.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$103.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$77.72
|
| Rate for Payer: Healthfirst Commercial |
$103.62
|
| Rate for Payer: Healthfirst Essential Plan |
$233.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$98.44
|
| Rate for Payer: Healthfirst QHP |
$103.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$72.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$103.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$88.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$72.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$103.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$77.72
|
| Rate for Payer: SOMOS Essential |
$77.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$103.62
|
|
|
CHG AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$542.71
|
|
|
Service Code
|
HCPCS 75625
|
| Min. Negotiated Rate |
$101.30 |
| Max. Negotiated Rate |
$325.62 |
| Rate for Payer: Cash Price |
$147.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$144.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$130.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$130.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$137.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$144.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$137.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$144.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$144.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$108.54
|
| Rate for Payer: Healthfirst Commercial |
$144.72
|
| Rate for Payer: Healthfirst Essential Plan |
$325.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$137.48
|
| Rate for Payer: Healthfirst QHP |
$144.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$101.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$144.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$123.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$101.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$144.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$108.54
|
| Rate for Payer: SOMOS Essential |
$108.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$144.72
|
|
|
CHG AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$282.66
|
|
|
Service Code
|
HCPCS 75625 26
|
| Min. Negotiated Rate |
$53.32 |
| Max. Negotiated Rate |
$171.38 |
| Rate for Payer: Cash Price |
$76.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$76.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$68.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$68.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$72.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$76.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$72.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.13
|
| Rate for Payer: Healthfirst Commercial |
$76.17
|
| Rate for Payer: Healthfirst Essential Plan |
$171.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$72.36
|
| Rate for Payer: Healthfirst QHP |
$76.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$53.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$76.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$64.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$53.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$76.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$57.13
|
| Rate for Payer: SOMOS Essential |
$57.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$76.17
|
|
|
CHG AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$260.05
|
|
|
Service Code
|
HCPCS 75625 TC
|
| Min. Negotiated Rate |
$47.98 |
| Max. Negotiated Rate |
$154.24 |
| Rate for Payer: Cash Price |
$70.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$68.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$61.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$65.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$68.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$65.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$68.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$68.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51.41
|
| Rate for Payer: Healthfirst Commercial |
$68.55
|
| Rate for Payer: Healthfirst Essential Plan |
$154.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$65.12
|
| Rate for Payer: Healthfirst QHP |
$68.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$47.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$68.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$58.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$47.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$68.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$51.41
|
| Rate for Payer: SOMOS Essential |
$51.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$68.55
|
|
|
CHG AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$295.86
|
|
|
Service Code
|
HCPCS 75605 TC
|
| Min. Negotiated Rate |
$55.48 |
| Max. Negotiated Rate |
$178.34 |
| Rate for Payer: Cash Price |
$81.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$79.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$71.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$71.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$75.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$79.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$75.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$79.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$59.45
|
| Rate for Payer: Healthfirst Commercial |
$79.26
|
| Rate for Payer: Healthfirst Essential Plan |
$178.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$75.30
|
| Rate for Payer: Healthfirst QHP |
$79.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$55.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$79.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$67.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$55.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$79.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$59.45
|
| Rate for Payer: SOMOS Essential |
$59.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$79.26
|
|
|
CHG AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$218.89
|
|
|
Service Code
|
HCPCS 75605 26
|
| Min. Negotiated Rate |
$41.38 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Cash Price |
$59.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$59.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$53.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$56.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$59.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$56.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.33
|
| Rate for Payer: Healthfirst Commercial |
$59.11
|
| Rate for Payer: Healthfirst Essential Plan |
$133.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$56.15
|
| Rate for Payer: Healthfirst QHP |
$59.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$41.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$59.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$50.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$41.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$59.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$44.33
|
| Rate for Payer: SOMOS Essential |
$44.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$59.11
|
|
|
CHG AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$514.71
|
|
|
Service Code
|
HCPCS 75605
|
| Min. Negotiated Rate |
$96.86 |
| Max. Negotiated Rate |
$311.33 |
| Rate for Payer: Cash Price |
$140.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$138.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$124.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$124.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$138.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$138.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$138.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$103.78
|
| Rate for Payer: Healthfirst Commercial |
$138.37
|
| Rate for Payer: Healthfirst Essential Plan |
$311.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$131.45
|
| Rate for Payer: Healthfirst QHP |
$138.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$96.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$138.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$117.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$96.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$138.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$103.78
|
| Rate for Payer: SOMOS Essential |
$103.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$138.37
|
|
|
CHG AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$101.96
|
|
|
Service Code
|
HCPCS 75600 26
|
| Min. Negotiated Rate |
$18.21 |
| Max. Negotiated Rate |
$58.55 |
| Rate for Payer: Cash Price |
$26.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.52
|
| Rate for Payer: Healthfirst Commercial |
$26.02
|
| Rate for Payer: Healthfirst Essential Plan |
$58.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24.72
|
| Rate for Payer: Healthfirst QHP |
$26.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19.52
|
| Rate for Payer: SOMOS Essential |
$19.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.02
|
|
|
CHG AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$698.36
|
|
|
Service Code
|
HCPCS 75600 TC
|
| Min. Negotiated Rate |
$122.86 |
| Max. Negotiated Rate |
$394.92 |
| Rate for Payer: Cash Price |
$188.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$175.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$157.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$157.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$166.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$175.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$166.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$175.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$131.64
|
| Rate for Payer: Healthfirst Commercial |
$175.52
|
| Rate for Payer: Healthfirst Essential Plan |
$394.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$166.74
|
| Rate for Payer: Healthfirst QHP |
$175.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$122.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$175.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$149.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$122.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$175.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$131.64
|
| Rate for Payer: SOMOS Essential |
$131.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$175.52
|
|
|
CHG AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$800.31
|
|
|
Service Code
|
HCPCS 75600
|
| Min. Negotiated Rate |
$141.08 |
| Max. Negotiated Rate |
$453.46 |
| Rate for Payer: Cash Price |
$214.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$201.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$181.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$181.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$191.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$201.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$191.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$201.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$201.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$151.16
|
| Rate for Payer: Healthfirst Commercial |
$201.54
|
| Rate for Payer: Healthfirst Essential Plan |
$453.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$191.46
|
| Rate for Payer: Healthfirst QHP |
$201.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$141.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$201.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$171.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$141.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$201.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$151.16
|
| Rate for Payer: SOMOS Essential |
$151.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$201.54
|
|
|
CHG AQMBF PET REST AND PHARMACOLOGIC STRESS
|
Professional
|
Both
|
$114.56
|
|
|
Service Code
|
HCPCS 78434 26
|
| Min. Negotiated Rate |
$21.76 |
| Max. Negotiated Rate |
$69.95 |
| Rate for Payer: Cash Price |
$31.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$27.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.32
|
| Rate for Payer: Healthfirst Commercial |
$31.09
|
| Rate for Payer: Healthfirst Essential Plan |
$69.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.54
|
| Rate for Payer: Healthfirst QHP |
$31.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$31.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.32
|
| Rate for Payer: SOMOS Essential |
$23.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.09
|
|
|
CHG ASSAY OF THYROID STIMULATING HORMONE TSH
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS 84443
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.60
|
| Rate for Payer: Healthfirst Commercial |
$16.80
|
| Rate for Payer: Healthfirst Essential Plan |
$37.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.96
|
| Rate for Payer: Healthfirst QHP |
$16.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$14.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.72
|
| Rate for Payer: SOMOS Essential |
$6.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.80
|
|
|
CHG BASIC METABOLIC PANEL CALCIUM TOTAL
|
Professional
|
Both
|
$21.15
|
|
|
Service Code
|
HCPCS 80048
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$19.04 |
| Rate for Payer: Cash Price |
$8.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.34
|
| Rate for Payer: Healthfirst Commercial |
$8.46
|
| Rate for Payer: Healthfirst Essential Plan |
$19.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.04
|
| Rate for Payer: Healthfirst QHP |
$8.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$5.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$5.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.38
|
| Rate for Payer: SOMOS Essential |
$3.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.46
|
|
|
CHG BASIC RADIATION DOSIMETRY CALCULATION
|
Professional
|
Both
|
$278.22
|
|
|
Service Code
|
HCPCS 77300
|
| Min. Negotiated Rate |
$53.63 |
| Max. Negotiated Rate |
$172.40 |
| Rate for Payer: Cash Price |
$75.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$76.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$68.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$68.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$72.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$76.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$72.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.47
|
| Rate for Payer: Healthfirst Commercial |
$76.62
|
| Rate for Payer: Healthfirst Essential Plan |
$172.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$72.79
|
| Rate for Payer: Healthfirst QHP |
$76.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$53.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$76.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$65.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$53.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$76.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$57.47
|
| Rate for Payer: SOMOS Essential |
$57.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$76.62
|
|
|
CHG BASIC RADIATION DOSIMETRY CALCULATION
|
Professional
|
Both
|
$143.61
|
|
|
Service Code
|
HCPCS 77300 TC
|
| Min. Negotiated Rate |
$28.15 |
| Max. Negotiated Rate |
$90.47 |
| Rate for Payer: Cash Price |
$39.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$40.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.16
|
| Rate for Payer: Healthfirst Commercial |
$40.21
|
| Rate for Payer: Healthfirst Essential Plan |
$90.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.20
|
| Rate for Payer: Healthfirst QHP |
$40.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$40.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$30.16
|
| Rate for Payer: SOMOS Essential |
$30.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.21
|
|
