|
CHG LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY
|
Professional
|
Both
|
$18.52
|
|
|
Service Code
|
HCPCS 88300 26
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$11.09 |
| Rate for Payer: Cash Price |
$4.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.70
|
| Rate for Payer: Healthfirst Commercial |
$4.93
|
| Rate for Payer: Healthfirst Essential Plan |
$11.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.68
|
| Rate for Payer: Healthfirst QHP |
$4.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$4.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.70
|
| Rate for Payer: SOMOS Essential |
$3.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.93
|
|
|
CHG LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY
|
Professional
|
Both
|
$51.63
|
|
|
Service Code
|
HCPCS 88300 TC
|
| Min. Negotiated Rate |
$10.21 |
| Max. Negotiated Rate |
$32.83 |
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.94
|
| Rate for Payer: Healthfirst Commercial |
$14.59
|
| Rate for Payer: Healthfirst Essential Plan |
$32.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.86
|
| Rate for Payer: Healthfirst QHP |
$14.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$10.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$14.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$12.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$10.94
|
| Rate for Payer: SOMOS Essential |
$10.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.59
|
|
|
CHG LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY
|
Professional
|
Both
|
$70.11
|
|
|
Service Code
|
HCPCS 88300
|
| Min. Negotiated Rate |
$13.66 |
| Max. Negotiated Rate |
$43.92 |
| Rate for Payer: Cash Price |
$19.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.64
|
| Rate for Payer: Healthfirst Commercial |
$19.52
|
| Rate for Payer: Healthfirst Essential Plan |
$43.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.54
|
| Rate for Payer: Healthfirst QHP |
$19.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$14.64
|
| Rate for Payer: SOMOS Essential |
$14.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.52
|
|
|
CHG LIPID PANEL
|
Professional
|
Both
|
$33.47
|
|
|
Service Code
|
HCPCS 80061
|
| Min. Negotiated Rate |
$5.36 |
| Max. Negotiated Rate |
$30.13 |
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.04
|
| Rate for Payer: Healthfirst Commercial |
$13.39
|
| Rate for Payer: Healthfirst Essential Plan |
$30.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.72
|
| Rate for Payer: Healthfirst QHP |
$13.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$13.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$11.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5.36
|
| Rate for Payer: SOMOS Essential |
$5.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.39
|
|
|
CHG LIVER IMAGING STATIC ONLY
|
Professional
|
Both
|
$689.43
|
|
|
Service Code
|
HCPCS 78201 TC
|
| Min. Negotiated Rate |
$126.99 |
| Max. Negotiated Rate |
$408.17 |
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$181.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$163.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$163.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$172.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$181.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$172.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$181.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$181.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$136.06
|
| Rate for Payer: Healthfirst Commercial |
$181.41
|
| Rate for Payer: Healthfirst Essential Plan |
$408.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$172.34
|
| Rate for Payer: Healthfirst QHP |
$181.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$126.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$181.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$154.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$126.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$181.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$136.06
|
| Rate for Payer: SOMOS Essential |
$136.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$181.41
|
|
|
CHG LIVER IMAGING STATIC ONLY
|
Professional
|
Both
|
$80.71
|
|
|
Service Code
|
HCPCS 78201 26
|
| Min. Negotiated Rate |
$15.28 |
| Max. Negotiated Rate |
$49.12 |
| Rate for Payer: Cash Price |
$21.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$19.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$20.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.37
|
| Rate for Payer: Healthfirst Commercial |
$21.83
|
| Rate for Payer: Healthfirst Essential Plan |
$49.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20.74
|
| Rate for Payer: Healthfirst QHP |
$21.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$15.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$21.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$18.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$16.37
|
| Rate for Payer: SOMOS Essential |
$16.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.83
|
|
|
CHG LIVER IMAGING STATIC ONLY
|
Professional
|
Both
|
$770.14
|
|
|
Service Code
|
HCPCS 78201
|
| Min. Negotiated Rate |
$142.27 |
| Max. Negotiated Rate |
$457.29 |
| Rate for Payer: Cash Price |
$207.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$203.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$182.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$182.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$193.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$203.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$193.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$203.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$203.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$152.43
|
| Rate for Payer: Healthfirst Commercial |
$203.24
|
| Rate for Payer: Healthfirst Essential Plan |
$457.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$193.08
|
| Rate for Payer: Healthfirst QHP |
$203.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$142.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$203.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$172.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$142.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$203.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$152.43
|
| Rate for Payer: SOMOS Essential |
$152.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$203.24
|
|
|
CHG LIVER IMAGING W/VASCULAR FLOW
|
Professional
|
Both
|
$746.94
|
|
|
Service Code
|
HCPCS 78202 TC
|
| Min. Negotiated Rate |
$139.76 |
| Max. Negotiated Rate |
$449.24 |
| Rate for Payer: Cash Price |
$202.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$199.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$179.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$179.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$189.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$199.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$189.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$199.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$199.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$149.75
|
| Rate for Payer: Healthfirst Commercial |
$199.66
|
| Rate for Payer: Healthfirst Essential Plan |
$449.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$189.68
|
| Rate for Payer: Healthfirst QHP |
$199.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$139.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$199.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$169.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$139.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$199.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$149.75
|
| Rate for Payer: SOMOS Essential |
$149.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$199.66
|
|
|
CHG LIVER IMAGING W/VASCULAR FLOW
|
Professional
|
Both
|
$92.37
|
|
|
Service Code
|
HCPCS 78202 26
|
| Min. Negotiated Rate |
$18.21 |
| Max. Negotiated Rate |
$58.55 |
| Rate for Payer: Cash Price |
$25.32
|
| 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 LIVER IMAGING W/VASCULAR FLOW
|
Professional
|
Both
|
$839.30
|
|
|
Service Code
|
HCPCS 78202
|
| Min. Negotiated Rate |
$157.98 |
| Max. Negotiated Rate |
$507.78 |
| Rate for Payer: Cash Price |
$228.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$225.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$203.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$203.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$214.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$225.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$214.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$225.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$169.26
|
| Rate for Payer: Healthfirst Commercial |
$225.68
|
| Rate for Payer: Healthfirst Essential Plan |
$507.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$214.40
|
| Rate for Payer: Healthfirst QHP |
$225.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$157.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$225.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$191.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$157.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$225.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$169.26
|
| Rate for Payer: SOMOS Essential |
$169.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$225.68
|
|
|
CHG LIVER & SPLEEN IMAGING STATIC ONLY
|
Professional
|
Both
|
$91.28
|
|
|
Service Code
|
HCPCS 78215 26
|
| Min. Negotiated Rate |
$17.30 |
| Max. Negotiated Rate |
$55.60 |
| Rate for Payer: Cash Price |
$24.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.53
|
| Rate for Payer: Healthfirst Commercial |
$24.71
|
| Rate for Payer: Healthfirst Essential Plan |
$55.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23.47
|
| Rate for Payer: Healthfirst QHP |
$24.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$24.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$21.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18.53
|
| Rate for Payer: SOMOS Essential |
$18.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.71
|
|
|
CHG LIVER & SPLEEN IMAGING STATIC ONLY
|
Professional
|
Both
|
$792.23
|
|
|
Service Code
|
HCPCS 78215
|
| Min. Negotiated Rate |
$145.92 |
| Max. Negotiated Rate |
$469.04 |
| Rate for Payer: Cash Price |
$213.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$208.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$187.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$187.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$198.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$208.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$198.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$208.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$208.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$156.34
|
| Rate for Payer: Healthfirst Commercial |
$208.46
|
| Rate for Payer: Healthfirst Essential Plan |
$469.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$198.04
|
| Rate for Payer: Healthfirst QHP |
$208.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$145.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$208.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$177.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$145.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$208.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$156.34
|
| Rate for Payer: SOMOS Essential |
$156.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$208.46
|
|
|
CHG LIVER & SPLEEN IMAGING STATIC ONLY
|
Professional
|
Both
|
$700.95
|
|
|
Service Code
|
HCPCS 78215 TC
|
| Min. Negotiated Rate |
$128.62 |
| Max. Negotiated Rate |
$413.42 |
| Rate for Payer: Cash Price |
$189.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$183.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$165.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$165.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$174.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$183.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$174.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$183.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$183.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$137.81
|
| Rate for Payer: Healthfirst Commercial |
$183.74
|
| Rate for Payer: Healthfirst Essential Plan |
$413.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$174.55
|
| Rate for Payer: Healthfirst QHP |
$183.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$128.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$183.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$156.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$128.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$183.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$137.81
|
| Rate for Payer: SOMOS Essential |
$137.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$183.74
|
|
|
CHG LIVER & SPLEEN IMAGING W/VASCULAR FLOW
|
Professional
|
Both
|
$108.22
|
|
|
Service Code
|
HCPCS 78216 26
|
| Min. Negotiated Rate |
$20.75 |
| Max. Negotiated Rate |
$66.69 |
| Rate for Payer: Cash Price |
$27.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$28.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.23
|
| Rate for Payer: Healthfirst Commercial |
$29.64
|
| Rate for Payer: Healthfirst Essential Plan |
$66.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.16
|
| Rate for Payer: Healthfirst QHP |
$29.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$25.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.23
|
| Rate for Payer: SOMOS Essential |
$22.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.64
|
|
|
CHG LIVER & SPLEEN IMAGING W/VASCULAR FLOW
|
Professional
|
Both
|
$553.28
|
|
|
Service Code
|
HCPCS 78216
|
| Min. Negotiated Rate |
$109.97 |
| Max. Negotiated Rate |
$353.48 |
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$141.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$149.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$149.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$117.83
|
| Rate for Payer: Healthfirst Commercial |
$157.10
|
| Rate for Payer: Healthfirst Essential Plan |
$353.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$149.25
|
| Rate for Payer: Healthfirst QHP |
$157.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$109.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$157.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$133.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$109.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$117.83
|
| Rate for Payer: SOMOS Essential |
$117.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.10
|
|
|
CHG LIVER & SPLEEN IMAGING W/VASCULAR FLOW
|
Professional
|
Both
|
$445.06
|
|
|
Service Code
|
HCPCS 78216 TC
|
| Min. Negotiated Rate |
$89.22 |
| Max. Negotiated Rate |
$286.79 |
| Rate for Payer: Cash Price |
$121.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$114.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$114.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$121.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$121.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$127.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$95.59
|
| Rate for Payer: Healthfirst Commercial |
$127.46
|
| Rate for Payer: Healthfirst Essential Plan |
$286.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$121.09
|
| Rate for Payer: Healthfirst QHP |
$127.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$89.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$127.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$108.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$89.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$95.59
|
| Rate for Payer: SOMOS Essential |
$95.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.46
|
|
|
CHG LYMPHANGIOGRAPHY EXTREMITY ONLY BILATERAL RS&I
|
Professional
|
Both
|
$224.77
|
|
|
Service Code
|
HCPCS 75803 26
|
| Min. Negotiated Rate |
$42.06 |
| Max. Negotiated Rate |
$135.20 |
| Rate for Payer: Cash Price |
$61.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$60.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$54.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$54.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$57.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$60.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$57.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.07
|
| Rate for Payer: Healthfirst Commercial |
$60.09
|
| Rate for Payer: Healthfirst Essential Plan |
$135.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$57.09
|
| Rate for Payer: Healthfirst QHP |
$60.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$42.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$60.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$51.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$42.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$60.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$45.07
|
| Rate for Payer: SOMOS Essential |
$45.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$60.09
|
|
|
CHG LYMPHANGIOGRAPHY EXTREMITY ONLY UNILATERAL RS&I
|
Professional
|
Both
|
$180.29
|
|
|
Service Code
|
HCPCS 75801 26
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$110.56 |
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$49.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$44.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$44.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$46.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$49.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$46.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.85
|
| Rate for Payer: Healthfirst Commercial |
$49.14
|
| Rate for Payer: Healthfirst Essential Plan |
$110.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.68
|
| Rate for Payer: Healthfirst QHP |
$49.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$49.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$49.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36.85
|
| Rate for Payer: SOMOS Essential |
$36.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$49.14
|
|
|
CHG LYMPHANGIOGRAPHY PELVIC/ABDOMINAL BILATERAL RS&I
|
Professional
|
Both
|
$212.98
|
|
|
Service Code
|
HCPCS 75807 26
|
| Min. Negotiated Rate |
$39.67 |
| Max. Negotiated Rate |
$127.51 |
| Rate for Payer: Cash Price |
$57.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$56.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$51.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$51.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$53.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$56.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$53.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.50
|
| Rate for Payer: Healthfirst Commercial |
$56.67
|
| Rate for Payer: Healthfirst Essential Plan |
$127.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$53.84
|
| Rate for Payer: Healthfirst QHP |
$56.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$39.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$56.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$48.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$39.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$56.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$42.50
|
| Rate for Payer: SOMOS Essential |
$42.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56.67
|
|
|
CHG LYMPHANGIOGRAPHY PELVIC/ABDOMINAL UNILAT RS&I
|
Professional
|
Both
|
$155.51
|
|
|
Service Code
|
HCPCS 75805 26
|
| Min. Negotiated Rate |
$29.41 |
| Max. Negotiated Rate |
$94.55 |
| Rate for Payer: Cash Price |
$42.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$42.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$39.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$42.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.52
|
| Rate for Payer: Healthfirst Commercial |
$42.02
|
| Rate for Payer: Healthfirst Essential Plan |
$94.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.92
|
| Rate for Payer: Healthfirst QHP |
$42.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$42.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$35.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$42.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31.52
|
| Rate for Payer: SOMOS Essential |
$31.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.02
|
|
|
CHG LYMPHATICS & LYMPH NODES IMAGING
|
Professional
|
Both
|
$1,186.82
|
|
|
Service Code
|
HCPCS 78195 TC
|
| Min. Negotiated Rate |
$214.64 |
| Max. Negotiated Rate |
$689.92 |
| Rate for Payer: Cash Price |
$318.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$306.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$275.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$275.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$291.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$306.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$291.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$306.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$306.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$229.97
|
| Rate for Payer: Healthfirst Commercial |
$306.63
|
| Rate for Payer: Healthfirst Essential Plan |
$689.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$291.30
|
| Rate for Payer: Healthfirst QHP |
$306.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$214.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$306.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$260.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$214.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$306.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$229.97
|
| Rate for Payer: SOMOS Essential |
$229.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$306.63
|
|
|
CHG LYMPHATICS & LYMPH NODES IMAGING
|
Professional
|
Both
|
$222.78
|
|
|
Service Code
|
HCPCS 78195 26
|
| Min. Negotiated Rate |
$41.70 |
| Max. Negotiated Rate |
$134.03 |
| Rate for Payer: Cash Price |
$60.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$59.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$53.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$56.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$59.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$56.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.68
|
| Rate for Payer: Healthfirst Commercial |
$59.57
|
| Rate for Payer: Healthfirst Essential Plan |
$134.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$56.59
|
| Rate for Payer: Healthfirst QHP |
$59.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$41.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$59.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$50.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$41.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$59.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$44.68
|
| Rate for Payer: SOMOS Essential |
$44.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$59.57
|
|
|
CHG LYMPHATICS & LYMPH NODES IMAGING
|
Professional
|
Both
|
$1,409.59
|
|
|
Service Code
|
HCPCS 78195
|
| Min. Negotiated Rate |
$256.34 |
| Max. Negotiated Rate |
$823.95 |
| Rate for Payer: Cash Price |
$379.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$366.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$329.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$329.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$347.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$366.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$347.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$366.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$366.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$274.65
|
| Rate for Payer: Healthfirst Commercial |
$366.20
|
| Rate for Payer: Healthfirst Essential Plan |
$823.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$347.89
|
| Rate for Payer: Healthfirst QHP |
$366.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$256.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$366.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$311.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$256.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$366.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$274.65
|
| Rate for Payer: SOMOS Essential |
$274.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$366.20
|
|
|
CHG MAGNETIC RESONANCE ELASTOGRAPHY
|
Professional
|
Both
|
$211.68
|
|
|
Service Code
|
HCPCS 76391 26
|
| Min. Negotiated Rate |
$39.56 |
| Max. Negotiated Rate |
$127.15 |
| Rate for Payer: Cash Price |
$57.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$56.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$50.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$50.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$53.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$56.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$53.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.38
|
| Rate for Payer: Healthfirst Commercial |
$56.51
|
| Rate for Payer: Healthfirst Essential Plan |
$127.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$53.68
|
| Rate for Payer: Healthfirst QHP |
$56.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$39.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$56.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$48.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$39.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$56.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$42.38
|
| Rate for Payer: SOMOS Essential |
$42.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56.51
|
|
|
CHG MAGNETIC RESONANCE ELASTOGRAPHY
|
Professional
|
Both
|
$688.28
|
|
|
Service Code
|
HCPCS 76391 TC
|
| Min. Negotiated Rate |
$123.14 |
| Max. Negotiated Rate |
$395.80 |
| Rate for Payer: Cash Price |
$183.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$175.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$158.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$158.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$167.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$175.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$167.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$175.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$131.93
|
| Rate for Payer: Healthfirst Commercial |
$175.91
|
| Rate for Payer: Healthfirst Essential Plan |
$395.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$167.11
|
| Rate for Payer: Healthfirst QHP |
$175.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$123.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$175.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$149.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$123.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$175.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$131.93
|
| Rate for Payer: SOMOS Essential |
$131.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$175.91
|
|
