|
CHG MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAS
|
Professional
|
Both
|
$411.50
|
|
|
Service Code
|
HCPCS 73220 26
|
| Min. Negotiated Rate |
$78.23 |
| Max. Negotiated Rate |
$251.46 |
| Rate for Payer: Cash Price |
$111.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$111.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$100.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$100.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$106.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$111.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$106.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$111.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$83.82
|
| Rate for Payer: Healthfirst Commercial |
$111.76
|
| Rate for Payer: Healthfirst Essential Plan |
$251.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$106.17
|
| Rate for Payer: Healthfirst QHP |
$111.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$78.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$111.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$95.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$78.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$111.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$83.82
|
| Rate for Payer: SOMOS Essential |
$83.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$111.76
|
|
|
CHG MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAS
|
Professional
|
Both
|
$1,421.14
|
|
|
Service Code
|
HCPCS 73220 TC
|
| Min. Negotiated Rate |
$255.51 |
| Max. Negotiated Rate |
$821.27 |
| Rate for Payer: Cash Price |
$379.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$365.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$328.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$328.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$346.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$365.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$346.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$365.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$365.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$273.76
|
| Rate for Payer: Healthfirst Commercial |
$365.01
|
| Rate for Payer: Healthfirst Essential Plan |
$821.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$346.76
|
| Rate for Payer: Healthfirst QHP |
$365.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$255.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$365.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$310.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$255.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$365.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$273.76
|
| Rate for Payer: SOMOS Essential |
$273.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$365.01
|
|
|
CHG MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAS
|
Professional
|
Both
|
$1,832.64
|
|
|
Service Code
|
HCPCS 73220
|
| Min. Negotiated Rate |
$333.74 |
| Max. Negotiated Rate |
$1,072.73 |
| Rate for Payer: Cash Price |
$490.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$476.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$429.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$429.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$452.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$476.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$452.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$476.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$476.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$357.58
|
| Rate for Payer: Healthfirst Commercial |
$476.77
|
| Rate for Payer: Healthfirst Essential Plan |
$1,072.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$452.93
|
| Rate for Payer: Healthfirst QHP |
$476.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$333.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$476.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$405.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$333.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$476.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$357.58
|
| Rate for Payer: SOMOS Essential |
$357.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$476.77
|
|
|
CHG MYELOGRAPHY CERVICAL RS&I
|
Professional
|
Both
|
$182.00
|
|
|
Service Code
|
HCPCS 72240 26
|
| Min. Negotiated Rate |
$33.08 |
| Max. Negotiated Rate |
$106.31 |
| Rate for Payer: Cash Price |
$48.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$42.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$44.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$44.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.44
|
| Rate for Payer: Healthfirst Commercial |
$47.25
|
| Rate for Payer: Healthfirst Essential Plan |
$106.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.89
|
| Rate for Payer: Healthfirst QHP |
$47.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$47.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$40.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35.44
|
| Rate for Payer: SOMOS Essential |
$35.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.25
|
|
|
CHG MYELOGRAPHY CERVICAL RS&I
|
Professional
|
Both
|
$489.48
|
|
|
Service Code
|
HCPCS 72240
|
| Min. Negotiated Rate |
$88.66 |
| Max. Negotiated Rate |
$284.99 |
| Rate for Payer: Cash Price |
$129.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$126.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$113.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$113.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$120.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$126.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$120.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$95.00
|
| Rate for Payer: Healthfirst Commercial |
$126.66
|
| Rate for Payer: Healthfirst Essential Plan |
$284.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$120.33
|
| Rate for Payer: Healthfirst QHP |
$126.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$88.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$126.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$107.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$88.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$126.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$95.00
|
| Rate for Payer: SOMOS Essential |
$95.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$126.66
|
|
|
CHG MYELOGRAPHY CERVICAL RS&I
|
Professional
|
Both
|
$307.48
|
|
|
Service Code
|
HCPCS 72240 TC
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$178.67 |
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$79.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$71.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$71.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$75.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$79.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$75.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$79.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$59.56
|
| Rate for Payer: Healthfirst Commercial |
$79.41
|
| Rate for Payer: Healthfirst Essential Plan |
$178.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$75.44
|
| Rate for Payer: Healthfirst QHP |
$79.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$55.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$79.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$67.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$55.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$79.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$59.56
|
| Rate for Payer: SOMOS Essential |
$59.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$79.41
|
|
|
CHG MYELOGRAPHY THORACIC RS&I
|
Professional
|
Both
|
$516.39
|
|
|
Service Code
|
HCPCS 72255
|
| Min. Negotiated Rate |
$84.43 |
| Max. Negotiated Rate |
$271.37 |
| Rate for Payer: Cash Price |
$124.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$120.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$108.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$114.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$120.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$114.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$120.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$90.46
|
| Rate for Payer: Healthfirst Commercial |
$120.61
|
| Rate for Payer: Healthfirst Essential Plan |
$271.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$114.58
|
| Rate for Payer: Healthfirst QHP |
$120.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$84.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$120.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$102.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$84.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$120.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$90.46
|
| Rate for Payer: SOMOS Essential |
$90.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$120.61
|
|
|
CHG MYELOGRAPHY THORACIC RS&I
|
Professional
|
Both
|
$195.97
|
|
|
Service Code
|
HCPCS 72255 26
|
| Min. Negotiated Rate |
$32.64 |
| Max. Negotiated Rate |
$104.92 |
| Rate for Payer: Cash Price |
$47.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$44.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$44.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.97
|
| Rate for Payer: Healthfirst Commercial |
$46.63
|
| Rate for Payer: Healthfirst Essential Plan |
$104.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.30
|
| Rate for Payer: Healthfirst QHP |
$46.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$46.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$34.97
|
| Rate for Payer: SOMOS Essential |
$34.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.63
|
|
|
CHG MYELOGRAPHY THORACIC RS&I
|
Professional
|
Both
|
$320.43
|
|
|
Service Code
|
HCPCS 72255 TC
|
| Min. Negotiated Rate |
$51.79 |
| Max. Negotiated Rate |
$166.46 |
| Rate for Payer: Cash Price |
$76.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$73.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$66.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$66.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$70.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$73.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$70.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$55.48
|
| Rate for Payer: Healthfirst Commercial |
$73.98
|
| Rate for Payer: Healthfirst Essential Plan |
$166.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$70.28
|
| Rate for Payer: Healthfirst QHP |
$73.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$51.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$73.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$62.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$51.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$73.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$55.48
|
| Rate for Payer: SOMOS Essential |
$55.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$73.98
|
|
|
CHG MYELOGRAPY 2/MORE REGIONS RS&I
|
Professional
|
Both
|
$695.91
|
|
|
Service Code
|
HCPCS 72270
|
| Min. Negotiated Rate |
$121.65 |
| Max. Negotiated Rate |
$391.03 |
| Rate for Payer: Cash Price |
$176.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$173.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$156.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$156.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$165.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$173.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$165.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$173.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$173.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$130.34
|
| Rate for Payer: Healthfirst Commercial |
$173.79
|
| Rate for Payer: Healthfirst Essential Plan |
$391.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$165.10
|
| Rate for Payer: Healthfirst QHP |
$173.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$121.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$173.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$147.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$121.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$173.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$130.34
|
| Rate for Payer: SOMOS Essential |
$130.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$173.79
|
|
|
CHG MYELOGRAPY 2/MORE REGIONS RS&I
|
Professional
|
Both
|
$266.25
|
|
|
Service Code
|
HCPCS 72270 26
|
| Min. Negotiated Rate |
$51.12 |
| Max. Negotiated Rate |
$164.32 |
| Rate for Payer: Cash Price |
$71.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$73.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$65.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$69.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$73.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$69.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.77
|
| Rate for Payer: Healthfirst Commercial |
$73.03
|
| Rate for Payer: Healthfirst Essential Plan |
$164.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.38
|
| Rate for Payer: Healthfirst QHP |
$73.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$51.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$73.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$62.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$51.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$73.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$54.77
|
| Rate for Payer: SOMOS Essential |
$54.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$73.03
|
|
|
CHG MYELOGRAPY 2/MORE REGIONS RS&I
|
Professional
|
Both
|
$429.66
|
|
|
Service Code
|
HCPCS 72270 TC
|
| Min. Negotiated Rate |
$70.53 |
| Max. Negotiated Rate |
$226.71 |
| Rate for Payer: Cash Price |
$104.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$100.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$90.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$90.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$95.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$100.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$95.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$75.57
|
| Rate for Payer: Healthfirst Commercial |
$100.76
|
| Rate for Payer: Healthfirst Essential Plan |
$226.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$95.72
|
| Rate for Payer: Healthfirst QHP |
$100.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$70.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$100.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$85.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$70.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$100.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$75.57
|
| Rate for Payer: SOMOS Essential |
$75.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$100.76
|
|
|
CHG MYELOGRAPY LUMBOSACRAL RS&I
|
Professional
|
Both
|
$304.61
|
|
|
Service Code
|
HCPCS 72265 TC
|
| Min. Negotiated Rate |
$55.86 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Cash Price |
$82.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$79.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$71.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$71.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$75.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$79.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$75.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$79.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$59.85
|
| Rate for Payer: Healthfirst Commercial |
$79.80
|
| Rate for Payer: Healthfirst Essential Plan |
$179.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$75.81
|
| Rate for Payer: Healthfirst QHP |
$79.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$55.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$79.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$67.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$55.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$79.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$59.85
|
| Rate for Payer: SOMOS Essential |
$59.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$79.80
|
|
|
CHG MYELOGRAPY LUMBOSACRAL RS&I
|
Professional
|
Both
|
$464.07
|
|
|
Service Code
|
HCPCS 72265
|
| Min. Negotiated Rate |
$86.30 |
| Max. Negotiated Rate |
$277.40 |
| Rate for Payer: Cash Price |
$125.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$123.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$110.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$110.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$117.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$123.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$117.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$123.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$123.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$92.47
|
| Rate for Payer: Healthfirst Commercial |
$123.29
|
| Rate for Payer: Healthfirst Essential Plan |
$277.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$117.13
|
| Rate for Payer: Healthfirst QHP |
$123.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$86.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$123.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$104.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$86.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$123.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$92.47
|
| Rate for Payer: SOMOS Essential |
$92.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$123.29
|
|
|
CHG MYELOGRAPY LUMBOSACRAL RS&I
|
Professional
|
Both
|
$159.46
|
|
|
Service Code
|
HCPCS 72265 26
|
| Min. Negotiated Rate |
$30.44 |
| Max. Negotiated Rate |
$97.85 |
| Rate for Payer: Cash Price |
$43.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$43.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.62
|
| Rate for Payer: Healthfirst Commercial |
$43.49
|
| Rate for Payer: Healthfirst Essential Plan |
$97.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.32
|
| Rate for Payer: Healthfirst QHP |
$43.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$43.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$36.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.62
|
| Rate for Payer: SOMOS Essential |
$32.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.49
|
|
|
CHG MYELOGRAPY POST FOSSA RS&I
|
Professional
|
Both
|
$242.38
|
|
|
Service Code
|
HCPCS 70010
|
| Min. Negotiated Rate |
$45.84 |
| Max. Negotiated Rate |
$147.35 |
| Rate for Payer: Cash Price |
$64.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$65.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$58.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$65.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$49.12
|
| Rate for Payer: Healthfirst Commercial |
$65.49
|
| Rate for Payer: Healthfirst Essential Plan |
$147.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.22
|
| Rate for Payer: Healthfirst QHP |
$65.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$65.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$55.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$65.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$49.12
|
| Rate for Payer: SOMOS Essential |
$49.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.49
|
|
|
CHG MYOCARDIAL IMAGING INFARCT AVID PLANAR QUAL/QUAN
|
Professional
|
Both
|
$133.32
|
|
|
Service Code
|
HCPCS 78466 26
|
| Min. Negotiated Rate |
$23.75 |
| Max. Negotiated Rate |
$76.34 |
| Rate for Payer: Cash Price |
$34.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.45
|
| Rate for Payer: Healthfirst Commercial |
$33.93
|
| Rate for Payer: Healthfirst Essential Plan |
$76.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.23
|
| Rate for Payer: Healthfirst QHP |
$33.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$33.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.45
|
| Rate for Payer: SOMOS Essential |
$25.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.93
|
|
|
CHG MYOCARDIAL IMAGING INFARCT AVID PLANAR QUAL/QUAN
|
Professional
|
Both
|
$613.27
|
|
|
Service Code
|
HCPCS 78466 TC
|
| Min. Negotiated Rate |
$105.25 |
| Max. Negotiated Rate |
$338.31 |
| Rate for Payer: Cash Price |
$160.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$150.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$135.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$135.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$142.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$150.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$142.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$112.77
|
| Rate for Payer: Healthfirst Commercial |
$150.36
|
| Rate for Payer: Healthfirst Essential Plan |
$338.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$142.84
|
| Rate for Payer: Healthfirst QHP |
$150.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$105.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$150.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$127.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$105.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$150.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$112.77
|
| Rate for Payer: SOMOS Essential |
$112.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$150.36
|
|
|
CHG MYOCARDIAL IMAGING INFARCT AVID PLANAR QUAL/QUAN
|
Professional
|
Both
|
$746.55
|
|
|
Service Code
|
HCPCS 78466
|
| Min. Negotiated Rate |
$129.00 |
| Max. Negotiated Rate |
$414.65 |
| Rate for Payer: Cash Price |
$194.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$184.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$165.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$165.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$175.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$184.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$175.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$184.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$184.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$138.22
|
| Rate for Payer: Healthfirst Commercial |
$184.29
|
| Rate for Payer: Healthfirst Essential Plan |
$414.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$175.08
|
| Rate for Payer: Healthfirst QHP |
$184.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$129.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$184.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$156.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$129.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$184.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$138.22
|
| Rate for Payer: SOMOS Essential |
$138.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$184.29
|
|
|
CHG MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS
|
Professional
|
Both
|
$1,164.87
|
|
|
Service Code
|
HCPCS 78453
|
| Min. Negotiated Rate |
$213.16 |
| Max. Negotiated Rate |
$685.15 |
| Rate for Payer: Cash Price |
$311.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$304.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$274.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$274.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$289.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$304.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$289.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$304.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$304.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$228.38
|
| Rate for Payer: Healthfirst Commercial |
$304.51
|
| Rate for Payer: Healthfirst Essential Plan |
$685.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$289.28
|
| Rate for Payer: Healthfirst QHP |
$304.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$213.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$304.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$258.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$213.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$304.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$228.38
|
| Rate for Payer: SOMOS Essential |
$228.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$304.51
|
|
|
CHG MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS
|
Professional
|
Both
|
$183.65
|
|
|
Service Code
|
HCPCS 78453 26
|
| Min. Negotiated Rate |
$34.81 |
| Max. Negotiated Rate |
$111.89 |
| Rate for Payer: Cash Price |
$48.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$49.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$44.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$44.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$47.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$49.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$47.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$37.30
|
| Rate for Payer: Healthfirst Commercial |
$49.73
|
| Rate for Payer: Healthfirst Essential Plan |
$111.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.24
|
| Rate for Payer: Healthfirst QHP |
$49.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$49.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$42.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$49.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$37.30
|
| Rate for Payer: SOMOS Essential |
$37.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$49.73
|
|
|
CHG MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS
|
Professional
|
Both
|
$981.26
|
|
|
Service Code
|
HCPCS 78453 TC
|
| Min. Negotiated Rate |
$178.35 |
| Max. Negotiated Rate |
$573.25 |
| Rate for Payer: Cash Price |
$262.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$254.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$229.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$229.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$242.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$254.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$242.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$254.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$254.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$191.09
|
| Rate for Payer: Healthfirst Commercial |
$254.78
|
| Rate for Payer: Healthfirst Essential Plan |
$573.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$242.04
|
| Rate for Payer: Healthfirst QHP |
$254.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$178.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$254.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$216.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$178.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$254.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$191.09
|
| Rate for Payer: SOMOS Essential |
$191.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$254.78
|
|
|
CHG MYOCARDIAL PERFUSION PLANAR MULTIPLE STUDIES
|
Professional
|
Both
|
$255.99
|
|
|
Service Code
|
HCPCS 78454 26
|
| Min. Negotiated Rate |
$47.95 |
| Max. Negotiated Rate |
$154.12 |
| Rate for Payer: Cash Price |
$69.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$68.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$61.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$65.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$68.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$65.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$68.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$68.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51.38
|
| Rate for Payer: Healthfirst Commercial |
$68.50
|
| Rate for Payer: Healthfirst Essential Plan |
$154.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$65.08
|
| Rate for Payer: Healthfirst QHP |
$68.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$47.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$68.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$58.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$47.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$68.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$51.38
|
| Rate for Payer: SOMOS Essential |
$51.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$68.50
|
|
|
CHG MYOCARDIAL PERFUSION PLANAR MULTIPLE STUDIES
|
Professional
|
Both
|
$1,742.83
|
|
|
Service Code
|
HCPCS 78454
|
| Min. Negotiated Rate |
$316.01 |
| Max. Negotiated Rate |
$1,015.74 |
| Rate for Payer: Cash Price |
$466.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$451.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$406.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$406.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$428.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$451.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$428.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$451.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$451.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$338.58
|
| Rate for Payer: Healthfirst Commercial |
$451.44
|
| Rate for Payer: Healthfirst Essential Plan |
$1,015.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$428.87
|
| Rate for Payer: Healthfirst QHP |
$451.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$316.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$451.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$383.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$316.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$451.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$338.58
|
| Rate for Payer: SOMOS Essential |
$338.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$451.44
|
|
|
CHG MYOCARDIAL PERFUSION PLANAR MULTIPLE STUDIES
|
Professional
|
Both
|
$1,486.84
|
|
|
Service Code
|
HCPCS 78454 TC
|
| Min. Negotiated Rate |
$268.06 |
| Max. Negotiated Rate |
$861.62 |
| Rate for Payer: Cash Price |
$397.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$382.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$344.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$344.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$363.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$382.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$363.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$382.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$382.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$287.20
|
| Rate for Payer: Healthfirst Commercial |
$382.94
|
| Rate for Payer: Healthfirst Essential Plan |
$861.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$363.79
|
| Rate for Payer: Healthfirst QHP |
$382.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$268.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$382.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$325.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$268.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$382.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$287.20
|
| Rate for Payer: SOMOS Essential |
$287.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$382.94
|
|
