|
CHG MYOCARDIAL SPECT MULTIPLE STUDIES
|
Professional
|
Both
|
$1,871.45
|
|
|
Service Code
|
HCPCS 78452
|
| Min. Negotiated Rate |
$340.42 |
| Max. Negotiated Rate |
$1,094.22 |
| Rate for Payer: Cash Price |
$506.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$486.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$437.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$437.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$462.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$486.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$462.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$486.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$486.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$364.74
|
| Rate for Payer: Healthfirst Commercial |
$486.32
|
| Rate for Payer: Healthfirst Essential Plan |
$1,094.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$462.00
|
| Rate for Payer: Healthfirst QHP |
$486.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$340.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$486.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$413.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$340.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$486.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$364.74
|
| Rate for Payer: SOMOS Essential |
$364.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$486.32
|
|
|
CHG MYOCARDIAL SPECT MULTIPLE STUDIES
|
Professional
|
Both
|
$299.81
|
|
|
Service Code
|
HCPCS 78452 26
|
| Min. Negotiated Rate |
$56.44 |
| Max. Negotiated Rate |
$181.42 |
| Rate for Payer: Cash Price |
$81.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$80.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$72.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$72.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$76.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$80.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$76.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.47
|
| Rate for Payer: Healthfirst Commercial |
$80.63
|
| Rate for Payer: Healthfirst Essential Plan |
$181.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$76.60
|
| Rate for Payer: Healthfirst QHP |
$80.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$56.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$80.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$68.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$56.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$80.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$60.47
|
| Rate for Payer: SOMOS Essential |
$60.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$80.63
|
|
|
CHG MYOCARDIAL SPECT MULTIPLE STUDIES
|
Professional
|
Both
|
$1,571.64
|
|
|
Service Code
|
HCPCS 78452 TC
|
| Min. Negotiated Rate |
$283.98 |
| Max. Negotiated Rate |
$912.78 |
| Rate for Payer: Cash Price |
$424.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$405.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$365.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$365.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$385.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$405.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$385.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$405.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$405.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$304.26
|
| Rate for Payer: Healthfirst Commercial |
$405.68
|
| Rate for Payer: Healthfirst Essential Plan |
$912.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$385.40
|
| Rate for Payer: Healthfirst QHP |
$405.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$283.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$405.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$344.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$283.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$405.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$304.26
|
| Rate for Payer: SOMOS Essential |
$304.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$405.68
|
|
|
CHG MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS
|
Professional
|
Both
|
$251.34
|
|
|
Service Code
|
HCPCS 78451 26
|
| Min. Negotiated Rate |
$47.78 |
| Max. Negotiated Rate |
$153.59 |
| Rate for Payer: Cash Price |
$69.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$68.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$61.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$68.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$68.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$68.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51.20
|
| Rate for Payer: Healthfirst Commercial |
$68.26
|
| Rate for Payer: Healthfirst Essential Plan |
$153.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$64.85
|
| Rate for Payer: Healthfirst QHP |
$68.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$47.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$68.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$58.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$47.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$68.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$51.20
|
| Rate for Payer: SOMOS Essential |
$51.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$68.26
|
|
|
CHG MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS
|
Professional
|
Both
|
$1,343.30
|
|
|
Service Code
|
HCPCS 78451
|
| Min. Negotiated Rate |
$246.50 |
| Max. Negotiated Rate |
$792.32 |
| Rate for Payer: Cash Price |
$365.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$352.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$316.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$316.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$334.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$352.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$334.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$352.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$264.11
|
| Rate for Payer: Healthfirst Commercial |
$352.14
|
| Rate for Payer: Healthfirst Essential Plan |
$792.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$334.53
|
| Rate for Payer: Healthfirst QHP |
$352.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$246.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$352.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$299.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$246.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$352.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$264.11
|
| Rate for Payer: SOMOS Essential |
$264.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$352.14
|
|
|
CHG MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS
|
Professional
|
Both
|
$1,091.93
|
|
|
Service Code
|
HCPCS 78451 TC
|
| Min. Negotiated Rate |
$198.72 |
| Max. Negotiated Rate |
$638.75 |
| Rate for Payer: Cash Price |
$295.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$283.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$255.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$255.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$269.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$283.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$269.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$283.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$283.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$212.92
|
| Rate for Payer: Healthfirst Commercial |
$283.89
|
| Rate for Payer: Healthfirst Essential Plan |
$638.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$269.70
|
| Rate for Payer: Healthfirst QHP |
$283.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$198.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$283.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$241.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$198.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$283.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$212.92
|
| Rate for Payer: SOMOS Essential |
$212.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$283.89
|
|
|
CHG MYOCRD IMG INFARCT AVID PLNR EJEC FXJ 1ST PS TQ
|
Professional
|
Both
|
$636.27
|
|
|
Service Code
|
HCPCS 78468 TC
|
| Min. Negotiated Rate |
$118.29 |
| Max. Negotiated Rate |
$380.23 |
| Rate for Payer: Cash Price |
$173.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$168.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$152.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$152.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$160.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$168.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$160.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$168.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$168.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$126.74
|
| Rate for Payer: Healthfirst Commercial |
$168.99
|
| Rate for Payer: Healthfirst Essential Plan |
$380.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$160.54
|
| Rate for Payer: Healthfirst QHP |
$168.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$118.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$168.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$143.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$118.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$168.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$126.74
|
| Rate for Payer: SOMOS Essential |
$126.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$168.99
|
|
|
CHG MYOCRD IMG INFARCT AVID PLNR EJEC FXJ 1ST PS TQ
|
Professional
|
Both
|
$144.48
|
|
|
Service Code
|
HCPCS 78468 26
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$90.63 |
| Rate for Payer: Cash Price |
$40.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$40.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.21
|
| Rate for Payer: Healthfirst Commercial |
$40.28
|
| Rate for Payer: Healthfirst Essential Plan |
$90.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.27
|
| Rate for Payer: Healthfirst QHP |
$40.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$40.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$30.21
|
| Rate for Payer: SOMOS Essential |
$30.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.28
|
|
|
CHG MYOCRD IMG INFARCT AVID PLNR EJEC FXJ 1ST PS TQ
|
Professional
|
Both
|
$780.75
|
|
|
Service Code
|
HCPCS 78468
|
| Min. Negotiated Rate |
$146.49 |
| Max. Negotiated Rate |
$470.86 |
| Rate for Payer: Cash Price |
$214.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$209.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$188.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$188.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$198.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$209.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$198.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$156.95
|
| Rate for Payer: Healthfirst Commercial |
$209.27
|
| Rate for Payer: Healthfirst Essential Plan |
$470.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$198.81
|
| Rate for Payer: Healthfirst QHP |
$209.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$146.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$209.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$177.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$146.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$209.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$156.95
|
| Rate for Payer: SOMOS Essential |
$156.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$209.27
|
|
|
CHG MYOCRD IMG PET METAB EVAL SINGLE STUDY
|
Professional
|
Both
|
$283.05
|
|
|
Service Code
|
HCPCS 78459 26
|
| Min. Negotiated Rate |
$54.84 |
| Max. Negotiated Rate |
$176.29 |
| Rate for Payer: Cash Price |
$78.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$78.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$70.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$70.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$74.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$78.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$74.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$78.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$78.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$58.76
|
| Rate for Payer: Healthfirst Commercial |
$78.35
|
| Rate for Payer: Healthfirst Essential Plan |
$176.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$74.43
|
| Rate for Payer: Healthfirst QHP |
$78.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$54.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$78.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$66.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$54.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$78.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$58.76
|
| Rate for Payer: SOMOS Essential |
$58.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$78.35
|
|
|
CHG MYOCRD IMG PET METAB EVAL SINGLE STUDY CNCRNT CT
|
Professional
|
Both
|
$311.61
|
|
|
Service Code
|
HCPCS 78429 26
|
| Min. Negotiated Rate |
$59.00 |
| Max. Negotiated Rate |
$189.65 |
| Rate for Payer: Cash Price |
$84.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$84.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$75.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$75.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$80.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$84.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$80.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$84.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$84.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$63.22
|
| Rate for Payer: Healthfirst Commercial |
$84.29
|
| Rate for Payer: Healthfirst Essential Plan |
$189.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$80.08
|
| Rate for Payer: Healthfirst QHP |
$84.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$59.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$84.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$71.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$59.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$84.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$63.22
|
| Rate for Payer: SOMOS Essential |
$63.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$84.29
|
|
|
CHG MYOCRD IMG PET PRFUJ 1STD REST/STRESS CNCRNT CT
|
Professional
|
Both
|
$291.97
|
|
|
Service Code
|
HCPCS 78430 26
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$178.67 |
| Rate for Payer: Cash Price |
$80.62
|
| 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 MYOCRD IMG PET PRFUJ MLT STD RST&STRS CNCRNT CT
|
Professional
|
Both
|
$344.96
|
|
|
Service Code
|
HCPCS 78431 26
|
| Min. Negotiated Rate |
$65.37 |
| Max. Negotiated Rate |
$210.13 |
| Rate for Payer: Cash Price |
$94.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$93.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$84.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$84.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$88.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$93.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$88.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$70.04
|
| Rate for Payer: Healthfirst Commercial |
$93.39
|
| Rate for Payer: Healthfirst Essential Plan |
$210.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$88.72
|
| Rate for Payer: Healthfirst QHP |
$93.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$65.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$93.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$79.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$65.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$93.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$70.04
|
| Rate for Payer: SOMOS Essential |
$70.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$93.39
|
|
|
CHG MYOCRD IMG PET PRFUJ MULTIPLE STUDY REST&STRESS
|
Professional
|
Both
|
$331.00
|
|
|
Service Code
|
HCPCS 78492 26
|
| Min. Negotiated Rate |
$62.41 |
| Max. Negotiated Rate |
$200.61 |
| Rate for Payer: Cash Price |
$90.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$89.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$80.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$80.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$89.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$84.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$89.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$89.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$66.87
|
| Rate for Payer: Healthfirst Commercial |
$89.16
|
| Rate for Payer: Healthfirst Essential Plan |
$200.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$84.70
|
| Rate for Payer: Healthfirst QHP |
$89.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$62.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$89.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$75.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$62.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$89.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$66.87
|
| Rate for Payer: SOMOS Essential |
$66.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$89.16
|
|
|
CHG MYOCRD IMG PET PRFUJ SINGLE STUDY REST/STRESS
|
Professional
|
Both
|
$275.35
|
|
|
Service Code
|
HCPCS 78491 26
|
| Min. Negotiated Rate |
$53.91 |
| Max. Negotiated Rate |
$173.29 |
| Rate for Payer: Cash Price |
$77.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$77.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$69.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$69.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$73.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$77.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$73.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.77
|
| Rate for Payer: Healthfirst Commercial |
$77.02
|
| Rate for Payer: Healthfirst Essential Plan |
$173.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$73.17
|
| Rate for Payer: Healthfirst QHP |
$77.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$53.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$77.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$65.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$53.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$77.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$57.77
|
| Rate for Payer: SOMOS Essential |
$57.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$77.02
|
|
|
CHG MYOCRD IMG PET PRFUJ W/METAB 2RTRACER CNCRNT CT
|
Professional
|
Both
|
$399.95
|
|
|
Service Code
|
HCPCS 78433 26
|
| Min. Negotiated Rate |
$76.82 |
| Max. Negotiated Rate |
$246.91 |
| Rate for Payer: Cash Price |
$110.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$109.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$98.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$98.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$104.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$109.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$104.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$109.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$82.31
|
| Rate for Payer: Healthfirst Commercial |
$109.74
|
| Rate for Payer: Healthfirst Essential Plan |
$246.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$104.25
|
| Rate for Payer: Healthfirst QHP |
$109.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$76.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$109.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$93.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$76.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$109.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$82.31
|
| Rate for Payer: SOMOS Essential |
$82.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$109.74
|
|
|
CHG MYOCRD IMG PET PRFUJ W/METAB DUAL RADIOTRACER
|
Professional
|
Both
|
$367.54
|
|
|
Service Code
|
HCPCS 78432 26
|
| Min. Negotiated Rate |
$72.24 |
| Max. Negotiated Rate |
$232.20 |
| Rate for Payer: Cash Price |
$100.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$103.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$92.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$92.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$98.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$103.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$98.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$103.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$77.40
|
| Rate for Payer: Healthfirst Commercial |
$103.20
|
| Rate for Payer: Healthfirst Essential Plan |
$232.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$98.04
|
| Rate for Payer: Healthfirst QHP |
$103.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$72.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$103.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$87.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$72.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$103.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$77.40
|
| Rate for Payer: SOMOS Essential |
$77.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$103.20
|
|
|
CHG MYOCRD INFARCT AVID PLNR TOMOG SPECT W/WO QUANTJ
|
Professional
|
Both
|
$888.93
|
|
|
Service Code
|
HCPCS 78469
|
| Min. Negotiated Rate |
$164.77 |
| Max. Negotiated Rate |
$529.61 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$235.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$211.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$211.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$223.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$235.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$223.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$235.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$235.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$176.53
|
| Rate for Payer: Healthfirst Commercial |
$235.38
|
| Rate for Payer: Healthfirst Essential Plan |
$529.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$223.61
|
| Rate for Payer: Healthfirst QHP |
$235.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$164.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$235.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$200.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$164.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$235.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$176.53
|
| Rate for Payer: SOMOS Essential |
$176.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$235.38
|
|
|
CHG MYOCRD INFARCT AVID PLNR TOMOG SPECT W/WO QUANTJ
|
Professional
|
Both
|
$718.20
|
|
|
Service Code
|
HCPCS 78469 TC
|
| Min. Negotiated Rate |
$132.15 |
| Max. Negotiated Rate |
$424.78 |
| Rate for Payer: Cash Price |
$193.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$188.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$169.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$169.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$179.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$188.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$179.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$188.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$188.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$141.59
|
| Rate for Payer: Healthfirst Commercial |
$188.79
|
| Rate for Payer: Healthfirst Essential Plan |
$424.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$179.35
|
| Rate for Payer: Healthfirst QHP |
$188.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$132.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$188.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$160.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$132.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$188.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$141.59
|
| Rate for Payer: SOMOS Essential |
$141.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$188.79
|
|
|
CHG MYOCRD INFARCT AVID PLNR TOMOG SPECT W/WO QUANTJ
|
Professional
|
Both
|
$170.73
|
|
|
Service Code
|
HCPCS 78469 26
|
| Min. Negotiated Rate |
$32.61 |
| Max. Negotiated Rate |
$104.83 |
| Rate for Payer: Cash Price |
$46.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$44.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$44.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.94
|
| Rate for Payer: Healthfirst Commercial |
$46.59
|
| Rate for Payer: Healthfirst Essential Plan |
$104.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.26
|
| Rate for Payer: Healthfirst QHP |
$46.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$46.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$34.94
|
| Rate for Payer: SOMOS Essential |
$34.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.59
|
|
|
CHG NFS/INSTLJ RADIOELMNT SLN 3 MO FOLLOW-UP CARE
|
Professional
|
Both
|
$1,619.10
|
|
|
Service Code
|
HCPCS 77750
|
| Min. Negotiated Rate |
$314.25 |
| Max. Negotiated Rate |
$1,010.09 |
| Rate for Payer: Cash Price |
$447.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$448.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$404.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$404.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$426.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$448.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$426.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$448.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$448.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$336.70
|
| Rate for Payer: Healthfirst Commercial |
$448.93
|
| Rate for Payer: Healthfirst Essential Plan |
$1,010.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$426.48
|
| Rate for Payer: Healthfirst QHP |
$448.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$314.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$448.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$381.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$314.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$448.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$336.70
|
| Rate for Payer: SOMOS Essential |
$336.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$448.93
|
|
|
CHG NFS/INSTLJ RADIOELMNT SLN 3 MO FOLLOW-UP CARE
|
Professional
|
Both
|
$562.94
|
|
|
Service Code
|
HCPCS 77750 TC
|
| Min. Negotiated Rate |
$109.87 |
| Max. Negotiated Rate |
$353.16 |
| Rate for Payer: Cash Price |
$157.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$156.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$141.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$149.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$156.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$149.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$156.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$156.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$117.72
|
| Rate for Payer: Healthfirst Commercial |
$156.96
|
| Rate for Payer: Healthfirst Essential Plan |
$353.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$149.11
|
| Rate for Payer: Healthfirst QHP |
$156.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$109.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$156.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$133.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$109.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$156.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$117.72
|
| Rate for Payer: SOMOS Essential |
$117.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$156.96
|
|
|
CHG NFS/INSTLJ RADIOELMNT SLN 3 MO FOLLOW-UP CARE
|
Professional
|
Both
|
$1,056.16
|
|
|
Service Code
|
HCPCS 77750 26
|
| Min. Negotiated Rate |
$204.38 |
| Max. Negotiated Rate |
$656.93 |
| Rate for Payer: Cash Price |
$290.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$291.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$262.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$262.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$277.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$291.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$277.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$291.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$291.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$218.98
|
| Rate for Payer: Healthfirst Commercial |
$291.97
|
| Rate for Payer: Healthfirst Essential Plan |
$656.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$277.37
|
| Rate for Payer: Healthfirst QHP |
$291.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$204.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$291.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$248.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$204.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$291.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$218.98
|
| Rate for Payer: SOMOS Essential |
$218.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$291.97
|
|
|
CHG NJX RP LOCLZJ NON-IMG PROBE STUDY INTRAVENOUS
|
Professional
|
Both
|
$168.88
|
|
|
Service Code
|
HCPCS 78808
|
| Min. Negotiated Rate |
$32.38 |
| Max. Negotiated Rate |
$104.06 |
| Rate for Payer: Cash Price |
$46.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.69
|
| Rate for Payer: Healthfirst Commercial |
$46.25
|
| Rate for Payer: Healthfirst Essential Plan |
$104.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43.94
|
| Rate for Payer: Healthfirst QHP |
$46.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$46.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$34.69
|
| Rate for Payer: SOMOS Essential |
$34.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.25
|
|
|
CHG NONCARDIAC VASCULAR FLOW IMAGING
|
Professional
|
Both
|
$748.37
|
|
|
Service Code
|
HCPCS 78445 TC
|
| Min. Negotiated Rate |
$121.28 |
| Max. Negotiated Rate |
$389.83 |
| Rate for Payer: Cash Price |
$195.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$173.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$155.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$155.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$164.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$173.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$164.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$173.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$173.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$129.94
|
| Rate for Payer: Healthfirst Commercial |
$173.26
|
| Rate for Payer: Healthfirst Essential Plan |
$389.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$164.60
|
| Rate for Payer: Healthfirst QHP |
$173.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$121.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$173.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$147.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$121.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$173.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$129.94
|
| Rate for Payer: SOMOS Essential |
$129.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$173.26
|
|
