|
CHG PATHOLOGY CLINICAL CONSLTJ PROLNG SVC EA ADDL 30
|
Professional
|
Both
|
$172.97
|
|
|
Service Code
|
HCPCS 80506
|
| Min. Negotiated Rate |
$32.43 |
| Max. Negotiated Rate |
$104.24 |
| Rate for Payer: Cash Price |
$46.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$44.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$44.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.75
|
| Rate for Payer: Healthfirst Commercial |
$46.33
|
| Rate for Payer: Healthfirst Essential Plan |
$104.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.01
|
| Rate for Payer: Healthfirst QHP |
$46.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$46.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$34.75
|
| Rate for Payer: SOMOS Essential |
$34.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.33
|
|
|
CHG PATHOLOGY CLINICAL CONSULTATION HI MDM 41-60 MIN
|
Professional
|
Both
|
$363.72
|
|
|
Service Code
|
HCPCS 80505
|
| Min. Negotiated Rate |
$68.38 |
| Max. Negotiated Rate |
$219.80 |
| Rate for Payer: Cash Price |
$98.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$97.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$87.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$87.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$92.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$97.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$92.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$97.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$97.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.27
|
| Rate for Payer: Healthfirst Commercial |
$97.69
|
| Rate for Payer: Healthfirst Essential Plan |
$219.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$92.81
|
| Rate for Payer: Healthfirst QHP |
$97.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$68.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$97.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$83.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$68.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$97.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$73.27
|
| Rate for Payer: SOMOS Essential |
$73.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$97.69
|
|
|
CHG PATHOLOGY CLINICAL CONSULTATION MOD MDM 21-40MIN
|
Professional
|
Both
|
$189.60
|
|
|
Service Code
|
HCPCS 80504
|
| Min. Negotiated Rate |
$35.63 |
| Max. Negotiated Rate |
$114.53 |
| Rate for Payer: Cash Price |
$52.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$50.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$45.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$45.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$48.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$50.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$48.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.17
|
| Rate for Payer: Healthfirst Commercial |
$50.90
|
| Rate for Payer: Healthfirst Essential Plan |
$114.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$48.35
|
| Rate for Payer: Healthfirst QHP |
$50.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$35.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$50.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$43.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$35.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$50.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$38.17
|
| Rate for Payer: SOMOS Essential |
$38.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.90
|
|
|
CHG PATHOLOGY CLINICAL CONSULTATION SF MDM 5-20 MIN
|
Professional
|
Both
|
$88.10
|
|
|
Service Code
|
HCPCS 80503
|
| Min. Negotiated Rate |
$16.67 |
| Max. Negotiated Rate |
$53.57 |
| Rate for Payer: Cash Price |
$24.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$23.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$23.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.86
|
| Rate for Payer: Healthfirst Commercial |
$23.81
|
| Rate for Payer: Healthfirst Essential Plan |
$53.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.62
|
| Rate for Payer: Healthfirst QHP |
$23.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$16.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$23.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$20.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$16.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$17.86
|
| Rate for Payer: SOMOS Essential |
$17.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.81
|
|
|
CHG PATHOLOGY CONSULTATION DURING SURGERY
|
Professional
|
Both
|
$142.31
|
|
|
Service Code
|
HCPCS 88329
|
| Min. Negotiated Rate |
$26.58 |
| Max. Negotiated Rate |
$85.43 |
| Rate for Payer: Cash Price |
$38.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.48
|
| Rate for Payer: Healthfirst Commercial |
$37.97
|
| Rate for Payer: Healthfirst Essential Plan |
$85.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.07
|
| Rate for Payer: Healthfirst QHP |
$37.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.48
|
| Rate for Payer: SOMOS Essential |
$28.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.97
|
|
|
CHG PERCUTANEOUS PLACEMENT ENTEROCLYSIS TUBE RS&I
|
Professional
|
Both
|
$146.37
|
|
|
Service Code
|
HCPCS 74355 26
|
| Min. Negotiated Rate |
$27.66 |
| Max. Negotiated Rate |
$88.92 |
| Rate for Payer: Cash Price |
$39.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$39.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.64
|
| Rate for Payer: Healthfirst Commercial |
$39.52
|
| Rate for Payer: Healthfirst Essential Plan |
$88.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.54
|
| Rate for Payer: Healthfirst QHP |
$39.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$39.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.64
|
| Rate for Payer: SOMOS Essential |
$29.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.52
|
|
|
CHG PERINEOGRAM
|
Professional
|
Both
|
$121.66
|
|
|
Service Code
|
HCPCS 74775 26
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$72.31 |
| Rate for Payer: Cash Price |
$32.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.11
|
| Rate for Payer: Healthfirst Commercial |
$32.14
|
| Rate for Payer: Healthfirst Essential Plan |
$72.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.53
|
| Rate for Payer: Healthfirst QHP |
$32.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.11
|
| Rate for Payer: SOMOS Essential |
$24.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.14
|
|
|
CHG PERITONEAL-VENOUS SHUNT PATENCY TEST
|
Professional
|
Both
|
$167.16
|
|
|
Service Code
|
HCPCS 78291 26
|
| Min. Negotiated Rate |
$31.65 |
| Max. Negotiated Rate |
$101.72 |
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$45.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$45.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.91
|
| Rate for Payer: Healthfirst Commercial |
$45.21
|
| Rate for Payer: Healthfirst Essential Plan |
$101.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42.95
|
| Rate for Payer: Healthfirst QHP |
$45.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$45.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$38.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$33.91
|
| Rate for Payer: SOMOS Essential |
$33.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.21
|
|
|
CHG PERITONEAL-VENOUS SHUNT PATENCY TEST
|
Professional
|
Both
|
$884.94
|
|
|
Service Code
|
HCPCS 78291 TC
|
| Min. Negotiated Rate |
$160.95 |
| Max. Negotiated Rate |
$517.34 |
| Rate for Payer: Cash Price |
$238.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$229.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$206.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$206.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$218.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$229.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$218.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$229.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$229.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$172.45
|
| Rate for Payer: Healthfirst Commercial |
$229.93
|
| Rate for Payer: Healthfirst Essential Plan |
$517.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$218.43
|
| Rate for Payer: Healthfirst QHP |
$229.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$160.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$229.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$195.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$160.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$229.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$172.45
|
| Rate for Payer: SOMOS Essential |
$172.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$229.93
|
|
|
CHG PERITONEAL-VENOUS SHUNT PATENCY TEST
|
Professional
|
Both
|
$1,052.10
|
|
|
Service Code
|
HCPCS 78291
|
| Min. Negotiated Rate |
$192.60 |
| Max. Negotiated Rate |
$619.07 |
| Rate for Payer: Cash Price |
$284.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$275.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$247.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$247.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$261.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$275.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$261.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$275.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$206.35
|
| Rate for Payer: Healthfirst Commercial |
$275.14
|
| Rate for Payer: Healthfirst Essential Plan |
$619.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$261.38
|
| Rate for Payer: Healthfirst QHP |
$275.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$192.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$275.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$233.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$192.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$275.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$206.35
|
| Rate for Payer: SOMOS Essential |
$206.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$275.14
|
|
|
CHG PERITONEOGRAM RS&I
|
Professional
|
Both
|
$91.18
|
|
|
Service Code
|
HCPCS 74190 26
|
| Min. Negotiated Rate |
$16.67 |
| Max. Negotiated Rate |
$53.59 |
| Rate for Payer: Cash Price |
$24.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$23.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$23.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.86
|
| Rate for Payer: Healthfirst Commercial |
$23.82
|
| Rate for Payer: Healthfirst Essential Plan |
$53.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.63
|
| Rate for Payer: Healthfirst QHP |
$23.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$16.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$23.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$20.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$16.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$17.86
|
| Rate for Payer: SOMOS Essential |
$17.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.82
|
|
|
CHG PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH
|
Professional
|
Both
|
$452.13
|
|
|
Service Code
|
HCPCS 78815 26
|
| Min. Negotiated Rate |
$86.04 |
| Max. Negotiated Rate |
$276.55 |
| Rate for Payer: Cash Price |
$122.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$122.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$110.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$110.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$116.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$122.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$116.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$122.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$122.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$92.18
|
| Rate for Payer: Healthfirst Commercial |
$122.91
|
| Rate for Payer: Healthfirst Essential Plan |
$276.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$116.76
|
| Rate for Payer: Healthfirst QHP |
$122.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$86.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$122.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$104.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$86.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$122.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$92.18
|
| Rate for Payer: SOMOS Essential |
$92.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$122.91
|
|
|
CHG PET IMAGING CT FOR ATTENUATION LIMITED AREA
|
Professional
|
Both
|
$407.86
|
|
|
Service Code
|
HCPCS 78814 26
|
| Min. Negotiated Rate |
$76.67 |
| Max. Negotiated Rate |
$246.44 |
| Rate for Payer: Cash Price |
$110.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$109.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$98.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$98.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$104.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$109.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$104.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$109.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$82.15
|
| Rate for Payer: Healthfirst Commercial |
$109.53
|
| Rate for Payer: Healthfirst Essential Plan |
$246.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$104.05
|
| Rate for Payer: Healthfirst QHP |
$109.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$76.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$109.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$93.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$76.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$109.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$82.15
|
| Rate for Payer: SOMOS Essential |
$82.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$109.53
|
|
|
CHG PET IMAGING FOR CT ATTENUATION WHOLE BODY
|
Professional
|
Both
|
$452.62
|
|
|
Service Code
|
HCPCS 78816 26
|
| Min. Negotiated Rate |
$86.08 |
| Max. Negotiated Rate |
$276.68 |
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$122.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$110.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$110.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$116.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$122.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$116.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$122.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$122.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$92.23
|
| Rate for Payer: Healthfirst Commercial |
$122.97
|
| Rate for Payer: Healthfirst Essential Plan |
$276.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$116.82
|
| Rate for Payer: Healthfirst QHP |
$122.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$86.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$122.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$104.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$86.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$122.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$92.23
|
| Rate for Payer: SOMOS Essential |
$92.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$122.97
|
|
|
CHG PET IMAGING LIMITED AREA CHEST HEAD/NECK
|
Professional
|
Both
|
$278.29
|
|
|
Service Code
|
HCPCS 78811 26
|
| Min. Negotiated Rate |
$53.59 |
| Max. Negotiated Rate |
$172.26 |
| Rate for Payer: Cash Price |
$76.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$76.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$68.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$68.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$72.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$76.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$72.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.42
|
| Rate for Payer: Healthfirst Commercial |
$76.56
|
| Rate for Payer: Healthfirst Essential Plan |
$172.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$72.73
|
| Rate for Payer: Healthfirst QHP |
$76.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$53.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$76.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$65.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$53.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$76.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$57.42
|
| Rate for Payer: SOMOS Essential |
$57.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$76.56
|
|
|
CHG PET IMAGING SKULL BASE TO MID-THIGH
|
Professional
|
Both
|
$361.10
|
|
|
Service Code
|
HCPCS 78812 26
|
| Min. Negotiated Rate |
$67.39 |
| Max. Negotiated Rate |
$216.61 |
| Rate for Payer: Cash Price |
$97.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$96.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$86.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$86.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$91.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$96.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$91.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$96.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$96.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.20
|
| Rate for Payer: Healthfirst Commercial |
$96.27
|
| Rate for Payer: Healthfirst Essential Plan |
$216.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$91.46
|
| Rate for Payer: Healthfirst QHP |
$96.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$67.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$96.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$81.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$67.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$96.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$72.20
|
| Rate for Payer: SOMOS Essential |
$72.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$96.27
|
|
|
CHG PET IMAGING WHOLE BODY
|
Professional
|
Both
|
$360.08
|
|
|
Service Code
|
HCPCS 78813 26
|
| Min. Negotiated Rate |
$68.54 |
| Max. Negotiated Rate |
$220.30 |
| Rate for Payer: Cash Price |
$99.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$97.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$88.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$88.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$93.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$97.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$93.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$97.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$97.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.43
|
| Rate for Payer: Healthfirst Commercial |
$97.91
|
| Rate for Payer: Healthfirst Essential Plan |
$220.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$93.01
|
| Rate for Payer: Healthfirst QHP |
$97.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$68.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$97.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$83.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$68.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$97.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$73.43
|
| Rate for Payer: SOMOS Essential |
$73.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$97.91
|
|
|
CHG PH BODY FLUID NOT ELSEWHERE SPECIFIED
|
Professional
|
Both
|
$9.00
|
|
|
Service Code
|
HCPCS 83986
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$8.05 |
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.69
|
| Rate for Payer: Healthfirst Commercial |
$3.58
|
| Rate for Payer: Healthfirst Essential Plan |
$8.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.40
|
| Rate for Payer: Healthfirst QHP |
$3.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.43
|
| Rate for Payer: SOMOS Essential |
$1.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.58
|
|
|
CHG PLASMA VOL RADIOPHARM VOL DILUTE SPX MULT SMPLES
|
Professional
|
Both
|
$36.05
|
|
|
Service Code
|
HCPCS 78111 26
|
| Min. Negotiated Rate |
$7.91 |
| Max. Negotiated Rate |
$25.43 |
| Rate for Payer: Cash Price |
$9.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.47
|
| Rate for Payer: Healthfirst Commercial |
$11.30
|
| Rate for Payer: Healthfirst Essential Plan |
$25.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.73
|
| Rate for Payer: Healthfirst QHP |
$11.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$7.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$11.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$9.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.47
|
| Rate for Payer: SOMOS Essential |
$8.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.30
|
|
|
CHG PLASMA VOL RADIOPHARM VOL DILUTE SPX MULT SMPLES
|
Professional
|
Both
|
$317.24
|
|
|
Service Code
|
HCPCS 78111
|
| Min. Negotiated Rate |
$74.85 |
| Max. Negotiated Rate |
$240.59 |
| Rate for Payer: Cash Price |
$86.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$106.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$96.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$96.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$101.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$106.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$101.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$106.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.20
|
| Rate for Payer: Healthfirst Commercial |
$106.93
|
| Rate for Payer: Healthfirst Essential Plan |
$240.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$101.58
|
| Rate for Payer: Healthfirst QHP |
$106.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$74.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$106.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$90.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$74.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$106.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$80.20
|
| Rate for Payer: SOMOS Essential |
$80.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$106.93
|
|
|
CHG PLASMA VOL RADIOPHARM VOL DILUTE SPX MULT SMPLES
|
Professional
|
Both
|
$281.19
|
|
|
Service Code
|
HCPCS 78111 TC
|
| Min. Negotiated Rate |
$66.94 |
| Max. Negotiated Rate |
$215.17 |
| Rate for Payer: Cash Price |
$76.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$95.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$86.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$86.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$90.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$95.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$90.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$95.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$95.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$71.72
|
| Rate for Payer: Healthfirst Commercial |
$95.63
|
| Rate for Payer: Healthfirst Essential Plan |
$215.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$90.85
|
| Rate for Payer: Healthfirst QHP |
$95.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$66.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$95.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$81.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$66.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$95.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$71.72
|
| Rate for Payer: SOMOS Essential |
$71.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$95.63
|
|
|
CHG PLASMA VOL RADIOPHARM VOL DILUTION SPX 1 SAMPLE
|
Professional
|
Both
|
$299.11
|
|
|
Service Code
|
HCPCS 78110
|
| Min. Negotiated Rate |
$57.02 |
| Max. Negotiated Rate |
$183.26 |
| Rate for Payer: Cash Price |
$81.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$81.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$73.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$77.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$61.09
|
| Rate for Payer: Healthfirst Commercial |
$81.45
|
| Rate for Payer: Healthfirst Essential Plan |
$183.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$77.38
|
| Rate for Payer: Healthfirst QHP |
$81.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$57.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$81.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$69.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$57.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$61.09
|
| Rate for Payer: SOMOS Essential |
$61.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.45
|
|
|
CHG PLASMA VOL RADIOPHARM VOL DILUTION SPX 1 SAMPLE
|
Professional
|
Both
|
$268.24
|
|
|
Service Code
|
HCPCS 78110 TC
|
| Min. Negotiated Rate |
$51.18 |
| Max. Negotiated Rate |
$164.52 |
| Rate for Payer: Cash Price |
$73.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$73.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$65.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$69.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$73.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$69.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.84
|
| Rate for Payer: Healthfirst Commercial |
$73.12
|
| Rate for Payer: Healthfirst Essential Plan |
$164.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.46
|
| Rate for Payer: Healthfirst QHP |
$73.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$51.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$73.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$62.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$51.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$73.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$54.84
|
| Rate for Payer: SOMOS Essential |
$54.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$73.12
|
|
|
CHG PLASMA VOL RADIOPHARM VOL DILUTION SPX 1 SAMPLE
|
Professional
|
Both
|
$30.84
|
|
|
Service Code
|
HCPCS 78110 26
|
| Min. Negotiated Rate |
$5.83 |
| Max. Negotiated Rate |
$18.74 |
| Rate for Payer: Cash Price |
$8.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.25
|
| Rate for Payer: Healthfirst Commercial |
$8.33
|
| Rate for Payer: Healthfirst Essential Plan |
$18.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.91
|
| Rate for Payer: Healthfirst QHP |
$8.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$5.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$5.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.25
|
| Rate for Payer: SOMOS Essential |
$6.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.33
|
|
|
CHG PLATELET AGGREGATION IN VITRO EACH AGENT
|
Professional
|
Both
|
$69.20
|
|
|
Service Code
|
HCPCS 85576 26
|
| Min. Negotiated Rate |
$7.68 |
| Max. Negotiated Rate |
$43.18 |
| Rate for Payer: Cash Price |
$19.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.39
|
| Rate for Payer: Healthfirst Commercial |
$19.19
|
| Rate for Payer: Healthfirst Essential Plan |
$43.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.23
|
| Rate for Payer: Healthfirst QHP |
$19.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.68
|
| Rate for Payer: SOMOS Essential |
$7.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.19
|
|
