|
CHG PLATELET SURVIVAL STUDY
|
Professional
|
Both
|
$434.74
|
|
|
Service Code
|
HCPCS 78191 TC
|
| Min. Negotiated Rate |
$82.59 |
| Max. Negotiated Rate |
$265.48 |
| Rate for Payer: Cash Price |
$119.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$117.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$106.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$106.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$112.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$117.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$112.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$117.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$117.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.49
|
| Rate for Payer: Healthfirst Commercial |
$117.99
|
| Rate for Payer: Healthfirst Essential Plan |
$265.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$112.09
|
| Rate for Payer: Healthfirst QHP |
$117.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$82.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$117.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$100.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$82.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$117.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$88.49
|
| Rate for Payer: SOMOS Essential |
$88.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$117.99
|
|
|
CHG PLATELET SURVIVAL STUDY
|
Professional
|
Both
|
$93.52
|
|
|
Service Code
|
HCPCS 78191 26
|
| Min. Negotiated Rate |
$17.86 |
| Max. Negotiated Rate |
$57.40 |
| Rate for Payer: Cash Price |
$25.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.13
|
| Rate for Payer: Healthfirst Commercial |
$25.51
|
| Rate for Payer: Healthfirst Essential Plan |
$57.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24.23
|
| Rate for Payer: Healthfirst QHP |
$25.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$25.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$21.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19.13
|
| Rate for Payer: SOMOS Essential |
$19.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.51
|
|
|
CHG PLATELET SURVIVAL STUDY
|
Professional
|
Both
|
$528.26
|
|
|
Service Code
|
HCPCS 78191
|
| Min. Negotiated Rate |
$100.45 |
| Max. Negotiated Rate |
$322.88 |
| Rate for Payer: Cash Price |
$145.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$143.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$129.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$129.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$136.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$143.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$136.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$143.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$143.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$107.62
|
| Rate for Payer: Healthfirst Commercial |
$143.50
|
| Rate for Payer: Healthfirst Essential Plan |
$322.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$136.32
|
| Rate for Payer: Healthfirst QHP |
$143.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$100.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$143.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$121.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$100.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$143.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$107.62
|
| Rate for Payer: SOMOS Essential |
$107.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$143.50
|
|
|
CHG PLMT DSTL XTN PRSTH EVASC DESC THORAC AORTA RS&I
|
Professional
|
Both
|
$719.71
|
|
|
Service Code
|
HCPCS 75959 26
|
| Min. Negotiated Rate |
$132.41 |
| Max. Negotiated Rate |
$425.61 |
| Rate for Payer: Cash Price |
$192.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$189.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$170.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$170.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$179.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$189.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$179.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$189.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$189.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$141.87
|
| Rate for Payer: Healthfirst Commercial |
$189.16
|
| Rate for Payer: Healthfirst Essential Plan |
$425.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$179.70
|
| Rate for Payer: Healthfirst QHP |
$189.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$132.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$189.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$160.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$132.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$189.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$141.87
|
| Rate for Payer: SOMOS Essential |
$141.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$189.16
|
|
|
CHG PLMT PROX XTN PRSTH EVASC DESC THORAC AORTA RS&I
|
Professional
|
Both
|
$822.64
|
|
|
Service Code
|
HCPCS 75958 26
|
| Min. Negotiated Rate |
$152.00 |
| Max. Negotiated Rate |
$488.56 |
| Rate for Payer: Cash Price |
$216.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$217.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$195.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$195.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$217.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$217.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$217.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$162.85
|
| Rate for Payer: Healthfirst Commercial |
$217.14
|
| Rate for Payer: Healthfirst Essential Plan |
$488.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$206.28
|
| Rate for Payer: Healthfirst QHP |
$217.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$152.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$217.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$184.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$152.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$217.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$162.85
|
| Rate for Payer: SOMOS Essential |
$162.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$217.14
|
|
|
CHG PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI
|
Professional
|
Both
|
$69.20
|
|
|
Service Code
|
HCPCS 84166 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
|
|
|
CHG PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM
|
Professional
|
Both
|
$69.20
|
|
|
Service Code
|
HCPCS 84165 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
|
|
|
CHG PROTEIN WESTRN BLOT BLOOD/OTH FLU IMMUNOLOGICAL
|
Professional
|
Both
|
$69.20
|
|
|
Service Code
|
HCPCS 84182 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
|
|
|
CHG PROTEIN WESTRN BLOT I&R BLOOD/OTHER FLUID
|
Professional
|
Both
|
$69.20
|
|
|
Service Code
|
HCPCS 84181 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
|
|
|
CHG PROTHROMBIN TIME
|
Professional
|
Both
|
$10.72
|
|
|
Service Code
|
HCPCS 85610
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$9.65 |
| Rate for Payer: Cash Price |
$4.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.22
|
| Rate for Payer: Healthfirst Commercial |
$4.29
|
| Rate for Payer: Healthfirst Essential Plan |
$9.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.08
|
| Rate for Payer: Healthfirst QHP |
$4.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.72
|
| Rate for Payer: SOMOS Essential |
$1.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.29
|
|
|
CHG PRQ TRANSHEPATC DILAT BILIARY DUCT STRICTRE RS&I
|
Professional
|
Both
|
$165.73
|
|
|
Service Code
|
HCPCS 74363 26
|
| Min. Negotiated Rate |
$30.34 |
| Max. Negotiated Rate |
$97.52 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$43.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.51
|
| Rate for Payer: Healthfirst Commercial |
$43.34
|
| Rate for Payer: Healthfirst Essential Plan |
$97.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.17
|
| Rate for Payer: Healthfirst QHP |
$43.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$43.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$36.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.51
|
| Rate for Payer: SOMOS Essential |
$32.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.34
|
|
|
CHG PRQ TRANSHEPATC PORTOGRAPY HEMODYN EVAL RS&I
|
Professional
|
Both
|
$314.55
|
|
|
Service Code
|
HCPCS 75885 TC
|
| Min. Negotiated Rate |
$59.56 |
| Max. Negotiated Rate |
$191.43 |
| Rate for Payer: Cash Price |
$85.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$85.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$76.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$76.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$80.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$85.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$80.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$63.81
|
| Rate for Payer: Healthfirst Commercial |
$85.08
|
| Rate for Payer: Healthfirst Essential Plan |
$191.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$80.83
|
| Rate for Payer: Healthfirst QHP |
$85.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$59.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$85.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$72.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$59.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$85.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$63.81
|
| Rate for Payer: SOMOS Essential |
$63.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$85.08
|
|
|
CHG PRQ TRANSHEPATC PORTOGRAPY HEMODYN EVAL RS&I
|
Professional
|
Both
|
$262.36
|
|
|
Service Code
|
HCPCS 75885 26
|
| Min. Negotiated Rate |
$49.92 |
| Max. Negotiated Rate |
$160.45 |
| Rate for Payer: Cash Price |
$71.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$71.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$64.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$64.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$67.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$71.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$67.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$71.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$71.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$53.48
|
| Rate for Payer: Healthfirst Commercial |
$71.31
|
| Rate for Payer: Healthfirst Essential Plan |
$160.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$67.74
|
| Rate for Payer: Healthfirst QHP |
$71.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$49.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$71.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$60.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$49.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$71.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$53.48
|
| Rate for Payer: SOMOS Essential |
$53.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$71.31
|
|
|
CHG PRQ TRANSHEPATC PORTOGRAPY HEMODYN EVAL RS&I
|
Professional
|
Both
|
$576.87
|
|
|
Service Code
|
HCPCS 75885
|
| Min. Negotiated Rate |
$109.47 |
| Max. Negotiated Rate |
$351.88 |
| Rate for Payer: Cash Price |
$157.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$156.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$140.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$140.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$148.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$156.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$148.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$156.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$156.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$117.29
|
| Rate for Payer: Healthfirst Commercial |
$156.39
|
| Rate for Payer: Healthfirst Essential Plan |
$351.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$148.57
|
| Rate for Payer: Healthfirst QHP |
$156.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$109.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$156.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$132.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$109.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$156.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$117.29
|
| Rate for Payer: SOMOS Essential |
$117.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$156.39
|
|
|
CHG PRQ TRANSHEPATC PORTOGRAPY W/O HEMODYN EVL INTRP
|
Professional
|
Both
|
$266.67
|
|
|
Service Code
|
HCPCS 75887 26
|
| Min. Negotiated Rate |
$50.46 |
| Max. Negotiated Rate |
$162.20 |
| Rate for Payer: Cash Price |
$71.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$72.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$64.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$64.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$68.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$68.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.07
|
| Rate for Payer: Healthfirst Commercial |
$72.09
|
| Rate for Payer: Healthfirst Essential Plan |
$162.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$68.49
|
| Rate for Payer: Healthfirst QHP |
$72.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$50.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$72.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$61.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$50.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$54.07
|
| Rate for Payer: SOMOS Essential |
$54.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.09
|
|
|
CHG PRQ TRANSHEPATC PORTOGRAPY W/O HEMODYN EVL INTRP
|
Professional
|
Both
|
$318.85
|
|
|
Service Code
|
HCPCS 75887 TC
|
| Min. Negotiated Rate |
$59.56 |
| Max. Negotiated Rate |
$191.43 |
| Rate for Payer: Cash Price |
$86.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$85.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$76.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$76.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$80.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$85.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$80.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$63.81
|
| Rate for Payer: Healthfirst Commercial |
$85.08
|
| Rate for Payer: Healthfirst Essential Plan |
$191.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$80.83
|
| Rate for Payer: Healthfirst QHP |
$85.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$59.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$85.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$72.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$59.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$85.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$63.81
|
| Rate for Payer: SOMOS Essential |
$63.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$85.08
|
|
|
CHG PRQ TRANSHEPATC PORTOGRAPY W/O HEMODYN EVL INTRP
|
Professional
|
Both
|
$585.52
|
|
|
Service Code
|
HCPCS 75887
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$353.63 |
| Rate for Payer: Cash Price |
$158.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$141.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$149.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$149.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$117.88
|
| Rate for Payer: Healthfirst Commercial |
$157.17
|
| Rate for Payer: Healthfirst Essential Plan |
$353.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$149.31
|
| Rate for Payer: Healthfirst QHP |
$157.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$110.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$157.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$133.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$110.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$117.88
|
| Rate for Payer: SOMOS Essential |
$117.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.17
|
|
|
CHG PULMONARY PERFUSION IMAGING PARTICULATE
|
Professional
|
Both
|
$808.75
|
|
|
Service Code
|
HCPCS 78580 TC
|
| Min. Negotiated Rate |
$146.28 |
| Max. Negotiated Rate |
$470.18 |
| Rate for Payer: Cash Price |
$216.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$208.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$188.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$188.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$198.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$208.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$198.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$208.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$208.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$156.73
|
| Rate for Payer: Healthfirst Commercial |
$208.97
|
| Rate for Payer: Healthfirst Essential Plan |
$470.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$198.52
|
| Rate for Payer: Healthfirst QHP |
$208.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$146.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$208.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$177.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$146.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$208.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$156.73
|
| Rate for Payer: SOMOS Essential |
$156.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$208.97
|
|
|
CHG PULMONARY PERFUSION IMAGING PARTICULATE
|
Professional
|
Both
|
$139.58
|
|
|
Service Code
|
HCPCS 78580 26
|
| Min. Negotiated Rate |
$26.37 |
| Max. Negotiated Rate |
$84.76 |
| Rate for Payer: Cash Price |
$37.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.25
|
| Rate for Payer: Healthfirst Commercial |
$37.67
|
| Rate for Payer: Healthfirst Essential Plan |
$84.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.79
|
| Rate for Payer: Healthfirst QHP |
$37.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.25
|
| Rate for Payer: SOMOS Essential |
$28.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.67
|
|
|
CHG PULMONARY PERFUSION IMAGING PARTICULATE
|
Professional
|
Both
|
$948.33
|
|
|
Service Code
|
HCPCS 78580
|
| Min. Negotiated Rate |
$172.65 |
| Max. Negotiated Rate |
$554.94 |
| Rate for Payer: Cash Price |
$254.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$246.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$221.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$221.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$234.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$234.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$246.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$184.98
|
| Rate for Payer: Healthfirst Commercial |
$246.64
|
| Rate for Payer: Healthfirst Essential Plan |
$554.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$234.31
|
| Rate for Payer: Healthfirst QHP |
$246.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$172.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$246.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$209.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$172.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$184.98
|
| Rate for Payer: SOMOS Essential |
$184.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.64
|
|
|
CHG PULMONARY VENTILATION IMAGING
|
Professional
|
Both
|
$91.28
|
|
|
Service Code
|
HCPCS 78579 26
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$54.74 |
| Rate for Payer: Cash Price |
$24.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.25
|
| Rate for Payer: Healthfirst Commercial |
$24.33
|
| Rate for Payer: Healthfirst Essential Plan |
$54.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23.11
|
| Rate for Payer: Healthfirst QHP |
$24.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$24.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$20.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18.25
|
| Rate for Payer: SOMOS Essential |
$18.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.33
|
|
|
CHG PULMONARY VENTILATION IMAGING
|
Professional
|
Both
|
$666.44
|
|
|
Service Code
|
HCPCS 78579 TC
|
| Min. Negotiated Rate |
$119.76 |
| Max. Negotiated Rate |
$384.95 |
| Rate for Payer: Cash Price |
$177.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$171.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$153.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$153.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$171.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$171.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$171.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$128.32
|
| Rate for Payer: Healthfirst Commercial |
$171.09
|
| Rate for Payer: Healthfirst Essential Plan |
$384.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$162.54
|
| Rate for Payer: Healthfirst QHP |
$171.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$119.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$171.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$145.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$119.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$171.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$128.32
|
| Rate for Payer: SOMOS Essential |
$128.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$171.09
|
|
|
CHG PULMONARY VENTILATION IMAGING
|
Professional
|
Both
|
$757.72
|
|
|
Service Code
|
HCPCS 78579
|
| Min. Negotiated Rate |
$136.79 |
| Max. Negotiated Rate |
$439.69 |
| Rate for Payer: Cash Price |
$202.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$195.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$175.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$175.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$185.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$195.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$185.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$195.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$146.56
|
| Rate for Payer: Healthfirst Commercial |
$195.42
|
| Rate for Payer: Healthfirst Essential Plan |
$439.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$185.65
|
| Rate for Payer: Healthfirst QHP |
$195.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$136.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$195.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$166.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$136.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$195.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$146.56
|
| Rate for Payer: SOMOS Essential |
$146.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$195.42
|
|
|
CHG PULMONARY VENTILATION & PERFUSION IMAGING
|
Professional
|
Both
|
$1,321.71
|
|
|
Service Code
|
HCPCS 78582
|
| Min. Negotiated Rate |
$239.57 |
| Max. Negotiated Rate |
$770.04 |
| Rate for Payer: Cash Price |
$355.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$342.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$308.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$308.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$325.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$342.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$325.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$342.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$342.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$256.68
|
| Rate for Payer: Healthfirst Commercial |
$342.24
|
| Rate for Payer: Healthfirst Essential Plan |
$770.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$325.13
|
| Rate for Payer: Healthfirst QHP |
$342.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$239.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$342.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$290.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$239.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$342.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$256.68
|
| Rate for Payer: SOMOS Essential |
$256.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$342.24
|
|
|
CHG PULMONARY VENTILATION & PERFUSION IMAGING
|
Professional
|
Both
|
$1,125.01
|
|
|
Service Code
|
HCPCS 78582 TC
|
| Min. Negotiated Rate |
$202.25 |
| Max. Negotiated Rate |
$650.09 |
| Rate for Payer: Cash Price |
$300.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$288.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$260.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$260.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$274.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$288.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$274.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$288.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$288.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$216.70
|
| Rate for Payer: Healthfirst Commercial |
$288.93
|
| Rate for Payer: Healthfirst Essential Plan |
$650.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$274.48
|
| Rate for Payer: Healthfirst QHP |
$288.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$202.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$288.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$245.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$202.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$288.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$216.70
|
| Rate for Payer: SOMOS Essential |
$216.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$288.93
|
|
