|
CHG RED CELL SURVIVAL STUDY
|
Professional
|
Both
|
$528.26
|
|
|
Service Code
|
HCPCS 78130
|
| 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 RED CELL SURVIVAL STUDY
|
Professional
|
Both
|
$93.52
|
|
|
Service Code
|
HCPCS 78130 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 RED CELL SURVIVAL STUDY
|
Professional
|
Both
|
$434.74
|
|
|
Service Code
|
HCPCS 78130 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 RED CELL VOLUME DETERMINATION SPX 1 SAMPLING
|
Professional
|
Both
|
$37.31
|
|
|
Service Code
|
HCPCS 78120 26
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$22.70 |
| Rate for Payer: Cash Price |
$10.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.57
|
| Rate for Payer: Healthfirst Commercial |
$10.09
|
| Rate for Payer: Healthfirst Essential Plan |
$22.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.59
|
| Rate for Payer: Healthfirst QHP |
$10.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$7.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$10.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.57
|
| Rate for Payer: SOMOS Essential |
$7.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.09
|
|
|
CHG RED CELL VOLUME DETERMINATION SPX 1 SAMPLING
|
Professional
|
Both
|
$268.24
|
|
|
Service Code
|
HCPCS 78120 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 RED CELL VOLUME DETERMINATION SPX 1 SAMPLING
|
Professional
|
Both
|
$305.55
|
|
|
Service Code
|
HCPCS 78120
|
| Min. Negotiated Rate |
$58.25 |
| Max. Negotiated Rate |
$187.22 |
| Rate for Payer: Cash Price |
$83.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$83.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$74.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$74.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$79.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$83.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$79.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$62.41
|
| Rate for Payer: Healthfirst Commercial |
$83.21
|
| Rate for Payer: Healthfirst Essential Plan |
$187.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$79.05
|
| Rate for Payer: Healthfirst QHP |
$83.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$58.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$83.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$70.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$58.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$83.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$62.41
|
| Rate for Payer: SOMOS Essential |
$62.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$83.21
|
|
|
CHG RED CELL VOLUME DETERMINATION SPX MULT SAMPLINGS
|
Professional
|
Both
|
$331.21
|
|
|
Service Code
|
HCPCS 78121
|
| Min. Negotiated Rate |
$76.72 |
| Max. Negotiated Rate |
$246.60 |
| Rate for Payer: Cash Price |
$90.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$109.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$98.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$98.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$104.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$109.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$104.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$109.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$82.20
|
| Rate for Payer: Healthfirst Commercial |
$109.60
|
| Rate for Payer: Healthfirst Essential Plan |
$246.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$104.12
|
| Rate for Payer: Healthfirst QHP |
$109.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$76.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$109.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$93.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$76.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$109.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$82.20
|
| Rate for Payer: SOMOS Essential |
$82.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$109.60
|
|
|
CHG RED CELL VOLUME DETERMINATION SPX MULT SAMPLINGS
|
Professional
|
Both
|
$50.02
|
|
|
Service Code
|
HCPCS 78121 26
|
| Min. Negotiated Rate |
$11.14 |
| Max. Negotiated Rate |
$35.80 |
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.93
|
| Rate for Payer: Healthfirst Commercial |
$15.91
|
| Rate for Payer: Healthfirst Essential Plan |
$35.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.11
|
| Rate for Payer: Healthfirst QHP |
$15.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$15.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$13.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$11.93
|
| Rate for Payer: SOMOS Essential |
$11.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.91
|
|
|
CHG RED CELL VOLUME DETERMINATION SPX MULT SAMPLINGS
|
Professional
|
Both
|
$281.19
|
|
|
Service Code
|
HCPCS 78121 TC
|
| Min. Negotiated Rate |
$65.58 |
| Max. Negotiated Rate |
$210.80 |
| Rate for Payer: Cash Price |
$76.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$93.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$84.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$84.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$89.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$93.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$89.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$70.27
|
| Rate for Payer: Healthfirst Commercial |
$93.69
|
| Rate for Payer: Healthfirst Essential Plan |
$210.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$89.01
|
| Rate for Payer: Healthfirst QHP |
$93.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$65.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$93.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$79.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$65.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$93.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$70.27
|
| Rate for Payer: SOMOS Essential |
$70.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$93.69
|
|
|
CHG RESPIRATORY MOTION MANAGEMENT SIMULATION
|
Professional
|
Both
|
$1,333.43
|
|
|
Service Code
|
HCPCS 77293 TC
|
| Min. Negotiated Rate |
$242.58 |
| Max. Negotiated Rate |
$779.72 |
| Rate for Payer: Cash Price |
$359.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$346.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$311.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$311.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$329.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$346.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$329.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$346.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$346.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$259.90
|
| Rate for Payer: Healthfirst Commercial |
$346.54
|
| Rate for Payer: Healthfirst Essential Plan |
$779.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$329.21
|
| Rate for Payer: Healthfirst QHP |
$346.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$242.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$346.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$294.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$242.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$346.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$259.90
|
| Rate for Payer: SOMOS Essential |
$259.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$346.54
|
|
|
CHG RESPIRATORY MOTION MANAGEMENT SIMULATION
|
Professional
|
Both
|
$1,755.32
|
|
|
Service Code
|
HCPCS 77293
|
| Min. Negotiated Rate |
$323.72 |
| Max. Negotiated Rate |
$1,040.54 |
| Rate for Payer: Cash Price |
$475.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$462.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$416.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$416.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$439.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$462.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$439.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$462.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$462.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$346.85
|
| Rate for Payer: Healthfirst Commercial |
$462.46
|
| Rate for Payer: Healthfirst Essential Plan |
$1,040.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$439.34
|
| Rate for Payer: Healthfirst QHP |
$462.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$323.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$462.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$393.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$323.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$462.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$346.85
|
| Rate for Payer: SOMOS Essential |
$346.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$462.46
|
|
|
CHG RESPIRATORY MOTION MANAGEMENT SIMULATION
|
Professional
|
Both
|
$421.89
|
|
|
Service Code
|
HCPCS 77293 26
|
| Min. Negotiated Rate |
$81.14 |
| Max. Negotiated Rate |
$260.82 |
| Rate for Payer: Cash Price |
$116.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$115.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$104.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$104.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$110.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$115.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$110.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$115.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$115.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$86.94
|
| Rate for Payer: Healthfirst Commercial |
$115.92
|
| Rate for Payer: Healthfirst Essential Plan |
$260.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$110.12
|
| Rate for Payer: Healthfirst QHP |
$115.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$81.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$115.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$98.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$81.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$115.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$86.94
|
| Rate for Payer: SOMOS Essential |
$86.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$115.92
|
|
|
CHG RMVL FB ESOPHAGEAL W/USE BALLOON CATH RS&I
|
Professional
|
Both
|
$228.73
|
|
|
Service Code
|
HCPCS 74235 26
|
| Min. Negotiated Rate |
$42.81 |
| Max. Negotiated Rate |
$137.61 |
| Rate for Payer: Cash Price |
$61.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$61.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$55.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$55.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$58.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$61.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$58.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$61.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.87
|
| Rate for Payer: Healthfirst Commercial |
$61.16
|
| Rate for Payer: Healthfirst Essential Plan |
$137.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$58.10
|
| Rate for Payer: Healthfirst QHP |
$61.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$42.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$61.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$51.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$42.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$61.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$45.87
|
| Rate for Payer: SOMOS Essential |
$45.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$61.16
|
|
|
CHG RP LOCLZJ TUM PLNR 1 AREA SINGLE DAY IMAGING
|
Professional
|
Both
|
$889.25
|
|
|
Service Code
|
HCPCS 78800 TC
|
| Min. Negotiated Rate |
$161.77 |
| Max. Negotiated Rate |
$519.98 |
| Rate for Payer: Cash Price |
$239.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$207.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$207.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$231.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$173.32
|
| Rate for Payer: Healthfirst Commercial |
$231.10
|
| Rate for Payer: Healthfirst Essential Plan |
$519.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$219.54
|
| Rate for Payer: Healthfirst QHP |
$231.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$161.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$231.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$196.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$161.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$173.32
|
| Rate for Payer: SOMOS Essential |
$173.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.10
|
|
|
CHG RP LOCLZJ TUM PLNR 1 AREA SINGLE DAY IMAGING
|
Professional
|
Both
|
$122.75
|
|
|
Service Code
|
HCPCS 78800 26
|
| Min. Negotiated Rate |
$23.58 |
| Max. Negotiated Rate |
$75.78 |
| Rate for Payer: Cash Price |
$34.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.26
|
| Rate for Payer: Healthfirst Commercial |
$33.68
|
| Rate for Payer: Healthfirst Essential Plan |
$75.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.00
|
| Rate for Payer: Healthfirst QHP |
$33.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$33.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.26
|
| Rate for Payer: SOMOS Essential |
$25.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.68
|
|
|
CHG RP LOCLZJ TUM PLNR 1 AREA SINGLE DAY IMAGING
|
Professional
|
Both
|
$1,011.99
|
|
|
Service Code
|
HCPCS 78800
|
| Min. Negotiated Rate |
$185.35 |
| Max. Negotiated Rate |
$595.75 |
| Rate for Payer: Cash Price |
$273.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$264.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$238.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$238.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$251.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$264.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$251.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$264.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$198.59
|
| Rate for Payer: Healthfirst Commercial |
$264.78
|
| Rate for Payer: Healthfirst Essential Plan |
$595.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$251.54
|
| Rate for Payer: Healthfirst QHP |
$264.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$185.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$264.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$225.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$185.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$264.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$198.59
|
| Rate for Payer: SOMOS Essential |
$198.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$264.78
|
|
|
CHG RP LOCLZJ TUM PLNR 2+AREA 1+D IMG/1 AREA IMG>2+D
|
Professional
|
Both
|
$1,096.55
|
|
|
Service Code
|
HCPCS 78801
|
| Min. Negotiated Rate |
$197.78 |
| Max. Negotiated Rate |
$635.74 |
| Rate for Payer: Cash Price |
$292.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$282.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$254.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$254.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$268.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$282.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$268.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$282.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$282.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$211.91
|
| Rate for Payer: Healthfirst Commercial |
$282.55
|
| Rate for Payer: Healthfirst Essential Plan |
$635.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$268.42
|
| Rate for Payer: Healthfirst QHP |
$282.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$197.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$282.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$240.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$197.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$282.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$211.91
|
| Rate for Payer: SOMOS Essential |
$211.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$282.55
|
|
|
CHG RP LOCLZJ TUM PLNR 2+AREA 1+D IMG/1 AREA IMG>2+D
|
Professional
|
Both
|
$959.70
|
|
|
Service Code
|
HCPCS 78801 TC
|
| Min. Negotiated Rate |
$172.37 |
| Max. Negotiated Rate |
$554.04 |
| Rate for Payer: Cash Price |
$255.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$246.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$221.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$221.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$233.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$233.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$246.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$184.68
|
| Rate for Payer: Healthfirst Commercial |
$246.24
|
| Rate for Payer: Healthfirst Essential Plan |
$554.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$233.93
|
| Rate for Payer: Healthfirst QHP |
$246.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$172.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$246.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$209.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$172.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$184.68
|
| Rate for Payer: SOMOS Essential |
$184.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.24
|
|
|
CHG RP LOCLZJ TUM PLNR 2+AREA 1+D IMG/1 AREA IMG>2+D
|
Professional
|
Both
|
$136.89
|
|
|
Service Code
|
HCPCS 78801 26
|
| Min. Negotiated Rate |
$25.42 |
| Max. Negotiated Rate |
$81.72 |
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$36.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.24
|
| Rate for Payer: Healthfirst Commercial |
$36.32
|
| Rate for Payer: Healthfirst Essential Plan |
$81.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.50
|
| Rate for Payer: Healthfirst QHP |
$36.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$36.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.24
|
| Rate for Payer: SOMOS Essential |
$27.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.32
|
|
|
CHG RP LOCLZJ TUM PLNR WHOLE BODY 2+ DAYS IMAGING
|
Professional
|
Both
|
$184.87
|
|
|
Service Code
|
HCPCS 78804 26
|
| Min. Negotiated Rate |
$35.06 |
| Max. Negotiated Rate |
$112.68 |
| Rate for Payer: Cash Price |
$50.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$50.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$45.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$45.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$47.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$50.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$47.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$37.56
|
| Rate for Payer: Healthfirst Commercial |
$50.08
|
| Rate for Payer: Healthfirst Essential Plan |
$112.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.58
|
| Rate for Payer: Healthfirst QHP |
$50.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$35.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$50.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$42.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$35.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$50.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$37.56
|
| Rate for Payer: SOMOS Essential |
$37.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.08
|
|
|
CHG RP LOCLZJ TUM PLNR WHOLE BODY 2+ DAYS IMAGING
|
Professional
|
Both
|
$2,403.84
|
|
|
Service Code
|
HCPCS 78804 TC
|
| Min. Negotiated Rate |
$428.15 |
| Max. Negotiated Rate |
$1,376.19 |
| Rate for Payer: Cash Price |
$638.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$611.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$550.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$550.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$581.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$611.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$581.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$611.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$611.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$458.73
|
| Rate for Payer: Healthfirst Commercial |
$611.64
|
| Rate for Payer: Healthfirst Essential Plan |
$1,376.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$581.06
|
| Rate for Payer: Healthfirst QHP |
$611.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$428.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$611.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$519.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$428.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$611.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$458.73
|
| Rate for Payer: SOMOS Essential |
$458.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$611.64
|
|
|
CHG RP LOCLZJ TUM PLNR WHOLE BODY 2+ DAYS IMAGING
|
Professional
|
Both
|
$2,588.71
|
|
|
Service Code
|
HCPCS 78804
|
| Min. Negotiated Rate |
$463.20 |
| Max. Negotiated Rate |
$1,488.85 |
| Rate for Payer: Cash Price |
$689.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$661.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$595.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$595.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$628.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$661.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$628.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$661.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$661.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$496.28
|
| Rate for Payer: Healthfirst Commercial |
$661.71
|
| Rate for Payer: Healthfirst Essential Plan |
$1,488.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$628.62
|
| Rate for Payer: Healthfirst QHP |
$661.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$463.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$661.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$562.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$463.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$661.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$496.28
|
| Rate for Payer: SOMOS Essential |
$496.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$661.71
|
|
|
CHG RP LOCLZJ TUM PLNR WHOLE BODY SINGLE DAY IMAGING
|
Professional
|
Both
|
$148.51
|
|
|
Service Code
|
HCPCS 78802 26
|
| Min. Negotiated Rate |
$28.08 |
| Max. Negotiated Rate |
$90.27 |
| Rate for Payer: Cash Price |
$40.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$40.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.09
|
| Rate for Payer: Healthfirst Commercial |
$40.12
|
| Rate for Payer: Healthfirst Essential Plan |
$90.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.11
|
| Rate for Payer: Healthfirst QHP |
$40.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$40.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$30.09
|
| Rate for Payer: SOMOS Essential |
$30.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.12
|
|
|
CHG RP LOCLZJ TUM PLNR WHOLE BODY SINGLE DAY IMAGING
|
Professional
|
Both
|
$1,089.06
|
|
|
Service Code
|
HCPCS 78802 TC
|
| Min. Negotiated Rate |
$194.91 |
| Max. Negotiated Rate |
$626.51 |
| Rate for Payer: Cash Price |
$289.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$278.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$250.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$250.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$264.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$278.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$264.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$278.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$208.84
|
| Rate for Payer: Healthfirst Commercial |
$278.45
|
| Rate for Payer: Healthfirst Essential Plan |
$626.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$264.53
|
| Rate for Payer: Healthfirst QHP |
$278.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$194.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$278.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$236.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$194.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$278.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$208.84
|
| Rate for Payer: SOMOS Essential |
$208.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$278.45
|
|
|
CHG RP LOCLZJ TUM PLNR WHOLE BODY SINGLE DAY IMAGING
|
Professional
|
Both
|
$1,237.60
|
|
|
Service Code
|
HCPCS 78802
|
| Min. Negotiated Rate |
$223.01 |
| Max. Negotiated Rate |
$716.80 |
| Rate for Payer: Cash Price |
$329.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$318.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$286.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$286.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$302.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$318.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$302.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$318.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$318.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$238.94
|
| Rate for Payer: Healthfirst Commercial |
$318.58
|
| Rate for Payer: Healthfirst Essential Plan |
$716.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$302.65
|
| Rate for Payer: Healthfirst QHP |
$318.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$223.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$318.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$270.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$223.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$318.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$238.94
|
| Rate for Payer: SOMOS Essential |
$238.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$318.58
|
|
