|
CHG CARD BL POOL GATED SPECT REST WAL MOTN EJCT FRCT
|
Professional
|
$909.79
|
|
|
Service Code
|
HCPCS 78494
|
| Min. Negotiated Rate |
$43.78 |
| Max. Negotiated Rate |
$682.34 |
| Rate for Payer: Cash Price |
$246.51
|
| Rate for Payer: Cash Price |
$246.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$233.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$233.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$246.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$259.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$246.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$259.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$259.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$194.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$246.94
|
| Rate for Payer: Healthfirst QHP |
$259.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$181.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$259.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$220.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$181.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$259.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$682.34
|
| Rate for Payer: SOMOS Essential |
$682.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$259.94
|
|
|
CHG CARD BL POOL PLANAR 1 STDY WAL MOTN EJECT FRACT
|
Professional
|
$182.56
|
|
|
Service Code
|
HCPCS 78481 26
|
| Min. Negotiated Rate |
$36.51 |
| Max. Negotiated Rate |
$532.17 |
| Rate for Payer: Cash Price |
$49.64
|
| Rate for Payer: Cash Price |
$49.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$46.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$46.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.55
|
| Rate for Payer: Healthfirst QHP |
$52.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$136.92
|
| Rate for Payer: SOMOS Essential |
$136.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.16
|
|
|
CHG CARD BL POOL PLANAR 1 STDY WAL MOTN EJECT FRACT
|
Professional
|
$527.00
|
|
|
Service Code
|
HCPCS 78481 TC
|
| Min. Negotiated Rate |
$36.51 |
| Max. Negotiated Rate |
$532.17 |
| Rate for Payer: Cash Price |
$142.55
|
| Rate for Payer: Cash Price |
$142.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$135.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$135.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$143.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$150.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$143.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$112.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$143.04
|
| Rate for Payer: Healthfirst QHP |
$150.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$105.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$150.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$127.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$105.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$150.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$395.25
|
| Rate for Payer: SOMOS Essential |
$395.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$150.57
|
|
|
CHG CARD BL POOL PLANAR 1 STDY WAL MOTN EJECT FRACT
|
Professional
|
$709.56
|
|
|
Service Code
|
HCPCS 78481
|
| Min. Negotiated Rate |
$36.51 |
| Max. Negotiated Rate |
$532.17 |
| Rate for Payer: Cash Price |
$192.19
|
| Rate for Payer: Cash Price |
$192.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$182.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$182.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$192.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$202.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$192.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$202.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$202.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$152.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$192.59
|
| Rate for Payer: Healthfirst QHP |
$202.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$141.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$202.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$172.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$141.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$202.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$532.17
|
| Rate for Payer: SOMOS Essential |
$532.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$202.73
|
|
|
CHG CARD BL POOL PLNR MLT STDY WAL MOTN EJECT FRACT
|
Professional
|
$268.38
|
|
|
Service Code
|
HCPCS 78483 26
|
| Min. Negotiated Rate |
$53.68 |
| Max. Negotiated Rate |
$711.90 |
| Rate for Payer: Cash Price |
$74.04
|
| Rate for Payer: Cash Price |
$74.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$69.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$69.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$72.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$76.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$72.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$72.85
|
| Rate for Payer: Healthfirst QHP |
$76.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$53.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$76.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$65.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$53.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$76.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$201.28
|
| Rate for Payer: SOMOS Essential |
$201.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$76.68
|
|
|
CHG CARD BL POOL PLNR MLT STDY WAL MOTN EJECT FRACT
|
Professional
|
$680.82
|
|
|
Service Code
|
HCPCS 78483 TC
|
| Min. Negotiated Rate |
$53.68 |
| Max. Negotiated Rate |
$711.90 |
| Rate for Payer: Cash Price |
$183.25
|
| Rate for Payer: Cash Price |
$183.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$175.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$175.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$184.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$194.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$184.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$194.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$194.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$145.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$184.79
|
| Rate for Payer: Healthfirst QHP |
$194.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$136.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$194.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$165.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$136.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$194.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$510.62
|
| Rate for Payer: SOMOS Essential |
$510.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$194.52
|
|
|
CHG CARD BL POOL PLNR MLT STDY WAL MOTN EJECT FRACT
|
Professional
|
$949.20
|
|
|
Service Code
|
HCPCS 78483
|
| Min. Negotiated Rate |
$53.68 |
| Max. Negotiated Rate |
$711.90 |
| Rate for Payer: Cash Price |
$257.29
|
| Rate for Payer: Cash Price |
$257.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$244.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$244.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$257.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$271.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$257.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$271.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$271.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$203.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$257.64
|
| Rate for Payer: Healthfirst QHP |
$271.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$189.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$271.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$230.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$189.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$271.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$711.90
|
| Rate for Payer: SOMOS Essential |
$711.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$271.20
|
|
|
CHG CARDIAC MRI FOR VELOCITY FLOW MAPPING
|
Professional
|
$153.83
|
|
|
Service Code
|
HCPCS 75565 TC
|
| Min. Negotiated Rate |
$9.39 |
| Max. Negotiated Rate |
$150.60 |
| Rate for Payer: Cash Price |
$41.26
|
| Rate for Payer: Cash Price |
$41.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.75
|
| Rate for Payer: Healthfirst QHP |
$43.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$43.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$115.37
|
| Rate for Payer: SOMOS Essential |
$115.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.95
|
|
|
CHG CARDIAC MRI FOR VELOCITY FLOW MAPPING
|
Professional
|
$46.97
|
|
|
Service Code
|
HCPCS 75565 26
|
| Min. Negotiated Rate |
$9.39 |
| Max. Negotiated Rate |
$150.60 |
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.75
|
| Rate for Payer: Healthfirst QHP |
$13.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$13.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$11.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35.23
|
| Rate for Payer: SOMOS Essential |
$35.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.42
|
|
|
CHG CARDIAC MRI FOR VELOCITY FLOW MAPPING
|
Professional
|
$200.80
|
|
|
Service Code
|
HCPCS 75565
|
| Min. Negotiated Rate |
$9.39 |
| Max. Negotiated Rate |
$150.60 |
| Rate for Payer: Cash Price |
$54.14
|
| Rate for Payer: Cash Price |
$54.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$51.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$51.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$54.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$57.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$54.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$54.50
|
| Rate for Payer: Healthfirst QHP |
$57.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$40.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$57.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$48.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$40.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$57.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$150.60
|
| Rate for Payer: SOMOS Essential |
$150.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$57.37
|
|
|
CHG CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST
|
Professional
|
$441.00
|
|
|
Service Code
|
HCPCS 75557 26
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$915.97 |
| Rate for Payer: Cash Price |
$120.04
|
| Rate for Payer: Cash Price |
$120.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$113.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$113.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$119.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$126.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$119.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$94.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$119.70
|
| Rate for Payer: Healthfirst QHP |
$126.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$88.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$126.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$107.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$88.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$126.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$330.75
|
| Rate for Payer: SOMOS Essential |
$330.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$126.00
|
|
|
CHG CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST
|
Professional
|
$780.29
|
|
|
Service Code
|
HCPCS 75557 TC
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$915.97 |
| Rate for Payer: Cash Price |
$209.50
|
| Rate for Payer: Cash Price |
$209.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$200.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$200.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$211.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$222.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$211.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$222.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$222.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$167.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$211.79
|
| Rate for Payer: Healthfirst QHP |
$222.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$156.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$222.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$189.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$156.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$222.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$585.22
|
| Rate for Payer: SOMOS Essential |
$585.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$222.94
|
|
|
CHG CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST
|
Professional
|
$1,221.29
|
|
|
Service Code
|
HCPCS 75557
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$915.97 |
| Rate for Payer: Cash Price |
$329.54
|
| Rate for Payer: Cash Price |
$329.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$314.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$314.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$331.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$348.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$331.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$348.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$348.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$261.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$331.49
|
| Rate for Payer: Healthfirst QHP |
$348.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$244.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$348.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$296.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$244.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$348.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$915.97
|
| Rate for Payer: SOMOS Essential |
$915.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$348.94
|
|
|
CHG CARDIAC MRI W/O CONTRAST W/STRESS IMAGING
|
Professional
|
$1,635.69
|
|
|
Service Code
|
HCPCS 75559
|
| Min. Negotiated Rate |
$108.12 |
| Max. Negotiated Rate |
$1,226.77 |
| Rate for Payer: Cash Price |
$442.96
|
| Rate for Payer: Cash Price |
$442.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$420.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$420.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$443.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$467.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$443.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$467.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$467.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$350.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$443.97
|
| Rate for Payer: Healthfirst QHP |
$467.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$327.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$467.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$397.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$327.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$467.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,226.77
|
| Rate for Payer: SOMOS Essential |
$1,226.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$467.34
|
|
|
CHG CARDIAC MRI W/O CONTRAST W/STRESS IMAGING
|
Professional
|
$1,095.08
|
|
|
Service Code
|
HCPCS 75559 TC
|
| Min. Negotiated Rate |
$108.12 |
| Max. Negotiated Rate |
$1,226.77 |
| Rate for Payer: Cash Price |
$294.77
|
| Rate for Payer: Cash Price |
$294.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$281.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$281.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$297.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$312.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$297.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$312.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$312.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$234.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$297.24
|
| Rate for Payer: Healthfirst QHP |
$312.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$219.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$312.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$265.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$219.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$312.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$821.31
|
| Rate for Payer: SOMOS Essential |
$821.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$312.88
|
|
|
CHG CARDIAC MRI W/O CONTRAST W/STRESS IMAGING
|
Professional
|
$540.58
|
|
|
Service Code
|
HCPCS 75559 26
|
| Min. Negotiated Rate |
$108.12 |
| Max. Negotiated Rate |
$1,226.77 |
| Rate for Payer: Cash Price |
$148.19
|
| Rate for Payer: Cash Price |
$148.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$139.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$139.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$146.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$154.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$146.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$154.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$154.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$115.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$146.73
|
| Rate for Payer: Healthfirst QHP |
$154.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$108.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$154.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$131.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$108.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$154.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$405.44
|
| Rate for Payer: SOMOS Essential |
$405.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$154.45
|
|
|
CHG CARDIAC MRI W/WO CONTRAST & FURTHER SEQ
|
Professional
|
$488.01
|
|
|
Service Code
|
HCPCS 75561 26
|
| Min. Negotiated Rate |
$97.60 |
| Max. Negotiated Rate |
$1,203.49 |
| Rate for Payer: Cash Price |
$132.92
|
| Rate for Payer: Cash Price |
$132.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$125.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$132.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$139.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$132.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$139.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$139.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$104.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$132.46
|
| Rate for Payer: Healthfirst QHP |
$139.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$97.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$139.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$118.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$97.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$139.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$366.01
|
| Rate for Payer: SOMOS Essential |
$366.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$139.43
|
|
|
CHG CARDIAC MRI W/WO CONTRAST & FURTHER SEQ
|
Professional
|
$1,116.64
|
|
|
Service Code
|
HCPCS 75561 TC
|
| Min. Negotiated Rate |
$97.60 |
| Max. Negotiated Rate |
$1,203.49 |
| Rate for Payer: Cash Price |
$299.33
|
| Rate for Payer: Cash Price |
$299.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$287.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$287.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$303.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$319.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$303.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$319.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$319.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$239.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$303.09
|
| Rate for Payer: Healthfirst QHP |
$319.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$223.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$319.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$271.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$223.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$319.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$837.48
|
| Rate for Payer: SOMOS Essential |
$837.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$319.04
|
|
|
CHG CARDIAC MRI W/WO CONTRAST & FURTHER SEQ
|
Professional
|
$1,604.65
|
|
|
Service Code
|
HCPCS 75561
|
| Min. Negotiated Rate |
$97.60 |
| Max. Negotiated Rate |
$1,203.49 |
| Rate for Payer: Cash Price |
$432.24
|
| Rate for Payer: Cash Price |
$432.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$412.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$412.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$435.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$458.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$435.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$458.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$458.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$343.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$435.55
|
| Rate for Payer: Healthfirst QHP |
$458.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$320.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$458.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$389.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$320.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$458.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,203.49
|
| Rate for Payer: SOMOS Essential |
$1,203.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$458.47
|
|
|
CHG CARDIAC MRI W/W/O CONTRAST W/STRESS
|
Professional
|
$1,864.49
|
|
|
Service Code
|
HCPCS 75563
|
| Min. Negotiated Rate |
$109.95 |
| Max. Negotiated Rate |
$1,398.37 |
| Rate for Payer: Cash Price |
$503.56
|
| Rate for Payer: Cash Price |
$503.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$479.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$479.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$506.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$532.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$506.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$532.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$532.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$399.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$506.07
|
| Rate for Payer: Healthfirst QHP |
$532.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$372.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$532.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$452.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$372.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$532.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,398.37
|
| Rate for Payer: SOMOS Essential |
$1,398.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$532.71
|
|
|
CHG CARDIAC MRI W/W/O CONTRAST W/STRESS
|
Professional
|
$549.75
|
|
|
Service Code
|
HCPCS 75563 26
|
| Min. Negotiated Rate |
$109.95 |
| Max. Negotiated Rate |
$1,398.37 |
| Rate for Payer: Cash Price |
$151.58
|
| Rate for Payer: Cash Price |
$151.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$141.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$149.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$149.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$117.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$149.22
|
| Rate for Payer: Healthfirst QHP |
$157.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$109.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$157.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$133.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$109.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$412.31
|
| Rate for Payer: SOMOS Essential |
$412.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.07
|
|
|
CHG CARDIAC MRI W/W/O CONTRAST W/STRESS
|
Professional
|
$1,314.74
|
|
|
Service Code
|
HCPCS 75563 TC
|
| Min. Negotiated Rate |
$109.95 |
| Max. Negotiated Rate |
$1,398.37 |
| Rate for Payer: Cash Price |
$351.98
|
| Rate for Payer: Cash Price |
$351.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$338.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$338.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$356.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$375.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$356.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$375.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$375.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$281.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$356.86
|
| Rate for Payer: Healthfirst QHP |
$375.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$262.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$375.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$319.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$262.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$375.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$986.06
|
| Rate for Payer: SOMOS Essential |
$986.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$375.64
|
|
|
CHG CARDIAC SHUNT DETECTION
|
Professional
|
$752.08
|
|
|
Service Code
|
HCPCS 78428
|
| Min. Negotiated Rate |
$28.92 |
| Max. Negotiated Rate |
$564.06 |
| Rate for Payer: Cash Price |
$202.90
|
| Rate for Payer: Cash Price |
$202.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$193.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$193.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$204.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$214.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$204.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$214.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$214.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$161.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$204.14
|
| Rate for Payer: Healthfirst QHP |
$214.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$150.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$214.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$182.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$150.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$214.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$564.06
|
| Rate for Payer: SOMOS Essential |
$564.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$214.88
|
|
|
CHG CARDIAC SHUNT DETECTION
|
Professional
|
$607.50
|
|
|
Service Code
|
HCPCS 78428 TC
|
| Min. Negotiated Rate |
$28.92 |
| Max. Negotiated Rate |
$564.06 |
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$156.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$156.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$164.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$173.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$164.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$173.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$173.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$130.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$164.89
|
| Rate for Payer: Healthfirst QHP |
$173.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$121.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$173.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$147.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$121.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$173.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$455.62
|
| Rate for Payer: SOMOS Essential |
$455.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$173.57
|
|
|
CHG CARDIAC SHUNT DETECTION
|
Professional
|
$144.59
|
|
|
Service Code
|
HCPCS 78428 26
|
| Min. Negotiated Rate |
$28.92 |
| Max. Negotiated Rate |
$564.06 |
| Rate for Payer: Cash Price |
$38.90
|
| Rate for Payer: Cash Price |
$38.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$39.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.24
|
| Rate for Payer: Healthfirst QHP |
$41.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$41.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$35.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$108.44
|
| Rate for Payer: SOMOS Essential |
$108.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.31
|
|
