|
CHG KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/O RX
|
Professional
|
$757.02
|
|
|
Service Code
|
HCPCS 78707 TC
|
| Min. Negotiated Rate |
$35.15 |
| Max. Negotiated Rate |
$699.56 |
| Rate for Payer: Cash Price |
$203.29
|
| Rate for Payer: Cash Price |
$203.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$194.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$194.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$205.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$216.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$205.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$216.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$216.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$162.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$205.48
|
| Rate for Payer: Healthfirst QHP |
$216.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$151.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$216.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$183.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$151.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$216.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$567.76
|
| Rate for Payer: SOMOS Essential |
$567.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$216.29
|
|
|
CHG KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/O RX
|
Professional
|
$175.74
|
|
|
Service Code
|
HCPCS 78707 26
|
| Min. Negotiated Rate |
$35.15 |
| Max. Negotiated Rate |
$699.56 |
| Rate for Payer: Cash Price |
$47.77
|
| Rate for Payer: Cash Price |
$47.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$45.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$45.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$47.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$50.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$47.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$37.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.70
|
| Rate for Payer: Healthfirst QHP |
$50.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$35.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$50.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$42.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$35.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$50.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$131.80
|
| Rate for Payer: SOMOS Essential |
$131.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.21
|
|
|
CHG KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/RX
|
Professional
|
$220.01
|
|
|
Service Code
|
HCPCS 78708 26
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$551.62 |
| Rate for Payer: Cash Price |
$60.65
|
| Rate for Payer: Cash Price |
$60.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$56.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$56.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$59.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$59.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$62.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$59.72
|
| Rate for Payer: Healthfirst QHP |
$62.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$44.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$62.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$53.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$44.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$165.01
|
| Rate for Payer: SOMOS Essential |
$165.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.86
|
|
|
CHG KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/RX
|
Professional
|
$735.49
|
|
|
Service Code
|
HCPCS 78708
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$551.62 |
| Rate for Payer: Cash Price |
$203.27
|
| Rate for Payer: Cash Price |
$203.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$189.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$189.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$199.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$210.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$199.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$210.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$210.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$157.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$199.63
|
| Rate for Payer: Healthfirst QHP |
$210.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$147.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$210.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$178.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$147.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$210.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$551.62
|
| Rate for Payer: SOMOS Essential |
$551.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$210.14
|
|
|
CHG KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/RX
|
Professional
|
$515.52
|
|
|
Service Code
|
HCPCS 78708 TC
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$551.62 |
| Rate for Payer: Cash Price |
$142.62
|
| Rate for Payer: Cash Price |
$142.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$132.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$132.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$139.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$139.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$147.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$110.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$139.93
|
| Rate for Payer: Healthfirst QHP |
$147.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$103.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$147.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$125.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$103.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$386.64
|
| Rate for Payer: SOMOS Essential |
$386.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.29
|
|
|
CHG KIDNEY IMG MORPHOLOGY VASCULAR FLOW MULTIPLE
|
Professional
|
$1,215.31
|
|
|
Service Code
|
HCPCS 78709 TC
|
| Min. Negotiated Rate |
$52.12 |
| Max. Negotiated Rate |
$1,106.91 |
| Rate for Payer: Cash Price |
$323.99
|
| Rate for Payer: Cash Price |
$323.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$312.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$312.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$329.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$347.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$329.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$347.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$347.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$260.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$329.87
|
| Rate for Payer: Healthfirst QHP |
$347.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$243.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$347.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$295.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$243.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$347.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$911.48
|
| Rate for Payer: SOMOS Essential |
$911.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$347.23
|
|
|
CHG KIDNEY IMG MORPHOLOGY VASCULAR FLOW MULTIPLE
|
Professional
|
$260.58
|
|
|
Service Code
|
HCPCS 78709 26
|
| Min. Negotiated Rate |
$52.12 |
| Max. Negotiated Rate |
$1,106.91 |
| Rate for Payer: Cash Price |
$70.61
|
| Rate for Payer: Cash Price |
$70.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$67.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$67.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$70.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$74.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$70.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$74.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$55.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$70.73
|
| Rate for Payer: Healthfirst QHP |
$74.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$52.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$74.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$63.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$52.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$74.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$195.44
|
| Rate for Payer: SOMOS Essential |
$195.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$74.45
|
|
|
CHG KIDNEY IMG MORPHOLOGY VASCULAR FLOW MULTIPLE
|
Professional
|
$1,475.88
|
|
|
Service Code
|
HCPCS 78709
|
| Min. Negotiated Rate |
$52.12 |
| Max. Negotiated Rate |
$1,106.91 |
| Rate for Payer: Cash Price |
$394.60
|
| Rate for Payer: Cash Price |
$394.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$379.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$379.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$400.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$421.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$400.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$421.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$421.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$316.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$400.60
|
| Rate for Payer: Healthfirst QHP |
$421.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$295.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$421.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$358.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$295.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$421.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,106.91
|
| Rate for Payer: SOMOS Essential |
$1,106.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$421.68
|
|
|
CHG LABELED RBC SEQUESTRATION DIFFERNTL ORGAN/TISSUE
|
Professional
|
$93.52
|
|
|
Service Code
|
HCPCS 78140 26
|
| Min. Negotiated Rate |
$18.70 |
| Max. Negotiated Rate |
$347.86 |
| Rate for Payer: Cash Price |
$25.83
|
| Rate for Payer: Cash Price |
$25.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.38
|
| Rate for Payer: Healthfirst QHP |
$26.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$70.14
|
| Rate for Payer: SOMOS Essential |
$70.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.72
|
|
|
CHG LABELED RBC SEQUESTRATION DIFFERNTL ORGAN/TISSUE
|
Professional
|
$370.34
|
|
|
Service Code
|
HCPCS 78140 TC
|
| Min. Negotiated Rate |
$18.70 |
| Max. Negotiated Rate |
$347.86 |
| Rate for Payer: Cash Price |
$101.75
|
| Rate for Payer: Cash Price |
$101.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$95.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$95.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$100.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$105.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$100.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$79.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$100.52
|
| Rate for Payer: Healthfirst QHP |
$105.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$74.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$105.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$89.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$74.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$105.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$277.76
|
| Rate for Payer: SOMOS Essential |
$277.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$105.81
|
|
|
CHG LABELED RBC SEQUESTRATION DIFFERNTL ORGAN/TISSUE
|
Professional
|
$463.82
|
|
|
Service Code
|
HCPCS 78140
|
| Min. Negotiated Rate |
$18.70 |
| Max. Negotiated Rate |
$347.86 |
| Rate for Payer: Cash Price |
$127.58
|
| Rate for Payer: Cash Price |
$127.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$119.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$119.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$125.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$132.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$125.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$132.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$132.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$99.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.89
|
| Rate for Payer: Healthfirst QHP |
$132.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$92.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$132.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$112.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$92.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$132.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$347.86
|
| Rate for Payer: SOMOS Essential |
$347.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$132.52
|
|
|
CHG LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY
|
Professional
|
$51.63
|
|
|
Service Code
|
HCPCS 88300 TC
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$52.58 |
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.01
|
| Rate for Payer: Healthfirst QHP |
$14.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$10.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$14.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$12.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$38.72
|
| Rate for Payer: SOMOS Essential |
$38.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.75
|
|
|
CHG LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY
|
Professional
|
$18.52
|
|
|
Service Code
|
HCPCS 88300 26
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$52.58 |
| Rate for Payer: Cash Price |
$4.99
|
| Rate for Payer: Cash Price |
$4.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.03
|
| Rate for Payer: Healthfirst QHP |
$5.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$5.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$4.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$13.89
|
| Rate for Payer: SOMOS Essential |
$13.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.29
|
|
|
CHG LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY
|
Professional
|
$70.11
|
|
|
Service Code
|
HCPCS 88300
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$52.58 |
| Rate for Payer: Cash Price |
$19.37
|
| Rate for Payer: Cash Price |
$19.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.03
|
| Rate for Payer: Healthfirst QHP |
$20.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$20.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$17.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$14.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$52.58
|
| Rate for Payer: SOMOS Essential |
$52.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.03
|
|
|
CHG LIPID PANEL
|
Professional
|
$33.47
|
|
|
Service Code
|
HCPCS 80061
|
| Min. Negotiated Rate |
$9.37 |
| Max. Negotiated Rate |
$25.10 |
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.72
|
| Rate for Payer: Healthfirst QHP |
$13.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$13.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$11.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.10
|
| Rate for Payer: SOMOS Essential |
$25.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.39
|
|
|
CHG LIVER IMAGING STATIC ONLY
|
Professional
|
$770.14
|
|
|
Service Code
|
HCPCS 78201
|
| Min. Negotiated Rate |
$16.14 |
| Max. Negotiated Rate |
$577.60 |
| Rate for Payer: Cash Price |
$207.70
|
| Rate for Payer: Cash Price |
$207.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$198.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$198.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$209.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$220.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$209.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$220.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$220.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.04
|
| Rate for Payer: Healthfirst QHP |
$220.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$154.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$220.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$187.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$154.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$220.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$577.60
|
| Rate for Payer: SOMOS Essential |
$577.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$220.04
|
|
|
CHG LIVER IMAGING STATIC ONLY
|
Professional
|
$80.71
|
|
|
Service Code
|
HCPCS 78201 26
|
| Min. Negotiated Rate |
$16.14 |
| Max. Negotiated Rate |
$577.60 |
| Rate for Payer: Cash Price |
$21.70
|
| Rate for Payer: Cash Price |
$21.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$23.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.91
|
| Rate for Payer: Healthfirst QHP |
$23.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$16.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$23.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$19.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$16.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$60.53
|
| Rate for Payer: SOMOS Essential |
$60.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.06
|
|
|
CHG LIVER IMAGING STATIC ONLY
|
Professional
|
$689.43
|
|
|
Service Code
|
HCPCS 78201 TC
|
| Min. Negotiated Rate |
$16.14 |
| Max. Negotiated Rate |
$577.60 |
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$177.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$177.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$187.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$196.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$187.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$196.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$196.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$147.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$187.13
|
| Rate for Payer: Healthfirst QHP |
$196.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$137.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$196.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$167.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$137.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$196.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$517.07
|
| Rate for Payer: SOMOS Essential |
$517.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$196.98
|
|
|
CHG LIVER IMAGING W/VASCULAR FLOW
|
Professional
|
$746.94
|
|
|
Service Code
|
HCPCS 78202 TC
|
| Min. Negotiated Rate |
$18.47 |
| Max. Negotiated Rate |
$629.48 |
| Rate for Payer: Cash Price |
$202.90
|
| Rate for Payer: Cash Price |
$202.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$192.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$192.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$202.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$213.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$202.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$213.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$213.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$160.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$202.74
|
| Rate for Payer: Healthfirst QHP |
$213.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$149.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$213.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$181.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$149.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$213.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$560.20
|
| Rate for Payer: SOMOS Essential |
$560.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$213.41
|
|
|
CHG LIVER IMAGING W/VASCULAR FLOW
|
Professional
|
$839.30
|
|
|
Service Code
|
HCPCS 78202
|
| Min. Negotiated Rate |
$18.47 |
| Max. Negotiated Rate |
$629.48 |
| Rate for Payer: Cash Price |
$228.22
|
| Rate for Payer: Cash Price |
$228.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$215.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$215.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$227.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$239.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$227.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$239.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$239.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$179.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$227.81
|
| Rate for Payer: Healthfirst QHP |
$239.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$167.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$239.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$203.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$167.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$239.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$629.48
|
| Rate for Payer: SOMOS Essential |
$629.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$239.80
|
|
|
CHG LIVER IMAGING W/VASCULAR FLOW
|
Professional
|
$92.37
|
|
|
Service Code
|
HCPCS 78202 26
|
| Min. Negotiated Rate |
$18.47 |
| Max. Negotiated Rate |
$629.48 |
| Rate for Payer: Cash Price |
$25.32
|
| Rate for Payer: Cash Price |
$25.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.07
|
| Rate for Payer: Healthfirst QHP |
$26.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.28
|
| Rate for Payer: SOMOS Essential |
$69.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.39
|
|
|
CHG LIVER & SPLEEN IMAGING STATIC ONLY
|
Professional
|
$792.23
|
|
|
Service Code
|
HCPCS 78215
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$594.17 |
| Rate for Payer: Cash Price |
$213.77
|
| Rate for Payer: Cash Price |
$213.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$203.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$203.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$215.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$226.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$215.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$226.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$226.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$169.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$215.03
|
| Rate for Payer: Healthfirst QHP |
$226.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$158.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$226.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$192.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$158.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$226.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$594.17
|
| Rate for Payer: SOMOS Essential |
$594.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$226.35
|
|
|
CHG LIVER & SPLEEN IMAGING STATIC ONLY
|
Professional
|
$91.28
|
|
|
Service Code
|
HCPCS 78215 26
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$594.17 |
| Rate for Payer: Cash Price |
$24.63
|
| Rate for Payer: Cash Price |
$24.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24.78
|
| Rate for Payer: Healthfirst QHP |
$26.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$68.46
|
| Rate for Payer: SOMOS Essential |
$68.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.08
|
|
|
CHG LIVER & SPLEEN IMAGING STATIC ONLY
|
Professional
|
$700.95
|
|
|
Service Code
|
HCPCS 78215 TC
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$594.17 |
| Rate for Payer: Cash Price |
$189.14
|
| Rate for Payer: Cash Price |
$189.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$180.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$180.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$190.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$200.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$190.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$150.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$190.26
|
| Rate for Payer: Healthfirst QHP |
$200.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$140.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$200.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$170.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$140.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$200.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$525.71
|
| Rate for Payer: SOMOS Essential |
$525.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$200.27
|
|
|
CHG LIVER & SPLEEN IMAGING W/VASCULAR FLOW
|
Professional
|
$553.28
|
|
|
Service Code
|
HCPCS 78216
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$414.96 |
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$142.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$142.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$150.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$158.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$150.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$158.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$158.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$118.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$150.18
|
| Rate for Payer: Healthfirst QHP |
$158.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$110.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$158.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$134.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$110.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$158.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$414.96
|
| Rate for Payer: SOMOS Essential |
$414.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$158.08
|
|
