|
CHG MRI UPPER EXTREMITY OTH THAN JT W/CONTR MATRL
|
Professional
|
$1,175.30
|
|
|
Service Code
|
HCPCS 73219 TC
|
| Min. Negotiated Rate |
$61.92 |
| Max. Negotiated Rate |
$1,113.68 |
| Rate for Payer: Cash Price |
$313.08
|
| Rate for Payer: Cash Price |
$313.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$302.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$302.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$319.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$335.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$319.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$335.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$335.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$251.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$319.01
|
| Rate for Payer: Healthfirst QHP |
$335.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$235.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$335.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$285.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$235.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$335.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$881.48
|
| Rate for Payer: SOMOS Essential |
$881.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$335.80
|
|
|
CHG MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL
|
Professional
|
$260.12
|
|
|
Service Code
|
HCPCS 73218 26
|
| Min. Negotiated Rate |
$52.02 |
| Max. Negotiated Rate |
$942.88 |
| Rate for Payer: Cash Price |
$70.71
|
| Rate for Payer: Cash Price |
$70.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$66.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$66.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$70.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$74.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$70.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$74.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$55.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$70.60
|
| Rate for Payer: Healthfirst QHP |
$74.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$52.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$74.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$63.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$52.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$74.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$195.09
|
| Rate for Payer: SOMOS Essential |
$195.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$74.32
|
|
|
CHG MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL
|
Professional
|
$1,257.17
|
|
|
Service Code
|
HCPCS 73218
|
| Min. Negotiated Rate |
$52.02 |
| Max. Negotiated Rate |
$942.88 |
| Rate for Payer: Cash Price |
$364.54
|
| Rate for Payer: Cash Price |
$364.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$350.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$350.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$369.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$389.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$369.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$389.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$389.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$291.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$369.72
|
| Rate for Payer: Healthfirst QHP |
$389.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$272.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$389.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$330.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$272.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$389.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$942.88
|
| Rate for Payer: SOMOS Essential |
$942.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$389.18
|
|
|
CHG MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL
|
Professional
|
$997.08
|
|
|
Service Code
|
HCPCS 73218 TC
|
| Min. Negotiated Rate |
$52.02 |
| Max. Negotiated Rate |
$942.88 |
| Rate for Payer: Cash Price |
$293.82
|
| Rate for Payer: Cash Price |
$293.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$283.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$283.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$299.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$314.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$299.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$314.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$314.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$236.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$299.12
|
| Rate for Payer: Healthfirst QHP |
$314.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$220.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$314.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$267.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$220.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$314.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$747.81
|
| Rate for Payer: SOMOS Essential |
$747.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$314.86
|
|
|
CHG MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAS
|
Professional
|
$411.50
|
|
|
Service Code
|
HCPCS 73220 26
|
| Min. Negotiated Rate |
$82.30 |
| Max. Negotiated Rate |
$1,374.48 |
| Rate for Payer: Cash Price |
$111.72
|
| Rate for Payer: Cash Price |
$111.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$105.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$105.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$111.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$117.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$111.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$117.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$117.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$111.69
|
| Rate for Payer: Healthfirst QHP |
$117.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$82.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$117.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$99.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$82.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$117.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$308.62
|
| Rate for Payer: SOMOS Essential |
$308.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$117.57
|
|
|
CHG MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAS
|
Professional
|
$1,421.14
|
|
|
Service Code
|
HCPCS 73220 TC
|
| Min. Negotiated Rate |
$82.30 |
| Max. Negotiated Rate |
$1,374.48 |
| Rate for Payer: Cash Price |
$379.09
|
| Rate for Payer: Cash Price |
$379.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$365.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$365.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$385.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$406.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$385.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$406.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$406.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$304.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$385.74
|
| Rate for Payer: Healthfirst QHP |
$406.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$284.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$406.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$345.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$284.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$406.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,065.86
|
| Rate for Payer: SOMOS Essential |
$1,065.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$406.04
|
|
|
CHG MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAS
|
Professional
|
$1,832.64
|
|
|
Service Code
|
HCPCS 73220
|
| Min. Negotiated Rate |
$82.30 |
| Max. Negotiated Rate |
$1,374.48 |
| Rate for Payer: Cash Price |
$490.81
|
| Rate for Payer: Cash Price |
$490.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$471.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$471.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$497.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$523.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$497.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$523.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$523.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$392.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$497.43
|
| Rate for Payer: Healthfirst QHP |
$523.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$366.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$523.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$445.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$366.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$523.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,374.48
|
| Rate for Payer: SOMOS Essential |
$1,374.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$523.61
|
|
|
CHG MYELOGRAPHY CERVICAL RS&I
|
Professional
|
$489.48
|
|
|
Service Code
|
HCPCS 72240
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$367.11 |
| Rate for Payer: Cash Price |
$129.63
|
| Rate for Payer: Cash Price |
$129.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$125.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$132.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$139.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$132.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$139.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$139.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$104.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$132.86
|
| Rate for Payer: Healthfirst QHP |
$139.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$97.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$139.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$118.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$97.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$139.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$367.11
|
| Rate for Payer: SOMOS Essential |
$367.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$139.85
|
|
|
CHG MYELOGRAPHY CERVICAL RS&I
|
Professional
|
$182.00
|
|
|
Service Code
|
HCPCS 72240 26
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$367.11 |
| Rate for Payer: Cash Price |
$48.06
|
| Rate for Payer: Cash Price |
$48.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$46.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$46.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.40
|
| Rate for Payer: Healthfirst QHP |
$52.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$136.50
|
| Rate for Payer: SOMOS Essential |
$136.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.00
|
|
|
CHG MYELOGRAPHY CERVICAL RS&I
|
Professional
|
$307.48
|
|
|
Service Code
|
HCPCS 72240 TC
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$367.11 |
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$79.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$79.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$83.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$87.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$83.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$87.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$87.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$65.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$83.46
|
| Rate for Payer: Healthfirst QHP |
$87.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$61.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$87.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$74.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$61.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$87.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$230.61
|
| Rate for Payer: SOMOS Essential |
$230.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$87.85
|
|
|
CHG MYELOGRAPHY THORACIC RS&I
|
Professional
|
$320.43
|
|
|
Service Code
|
HCPCS 72255 TC
|
| Min. Negotiated Rate |
$39.19 |
| Max. Negotiated Rate |
$387.29 |
| Rate for Payer: Cash Price |
$76.85
|
| Rate for Payer: Cash Price |
$76.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$82.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$82.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$86.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$91.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$86.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$91.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$68.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$86.97
|
| Rate for Payer: Healthfirst QHP |
$91.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$91.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$77.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$91.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$240.32
|
| Rate for Payer: SOMOS Essential |
$240.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$91.55
|
|
|
CHG MYELOGRAPHY THORACIC RS&I
|
Professional
|
$516.39
|
|
|
Service Code
|
HCPCS 72255
|
| Min. Negotiated Rate |
$39.19 |
| Max. Negotiated Rate |
$387.29 |
| Rate for Payer: Cash Price |
$124.29
|
| Rate for Payer: Cash Price |
$124.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$132.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$132.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$147.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$110.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$140.16
|
| Rate for Payer: Healthfirst QHP |
$147.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$103.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$147.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$125.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$103.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$387.29
|
| Rate for Payer: SOMOS Essential |
$387.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.54
|
|
|
CHG MYELOGRAPHY THORACIC RS&I
|
Professional
|
$195.97
|
|
|
Service Code
|
HCPCS 72255 26
|
| Min. Negotiated Rate |
$39.19 |
| Max. Negotiated Rate |
$387.29 |
| Rate for Payer: Cash Price |
$47.44
|
| Rate for Payer: Cash Price |
$47.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$50.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$50.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$53.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$55.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$53.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$53.19
|
| Rate for Payer: Healthfirst QHP |
$55.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$39.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$55.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$47.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$39.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$55.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$146.98
|
| Rate for Payer: SOMOS Essential |
$146.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.99
|
|
|
CHG MYELOGRAPY 2/MORE REGIONS RS&I
|
Professional
|
$695.91
|
|
|
Service Code
|
HCPCS 72270
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$521.93 |
| Rate for Payer: Cash Price |
$176.18
|
| Rate for Payer: Cash Price |
$176.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$178.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$178.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$188.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$198.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$188.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$198.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$198.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$149.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$188.89
|
| Rate for Payer: Healthfirst QHP |
$198.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$139.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$198.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$169.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$139.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$198.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$521.93
|
| Rate for Payer: SOMOS Essential |
$521.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$198.83
|
|
|
CHG MYELOGRAPY 2/MORE REGIONS RS&I
|
Professional
|
$429.66
|
|
|
Service Code
|
HCPCS 72270 TC
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$521.93 |
| Rate for Payer: Cash Price |
$104.36
|
| Rate for Payer: Cash Price |
$104.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$110.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$110.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$116.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$122.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$116.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$122.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$122.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$92.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$116.62
|
| Rate for Payer: Healthfirst QHP |
$122.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$85.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$122.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$104.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$85.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$122.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$322.24
|
| Rate for Payer: SOMOS Essential |
$322.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$122.76
|
|
|
CHG MYELOGRAPY 2/MORE REGIONS RS&I
|
Professional
|
$266.25
|
|
|
Service Code
|
HCPCS 72270 26
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$521.93 |
| Rate for Payer: Cash Price |
$71.82
|
| Rate for Payer: Cash Price |
$71.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$68.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$68.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$72.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$76.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$72.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$72.27
|
| Rate for Payer: Healthfirst QHP |
$76.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$53.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$76.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$64.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$53.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$76.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$199.69
|
| Rate for Payer: SOMOS Essential |
$199.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$76.07
|
|
|
CHG MYELOGRAPY LUMBOSACRAL RS&I
|
Professional
|
$304.61
|
|
|
Service Code
|
HCPCS 72265 TC
|
| Min. Negotiated Rate |
$31.89 |
| Max. Negotiated Rate |
$348.05 |
| Rate for Payer: Cash Price |
$82.36
|
| Rate for Payer: Cash Price |
$82.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$78.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$78.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$82.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$87.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$82.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$87.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$87.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$65.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$82.68
|
| Rate for Payer: Healthfirst QHP |
$87.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$60.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$87.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$73.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$60.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$87.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$228.46
|
| Rate for Payer: SOMOS Essential |
$228.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$87.03
|
|
|
CHG MYELOGRAPY LUMBOSACRAL RS&I
|
Professional
|
$159.46
|
|
|
Service Code
|
HCPCS 72265 26
|
| Min. Negotiated Rate |
$31.89 |
| Max. Negotiated Rate |
$348.05 |
| Rate for Payer: Cash Price |
$43.63
|
| Rate for Payer: Cash Price |
$43.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$45.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43.28
|
| Rate for Payer: Healthfirst QHP |
$45.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$45.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$38.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$119.60
|
| Rate for Payer: SOMOS Essential |
$119.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.56
|
|
|
CHG MYELOGRAPY LUMBOSACRAL RS&I
|
Professional
|
$464.07
|
|
|
Service Code
|
HCPCS 72265
|
| Min. Negotiated Rate |
$31.89 |
| Max. Negotiated Rate |
$348.05 |
| Rate for Payer: Cash Price |
$125.98
|
| Rate for Payer: Cash Price |
$125.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$119.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$119.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$125.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$132.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$125.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$132.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$132.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$99.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.96
|
| Rate for Payer: Healthfirst QHP |
$132.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$92.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$132.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$112.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$92.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$132.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$348.05
|
| Rate for Payer: SOMOS Essential |
$348.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$132.59
|
|
|
CHG MYELOGRAPY POST FOSSA RS&I
|
Professional
|
$242.38
|
|
|
Service Code
|
HCPCS 70010
|
| Min. Negotiated Rate |
$48.48 |
| Max. Negotiated Rate |
$181.78 |
| Rate for Payer: Cash Price |
$64.88
|
| Rate for Payer: Cash Price |
$64.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$62.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$65.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$69.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$65.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$69.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$69.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$65.79
|
| Rate for Payer: Healthfirst QHP |
$69.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$48.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$69.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$58.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$48.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$69.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$181.78
|
| Rate for Payer: SOMOS Essential |
$181.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$69.25
|
|
|
CHG MYOCARDIAL IMAGING INFARCT AVID PLANAR QUAL/QUAN
|
Professional
|
$133.32
|
|
|
Service Code
|
HCPCS 78466 26
|
| Min. Negotiated Rate |
$26.66 |
| Max. Negotiated Rate |
$559.91 |
| Rate for Payer: Cash Price |
$34.35
|
| Rate for Payer: Cash Price |
$34.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.19
|
| Rate for Payer: Healthfirst QHP |
$38.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$99.99
|
| Rate for Payer: SOMOS Essential |
$99.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.09
|
|
|
CHG MYOCARDIAL IMAGING INFARCT AVID PLANAR QUAL/QUAN
|
Professional
|
$746.55
|
|
|
Service Code
|
HCPCS 78466
|
| Min. Negotiated Rate |
$26.66 |
| Max. Negotiated Rate |
$559.91 |
| Rate for Payer: Cash Price |
$194.81
|
| Rate for Payer: Cash Price |
$194.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$191.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$191.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$202.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$213.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$202.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$213.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$213.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$159.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$202.64
|
| Rate for Payer: Healthfirst QHP |
$213.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$149.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$213.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$181.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$149.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$213.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$559.91
|
| Rate for Payer: SOMOS Essential |
$559.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$213.30
|
|
|
CHG MYOCARDIAL IMAGING INFARCT AVID PLANAR QUAL/QUAN
|
Professional
|
$613.27
|
|
|
Service Code
|
HCPCS 78466 TC
|
| Min. Negotiated Rate |
$26.66 |
| Max. Negotiated Rate |
$559.91 |
| Rate for Payer: Cash Price |
$160.46
|
| Rate for Payer: Cash Price |
$160.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$157.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$157.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$166.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$175.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$166.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$175.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$131.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$166.46
|
| Rate for Payer: Healthfirst QHP |
$175.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$122.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$175.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$148.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$122.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$175.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$459.95
|
| Rate for Payer: SOMOS Essential |
$459.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$175.22
|
|
|
CHG MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS
|
Professional
|
$183.65
|
|
|
Service Code
|
HCPCS 78453 26
|
| Min. Negotiated Rate |
$36.73 |
| Max. Negotiated Rate |
$873.65 |
| Rate for Payer: Cash Price |
$48.93
|
| Rate for Payer: Cash Price |
$48.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.85
|
| Rate for Payer: Healthfirst QHP |
$52.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$137.74
|
| Rate for Payer: SOMOS Essential |
$137.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.47
|
|
|
CHG MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS
|
Professional
|
$1,164.87
|
|
|
Service Code
|
HCPCS 78453
|
| Min. Negotiated Rate |
$36.73 |
| Max. Negotiated Rate |
$873.65 |
| Rate for Payer: Cash Price |
$311.39
|
| Rate for Payer: Cash Price |
$311.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$299.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$299.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$316.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$332.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$316.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$332.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$332.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$249.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$316.18
|
| Rate for Payer: Healthfirst QHP |
$332.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$232.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$332.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$282.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$232.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$332.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$873.65
|
| Rate for Payer: SOMOS Essential |
$873.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$332.82
|
|
