|
CHG MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS
|
Professional
|
$981.26
|
|
|
Service Code
|
HCPCS 78453 TC
|
| Min. Negotiated Rate |
$36.73 |
| Max. Negotiated Rate |
$873.65 |
| Rate for Payer: Cash Price |
$262.46
|
| Rate for Payer: Cash Price |
$262.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$252.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$252.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$266.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$280.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$266.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$280.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$280.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$210.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$266.34
|
| Rate for Payer: Healthfirst QHP |
$280.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$196.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$280.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$238.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$196.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$280.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$735.94
|
| Rate for Payer: SOMOS Essential |
$735.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$280.36
|
|
|
CHG MYOCARDIAL PERFUSION PLANAR MULTIPLE STUDIES
|
Professional
|
$255.99
|
|
|
Service Code
|
HCPCS 78454 26
|
| Min. Negotiated Rate |
$51.20 |
| Max. Negotiated Rate |
$1,307.12 |
| Rate for Payer: Cash Price |
$69.18
|
| Rate for Payer: Cash Price |
$69.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$65.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$69.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$73.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$69.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.48
|
| Rate for Payer: Healthfirst QHP |
$73.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$51.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$73.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$62.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$51.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$73.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$191.99
|
| Rate for Payer: SOMOS Essential |
$191.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$73.14
|
|
|
CHG MYOCARDIAL PERFUSION PLANAR MULTIPLE STUDIES
|
Professional
|
$1,742.83
|
|
|
Service Code
|
HCPCS 78454
|
| Min. Negotiated Rate |
$51.20 |
| Max. Negotiated Rate |
$1,307.12 |
| Rate for Payer: Cash Price |
$466.49
|
| Rate for Payer: Cash Price |
$466.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$448.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$448.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$473.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$497.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$473.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$497.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$497.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$373.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$473.05
|
| Rate for Payer: Healthfirst QHP |
$497.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$348.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$497.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$423.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$348.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$497.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,307.12
|
| Rate for Payer: SOMOS Essential |
$1,307.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$497.95
|
|
|
CHG MYOCARDIAL PERFUSION PLANAR MULTIPLE STUDIES
|
Professional
|
$1,486.84
|
|
|
Service Code
|
HCPCS 78454 TC
|
| Min. Negotiated Rate |
$51.20 |
| Max. Negotiated Rate |
$1,307.12 |
| Rate for Payer: Cash Price |
$397.31
|
| Rate for Payer: Cash Price |
$397.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$382.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$382.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$403.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$424.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$403.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$424.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$424.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$318.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$403.57
|
| Rate for Payer: Healthfirst QHP |
$424.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$297.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$424.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$361.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$297.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$424.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,115.13
|
| Rate for Payer: SOMOS Essential |
$1,115.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$424.81
|
|
|
CHG MYOCARDIAL SPECT MULTIPLE STUDIES
|
Professional
|
$299.81
|
|
|
Service Code
|
HCPCS 78452 26
|
| Min. Negotiated Rate |
$59.96 |
| Max. Negotiated Rate |
$1,403.59 |
| Rate for Payer: Cash Price |
$81.86
|
| Rate for Payer: Cash Price |
$81.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$77.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$77.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$81.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$85.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$81.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$81.38
|
| Rate for Payer: Healthfirst QHP |
$85.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$59.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$85.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$72.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$59.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$85.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$224.86
|
| Rate for Payer: SOMOS Essential |
$224.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$85.66
|
|
|
CHG MYOCARDIAL SPECT MULTIPLE STUDIES
|
Professional
|
$1,871.45
|
|
|
Service Code
|
HCPCS 78452
|
| Min. Negotiated Rate |
$59.96 |
| Max. Negotiated Rate |
$1,403.59 |
| Rate for Payer: Cash Price |
$506.51
|
| Rate for Payer: Cash Price |
$506.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$481.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$481.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$507.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$534.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$507.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$534.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$534.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$401.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$507.96
|
| Rate for Payer: Healthfirst QHP |
$534.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$374.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$534.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$454.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$374.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$534.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,403.59
|
| Rate for Payer: SOMOS Essential |
$1,403.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$534.70
|
|
|
CHG MYOCARDIAL SPECT MULTIPLE STUDIES
|
Professional
|
$1,571.64
|
|
|
Service Code
|
HCPCS 78452 TC
|
| Min. Negotiated Rate |
$59.96 |
| Max. Negotiated Rate |
$1,403.59 |
| Rate for Payer: Cash Price |
$424.66
|
| Rate for Payer: Cash Price |
$424.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$404.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$404.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$426.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$449.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$426.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$449.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$449.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$336.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$426.59
|
| Rate for Payer: Healthfirst QHP |
$449.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$314.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$449.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$381.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$314.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$449.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,178.73
|
| Rate for Payer: SOMOS Essential |
$1,178.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$449.04
|
|
|
CHG MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS
|
Professional
|
$1,091.93
|
|
|
Service Code
|
HCPCS 78451 TC
|
| Min. Negotiated Rate |
$50.27 |
| Max. Negotiated Rate |
$1,007.48 |
| Rate for Payer: Cash Price |
$295.86
|
| Rate for Payer: Cash Price |
$295.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$280.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$280.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$296.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$311.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$296.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$311.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$311.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$233.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$296.38
|
| Rate for Payer: Healthfirst QHP |
$311.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$218.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$311.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$265.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$218.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$311.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$818.95
|
| Rate for Payer: SOMOS Essential |
$818.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$311.98
|
|
|
CHG MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS
|
Professional
|
$1,343.30
|
|
|
Service Code
|
HCPCS 78451
|
| Min. Negotiated Rate |
$50.27 |
| Max. Negotiated Rate |
$1,007.48 |
| Rate for Payer: Cash Price |
$365.19
|
| Rate for Payer: Cash Price |
$365.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$345.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$345.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$364.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$383.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$364.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$383.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$287.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$364.61
|
| Rate for Payer: Healthfirst QHP |
$383.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$268.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$383.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$326.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$268.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$383.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,007.48
|
| Rate for Payer: SOMOS Essential |
$1,007.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$383.80
|
|
|
CHG MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS
|
Professional
|
$251.34
|
|
|
Service Code
|
HCPCS 78451 26
|
| Min. Negotiated Rate |
$50.27 |
| Max. Negotiated Rate |
$1,007.48 |
| Rate for Payer: Cash Price |
$69.33
|
| Rate for Payer: Cash Price |
$69.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$64.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$64.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$68.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$71.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$68.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$71.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$71.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$53.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$68.22
|
| Rate for Payer: Healthfirst QHP |
$71.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$50.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$71.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$61.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$50.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$71.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$188.50
|
| Rate for Payer: SOMOS Essential |
$188.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$71.81
|
|
|
CHG MYOCRD IMG INFARCT AVID PLNR EJEC FXJ 1ST PS TQ
|
Professional
|
$780.75
|
|
|
Service Code
|
HCPCS 78468
|
| Min. Negotiated Rate |
$28.90 |
| Max. Negotiated Rate |
$585.56 |
| Rate for Payer: Cash Price |
$214.21
|
| Rate for Payer: Cash Price |
$214.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$200.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$200.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$211.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$223.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$211.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$223.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$223.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$167.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$211.92
|
| Rate for Payer: Healthfirst QHP |
$223.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$156.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$223.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$189.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$156.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$223.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$585.56
|
| Rate for Payer: SOMOS Essential |
$585.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$223.07
|
|
|
CHG MYOCRD IMG INFARCT AVID PLNR EJEC FXJ 1ST PS TQ
|
Professional
|
$144.48
|
|
|
Service Code
|
HCPCS 78468 26
|
| Min. Negotiated Rate |
$28.90 |
| Max. Negotiated Rate |
$585.56 |
| Rate for Payer: Cash Price |
$40.38
|
| Rate for Payer: Cash Price |
$40.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$39.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.22
|
| Rate for Payer: Healthfirst QHP |
$41.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$41.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$35.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$108.36
|
| Rate for Payer: SOMOS Essential |
$108.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.28
|
|
|
CHG MYOCRD IMG INFARCT AVID PLNR EJEC FXJ 1ST PS TQ
|
Professional
|
$636.27
|
|
|
Service Code
|
HCPCS 78468 TC
|
| Min. Negotiated Rate |
$28.90 |
| Max. Negotiated Rate |
$585.56 |
| Rate for Payer: Cash Price |
$173.82
|
| Rate for Payer: Cash Price |
$173.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$163.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$163.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$172.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$181.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$172.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$181.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$181.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$136.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$172.70
|
| Rate for Payer: Healthfirst QHP |
$181.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$127.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$181.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$154.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$127.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$181.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$477.20
|
| Rate for Payer: SOMOS Essential |
$477.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$181.79
|
|
|
CHG MYOCRD IMG PET METAB EVAL SINGLE STUDY
|
Professional
|
$4,826.68
|
|
|
Service Code
|
HCPCS 78459
|
| Min. Negotiated Rate |
$56.61 |
| Max. Negotiated Rate |
$3,620.01 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,620.01
|
| Rate for Payer: SOMOS Essential |
$3,620.01
|
|
|
CHG MYOCRD IMG PET METAB EVAL SINGLE STUDY
|
Professional
|
$4,543.63
|
|
|
Service Code
|
HCPCS 78459 TC
|
| Min. Negotiated Rate |
$56.61 |
| Max. Negotiated Rate |
$3,620.01 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,407.72
|
| Rate for Payer: SOMOS Essential |
$3,407.72
|
|
|
CHG MYOCRD IMG PET METAB EVAL SINGLE STUDY
|
Professional
|
$283.05
|
|
|
Service Code
|
HCPCS 78459 26
|
| Min. Negotiated Rate |
$56.61 |
| Max. Negotiated Rate |
$3,620.01 |
| Rate for Payer: Cash Price |
$78.76
|
| Rate for Payer: Cash Price |
$78.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$72.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$72.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$76.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$80.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$76.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$76.83
|
| Rate for Payer: Healthfirst QHP |
$80.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$56.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$80.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$68.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$56.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$80.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$212.29
|
| Rate for Payer: SOMOS Essential |
$212.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$80.87
|
|
|
CHG MYOCRD IMG PET METAB EVAL SINGLE STUDY CNCRNT CT
|
Professional
|
$5,140.17
|
|
|
Service Code
|
HCPCS 78429 TC
|
| Min. Negotiated Rate |
$62.32 |
| Max. Negotiated Rate |
$4,088.84 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,855.13
|
| Rate for Payer: SOMOS Essential |
$3,855.13
|
|
|
CHG MYOCRD IMG PET METAB EVAL SINGLE STUDY CNCRNT CT
|
Professional
|
$311.61
|
|
|
Service Code
|
HCPCS 78429 26
|
| Min. Negotiated Rate |
$62.32 |
| Max. Negotiated Rate |
$4,088.84 |
| Rate for Payer: Cash Price |
$84.78
|
| Rate for Payer: Cash Price |
$84.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$80.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$80.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$89.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$84.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$89.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$89.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$66.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$84.58
|
| Rate for Payer: Healthfirst QHP |
$89.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$62.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$89.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$75.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$62.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$89.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$233.71
|
| Rate for Payer: SOMOS Essential |
$233.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$89.03
|
|
|
CHG MYOCRD IMG PET METAB EVAL SINGLE STUDY CNCRNT CT
|
Professional
|
$5,451.78
|
|
|
Service Code
|
HCPCS 78429
|
| Min. Negotiated Rate |
$62.32 |
| Max. Negotiated Rate |
$4,088.84 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4,088.84
|
| Rate for Payer: SOMOS Essential |
$4,088.84
|
|
|
CHG MYOCRD IMG PET PRFUJ 1STD REST/STRESS CNCRNT CT
|
Professional
|
$5,140.17
|
|
|
Service Code
|
HCPCS 78430 TC
|
| Min. Negotiated Rate |
$58.39 |
| Max. Negotiated Rate |
$4,074.10 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,855.13
|
| Rate for Payer: SOMOS Essential |
$3,855.13
|
|
|
CHG MYOCRD IMG PET PRFUJ 1STD REST/STRESS CNCRNT CT
|
Professional
|
$5,432.14
|
|
|
Service Code
|
HCPCS 78430
|
| Min. Negotiated Rate |
$58.39 |
| Max. Negotiated Rate |
$4,074.10 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4,074.10
|
| Rate for Payer: SOMOS Essential |
$4,074.10
|
|
|
CHG MYOCRD IMG PET PRFUJ 1STD REST/STRESS CNCRNT CT
|
Professional
|
$291.97
|
|
|
Service Code
|
HCPCS 78430 26
|
| Min. Negotiated Rate |
$58.39 |
| Max. Negotiated Rate |
$4,074.10 |
| Rate for Payer: Cash Price |
$80.62
|
| Rate for Payer: Cash Price |
$80.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$75.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$75.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$79.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$83.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$79.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$62.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$79.25
|
| Rate for Payer: Healthfirst QHP |
$83.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$58.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$83.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$70.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$58.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$83.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$218.98
|
| Rate for Payer: SOMOS Essential |
$218.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$83.42
|
|
|
CHG MYOCRD IMG PET PRFUJ MLT STD RST&STRS CNCRNT CT
|
Professional
|
$344.96
|
|
|
Service Code
|
HCPCS 78431 26
|
| Min. Negotiated Rate |
$68.99 |
| Max. Negotiated Rate |
$5,349.70 |
| Rate for Payer: Cash Price |
$94.37
|
| Rate for Payer: Cash Price |
$94.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$88.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$88.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$93.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$98.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$93.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$98.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$98.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$93.63
|
| Rate for Payer: Healthfirst QHP |
$98.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$68.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$98.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$83.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$68.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$98.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$258.72
|
| Rate for Payer: SOMOS Essential |
$258.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$98.56
|
|
|
CHG MYOCRD IMG PET PRFUJ MLT STD RST&STRS CNCRNT CT
|
Professional
|
$7,132.93
|
|
|
Service Code
|
HCPCS 78431
|
| Min. Negotiated Rate |
$68.99 |
| Max. Negotiated Rate |
$5,349.70 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5,349.70
|
| Rate for Payer: SOMOS Essential |
$5,349.70
|
|
|
CHG MYOCRD IMG PET PRFUJ MLT STD RST&STRS CNCRNT CT
|
Professional
|
$6,787.97
|
|
|
Service Code
|
HCPCS 78431 TC
|
| Min. Negotiated Rate |
$68.99 |
| Max. Negotiated Rate |
$5,349.70 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5,090.98
|
| Rate for Payer: SOMOS Essential |
$5,090.98
|
|
