|
CHG MYOCRD IMG PET PRFUJ MULTIPLE STUDY REST&STRESS
|
Professional
|
$5,471.17
|
|
|
Service Code
|
HCPCS 78492
|
| Min. Negotiated Rate |
$66.20 |
| Max. Negotiated Rate |
$4,103.38 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4,103.38
|
| Rate for Payer: SOMOS Essential |
$4,103.38
|
|
|
CHG MYOCRD IMG PET PRFUJ MULTIPLE STUDY REST&STRESS
|
Professional
|
$331.00
|
|
|
Service Code
|
HCPCS 78492 26
|
| Min. Negotiated Rate |
$66.20 |
| Max. Negotiated Rate |
$4,103.38 |
| Rate for Payer: Cash Price |
$90.89
|
| Rate for Payer: Cash Price |
$90.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$85.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$85.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$89.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$94.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$89.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$94.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$94.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$70.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$89.84
|
| Rate for Payer: Healthfirst QHP |
$94.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$66.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$94.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$80.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$66.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$94.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$248.25
|
| Rate for Payer: SOMOS Essential |
$248.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$94.57
|
|
|
CHG MYOCRD IMG PET PRFUJ MULTIPLE STUDY REST&STRESS
|
Professional
|
$5,140.17
|
|
|
Service Code
|
HCPCS 78492 TC
|
| Min. Negotiated Rate |
$66.20 |
| Max. Negotiated Rate |
$4,103.38 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,855.13
|
| Rate for Payer: SOMOS Essential |
$3,855.13
|
|
|
CHG MYOCRD IMG PET PRFUJ SINGLE STUDY REST/STRESS
|
Professional
|
$5,140.17
|
|
|
Service Code
|
HCPCS 78491 TC
|
| Min. Negotiated Rate |
$55.07 |
| Max. Negotiated Rate |
$4,061.64 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,855.13
|
| Rate for Payer: SOMOS Essential |
$3,855.13
|
|
|
CHG MYOCRD IMG PET PRFUJ SINGLE STUDY REST/STRESS
|
Professional
|
$275.35
|
|
|
Service Code
|
HCPCS 78491 26
|
| Min. Negotiated Rate |
$55.07 |
| Max. Negotiated Rate |
$4,061.64 |
| Rate for Payer: Cash Price |
$77.18
|
| Rate for Payer: Cash Price |
$77.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$70.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$70.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$74.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$78.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$74.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$78.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$78.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$59.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$74.74
|
| Rate for Payer: Healthfirst QHP |
$78.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$55.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$78.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$66.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$55.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$78.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$206.51
|
| Rate for Payer: SOMOS Essential |
$206.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$78.67
|
|
|
CHG MYOCRD IMG PET PRFUJ SINGLE STUDY REST/STRESS
|
Professional
|
$5,415.52
|
|
|
Service Code
|
HCPCS 78491
|
| Min. Negotiated Rate |
$55.07 |
| Max. Negotiated Rate |
$4,061.64 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4,061.64
|
| Rate for Payer: SOMOS Essential |
$4,061.64
|
|
|
CHG MYOCRD IMG PET PRFUJ W/METAB 2RTRACER CNCRNT CT
|
Professional
|
$8,112.13
|
|
|
Service Code
|
HCPCS 78433 TC
|
| Min. Negotiated Rate |
$79.99 |
| Max. Negotiated Rate |
$6,384.05 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6,084.10
|
| Rate for Payer: SOMOS Essential |
$6,084.10
|
|
|
CHG MYOCRD IMG PET PRFUJ W/METAB 2RTRACER CNCRNT CT
|
Professional
|
$8,512.07
|
|
|
Service Code
|
HCPCS 78433
|
| Min. Negotiated Rate |
$79.99 |
| Max. Negotiated Rate |
$6,384.05 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6,384.05
|
| Rate for Payer: SOMOS Essential |
$6,384.05
|
|
|
CHG MYOCRD IMG PET PRFUJ W/METAB 2RTRACER CNCRNT CT
|
Professional
|
$399.95
|
|
|
Service Code
|
HCPCS 78433 26
|
| Min. Negotiated Rate |
$79.99 |
| Max. Negotiated Rate |
$6,384.05 |
| Rate for Payer: Cash Price |
$110.54
|
| Rate for Payer: Cash Price |
$110.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$102.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$102.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$108.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$114.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$108.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$114.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$114.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$85.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$108.56
|
| Rate for Payer: Healthfirst QHP |
$114.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$79.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$114.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$97.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$79.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$114.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$299.96
|
| Rate for Payer: SOMOS Essential |
$299.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$114.27
|
|
|
CHG MYOCRD IMG PET PRFUJ W/METAB DUAL RADIOTRACER
|
Professional
|
$7,851.45
|
|
|
Service Code
|
HCPCS 78432 TC
|
| Min. Negotiated Rate |
$73.51 |
| Max. Negotiated Rate |
$6,164.26 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5,888.59
|
| Rate for Payer: SOMOS Essential |
$5,888.59
|
|
|
CHG MYOCRD IMG PET PRFUJ W/METAB DUAL RADIOTRACER
|
Professional
|
$367.54
|
|
|
Service Code
|
HCPCS 78432 26
|
| Min. Negotiated Rate |
$73.51 |
| Max. Negotiated Rate |
$6,164.26 |
| Rate for Payer: Cash Price |
$100.93
|
| Rate for Payer: Cash Price |
$100.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$94.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$94.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$99.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$105.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$99.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$78.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$99.76
|
| Rate for Payer: Healthfirst QHP |
$105.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$73.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$105.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$89.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$73.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$105.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$275.66
|
| Rate for Payer: SOMOS Essential |
$275.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$105.01
|
|
|
CHG MYOCRD IMG PET PRFUJ W/METAB DUAL RADIOTRACER
|
Professional
|
$8,219.02
|
|
|
Service Code
|
HCPCS 78432
|
| Min. Negotiated Rate |
$73.51 |
| Max. Negotiated Rate |
$6,164.26 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6,164.26
|
| Rate for Payer: SOMOS Essential |
$6,164.26
|
|
|
CHG MYOCRD INFARCT AVID PLNR TOMOG SPECT W/WO QUANTJ
|
Professional
|
$888.93
|
|
|
Service Code
|
HCPCS 78469
|
| Min. Negotiated Rate |
$34.15 |
| Max. Negotiated Rate |
$666.70 |
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$228.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$228.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$241.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$253.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$241.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$253.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$253.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$190.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$241.28
|
| Rate for Payer: Healthfirst QHP |
$253.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$177.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$253.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$215.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$177.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$253.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$666.70
|
| Rate for Payer: SOMOS Essential |
$666.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$253.98
|
|
|
CHG MYOCRD INFARCT AVID PLNR TOMOG SPECT W/WO QUANTJ
|
Professional
|
$170.73
|
|
|
Service Code
|
HCPCS 78469 26
|
| Min. Negotiated Rate |
$34.15 |
| Max. Negotiated Rate |
$666.70 |
| Rate for Payer: Cash Price |
$46.14
|
| Rate for Payer: Cash Price |
$46.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$46.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$48.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$46.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.34
|
| Rate for Payer: Healthfirst QHP |
$48.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$48.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$48.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$128.05
|
| Rate for Payer: SOMOS Essential |
$128.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$48.78
|
|
|
CHG MYOCRD INFARCT AVID PLNR TOMOG SPECT W/WO QUANTJ
|
Professional
|
$718.20
|
|
|
Service Code
|
HCPCS 78469 TC
|
| Min. Negotiated Rate |
$34.15 |
| Max. Negotiated Rate |
$666.70 |
| Rate for Payer: Cash Price |
$193.47
|
| Rate for Payer: Cash Price |
$193.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$184.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$184.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$194.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$205.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$194.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$205.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$205.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$153.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$194.94
|
| Rate for Payer: Healthfirst QHP |
$205.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$143.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$205.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$174.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$143.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$205.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$538.65
|
| Rate for Payer: SOMOS Essential |
$538.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$205.20
|
|
|
CHG NFS/INSTLJ RADIOELMNT SLN 3 MO FOLLOW-UP CARE
|
Professional
|
$1,619.10
|
|
|
Service Code
|
HCPCS 77750
|
| Min. Negotiated Rate |
$112.59 |
| Max. Negotiated Rate |
$1,214.32 |
| Rate for Payer: Cash Price |
$447.61
|
| Rate for Payer: Cash Price |
$447.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$416.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$416.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$439.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$462.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$439.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$462.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$462.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$346.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$439.47
|
| Rate for Payer: Healthfirst QHP |
$462.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$323.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$462.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$393.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$323.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$462.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,214.32
|
| Rate for Payer: SOMOS Essential |
$1,214.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$462.60
|
|
|
CHG NFS/INSTLJ RADIOELMNT SLN 3 MO FOLLOW-UP CARE
|
Professional
|
$562.94
|
|
|
Service Code
|
HCPCS 77750 TC
|
| Min. Negotiated Rate |
$112.59 |
| Max. Negotiated Rate |
$1,214.32 |
| Rate for Payer: Cash Price |
$157.55
|
| Rate for Payer: Cash Price |
$157.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$144.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$144.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$152.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$160.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$152.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$160.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$160.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$120.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$152.80
|
| Rate for Payer: Healthfirst QHP |
$160.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$112.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$160.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$136.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$112.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$160.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$422.20
|
| Rate for Payer: SOMOS Essential |
$422.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$160.84
|
|
|
CHG NFS/INSTLJ RADIOELMNT SLN 3 MO FOLLOW-UP CARE
|
Professional
|
$1,056.16
|
|
|
Service Code
|
HCPCS 77750 26
|
| Min. Negotiated Rate |
$112.59 |
| Max. Negotiated Rate |
$1,214.32 |
| Rate for Payer: Cash Price |
$290.06
|
| Rate for Payer: Cash Price |
$290.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$271.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$271.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$286.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$301.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$286.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$301.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$301.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$226.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$286.67
|
| Rate for Payer: Healthfirst QHP |
$301.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$211.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$301.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$256.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$211.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$301.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$792.12
|
| Rate for Payer: SOMOS Essential |
$792.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$301.76
|
|
|
CHG NJX RP LOCLZJ NON-IMG PROBE STUDY INTRAVENOUS
|
Professional
|
$168.88
|
|
|
Service Code
|
HCPCS 78808
|
| Min. Negotiated Rate |
$33.78 |
| Max. Negotiated Rate |
$126.66 |
| Rate for Payer: Cash Price |
$46.43
|
| Rate for Payer: Cash Price |
$46.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$48.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$45.84
|
| Rate for Payer: Healthfirst QHP |
$48.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$48.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$48.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$126.66
|
| Rate for Payer: SOMOS Essential |
$126.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$48.25
|
|
|
CHG NONCARDIAC VASCULAR FLOW IMAGING
|
Professional
|
$748.37
|
|
|
Service Code
|
HCPCS 78445 TC
|
| Min. Negotiated Rate |
$19.93 |
| Max. Negotiated Rate |
$636.02 |
| Rate for Payer: Cash Price |
$195.04
|
| Rate for Payer: Cash Price |
$195.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$192.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$192.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$203.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$213.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$203.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$213.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$213.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$160.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$203.13
|
| Rate for Payer: Healthfirst QHP |
$213.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$149.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$213.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$181.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$149.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$213.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$561.28
|
| Rate for Payer: SOMOS Essential |
$561.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$213.82
|
|
|
CHG NONCARDIAC VASCULAR FLOW IMAGING
|
Professional
|
$848.02
|
|
|
Service Code
|
HCPCS 78445
|
| Min. Negotiated Rate |
$19.93 |
| Max. Negotiated Rate |
$636.02 |
| Rate for Payer: Cash Price |
$222.33
|
| Rate for Payer: Cash Price |
$222.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$218.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$218.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$230.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$242.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$230.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$242.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$242.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$181.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$230.18
|
| Rate for Payer: Healthfirst QHP |
$242.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$169.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$242.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$205.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$169.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$242.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$636.02
|
| Rate for Payer: SOMOS Essential |
$636.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$242.29
|
|
|
CHG NONCARDIAC VASCULAR FLOW IMAGING
|
Professional
|
$99.65
|
|
|
Service Code
|
HCPCS 78445 26
|
| Min. Negotiated Rate |
$19.93 |
| Max. Negotiated Rate |
$636.02 |
| Rate for Payer: Cash Price |
$27.29
|
| Rate for Payer: Cash Price |
$27.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.05
|
| Rate for Payer: Healthfirst QHP |
$28.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$74.74
|
| Rate for Payer: SOMOS Essential |
$74.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.47
|
|
|
CHG NTSTY MODUL RADTHX PLN DOSE-VOL HISTOS
|
Professional
|
$1,691.76
|
|
|
Service Code
|
HCPCS 77301 26
|
| Min. Negotiated Rate |
$338.35 |
| Max. Negotiated Rate |
$5,875.64 |
| Rate for Payer: Cash Price |
$463.37
|
| Rate for Payer: Cash Price |
$463.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$435.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$435.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$459.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$483.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$459.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$483.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$483.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$362.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$459.19
|
| Rate for Payer: Healthfirst QHP |
$483.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$338.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$483.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$410.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$338.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$483.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,268.82
|
| Rate for Payer: SOMOS Essential |
$1,268.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$483.36
|
|
|
CHG NTSTY MODUL RADTHX PLN DOSE-VOL HISTOS
|
Professional
|
$6,142.43
|
|
|
Service Code
|
HCPCS 77301 TC
|
| Min. Negotiated Rate |
$338.35 |
| Max. Negotiated Rate |
$5,875.64 |
| Rate for Payer: Cash Price |
$1,692.64
|
| Rate for Payer: Cash Price |
$1,692.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,579.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,579.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,667.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,754.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,667.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,754.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,754.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,316.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,667.23
|
| Rate for Payer: Healthfirst QHP |
$1,754.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,228.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,754.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,491.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,228.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,754.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4,606.82
|
| Rate for Payer: SOMOS Essential |
$4,606.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,754.98
|
|
|
CHG NTSTY MODUL RADTHX PLN DOSE-VOL HISTOS
|
Professional
|
$7,834.19
|
|
|
Service Code
|
HCPCS 77301
|
| Min. Negotiated Rate |
$338.35 |
| Max. Negotiated Rate |
$5,875.64 |
| Rate for Payer: Cash Price |
$2,156.01
|
| Rate for Payer: Cash Price |
$2,156.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,014.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,014.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,126.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,238.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,126.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,238.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,238.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,678.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,126.42
|
| Rate for Payer: Healthfirst QHP |
$2,238.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,566.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,238.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,902.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,566.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,238.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5,875.64
|
| Rate for Payer: SOMOS Essential |
$5,875.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,238.34
|
|
