|
CHG PET IMAGING FOR CT ATTENUATION WHOLE BODY
|
Professional
|
$452.62
|
|
|
Service Code
|
HCPCS 78816 26
|
| Min. Negotiated Rate |
$90.52 |
| Max. Negotiated Rate |
$5,078.78 |
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$116.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$116.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$122.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$129.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$122.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$129.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$129.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$96.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$122.85
|
| Rate for Payer: Healthfirst QHP |
$129.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$90.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$129.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$109.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$90.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$129.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$339.46
|
| Rate for Payer: SOMOS Essential |
$339.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$129.32
|
|
|
CHG PET IMAGING FOR CT ATTENUATION WHOLE BODY
|
Professional
|
$6,319.08
|
|
|
Service Code
|
HCPCS 78816 TC
|
| Min. Negotiated Rate |
$90.52 |
| Max. Negotiated Rate |
$5,078.78 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4,739.31
|
| Rate for Payer: SOMOS Essential |
$4,739.31
|
|
|
CHG PET IMAGING LIMITED AREA CHEST HEAD/NECK
|
Professional
|
$5,910.28
|
|
|
Service Code
|
HCPCS 78811
|
| Min. Negotiated Rate |
$55.66 |
| Max. Negotiated Rate |
$4,432.71 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4,432.71
|
| Rate for Payer: SOMOS Essential |
$4,432.71
|
|
|
CHG PET IMAGING LIMITED AREA CHEST HEAD/NECK
|
Professional
|
$278.29
|
|
|
Service Code
|
HCPCS 78811 26
|
| Min. Negotiated Rate |
$55.66 |
| Max. Negotiated Rate |
$4,432.71 |
| Rate for Payer: Cash Price |
$76.94
|
| Rate for Payer: Cash Price |
$76.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$71.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$71.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$75.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$79.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$75.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$79.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$59.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$75.53
|
| Rate for Payer: Healthfirst QHP |
$79.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$55.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$79.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$67.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$55.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$79.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$208.72
|
| Rate for Payer: SOMOS Essential |
$208.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$79.51
|
|
|
CHG PET IMAGING LIMITED AREA CHEST HEAD/NECK
|
Professional
|
$5,631.96
|
|
|
Service Code
|
HCPCS 78811 TC
|
| Min. Negotiated Rate |
$55.66 |
| Max. Negotiated Rate |
$4,432.71 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4,223.97
|
| Rate for Payer: SOMOS Essential |
$4,223.97
|
|
|
CHG PET IMAGING SKULL BASE TO MID-THIGH
|
Professional
|
$6,680.17
|
|
|
Service Code
|
HCPCS 78812
|
| Min. Negotiated Rate |
$72.22 |
| Max. Negotiated Rate |
$5,010.13 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5,010.13
|
| Rate for Payer: SOMOS Essential |
$5,010.13
|
|
|
CHG PET IMAGING SKULL BASE TO MID-THIGH
|
Professional
|
$6,319.08
|
|
|
Service Code
|
HCPCS 78812 TC
|
| Min. Negotiated Rate |
$72.22 |
| Max. Negotiated Rate |
$5,010.13 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4,739.31
|
| Rate for Payer: SOMOS Essential |
$4,739.31
|
|
|
CHG PET IMAGING SKULL BASE TO MID-THIGH
|
Professional
|
$361.10
|
|
|
Service Code
|
HCPCS 78812 26
|
| Min. Negotiated Rate |
$72.22 |
| Max. Negotiated Rate |
$5,010.13 |
| Rate for Payer: Cash Price |
$97.30
|
| Rate for Payer: Cash Price |
$97.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$92.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$92.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$98.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$103.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$98.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$103.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$77.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$98.01
|
| Rate for Payer: Healthfirst QHP |
$103.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$72.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$103.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$87.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$72.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$103.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$270.82
|
| Rate for Payer: SOMOS Essential |
$270.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$103.17
|
|
|
CHG PET IMAGING WHOLE BODY
|
Professional
|
$360.08
|
|
|
Service Code
|
HCPCS 78813 26
|
| Min. Negotiated Rate |
$72.02 |
| Max. Negotiated Rate |
$5,009.37 |
| Rate for Payer: Cash Price |
$99.35
|
| Rate for Payer: Cash Price |
$99.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$92.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$92.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$97.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$102.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$97.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$102.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$102.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$77.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$97.74
|
| Rate for Payer: Healthfirst QHP |
$102.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$72.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$102.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$87.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$72.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$102.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$270.06
|
| Rate for Payer: SOMOS Essential |
$270.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$102.88
|
|
|
CHG PET IMAGING WHOLE BODY
|
Professional
|
$6,679.16
|
|
|
Service Code
|
HCPCS 78813
|
| Min. Negotiated Rate |
$72.02 |
| Max. Negotiated Rate |
$5,009.37 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5,009.37
|
| Rate for Payer: SOMOS Essential |
$5,009.37
|
|
|
CHG PET IMAGING WHOLE BODY
|
Professional
|
$6,319.08
|
|
|
Service Code
|
HCPCS 78813 TC
|
| Min. Negotiated Rate |
$72.02 |
| Max. Negotiated Rate |
$5,009.37 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4,739.31
|
| Rate for Payer: SOMOS Essential |
$4,739.31
|
|
|
CHG PH BODY FLUID NOT ELSEWHERE SPECIFIED
|
Professional
|
$9.00
|
|
|
Service Code
|
HCPCS 83986
|
| Min. Negotiated Rate |
$2.51 |
| Max. Negotiated Rate |
$6.75 |
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.40
|
| Rate for Payer: Healthfirst QHP |
$3.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.75
|
| Rate for Payer: SOMOS Essential |
$6.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.58
|
|
|
CHG PLASMA VOL RADIOPHARM VOL DILUTE SPX MULT SMPLES
|
Professional
|
$317.24
|
|
|
Service Code
|
HCPCS 78111
|
| Min. Negotiated Rate |
$7.21 |
| Max. Negotiated Rate |
$237.93 |
| Rate for Payer: Cash Price |
$86.24
|
| Rate for Payer: Cash Price |
$86.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$81.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$81.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$86.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$90.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$86.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$90.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$86.11
|
| Rate for Payer: Healthfirst QHP |
$90.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$63.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$90.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$77.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$63.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$90.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$237.93
|
| Rate for Payer: SOMOS Essential |
$237.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$90.64
|
|
|
CHG PLASMA VOL RADIOPHARM VOL DILUTE SPX MULT SMPLES
|
Professional
|
$281.19
|
|
|
Service Code
|
HCPCS 78111 TC
|
| Min. Negotiated Rate |
$7.21 |
| Max. Negotiated Rate |
$237.93 |
| Rate for Payer: Cash Price |
$76.77
|
| Rate for Payer: Cash Price |
$76.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$72.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$72.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$76.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$80.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$76.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$76.32
|
| Rate for Payer: Healthfirst QHP |
$80.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$56.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$80.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$68.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$56.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$80.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$210.89
|
| Rate for Payer: SOMOS Essential |
$210.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$80.34
|
|
|
CHG PLASMA VOL RADIOPHARM VOL DILUTE SPX MULT SMPLES
|
Professional
|
$36.05
|
|
|
Service Code
|
HCPCS 78111 26
|
| Min. Negotiated Rate |
$7.21 |
| Max. Negotiated Rate |
$237.93 |
| Rate for Payer: Cash Price |
$9.48
|
| Rate for Payer: Cash Price |
$9.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.78
|
| Rate for Payer: Healthfirst QHP |
$10.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$7.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$10.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.04
|
| Rate for Payer: SOMOS Essential |
$27.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.30
|
|
|
CHG PLASMA VOL RADIOPHARM VOL DILUTION SPX 1 SAMPLE
|
Professional
|
$30.84
|
|
|
Service Code
|
HCPCS 78110 26
|
| Min. Negotiated Rate |
$6.17 |
| Max. Negotiated Rate |
$224.33 |
| Rate for Payer: Cash Price |
$8.43
|
| Rate for Payer: Cash Price |
$8.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.37
|
| Rate for Payer: Healthfirst QHP |
$8.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.13
|
| Rate for Payer: SOMOS Essential |
$23.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.81
|
|
|
CHG PLASMA VOL RADIOPHARM VOL DILUTION SPX 1 SAMPLE
|
Professional
|
$268.24
|
|
|
Service Code
|
HCPCS 78110 TC
|
| Min. Negotiated Rate |
$6.17 |
| Max. Negotiated Rate |
$224.33 |
| Rate for Payer: Cash Price |
$73.23
|
| Rate for Payer: Cash Price |
$73.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$68.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$68.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$72.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$76.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$72.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$72.81
|
| Rate for Payer: Healthfirst QHP |
$76.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$53.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$76.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$65.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$53.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$76.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$201.18
|
| Rate for Payer: SOMOS Essential |
$201.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$76.64
|
|
|
CHG PLASMA VOL RADIOPHARM VOL DILUTION SPX 1 SAMPLE
|
Professional
|
$299.11
|
|
|
Service Code
|
HCPCS 78110
|
| Min. Negotiated Rate |
$6.17 |
| Max. Negotiated Rate |
$224.33 |
| Rate for Payer: Cash Price |
$81.66
|
| Rate for Payer: Cash Price |
$81.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$76.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$76.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$81.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$85.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$81.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$81.19
|
| Rate for Payer: Healthfirst QHP |
$85.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$59.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$85.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$72.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$59.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$85.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$224.33
|
| Rate for Payer: SOMOS Essential |
$224.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$85.46
|
|
|
CHG PLATELET AGGREGATION IN VITRO EACH AGENT
|
Professional
|
$69.20
|
|
|
Service Code
|
HCPCS 85576 26
|
| Min. Negotiated Rate |
$13.84 |
| Max. Negotiated Rate |
$51.90 |
| Rate for Payer: Cash Price |
$19.03
|
| Rate for Payer: Cash Price |
$19.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.78
|
| Rate for Payer: Healthfirst QHP |
$19.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$51.90
|
| Rate for Payer: SOMOS Essential |
$51.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.77
|
|
|
CHG PLATELET SURVIVAL STUDY
|
Professional
|
$528.26
|
|
|
Service Code
|
HCPCS 78191
|
| Min. Negotiated Rate |
$18.70 |
| Max. Negotiated Rate |
$396.20 |
| Rate for Payer: Cash Price |
$145.10
|
| Rate for Payer: Cash Price |
$145.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$135.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$135.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$143.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$150.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$143.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$113.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$143.38
|
| Rate for Payer: Healthfirst QHP |
$150.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$105.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$150.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$128.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$105.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$150.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$396.20
|
| Rate for Payer: SOMOS Essential |
$396.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$150.93
|
|
|
CHG PLATELET SURVIVAL STUDY
|
Professional
|
$434.74
|
|
|
Service Code
|
HCPCS 78191 TC
|
| Min. Negotiated Rate |
$18.70 |
| Max. Negotiated Rate |
$396.20 |
| Rate for Payer: Cash Price |
$119.28
|
| Rate for Payer: Cash Price |
$119.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$111.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$111.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$118.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$124.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$118.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$124.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$124.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$93.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$118.00
|
| Rate for Payer: Healthfirst QHP |
$124.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$86.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$124.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$105.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$86.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$124.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$326.06
|
| Rate for Payer: SOMOS Essential |
$326.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$124.21
|
|
|
CHG PLATELET SURVIVAL STUDY
|
Professional
|
$93.52
|
|
|
Service Code
|
HCPCS 78191 26
|
| Min. Negotiated Rate |
$18.70 |
| Max. Negotiated Rate |
$396.20 |
| Rate for Payer: Cash Price |
$25.83
|
| Rate for Payer: Cash Price |
$25.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.38
|
| Rate for Payer: Healthfirst QHP |
$26.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$70.14
|
| Rate for Payer: SOMOS Essential |
$70.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.72
|
|
|
CHG PLMT DSTL XTN PRSTH EVASC DESC THORAC AORTA RS&I
|
Professional
|
$1,387.72
|
|
|
Service Code
|
HCPCS 75959 TC
|
| Min. Negotiated Rate |
$143.94 |
| Max. Negotiated Rate |
$1,580.56 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,040.79
|
| Rate for Payer: SOMOS Essential |
$1,040.79
|
|
|
CHG PLMT DSTL XTN PRSTH EVASC DESC THORAC AORTA RS&I
|
Professional
|
$719.71
|
|
|
Service Code
|
HCPCS 75959 26
|
| Min. Negotiated Rate |
$143.94 |
| Max. Negotiated Rate |
$1,580.56 |
| Rate for Payer: Cash Price |
$192.74
|
| Rate for Payer: Cash Price |
$192.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$185.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$185.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$195.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$205.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$195.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$205.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$205.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$154.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$195.35
|
| Rate for Payer: Healthfirst QHP |
$205.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$143.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$205.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$174.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$143.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$205.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$539.78
|
| Rate for Payer: SOMOS Essential |
$539.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$205.63
|
|
|
CHG PLMT DSTL XTN PRSTH EVASC DESC THORAC AORTA RS&I
|
Professional
|
$2,107.42
|
|
|
Service Code
|
HCPCS 75959
|
| Min. Negotiated Rate |
$143.94 |
| Max. Negotiated Rate |
$1,580.56 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,580.56
|
| Rate for Payer: SOMOS Essential |
$1,580.56
|
|
