|
CHG BRAIN IMAGING MIN 4 STATIC VIEWS W VASCULAR FLOW
|
Professional
|
Both
|
$121.28
|
|
|
Service Code
|
HCPCS 78606 26
|
| Min. Negotiated Rate |
$22.71 |
| Max. Negotiated Rate |
$72.99 |
| Rate for Payer: Cash Price |
$32.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.33
|
| Rate for Payer: Healthfirst Commercial |
$32.44
|
| Rate for Payer: Healthfirst Essential Plan |
$72.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.82
|
| Rate for Payer: Healthfirst QHP |
$32.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.33
|
| Rate for Payer: SOMOS Essential |
$24.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.44
|
|
|
CHG BRAIN IMAGING MIN 4 STATIC VIEWS W VASCULAR FLOW
|
Professional
|
Both
|
$1,309.56
|
|
|
Service Code
|
HCPCS 78606
|
| Min. Negotiated Rate |
$239.79 |
| Max. Negotiated Rate |
$770.76 |
| Rate for Payer: Cash Price |
$354.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$342.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$308.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$308.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$325.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$342.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$325.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$342.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$342.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$256.92
|
| Rate for Payer: Healthfirst Commercial |
$342.56
|
| Rate for Payer: Healthfirst Essential Plan |
$770.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$325.43
|
| Rate for Payer: Healthfirst QHP |
$342.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$239.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$342.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$291.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$239.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$342.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$256.92
|
| Rate for Payer: SOMOS Essential |
$256.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$342.56
|
|
|
CHG BRAIN IMAGING MIN 4 STATIC VIEWS W VASCULAR FLOW
|
Professional
|
Both
|
$1,188.25
|
|
|
Service Code
|
HCPCS 78606 TC
|
| Min. Negotiated Rate |
$217.08 |
| Max. Negotiated Rate |
$697.77 |
| Rate for Payer: Cash Price |
$322.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$310.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$310.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$310.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$310.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$232.59
|
| Rate for Payer: Healthfirst Commercial |
$310.12
|
| Rate for Payer: Healthfirst Essential Plan |
$697.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$294.61
|
| Rate for Payer: Healthfirst QHP |
$310.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$217.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$310.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$263.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$217.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$310.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$232.59
|
| Rate for Payer: SOMOS Essential |
$232.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$310.12
|
|
|
CHG BRAIN IMAGING MINIMUM 4 STATIC VIEWS
|
Professional
|
Both
|
$814.21
|
|
|
Service Code
|
HCPCS 78605
|
| Min. Negotiated Rate |
$148.95 |
| Max. Negotiated Rate |
$478.75 |
| Rate for Payer: Cash Price |
$218.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$212.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$191.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$191.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$202.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$212.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$202.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$212.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$212.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$159.59
|
| Rate for Payer: Healthfirst Commercial |
$212.78
|
| Rate for Payer: Healthfirst Essential Plan |
$478.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$202.14
|
| Rate for Payer: Healthfirst QHP |
$212.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$148.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$212.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$180.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$148.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$212.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$159.59
|
| Rate for Payer: SOMOS Essential |
$159.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$212.78
|
|
|
CHG BRAIN IMAGING MINIMUM 4 STATIC VIEWS
|
Professional
|
Both
|
$709.56
|
|
|
Service Code
|
HCPCS 78605 TC
|
| Min. Negotiated Rate |
$129.70 |
| Max. Negotiated Rate |
$416.90 |
| Rate for Payer: Cash Price |
$190.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$185.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$166.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$166.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$176.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$185.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$176.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$185.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$185.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$138.97
|
| Rate for Payer: Healthfirst Commercial |
$185.29
|
| Rate for Payer: Healthfirst Essential Plan |
$416.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$176.03
|
| Rate for Payer: Healthfirst QHP |
$185.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$129.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$185.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$157.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$129.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$185.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$138.97
|
| Rate for Payer: SOMOS Essential |
$138.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$185.29
|
|
|
CHG BRAIN IMAGING MINIMUM 4 STATIC VIEWS
|
Professional
|
Both
|
$104.65
|
|
|
Service Code
|
HCPCS 78605 26
|
| Min. Negotiated Rate |
$19.24 |
| Max. Negotiated Rate |
$61.85 |
| Rate for Payer: Cash Price |
$27.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.62
|
| Rate for Payer: Healthfirst Commercial |
$27.49
|
| Rate for Payer: Healthfirst Essential Plan |
$61.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.12
|
| Rate for Payer: Healthfirst QHP |
$27.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$27.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.62
|
| Rate for Payer: SOMOS Essential |
$20.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.49
|
|
|
CHG BRAIN IMAGING PET METABOLIC EVALUATION
|
Professional
|
Both
|
$273.28
|
|
|
Service Code
|
HCPCS 78608 26
|
| Min. Negotiated Rate |
$51.65 |
| Max. Negotiated Rate |
$166.00 |
| Rate for Payer: Cash Price |
$74.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$73.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$66.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$66.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$70.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$73.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$70.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$55.34
|
| Rate for Payer: Healthfirst Commercial |
$73.78
|
| Rate for Payer: Healthfirst Essential Plan |
$166.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$70.09
|
| Rate for Payer: Healthfirst QHP |
$73.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$51.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$73.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$62.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$51.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$73.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$55.34
|
| Rate for Payer: SOMOS Essential |
$55.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$73.78
|
|
|
CHG BRAIN IMAGING VASCULAR FLOW ONLY
|
Professional
|
Both
|
$711.06
|
|
|
Service Code
|
HCPCS 78610
|
| Min. Negotiated Rate |
$130.04 |
| Max. Negotiated Rate |
$417.98 |
| Rate for Payer: Cash Price |
$190.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$185.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$167.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$167.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$176.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$185.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$176.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$185.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$185.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$139.33
|
| Rate for Payer: Healthfirst Commercial |
$185.77
|
| Rate for Payer: Healthfirst Essential Plan |
$417.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$176.48
|
| Rate for Payer: Healthfirst QHP |
$185.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$130.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$185.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$157.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$130.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$185.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$139.33
|
| Rate for Payer: SOMOS Essential |
$139.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$185.77
|
|
|
CHG BRAIN IMAGING VASCULAR FLOW ONLY
|
Professional
|
Both
|
$56.14
|
|
|
Service Code
|
HCPCS 78610 26
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$33.37 |
| Rate for Payer: Cash Price |
$15.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.12
|
| Rate for Payer: Healthfirst Commercial |
$14.83
|
| Rate for Payer: Healthfirst Essential Plan |
$33.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.09
|
| Rate for Payer: Healthfirst QHP |
$14.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$10.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$14.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$12.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$11.12
|
| Rate for Payer: SOMOS Essential |
$11.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.83
|
|
|
CHG BRAIN IMAGING VASCULAR FLOW ONLY
|
Professional
|
Both
|
$654.96
|
|
|
Service Code
|
HCPCS 78610 TC
|
| Min. Negotiated Rate |
$119.65 |
| Max. Negotiated Rate |
$384.59 |
| Rate for Payer: Cash Price |
$175.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$170.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$153.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$153.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$170.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$170.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$170.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$128.20
|
| Rate for Payer: Healthfirst Commercial |
$170.93
|
| Rate for Payer: Healthfirst Essential Plan |
$384.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$162.38
|
| Rate for Payer: Healthfirst QHP |
$170.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$119.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$170.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$145.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$119.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$170.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$128.20
|
| Rate for Payer: SOMOS Essential |
$128.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$170.93
|
|
|
CHG CARD BLOOD POOL GATED PLANAR 1 STUDY REST/STRESS
|
Professional
|
Both
|
$181.13
|
|
|
Service Code
|
HCPCS 78472 26
|
| Min. Negotiated Rate |
$34.33 |
| Max. Negotiated Rate |
$110.34 |
| Rate for Payer: Cash Price |
$49.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$49.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$44.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$44.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$46.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$49.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$46.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.78
|
| Rate for Payer: Healthfirst Commercial |
$49.04
|
| Rate for Payer: Healthfirst Essential Plan |
$110.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.59
|
| Rate for Payer: Healthfirst QHP |
$49.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$49.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$49.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36.78
|
| Rate for Payer: SOMOS Essential |
$36.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$49.04
|
|
|
CHG CARD BLOOD POOL GATED PLANAR 1 STUDY REST/STRESS
|
Professional
|
Both
|
$726.81
|
|
|
Service Code
|
HCPCS 78472 TC
|
| Min. Negotiated Rate |
$132.15 |
| Max. Negotiated Rate |
$424.78 |
| Rate for Payer: Cash Price |
$195.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$188.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$169.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$169.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$179.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$188.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$179.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$188.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$188.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$141.59
|
| Rate for Payer: Healthfirst Commercial |
$188.79
|
| Rate for Payer: Healthfirst Essential Plan |
$424.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$179.35
|
| Rate for Payer: Healthfirst QHP |
$188.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$132.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$188.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$160.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$132.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$188.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$141.59
|
| Rate for Payer: SOMOS Essential |
$141.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$188.79
|
|
|
CHG CARD BLOOD POOL GATED PLANAR 1 STUDY REST/STRESS
|
Professional
|
Both
|
$907.94
|
|
|
Service Code
|
HCPCS 78472
|
| Min. Negotiated Rate |
$166.48 |
| Max. Negotiated Rate |
$535.12 |
| Rate for Payer: Cash Price |
$245.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$237.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$214.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$214.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$225.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$237.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$225.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$237.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$237.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$178.37
|
| Rate for Payer: Healthfirst Commercial |
$237.83
|
| Rate for Payer: Healthfirst Essential Plan |
$535.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.94
|
| Rate for Payer: Healthfirst QHP |
$237.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$166.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$237.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$202.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$166.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$237.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$178.37
|
| Rate for Payer: SOMOS Essential |
$178.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$237.83
|
|
|
CHG CARD BL POOL GATED 1 STDY REST RT VENT EJCT FRCT
|
Professional
|
Both
|
$174.34
|
|
|
Service Code
|
HCPCS 78496
|
| Min. Negotiated Rate |
$32.49 |
| Max. Negotiated Rate |
$104.42 |
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$44.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$44.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.81
|
| Rate for Payer: Healthfirst Commercial |
$46.41
|
| Rate for Payer: Healthfirst Essential Plan |
$104.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.09
|
| Rate for Payer: Healthfirst QHP |
$46.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$46.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$34.81
|
| Rate for Payer: SOMOS Essential |
$34.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.41
|
|
|
CHG CARD BL POOL GATED 1 STDY REST RT VENT EJCT FRCT
|
Professional
|
Both
|
$81.80
|
|
|
Service Code
|
HCPCS 78496 TC
|
| Min. Negotiated Rate |
$15.64 |
| Max. Negotiated Rate |
$50.29 |
| Rate for Payer: Cash Price |
$22.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.76
|
| Rate for Payer: Healthfirst Commercial |
$22.35
|
| Rate for Payer: Healthfirst Essential Plan |
$50.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.23
|
| Rate for Payer: Healthfirst QHP |
$22.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$15.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$22.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$19.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$16.76
|
| Rate for Payer: SOMOS Essential |
$16.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.35
|
|
|
CHG CARD BL POOL GATED 1 STDY REST RT VENT EJCT FRCT
|
Professional
|
Both
|
$92.54
|
|
|
Service Code
|
HCPCS 78496 26
|
| Min. Negotiated Rate |
$16.84 |
| Max. Negotiated Rate |
$54.11 |
| Rate for Payer: Cash Price |
$25.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.04
|
| Rate for Payer: Healthfirst Commercial |
$24.05
|
| Rate for Payer: Healthfirst Essential Plan |
$54.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.85
|
| Rate for Payer: Healthfirst QHP |
$24.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$16.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$24.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$20.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$16.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18.04
|
| Rate for Payer: SOMOS Essential |
$18.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.05
|
|
|
CHG CARD BL POOL GATED MLT STDY WAL MOTN EJECT FRACT
|
Professional
|
Both
|
$877.77
|
|
|
Service Code
|
HCPCS 78473 TC
|
| Min. Negotiated Rate |
$159.32 |
| Max. Negotiated Rate |
$512.10 |
| Rate for Payer: Cash Price |
$238.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$227.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$204.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$204.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$216.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$227.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$216.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$227.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$227.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$170.70
|
| Rate for Payer: Healthfirst Commercial |
$227.60
|
| Rate for Payer: Healthfirst Essential Plan |
$512.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$216.22
|
| Rate for Payer: Healthfirst QHP |
$227.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$159.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$227.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$193.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$159.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$227.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$170.70
|
| Rate for Payer: SOMOS Essential |
$170.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$227.60
|
|
|
CHG CARD BL POOL GATED MLT STDY WAL MOTN EJECT FRACT
|
Professional
|
Both
|
$266.95
|
|
|
Service Code
|
HCPCS 78473 26
|
| Min. Negotiated Rate |
$51.47 |
| Max. Negotiated Rate |
$165.44 |
| Rate for Payer: Cash Price |
$73.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$73.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$66.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$66.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$69.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$73.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$69.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$55.15
|
| Rate for Payer: Healthfirst Commercial |
$73.53
|
| Rate for Payer: Healthfirst Essential Plan |
$165.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.85
|
| Rate for Payer: Healthfirst QHP |
$73.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$51.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$73.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$62.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$51.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$73.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$55.15
|
| Rate for Payer: SOMOS Essential |
$55.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$73.53
|
|
|
CHG CARD BL POOL GATED MLT STDY WAL MOTN EJECT FRACT
|
Professional
|
Both
|
$1,144.68
|
|
|
Service Code
|
HCPCS 78473
|
| Min. Negotiated Rate |
$210.79 |
| Max. Negotiated Rate |
$677.54 |
| Rate for Payer: Cash Price |
$311.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$301.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$271.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$271.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$286.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$301.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$286.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$301.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$301.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$225.85
|
| Rate for Payer: Healthfirst Commercial |
$301.13
|
| Rate for Payer: Healthfirst Essential Plan |
$677.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$286.07
|
| Rate for Payer: Healthfirst QHP |
$301.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$210.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$301.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$255.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$210.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$301.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$225.85
|
| Rate for Payer: SOMOS Essential |
$225.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$301.13
|
|
|
CHG CARD BL POOL GATED SPECT REST WAL MOTN EJCT FRCT
|
Professional
|
Both
|
$690.87
|
|
|
Service Code
|
HCPCS 78494 TC
|
| Min. Negotiated Rate |
$126.45 |
| Max. Negotiated Rate |
$406.44 |
| Rate for Payer: Cash Price |
$186.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$180.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$162.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$162.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$171.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$180.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$171.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$180.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$180.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$135.48
|
| Rate for Payer: Healthfirst Commercial |
$180.64
|
| Rate for Payer: Healthfirst Essential Plan |
$406.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$171.61
|
| Rate for Payer: Healthfirst QHP |
$180.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$126.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$180.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$153.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$126.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$180.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$135.48
|
| Rate for Payer: SOMOS Essential |
$135.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$180.64
|
|
|
CHG CARD BL POOL GATED SPECT REST WAL MOTN EJCT FRCT
|
Professional
|
Both
|
$909.79
|
|
|
Service Code
|
HCPCS 78494
|
| Min. Negotiated Rate |
$168.01 |
| Max. Negotiated Rate |
$540.04 |
| Rate for Payer: Cash Price |
$246.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$240.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$216.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$216.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$228.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$240.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$228.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$240.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$240.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$180.01
|
| Rate for Payer: Healthfirst Commercial |
$240.02
|
| Rate for Payer: Healthfirst Essential Plan |
$540.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$228.02
|
| Rate for Payer: Healthfirst QHP |
$240.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$168.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$240.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$204.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$168.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$240.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$180.01
|
| Rate for Payer: SOMOS Essential |
$180.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$240.02
|
|
|
CHG CARD BL POOL GATED SPECT REST WAL MOTN EJCT FRCT
|
Professional
|
Both
|
$218.93
|
|
|
Service Code
|
HCPCS 78494 26
|
| Min. Negotiated Rate |
$41.57 |
| Max. Negotiated Rate |
$133.60 |
| Rate for Payer: Cash Price |
$59.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$59.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$53.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$56.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$59.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$56.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.53
|
| Rate for Payer: Healthfirst Commercial |
$59.38
|
| Rate for Payer: Healthfirst Essential Plan |
$133.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$56.41
|
| Rate for Payer: Healthfirst QHP |
$59.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$41.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$59.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$50.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$41.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$59.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$44.53
|
| Rate for Payer: SOMOS Essential |
$44.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$59.38
|
|
|
CHG CARD BL POOL PLANAR 1 STDY WAL MOTN EJECT FRACT
|
Professional
|
Both
|
$709.56
|
|
|
Service Code
|
HCPCS 78481
|
| Min. Negotiated Rate |
$129.21 |
| Max. Negotiated Rate |
$415.31 |
| Rate for Payer: Cash Price |
$192.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$184.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$166.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$166.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$175.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$184.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$175.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$184.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$184.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$138.44
|
| Rate for Payer: Healthfirst Commercial |
$184.58
|
| Rate for Payer: Healthfirst Essential Plan |
$415.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$175.35
|
| Rate for Payer: Healthfirst QHP |
$184.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$129.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$184.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$156.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$129.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$184.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$138.44
|
| Rate for Payer: SOMOS Essential |
$138.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$184.58
|
|
|
CHG CARD BL POOL PLANAR 1 STDY WAL MOTN EJECT FRACT
|
Professional
|
Both
|
$527.00
|
|
|
Service Code
|
HCPCS 78481 TC
|
| Min. Negotiated Rate |
$95.31 |
| Max. Negotiated Rate |
$306.36 |
| Rate for Payer: Cash Price |
$142.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$136.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$122.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$122.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$129.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$136.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$129.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$136.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$136.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$102.12
|
| Rate for Payer: Healthfirst Commercial |
$136.16
|
| Rate for Payer: Healthfirst Essential Plan |
$306.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$129.35
|
| Rate for Payer: Healthfirst QHP |
$136.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$95.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$136.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$115.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$95.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$136.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$102.12
|
| Rate for Payer: SOMOS Essential |
$102.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$136.16
|
|
|
CHG CARD BL POOL PLANAR 1 STDY WAL MOTN EJECT FRACT
|
Professional
|
Both
|
$182.56
|
|
|
Service Code
|
HCPCS 78481 26
|
| Min. Negotiated Rate |
$33.89 |
| Max. Negotiated Rate |
$108.94 |
| Rate for Payer: Cash Price |
$49.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$48.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$46.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$48.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$46.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.31
|
| Rate for Payer: Healthfirst Commercial |
$48.42
|
| Rate for Payer: Healthfirst Essential Plan |
$108.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.00
|
| Rate for Payer: Healthfirst QHP |
$48.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$48.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$48.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36.31
|
| Rate for Payer: SOMOS Essential |
$36.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$48.42
|
|
