|
CHG CARD BL POOL PLNR MLT STDY WAL MOTN EJECT FRACT
|
Professional
|
Both
|
$680.82
|
|
|
Service Code
|
HCPCS 78483 TC
|
| Min. Negotiated Rate |
$123.19 |
| Max. Negotiated Rate |
$395.95 |
| Rate for Payer: Cash Price |
$183.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$175.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$158.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$158.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$167.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$175.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$167.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$175.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$131.99
|
| Rate for Payer: Healthfirst Commercial |
$175.98
|
| Rate for Payer: Healthfirst Essential Plan |
$395.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$167.18
|
| Rate for Payer: Healthfirst QHP |
$175.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$123.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$175.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$149.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$123.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$175.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$131.99
|
| Rate for Payer: SOMOS Essential |
$131.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$175.98
|
|
|
CHG CARD BL POOL PLNR MLT STDY WAL MOTN EJECT FRACT
|
Professional
|
Both
|
$268.38
|
|
|
Service Code
|
HCPCS 78483 26
|
| Min. Negotiated Rate |
$51.04 |
| Max. Negotiated Rate |
$164.05 |
| Rate for Payer: Cash Price |
$74.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$72.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$65.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$69.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$69.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.68
|
| Rate for Payer: Healthfirst Commercial |
$72.91
|
| Rate for Payer: Healthfirst Essential Plan |
$164.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.26
|
| Rate for Payer: Healthfirst QHP |
$72.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$51.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$72.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$61.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$51.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$54.68
|
| Rate for Payer: SOMOS Essential |
$54.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.91
|
|
|
CHG CARD BL POOL PLNR MLT STDY WAL MOTN EJECT FRACT
|
Professional
|
Both
|
$949.20
|
|
|
Service Code
|
HCPCS 78483
|
| Min. Negotiated Rate |
$174.22 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Cash Price |
$257.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$248.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$224.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$224.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$236.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$248.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$236.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$248.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$248.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$186.67
|
| Rate for Payer: Healthfirst Commercial |
$248.89
|
| Rate for Payer: Healthfirst Essential Plan |
$560.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$236.45
|
| Rate for Payer: Healthfirst QHP |
$248.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$174.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$248.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$211.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$174.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$248.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$186.67
|
| Rate for Payer: SOMOS Essential |
$186.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$248.89
|
|
|
CHG CARDIAC MRI FOR VELOCITY FLOW MAPPING
|
Professional
|
Both
|
$46.97
|
|
|
Service Code
|
HCPCS 75565 26
|
| Min. Negotiated Rate |
$8.90 |
| Max. Negotiated Rate |
$28.62 |
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.54
|
| Rate for Payer: Healthfirst Commercial |
$12.72
|
| Rate for Payer: Healthfirst Essential Plan |
$28.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.08
|
| Rate for Payer: Healthfirst QHP |
$12.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$12.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$10.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.54
|
| Rate for Payer: SOMOS Essential |
$9.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.72
|
|
|
CHG CARDIAC MRI FOR VELOCITY FLOW MAPPING
|
Professional
|
Both
|
$153.83
|
|
|
Service Code
|
HCPCS 75565 TC
|
| Min. Negotiated Rate |
$27.44 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Cash Price |
$41.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$39.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.40
|
| Rate for Payer: Healthfirst Commercial |
$39.20
|
| Rate for Payer: Healthfirst Essential Plan |
$88.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.24
|
| Rate for Payer: Healthfirst QHP |
$39.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$39.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.40
|
| Rate for Payer: SOMOS Essential |
$29.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.20
|
|
|
CHG CARDIAC MRI FOR VELOCITY FLOW MAPPING
|
Professional
|
Both
|
$200.80
|
|
|
Service Code
|
HCPCS 75565
|
| Min. Negotiated Rate |
$36.35 |
| Max. Negotiated Rate |
$116.84 |
| Rate for Payer: Cash Price |
$54.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$51.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$46.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$46.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$51.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.95
|
| Rate for Payer: Healthfirst Commercial |
$51.93
|
| Rate for Payer: Healthfirst Essential Plan |
$116.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.33
|
| Rate for Payer: Healthfirst QHP |
$51.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$51.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$51.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$38.95
|
| Rate for Payer: SOMOS Essential |
$38.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$51.93
|
|
|
CHG CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST
|
Professional
|
Both
|
$441.00
|
|
|
Service Code
|
HCPCS 75557 26
|
| Min. Negotiated Rate |
$83.55 |
| Max. Negotiated Rate |
$268.54 |
| Rate for Payer: Cash Price |
$120.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$119.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$107.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$107.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$119.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$119.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$119.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$89.51
|
| Rate for Payer: Healthfirst Commercial |
$119.35
|
| Rate for Payer: Healthfirst Essential Plan |
$268.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$113.38
|
| Rate for Payer: Healthfirst QHP |
$119.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$83.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$119.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$101.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$83.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$119.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$89.51
|
| Rate for Payer: SOMOS Essential |
$89.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$119.35
|
|
|
CHG CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST
|
Professional
|
Both
|
$1,221.29
|
|
|
Service Code
|
HCPCS 75557
|
| Min. Negotiated Rate |
$223.53 |
| Max. Negotiated Rate |
$718.49 |
| Rate for Payer: Cash Price |
$329.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$319.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$287.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$287.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$303.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$319.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$303.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$319.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$319.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$239.50
|
| Rate for Payer: Healthfirst Commercial |
$319.33
|
| Rate for Payer: Healthfirst Essential Plan |
$718.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$303.36
|
| Rate for Payer: Healthfirst QHP |
$319.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$223.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$319.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$271.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$223.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$319.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$239.50
|
| Rate for Payer: SOMOS Essential |
$239.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$319.33
|
|
|
CHG CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST
|
Professional
|
Both
|
$780.29
|
|
|
Service Code
|
HCPCS 75557 TC
|
| Min. Negotiated Rate |
$139.98 |
| Max. Negotiated Rate |
$449.93 |
| Rate for Payer: Cash Price |
$209.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$199.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$179.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$179.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$189.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$199.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$189.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$199.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$199.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$149.98
|
| Rate for Payer: Healthfirst Commercial |
$199.97
|
| Rate for Payer: Healthfirst Essential Plan |
$449.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$189.97
|
| Rate for Payer: Healthfirst QHP |
$199.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$139.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$199.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$169.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$139.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$199.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$149.98
|
| Rate for Payer: SOMOS Essential |
$149.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$199.97
|
|
|
CHG CARDIAC MRI W/O CONTRAST W/STRESS IMAGING
|
Professional
|
Both
|
$540.58
|
|
|
Service Code
|
HCPCS 75559 26
|
| Min. Negotiated Rate |
$102.31 |
| Max. Negotiated Rate |
$328.86 |
| Rate for Payer: Cash Price |
$148.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$146.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$131.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$131.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$138.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$146.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$138.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$146.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$146.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$109.62
|
| Rate for Payer: Healthfirst Commercial |
$146.16
|
| Rate for Payer: Healthfirst Essential Plan |
$328.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$138.85
|
| Rate for Payer: Healthfirst QHP |
$146.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$102.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$146.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$124.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$102.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$146.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$109.62
|
| Rate for Payer: SOMOS Essential |
$109.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$146.16
|
|
|
CHG CARDIAC MRI W/O CONTRAST W/STRESS IMAGING
|
Professional
|
Both
|
$1,635.69
|
|
|
Service Code
|
HCPCS 75559
|
| Min. Negotiated Rate |
$298.43 |
| Max. Negotiated Rate |
$959.24 |
| Rate for Payer: Cash Price |
$442.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$426.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$383.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$383.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$405.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$426.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$405.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$426.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$426.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$319.75
|
| Rate for Payer: Healthfirst Commercial |
$426.33
|
| Rate for Payer: Healthfirst Essential Plan |
$959.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$405.01
|
| Rate for Payer: Healthfirst QHP |
$426.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$298.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$426.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$362.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$298.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$426.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$319.75
|
| Rate for Payer: SOMOS Essential |
$319.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$426.33
|
|
|
CHG CARDIAC MRI W/O CONTRAST W/STRESS IMAGING
|
Professional
|
Both
|
$1,095.08
|
|
|
Service Code
|
HCPCS 75559 TC
|
| Min. Negotiated Rate |
$196.11 |
| Max. Negotiated Rate |
$630.36 |
| Rate for Payer: Cash Price |
$294.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$280.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$252.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$252.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$266.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$280.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$266.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$280.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$280.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$210.12
|
| Rate for Payer: Healthfirst Commercial |
$280.16
|
| Rate for Payer: Healthfirst Essential Plan |
$630.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$266.15
|
| Rate for Payer: Healthfirst QHP |
$280.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$196.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$280.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$238.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$196.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$280.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$210.12
|
| Rate for Payer: SOMOS Essential |
$210.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$280.16
|
|
|
CHG CARDIAC MRI W/WO CONTRAST & FURTHER SEQ
|
Professional
|
Both
|
$1,604.65
|
|
|
Service Code
|
HCPCS 75561
|
| Min. Negotiated Rate |
$292.54 |
| Max. Negotiated Rate |
$940.30 |
| Rate for Payer: Cash Price |
$432.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$417.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$376.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$376.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$397.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$417.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$397.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$417.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$417.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$313.43
|
| Rate for Payer: Healthfirst Commercial |
$417.91
|
| Rate for Payer: Healthfirst Essential Plan |
$940.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$397.01
|
| Rate for Payer: Healthfirst QHP |
$417.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$292.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$417.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$355.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$292.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$417.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$313.43
|
| Rate for Payer: SOMOS Essential |
$313.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$417.91
|
|
|
CHG CARDIAC MRI W/WO CONTRAST & FURTHER SEQ
|
Professional
|
Both
|
$1,116.64
|
|
|
Service Code
|
HCPCS 75561 TC
|
| Min. Negotiated Rate |
$199.65 |
| Max. Negotiated Rate |
$641.72 |
| Rate for Payer: Cash Price |
$299.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$285.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$256.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$256.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$270.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$285.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$270.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$285.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$285.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$213.91
|
| Rate for Payer: Healthfirst Commercial |
$285.21
|
| Rate for Payer: Healthfirst Essential Plan |
$641.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$270.95
|
| Rate for Payer: Healthfirst QHP |
$285.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$199.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$285.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$242.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$199.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$285.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$213.91
|
| Rate for Payer: SOMOS Essential |
$213.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$285.21
|
|
|
CHG CARDIAC MRI W/WO CONTRAST & FURTHER SEQ
|
Professional
|
Both
|
$488.01
|
|
|
Service Code
|
HCPCS 75561 26
|
| Min. Negotiated Rate |
$92.89 |
| Max. Negotiated Rate |
$298.57 |
| Rate for Payer: Cash Price |
$132.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$132.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$119.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$119.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$126.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$132.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$126.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$132.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$132.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$99.53
|
| Rate for Payer: Healthfirst Commercial |
$132.70
|
| Rate for Payer: Healthfirst Essential Plan |
$298.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$126.06
|
| Rate for Payer: Healthfirst QHP |
$132.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$92.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$132.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$112.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$92.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$132.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$99.53
|
| Rate for Payer: SOMOS Essential |
$99.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$132.70
|
|
|
CHG CARDIAC MRI W/W/O CONTRAST W/STRESS
|
Professional
|
Both
|
$1,864.49
|
|
|
Service Code
|
HCPCS 75563
|
| Min. Negotiated Rate |
$340.22 |
| Max. Negotiated Rate |
$1,093.57 |
| Rate for Payer: Cash Price |
$503.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$486.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$437.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$437.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$461.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$486.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$461.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$486.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$486.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$364.52
|
| Rate for Payer: Healthfirst Commercial |
$486.03
|
| Rate for Payer: Healthfirst Essential Plan |
$1,093.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$461.73
|
| Rate for Payer: Healthfirst QHP |
$486.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$340.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$486.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$413.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$340.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$486.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$364.52
|
| Rate for Payer: SOMOS Essential |
$364.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$486.03
|
|
|
CHG CARDIAC MRI W/W/O CONTRAST W/STRESS
|
Professional
|
Both
|
$1,314.74
|
|
|
Service Code
|
HCPCS 75563 TC
|
| Min. Negotiated Rate |
$234.42 |
| Max. Negotiated Rate |
$753.50 |
| Rate for Payer: Cash Price |
$351.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$334.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$301.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$301.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$318.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$334.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$318.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$334.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$334.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$251.17
|
| Rate for Payer: Healthfirst Commercial |
$334.89
|
| Rate for Payer: Healthfirst Essential Plan |
$753.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$318.15
|
| Rate for Payer: Healthfirst QHP |
$334.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$234.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$334.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$284.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$234.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$334.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$251.17
|
| Rate for Payer: SOMOS Essential |
$251.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$334.89
|
|
|
CHG CARDIAC MRI W/W/O CONTRAST W/STRESS
|
Professional
|
Both
|
$549.75
|
|
|
Service Code
|
HCPCS 75563 26
|
| Min. Negotiated Rate |
$105.79 |
| Max. Negotiated Rate |
$340.04 |
| Rate for Payer: Cash Price |
$151.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$151.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$136.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$136.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$143.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$151.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$143.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$151.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$151.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$113.35
|
| Rate for Payer: Healthfirst Commercial |
$151.13
|
| Rate for Payer: Healthfirst Essential Plan |
$340.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$143.57
|
| Rate for Payer: Healthfirst QHP |
$151.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$105.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$151.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$128.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$105.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$151.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$113.35
|
| Rate for Payer: SOMOS Essential |
$113.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$151.13
|
|
|
CHG CARDIAC SHUNT DETECTION
|
Professional
|
Both
|
$144.59
|
|
|
Service Code
|
HCPCS 78428 26
|
| Min. Negotiated Rate |
$27.17 |
| Max. Negotiated Rate |
$87.34 |
| Rate for Payer: Cash Price |
$38.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.11
|
| Rate for Payer: Healthfirst Commercial |
$38.82
|
| Rate for Payer: Healthfirst Essential Plan |
$87.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.88
|
| Rate for Payer: Healthfirst QHP |
$38.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.11
|
| Rate for Payer: SOMOS Essential |
$29.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.82
|
|
|
CHG CARDIAC SHUNT DETECTION
|
Professional
|
Both
|
$752.08
|
|
|
Service Code
|
HCPCS 78428
|
| Min. Negotiated Rate |
$137.86 |
| Max. Negotiated Rate |
$443.12 |
| Rate for Payer: Cash Price |
$202.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$196.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$177.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$177.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$187.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$196.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$187.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$196.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$196.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$147.71
|
| Rate for Payer: Healthfirst Commercial |
$196.94
|
| Rate for Payer: Healthfirst Essential Plan |
$443.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$187.09
|
| Rate for Payer: Healthfirst QHP |
$196.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$137.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$196.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$167.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$137.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$196.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$147.71
|
| Rate for Payer: SOMOS Essential |
$147.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$196.94
|
|
|
CHG CARDIAC SHUNT DETECTION
|
Professional
|
Both
|
$607.50
|
|
|
Service Code
|
HCPCS 78428 TC
|
| Min. Negotiated Rate |
$110.68 |
| Max. Negotiated Rate |
$355.77 |
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$158.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$142.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$142.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$150.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$158.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$150.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$158.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$158.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$118.59
|
| Rate for Payer: Healthfirst Commercial |
$158.12
|
| Rate for Payer: Healthfirst Essential Plan |
$355.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$150.21
|
| Rate for Payer: Healthfirst QHP |
$158.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$110.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$158.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$134.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$110.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$158.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$118.59
|
| Rate for Payer: SOMOS Essential |
$118.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$158.12
|
|
|
CHG CARD-VASC HEMODYNAM W/WO PHARM/EXER 1/MLT DETERM
|
Professional
|
Both
|
$82.11
|
|
|
Service Code
|
HCPCS 78414 26
|
| Min. Negotiated Rate |
$15.63 |
| Max. Negotiated Rate |
$50.24 |
| Rate for Payer: Cash Price |
$22.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.75
|
| Rate for Payer: Healthfirst Commercial |
$22.33
|
| Rate for Payer: Healthfirst Essential Plan |
$50.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.21
|
| Rate for Payer: Healthfirst QHP |
$22.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$15.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$22.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$18.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$16.75
|
| Rate for Payer: SOMOS Essential |
$16.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.33
|
|
|
CHG CELL ENUMERATION IMMUNE SELECTJ & ID PHYS INTERP
|
Professional
|
Both
|
$130.69
|
|
|
Service Code
|
HCPCS 86153 26
|
| Min. Negotiated Rate |
$24.84 |
| Max. Negotiated Rate |
$79.85 |
| Rate for Payer: Cash Price |
$35.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.62
|
| Rate for Payer: Healthfirst Commercial |
$35.49
|
| Rate for Payer: Healthfirst Essential Plan |
$79.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.72
|
| Rate for Payer: Healthfirst QHP |
$35.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.62
|
| Rate for Payer: SOMOS Essential |
$26.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.49
|
|
|
CHG CEPHALOGRAM ORTHODONTIC
|
Professional
|
Both
|
$34.09
|
|
|
Service Code
|
HCPCS 70350 26
|
| Min. Negotiated Rate |
$6.71 |
| Max. Negotiated Rate |
$21.55 |
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.18
|
| Rate for Payer: Healthfirst Commercial |
$9.58
|
| Rate for Payer: Healthfirst Essential Plan |
$21.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.10
|
| Rate for Payer: Healthfirst QHP |
$9.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.18
|
| Rate for Payer: SOMOS Essential |
$7.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.58
|
|
|
CHG CEPHALOGRAM ORTHODONTIC
|
Professional
|
Both
|
$69.90
|
|
|
Service Code
|
HCPCS 70350
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$45.65 |
| Rate for Payer: Cash Price |
$19.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.22
|
| Rate for Payer: Healthfirst Commercial |
$20.29
|
| Rate for Payer: Healthfirst Essential Plan |
$45.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.28
|
| Rate for Payer: Healthfirst QHP |
$20.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$20.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$17.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$14.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.22
|
| Rate for Payer: SOMOS Essential |
$15.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.29
|
|
