|
CHG CT ABDOMEN & PELVIS W/CONTRAST MATERIAL
|
Professional
|
Both
|
$1,350.41
|
|
|
Service Code
|
HCPCS 74177
|
| Min. Negotiated Rate |
$246.07 |
| Max. Negotiated Rate |
$790.94 |
| Rate for Payer: Cash Price |
$361.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$351.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$316.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$316.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$333.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$351.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$333.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$351.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$351.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$263.65
|
| Rate for Payer: Healthfirst Commercial |
$351.53
|
| Rate for Payer: Healthfirst Essential Plan |
$790.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$333.95
|
| Rate for Payer: Healthfirst QHP |
$351.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$246.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$351.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$298.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$246.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$351.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$263.65
|
| Rate for Payer: SOMOS Essential |
$263.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$351.53
|
|
|
CHG CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$335.86
|
|
|
Service Code
|
HCPCS 74176 26
|
| Min. Negotiated Rate |
$62.54 |
| Max. Negotiated Rate |
$201.01 |
| Rate for Payer: Cash Price |
$90.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$89.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$80.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$80.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$89.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$84.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$89.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$89.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67.00
|
| Rate for Payer: Healthfirst Commercial |
$89.34
|
| Rate for Payer: Healthfirst Essential Plan |
$201.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$84.87
|
| Rate for Payer: Healthfirst QHP |
$89.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$62.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$89.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$75.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$62.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$89.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$67.00
|
| Rate for Payer: SOMOS Essential |
$67.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$89.34
|
|
|
CHG CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$799.89
|
|
|
Service Code
|
HCPCS 74176
|
| Min. Negotiated Rate |
$148.18 |
| Max. Negotiated Rate |
$476.28 |
| Rate for Payer: Cash Price |
$216.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$211.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$190.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$190.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$201.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$211.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$201.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$211.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$211.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$158.76
|
| Rate for Payer: Healthfirst Commercial |
$211.68
|
| Rate for Payer: Healthfirst Essential Plan |
$476.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$201.10
|
| Rate for Payer: Healthfirst QHP |
$211.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$148.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$211.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$179.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$148.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$211.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$158.76
|
| Rate for Payer: SOMOS Essential |
$158.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$211.68
|
|
|
CHG CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$464.03
|
|
|
Service Code
|
HCPCS 74176 TC
|
| Min. Negotiated Rate |
$85.64 |
| Max. Negotiated Rate |
$275.26 |
| Rate for Payer: Cash Price |
$125.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$122.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$110.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$110.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$116.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$122.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$116.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$122.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$122.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$91.75
|
| Rate for Payer: Healthfirst Commercial |
$122.34
|
| Rate for Payer: Healthfirst Essential Plan |
$275.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$116.22
|
| Rate for Payer: Healthfirst QHP |
$122.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$85.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$122.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$103.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$85.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$122.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$91.75
|
| Rate for Payer: SOMOS Essential |
$91.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$122.34
|
|
|
CHG CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY RE
|
Professional
|
Both
|
$1,128.16
|
|
|
Service Code
|
HCPCS 74178 TC
|
| Min. Negotiated Rate |
$203.18 |
| Max. Negotiated Rate |
$653.09 |
| Rate for Payer: Cash Price |
$302.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$290.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$261.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$261.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$275.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$290.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$275.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$290.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$290.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$217.69
|
| Rate for Payer: Healthfirst Commercial |
$290.26
|
| Rate for Payer: Healthfirst Essential Plan |
$653.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$275.75
|
| Rate for Payer: Healthfirst QHP |
$290.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$203.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$290.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$246.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$203.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$290.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$217.69
|
| Rate for Payer: SOMOS Essential |
$217.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$290.26
|
|
|
CHG CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY RE
|
Professional
|
Both
|
$1,510.78
|
|
|
Service Code
|
HCPCS 74178
|
| Min. Negotiated Rate |
$275.54 |
| Max. Negotiated Rate |
$885.67 |
| Rate for Payer: Cash Price |
$405.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$393.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$354.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$354.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$373.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$393.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$373.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$393.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$393.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$295.22
|
| Rate for Payer: Healthfirst Commercial |
$393.63
|
| Rate for Payer: Healthfirst Essential Plan |
$885.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$373.95
|
| Rate for Payer: Healthfirst QHP |
$393.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$275.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$393.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$334.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$275.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$393.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$295.22
|
| Rate for Payer: SOMOS Essential |
$295.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$393.63
|
|
|
CHG CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY RE
|
Professional
|
Both
|
$382.62
|
|
|
Service Code
|
HCPCS 74178 26
|
| Min. Negotiated Rate |
$72.36 |
| Max. Negotiated Rate |
$232.58 |
| Rate for Payer: Cash Price |
$103.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$103.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$93.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$93.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$98.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$103.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$98.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$103.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$77.53
|
| Rate for Payer: Healthfirst Commercial |
$103.37
|
| Rate for Payer: Healthfirst Essential Plan |
$232.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$98.20
|
| Rate for Payer: Healthfirst QHP |
$103.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$72.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$103.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$87.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$72.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$103.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$77.53
|
| Rate for Payer: SOMOS Essential |
$77.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$103.37
|
|
|
CHG CT ABDOMEN W/CONTRAST MATERIAL
|
Professional
|
Both
|
$244.34
|
|
|
Service Code
|
HCPCS 74160 26
|
| Min. Negotiated Rate |
$45.72 |
| Max. Negotiated Rate |
$146.95 |
| Rate for Payer: Cash Price |
$66.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$65.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$58.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$65.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.98
|
| Rate for Payer: Healthfirst Commercial |
$65.31
|
| Rate for Payer: Healthfirst Essential Plan |
$146.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.04
|
| Rate for Payer: Healthfirst QHP |
$65.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$65.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$55.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$65.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$48.98
|
| Rate for Payer: SOMOS Essential |
$48.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.31
|
|
|
CHG CT ABDOMEN W/CONTRAST MATERIAL
|
Professional
|
Both
|
$767.34
|
|
|
Service Code
|
HCPCS 74160 TC
|
| Min. Negotiated Rate |
$142.43 |
| Max. Negotiated Rate |
$457.81 |
| Rate for Payer: Cash Price |
$212.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$203.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$183.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$183.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$193.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$203.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$193.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$203.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$203.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$152.60
|
| Rate for Payer: Healthfirst Commercial |
$203.47
|
| Rate for Payer: Healthfirst Essential Plan |
$457.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$193.30
|
| Rate for Payer: Healthfirst QHP |
$203.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$142.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$203.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$172.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$142.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$203.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$152.60
|
| Rate for Payer: SOMOS Essential |
$152.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$203.47
|
|
|
CHG CT ABDOMEN W/CONTRAST MATERIAL
|
Professional
|
Both
|
$1,011.68
|
|
|
Service Code
|
HCPCS 74160
|
| Min. Negotiated Rate |
$188.15 |
| Max. Negotiated Rate |
$604.75 |
| Rate for Payer: Cash Price |
$278.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$268.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$241.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$241.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$255.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$268.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$255.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$268.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$268.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$201.59
|
| Rate for Payer: Healthfirst Commercial |
$268.78
|
| Rate for Payer: Healthfirst Essential Plan |
$604.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$255.34
|
| Rate for Payer: Healthfirst QHP |
$268.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$188.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$268.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$228.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$188.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$268.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$201.59
|
| Rate for Payer: SOMOS Essential |
$201.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$268.78
|
|
|
CHG CT ABDOMEN W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$369.29
|
|
|
Service Code
|
HCPCS 74150 TC
|
| Min. Negotiated Rate |
$67.54 |
| Max. Negotiated Rate |
$217.10 |
| Rate for Payer: Cash Price |
$99.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$96.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$86.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$86.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$91.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$96.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$91.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$96.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$96.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.37
|
| Rate for Payer: Healthfirst Commercial |
$96.49
|
| Rate for Payer: Healthfirst Essential Plan |
$217.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$91.67
|
| Rate for Payer: Healthfirst QHP |
$96.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$67.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$96.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$82.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$67.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$96.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$72.37
|
| Rate for Payer: SOMOS Essential |
$72.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$96.49
|
|
|
CHG CT ABDOMEN W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$596.58
|
|
|
Service Code
|
HCPCS 74150
|
| Min. Negotiated Rate |
$110.09 |
| Max. Negotiated Rate |
$353.86 |
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$141.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$149.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$149.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$117.95
|
| Rate for Payer: Healthfirst Commercial |
$157.27
|
| Rate for Payer: Healthfirst Essential Plan |
$353.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$149.41
|
| Rate for Payer: Healthfirst QHP |
$157.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$110.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$157.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$133.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$110.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$117.95
|
| Rate for Payer: SOMOS Essential |
$117.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.27
|
|
|
CHG CT ABDOMEN W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$227.29
|
|
|
Service Code
|
HCPCS 74150 26
|
| Min. Negotiated Rate |
$42.55 |
| Max. Negotiated Rate |
$136.75 |
| Rate for Payer: Cash Price |
$61.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$60.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$54.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$54.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$57.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$60.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$57.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.59
|
| Rate for Payer: Healthfirst Commercial |
$60.78
|
| Rate for Payer: Healthfirst Essential Plan |
$136.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$57.74
|
| Rate for Payer: Healthfirst QHP |
$60.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$42.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$60.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$51.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$42.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$60.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$45.59
|
| Rate for Payer: SOMOS Essential |
$45.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$60.78
|
|
|
CHG CT ABDOMEN W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$266.39
|
|
|
Service Code
|
HCPCS 74170 26
|
| Min. Negotiated Rate |
$49.95 |
| Max. Negotiated Rate |
$160.54 |
| Rate for Payer: Cash Price |
$72.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$71.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$64.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$64.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$67.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$71.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$67.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$71.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$71.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$53.51
|
| Rate for Payer: Healthfirst Commercial |
$71.35
|
| Rate for Payer: Healthfirst Essential Plan |
$160.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$67.78
|
| Rate for Payer: Healthfirst QHP |
$71.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$49.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$71.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$60.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$49.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$71.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$53.51
|
| Rate for Payer: SOMOS Essential |
$53.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$71.35
|
|
|
CHG CT ABDOMEN W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$768.78
|
|
|
Service Code
|
HCPCS 74170 TC
|
| Min. Negotiated Rate |
$161.45 |
| Max. Negotiated Rate |
$518.94 |
| Rate for Payer: Cash Price |
$240.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$230.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$207.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$207.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$230.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$230.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$230.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$172.98
|
| Rate for Payer: Healthfirst Commercial |
$230.64
|
| Rate for Payer: Healthfirst Essential Plan |
$518.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$219.11
|
| Rate for Payer: Healthfirst QHP |
$230.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$161.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$230.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$196.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$161.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$230.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$172.98
|
| Rate for Payer: SOMOS Essential |
$172.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$230.64
|
|
|
CHG CT ABDOMEN W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$1,035.16
|
|
|
Service Code
|
HCPCS 74170
|
| Min. Negotiated Rate |
$211.39 |
| Max. Negotiated Rate |
$679.46 |
| Rate for Payer: Cash Price |
$313.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$301.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$271.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$271.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$286.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$301.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$286.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$301.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$301.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$226.49
|
| Rate for Payer: Healthfirst Commercial |
$301.98
|
| Rate for Payer: Healthfirst Essential Plan |
$679.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$286.88
|
| Rate for Payer: Healthfirst QHP |
$301.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$211.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$301.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$256.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$211.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$301.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$226.49
|
| Rate for Payer: SOMOS Essential |
$226.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$301.98
|
|
|
CHG CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST
|
Professional
|
Both
|
$1,221.54
|
|
|
Service Code
|
HCPCS 75574
|
| Min. Negotiated Rate |
$262.61 |
| Max. Negotiated Rate |
$844.09 |
| Rate for Payer: Cash Price |
$381.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$375.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$337.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$337.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$356.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$375.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$356.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$375.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$375.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$281.36
|
| Rate for Payer: Healthfirst Commercial |
$375.15
|
| Rate for Payer: Healthfirst Essential Plan |
$844.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$356.39
|
| Rate for Payer: Healthfirst QHP |
$375.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$262.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$375.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$318.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$262.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$375.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$281.36
|
| Rate for Payer: SOMOS Essential |
$281.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$375.15
|
|
|
CHG CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST
|
Professional
|
Both
|
$452.87
|
|
|
Service Code
|
HCPCS 75574 26
|
| Min. Negotiated Rate |
$86.16 |
| Max. Negotiated Rate |
$276.95 |
| Rate for Payer: Cash Price |
$123.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$123.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$110.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$110.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$116.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$123.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$116.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$123.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$123.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$92.32
|
| Rate for Payer: Healthfirst Commercial |
$123.09
|
| Rate for Payer: Healthfirst Essential Plan |
$276.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$116.94
|
| Rate for Payer: Healthfirst QHP |
$123.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$86.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$123.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$104.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$86.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$123.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$92.32
|
| Rate for Payer: SOMOS Essential |
$92.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$123.09
|
|
|
CHG CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST
|
Professional
|
Both
|
$768.64
|
|
|
Service Code
|
HCPCS 75574 TC
|
| Min. Negotiated Rate |
$176.44 |
| Max. Negotiated Rate |
$567.13 |
| Rate for Payer: Cash Price |
$258.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$252.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$226.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$226.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$239.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$252.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$239.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$252.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$252.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$189.04
|
| Rate for Payer: Healthfirst Commercial |
$252.06
|
| Rate for Payer: Healthfirst Essential Plan |
$567.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$239.46
|
| Rate for Payer: Healthfirst QHP |
$252.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$176.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$252.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$214.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$176.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$252.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$189.04
|
| Rate for Payer: SOMOS Essential |
$189.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$252.06
|
|
|
CHG CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG
|
Professional
|
Both
|
$1,265.88
|
|
|
Service Code
|
HCPCS 74174 TC
|
| Min. Negotiated Rate |
$230.78 |
| Max. Negotiated Rate |
$741.80 |
| Rate for Payer: Cash Price |
$340.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$329.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$296.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$296.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$313.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$329.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$313.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$329.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$329.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$247.27
|
| Rate for Payer: Healthfirst Commercial |
$329.69
|
| Rate for Payer: Healthfirst Essential Plan |
$741.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$313.21
|
| Rate for Payer: Healthfirst QHP |
$329.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$230.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$329.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$280.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$230.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$329.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$247.27
|
| Rate for Payer: SOMOS Essential |
$247.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$329.69
|
|
|
CHG CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG
|
Professional
|
Both
|
$1,684.94
|
|
|
Service Code
|
HCPCS 74174
|
| Min. Negotiated Rate |
$310.38 |
| Max. Negotiated Rate |
$997.65 |
| Rate for Payer: Cash Price |
$454.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$443.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$399.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$399.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$421.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$443.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$421.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$443.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$443.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$332.55
|
| Rate for Payer: Healthfirst Commercial |
$443.40
|
| Rate for Payer: Healthfirst Essential Plan |
$997.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$421.23
|
| Rate for Payer: Healthfirst QHP |
$443.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$310.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$443.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$376.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$310.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$443.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$332.55
|
| Rate for Payer: SOMOS Essential |
$332.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$443.40
|
|
|
CHG CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG
|
Professional
|
Both
|
$419.06
|
|
|
Service Code
|
HCPCS 74174 26
|
| Min. Negotiated Rate |
$79.60 |
| Max. Negotiated Rate |
$255.85 |
| Rate for Payer: Cash Price |
$113.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$113.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$102.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$102.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$108.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$113.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$108.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$113.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$113.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$85.28
|
| Rate for Payer: Healthfirst Commercial |
$113.71
|
| Rate for Payer: Healthfirst Essential Plan |
$255.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$108.02
|
| Rate for Payer: Healthfirst QHP |
$113.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$79.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$113.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$96.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$79.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$113.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$85.28
|
| Rate for Payer: SOMOS Essential |
$85.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$113.71
|
|
|
CHG CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST
|
Professional
|
Both
|
$347.31
|
|
|
Service Code
|
HCPCS 74175 26
|
| Min. Negotiated Rate |
$65.60 |
| Max. Negotiated Rate |
$210.87 |
| Rate for Payer: Cash Price |
$94.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$93.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$84.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$84.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$89.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$93.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$89.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$70.29
|
| Rate for Payer: Healthfirst Commercial |
$93.72
|
| Rate for Payer: Healthfirst Essential Plan |
$210.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$89.03
|
| Rate for Payer: Healthfirst QHP |
$93.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$65.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$93.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$79.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$65.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$93.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$70.29
|
| Rate for Payer: SOMOS Essential |
$70.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$93.72
|
|
|
CHG CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST
|
Professional
|
Both
|
$768.64
|
|
|
Service Code
|
HCPCS 74175 TC
|
| Min. Negotiated Rate |
$183.89 |
| Max. Negotiated Rate |
$591.08 |
| Rate for Payer: Cash Price |
$270.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$262.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$236.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$236.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$249.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$262.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$249.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$262.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$262.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$197.03
|
| Rate for Payer: Healthfirst Commercial |
$262.70
|
| Rate for Payer: Healthfirst Essential Plan |
$591.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$249.56
|
| Rate for Payer: Healthfirst QHP |
$262.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$183.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$262.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$223.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$183.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$262.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$197.03
|
| Rate for Payer: SOMOS Essential |
$197.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$262.70
|
|
|
CHG CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST
|
Professional
|
Both
|
$1,115.94
|
|
|
Service Code
|
HCPCS 74175
|
| Min. Negotiated Rate |
$249.49 |
| Max. Negotiated Rate |
$801.95 |
| Rate for Payer: Cash Price |
$364.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$356.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$320.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$320.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$338.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$356.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$338.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$356.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$356.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$267.31
|
| Rate for Payer: Healthfirst Commercial |
$356.42
|
| Rate for Payer: Healthfirst Essential Plan |
$801.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$338.60
|
| Rate for Payer: Healthfirst QHP |
$356.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$249.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$356.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$302.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$249.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$356.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$267.31
|
| Rate for Payer: SOMOS Essential |
$267.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$356.42
|
|
