|
CHG CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST
|
Professional
|
Both
|
$1,117.41
|
|
|
Service Code
|
HCPCS 71275
|
| Min. Negotiated Rate |
$229.93 |
| Max. Negotiated Rate |
$739.06 |
| Rate for Payer: Cash Price |
$335.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$328.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$295.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$295.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$312.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$328.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$312.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$328.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$328.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$246.35
|
| Rate for Payer: Healthfirst Commercial |
$328.47
|
| Rate for Payer: Healthfirst Essential Plan |
$739.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$312.05
|
| Rate for Payer: Healthfirst QHP |
$328.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$229.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$328.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$279.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$229.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$328.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$246.35
|
| Rate for Payer: SOMOS Essential |
$246.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$328.47
|
|
|
CHG CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST
|
Professional
|
Both
|
$348.74
|
|
|
Service Code
|
HCPCS 71275 26
|
| Min. Negotiated Rate |
$65.88 |
| Max. Negotiated Rate |
$211.75 |
| Rate for Payer: Cash Price |
$94.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$94.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$84.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$84.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$89.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$94.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$89.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$94.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$94.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$70.58
|
| Rate for Payer: Healthfirst Commercial |
$94.11
|
| Rate for Payer: Healthfirst Essential Plan |
$211.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$89.40
|
| Rate for Payer: Healthfirst QHP |
$94.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$65.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$94.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$79.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$65.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$94.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$70.58
|
| Rate for Payer: SOMOS Essential |
$70.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$94.11
|
|
|
CHG CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST
|
Professional
|
Both
|
$768.64
|
|
|
Service Code
|
HCPCS 71275 TC
|
| Min. Negotiated Rate |
$164.05 |
| Max. Negotiated Rate |
$527.31 |
| Rate for Payer: Cash Price |
$240.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$234.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$210.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$210.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$222.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$234.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$222.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$234.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$234.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$175.77
|
| Rate for Payer: Healthfirst Commercial |
$234.36
|
| Rate for Payer: Healthfirst Essential Plan |
$527.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$222.64
|
| Rate for Payer: Healthfirst QHP |
$234.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$164.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$234.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$199.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$164.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$234.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$175.77
|
| Rate for Payer: SOMOS Essential |
$175.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$234.36
|
|
|
CHG CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST
|
Professional
|
Both
|
$768.64
|
|
|
Service Code
|
HCPCS 70496 TC
|
| Min. Negotiated Rate |
$162.42 |
| Max. Negotiated Rate |
$522.07 |
| Rate for Payer: Cash Price |
$238.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$232.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$208.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$208.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$220.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$232.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$220.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$232.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$232.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$174.02
|
| Rate for Payer: Healthfirst Commercial |
$232.03
|
| Rate for Payer: Healthfirst Essential Plan |
$522.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$220.43
|
| Rate for Payer: Healthfirst QHP |
$232.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$162.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$232.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$197.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$162.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$232.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$174.02
|
| Rate for Payer: SOMOS Essential |
$174.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$232.03
|
|
|
CHG CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST
|
Professional
|
Both
|
$1,105.76
|
|
|
Service Code
|
HCPCS 70496
|
| Min. Negotiated Rate |
$225.20 |
| Max. Negotiated Rate |
$723.87 |
| Rate for Payer: Cash Price |
$328.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$321.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$289.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$289.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$305.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$321.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$305.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$321.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$321.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$241.29
|
| Rate for Payer: Healthfirst Commercial |
$321.72
|
| Rate for Payer: Healthfirst Essential Plan |
$723.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$305.63
|
| Rate for Payer: Healthfirst QHP |
$321.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$225.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$321.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$273.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$225.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$321.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$241.29
|
| Rate for Payer: SOMOS Essential |
$241.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$321.72
|
|
|
CHG CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST
|
Professional
|
Both
|
$337.12
|
|
|
Service Code
|
HCPCS 70496 26
|
| Min. Negotiated Rate |
$62.78 |
| Max. Negotiated Rate |
$201.78 |
| Rate for Payer: Cash Price |
$90.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$89.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$80.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$80.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$85.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$89.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$85.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$89.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$89.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67.26
|
| Rate for Payer: Healthfirst Commercial |
$89.68
|
| Rate for Payer: Healthfirst Essential Plan |
$201.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$85.20
|
| Rate for Payer: Healthfirst QHP |
$89.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$62.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$89.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$76.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$62.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$89.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$67.26
|
| Rate for Payer: SOMOS Essential |
$67.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$89.68
|
|
|
CHG CT ANGIOGRAPHY LOWER EXTREMITY
|
Professional
|
Both
|
$1,128.86
|
|
|
Service Code
|
HCPCS 73706
|
| Min. Negotiated Rate |
$263.54 |
| Max. Negotiated Rate |
$847.08 |
| Rate for Payer: Cash Price |
$385.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$376.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$338.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$338.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$357.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$376.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$357.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$376.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$376.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$282.36
|
| Rate for Payer: Healthfirst Commercial |
$376.48
|
| Rate for Payer: Healthfirst Essential Plan |
$847.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$357.66
|
| Rate for Payer: Healthfirst QHP |
$376.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$263.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$376.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$320.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$263.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$376.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$282.36
|
| Rate for Payer: SOMOS Essential |
$282.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$376.48
|
|
|
CHG CT ANGIOGRAPHY LOWER EXTREMITY
|
Professional
|
Both
|
$360.22
|
|
|
Service Code
|
HCPCS 73706 26
|
| Min. Negotiated Rate |
$68.08 |
| Max. Negotiated Rate |
$218.81 |
| Rate for Payer: Cash Price |
$97.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$97.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$87.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$87.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$92.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$97.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$92.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$97.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$97.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.94
|
| Rate for Payer: Healthfirst Commercial |
$97.25
|
| Rate for Payer: Healthfirst Essential Plan |
$218.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$92.39
|
| Rate for Payer: Healthfirst QHP |
$97.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$68.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$97.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$82.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$68.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$97.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$72.94
|
| Rate for Payer: SOMOS Essential |
$72.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$97.25
|
|
|
CHG CT ANGIOGRAPHY LOWER EXTREMITY
|
Professional
|
Both
|
$768.64
|
|
|
Service Code
|
HCPCS 73706 TC
|
| Min. Negotiated Rate |
$195.46 |
| Max. Negotiated Rate |
$628.27 |
| Rate for Payer: Cash Price |
$287.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$279.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$251.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$251.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$265.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$279.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$265.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$279.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$279.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$209.42
|
| Rate for Payer: Healthfirst Commercial |
$279.23
|
| Rate for Payer: Healthfirst Essential Plan |
$628.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$265.27
|
| Rate for Payer: Healthfirst QHP |
$279.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$195.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$279.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$237.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$195.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$279.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$209.42
|
| Rate for Payer: SOMOS Essential |
$209.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$279.23
|
|
|
CHG CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST
|
Professional
|
Both
|
$337.12
|
|
|
Service Code
|
HCPCS 70498 26
|
| Min. Negotiated Rate |
$62.78 |
| Max. Negotiated Rate |
$201.78 |
| Rate for Payer: Cash Price |
$90.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$89.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$80.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$80.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$85.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$89.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$85.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$89.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$89.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67.26
|
| Rate for Payer: Healthfirst Commercial |
$89.68
|
| Rate for Payer: Healthfirst Essential Plan |
$201.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$85.20
|
| Rate for Payer: Healthfirst QHP |
$89.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$62.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$89.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$76.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$62.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$89.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$67.26
|
| Rate for Payer: SOMOS Essential |
$67.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$89.68
|
|
|
CHG CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST
|
Professional
|
Both
|
$1,105.76
|
|
|
Service Code
|
HCPCS 70498
|
| Min. Negotiated Rate |
$224.93 |
| Max. Negotiated Rate |
$722.99 |
| Rate for Payer: Cash Price |
$328.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$321.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$289.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$289.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$305.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$321.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$305.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$321.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$321.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$241.00
|
| Rate for Payer: Healthfirst Commercial |
$321.33
|
| Rate for Payer: Healthfirst Essential Plan |
$722.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$305.26
|
| Rate for Payer: Healthfirst QHP |
$321.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$224.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$321.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$273.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$224.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$321.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$241.00
|
| Rate for Payer: SOMOS Essential |
$241.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$321.33
|
|
|
CHG CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST
|
Professional
|
Both
|
$768.64
|
|
|
Service Code
|
HCPCS 70498 TC
|
| Min. Negotiated Rate |
$162.15 |
| Max. Negotiated Rate |
$521.19 |
| Rate for Payer: Cash Price |
$237.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$208.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$208.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$220.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$220.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$231.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$173.73
|
| Rate for Payer: Healthfirst Commercial |
$231.64
|
| Rate for Payer: Healthfirst Essential Plan |
$521.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$220.06
|
| Rate for Payer: Healthfirst QHP |
$231.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$162.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$231.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$196.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$162.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$173.73
|
| Rate for Payer: SOMOS Essential |
$173.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.64
|
|
|
CHG CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST
|
Professional
|
Both
|
$768.64
|
|
|
Service Code
|
HCPCS 72191 TC
|
| Min. Negotiated Rate |
$183.62 |
| Max. Negotiated Rate |
$590.20 |
| Rate for Payer: Cash Price |
$270.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$262.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$236.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$236.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$249.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$262.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$249.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$262.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$262.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$196.73
|
| Rate for Payer: Healthfirst Commercial |
$262.31
|
| Rate for Payer: Healthfirst Essential Plan |
$590.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$249.19
|
| Rate for Payer: Healthfirst QHP |
$262.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$183.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$262.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$222.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$183.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$262.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$196.73
|
| Rate for Payer: SOMOS Essential |
$196.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$262.31
|
|
|
CHG CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST
|
Professional
|
Both
|
$1,111.85
|
|
|
Service Code
|
HCPCS 72191
|
| Min. Negotiated Rate |
$248.44 |
| Max. Negotiated Rate |
$798.55 |
| Rate for Payer: Cash Price |
$363.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$354.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$319.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$319.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$337.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$354.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$337.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$354.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$354.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$266.18
|
| Rate for Payer: Healthfirst Commercial |
$354.91
|
| Rate for Payer: Healthfirst Essential Plan |
$798.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$337.16
|
| Rate for Payer: Healthfirst QHP |
$354.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$248.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$354.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$301.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$248.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$354.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$266.18
|
| Rate for Payer: SOMOS Essential |
$266.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$354.91
|
|
|
CHG CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST
|
Professional
|
Both
|
$343.18
|
|
|
Service Code
|
HCPCS 72191 26
|
| Min. Negotiated Rate |
$64.82 |
| Max. Negotiated Rate |
$208.35 |
| Rate for Payer: Cash Price |
$92.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$92.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$83.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$83.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$87.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$92.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$87.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.45
|
| Rate for Payer: Healthfirst Commercial |
$92.60
|
| Rate for Payer: Healthfirst Essential Plan |
$208.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$87.97
|
| Rate for Payer: Healthfirst QHP |
$92.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$92.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$78.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$92.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.45
|
| Rate for Payer: SOMOS Essential |
$69.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$92.60
|
|
|
CHG CT ANGIOGRAPHY UPPER EXTREMITY
|
Professional
|
Both
|
$768.64
|
|
|
Service Code
|
HCPCS 73206 TC
|
| Min. Negotiated Rate |
$177.80 |
| Max. Negotiated Rate |
$571.50 |
| Rate for Payer: Cash Price |
$261.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$254.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$228.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$228.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$241.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$254.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$241.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$254.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$254.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$190.50
|
| Rate for Payer: Healthfirst Commercial |
$254.00
|
| Rate for Payer: Healthfirst Essential Plan |
$571.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$241.30
|
| Rate for Payer: Healthfirst QHP |
$254.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$177.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$254.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$215.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$177.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$254.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$190.50
|
| Rate for Payer: SOMOS Essential |
$190.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$254.00
|
|
|
CHG CT ANGIOGRAPHY UPPER EXTREMITY
|
Professional
|
Both
|
$1,111.85
|
|
|
Service Code
|
HCPCS 73206
|
| Min. Negotiated Rate |
$242.62 |
| Max. Negotiated Rate |
$779.85 |
| Rate for Payer: Cash Price |
$354.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$346.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$311.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$311.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$329.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$346.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$329.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$346.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$346.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$259.95
|
| Rate for Payer: Healthfirst Commercial |
$346.60
|
| Rate for Payer: Healthfirst Essential Plan |
$779.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$329.27
|
| Rate for Payer: Healthfirst QHP |
$346.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$242.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$346.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$294.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$242.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$346.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$259.95
|
| Rate for Payer: SOMOS Essential |
$259.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$346.60
|
|
|
CHG CT ANGIOGRAPHY UPPER EXTREMITY
|
Professional
|
Both
|
$343.18
|
|
|
Service Code
|
HCPCS 73206 26
|
| Min. Negotiated Rate |
$64.82 |
| Max. Negotiated Rate |
$208.35 |
| Rate for Payer: Cash Price |
$92.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$92.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$83.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$83.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$87.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$92.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$87.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.45
|
| Rate for Payer: Healthfirst Commercial |
$92.60
|
| Rate for Payer: Healthfirst Essential Plan |
$208.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$87.97
|
| Rate for Payer: Healthfirst QHP |
$92.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$92.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$78.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$92.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.45
|
| Rate for Payer: SOMOS Essential |
$69.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$92.60
|
|
|
CHG CT BONE MINERL DENSITY STUDY 1/> SITS AXIAL SKE
|
Professional
|
Both
|
$369.29
|
|
|
Service Code
|
HCPCS 77078 TC
|
| Min. Negotiated Rate |
$72.16 |
| Max. Negotiated Rate |
$231.95 |
| Rate for Payer: Cash Price |
$108.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$103.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$92.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$92.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$97.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$103.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$97.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$103.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$77.32
|
| Rate for Payer: Healthfirst Commercial |
$103.09
|
| Rate for Payer: Healthfirst Essential Plan |
$231.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$97.94
|
| Rate for Payer: Healthfirst QHP |
$103.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$72.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$103.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$87.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$72.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$103.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$77.32
|
| Rate for Payer: SOMOS Essential |
$77.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$103.09
|
|
|
CHG CT BONE MINERL DENSITY STUDY 1/> SITS AXIAL SKE
|
Professional
|
Both
|
$46.97
|
|
|
Service Code
|
HCPCS 77078 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 CT BONE MINERL DENSITY STUDY 1/> SITS AXIAL SKE
|
Professional
|
Both
|
$416.29
|
|
|
Service Code
|
HCPCS 77078
|
| Min. Negotiated Rate |
$81.07 |
| Max. Negotiated Rate |
$260.60 |
| Rate for Payer: Cash Price |
$121.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$115.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$104.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$104.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$110.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$115.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$110.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$115.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$115.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$86.86
|
| Rate for Payer: Healthfirst Commercial |
$115.82
|
| Rate for Payer: Healthfirst Essential Plan |
$260.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$110.03
|
| Rate for Payer: Healthfirst QHP |
$115.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$81.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$115.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$98.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$81.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$115.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$86.86
|
| Rate for Payer: SOMOS Essential |
$86.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$115.82
|
|
|
CHG CT CERVICAL SPINE W/CONTRAST MATERIAL
|
Professional
|
Both
|
$232.47
|
|
|
Service Code
|
HCPCS 72126 26
|
| Min. Negotiated Rate |
$43.54 |
| Max. Negotiated Rate |
$139.95 |
| Rate for Payer: Cash Price |
$63.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$55.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$55.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$59.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$59.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$62.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$46.65
|
| Rate for Payer: Healthfirst Commercial |
$62.20
|
| Rate for Payer: Healthfirst Essential Plan |
$139.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$59.09
|
| Rate for Payer: Healthfirst QHP |
$62.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$43.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$62.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$52.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$43.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$46.65
|
| Rate for Payer: SOMOS Essential |
$46.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.20
|
|
|
CHG CT CERVICAL SPINE W/CONTRAST MATERIAL
|
Professional
|
Both
|
$741.06
|
|
|
Service Code
|
HCPCS 72126
|
| Min. Negotiated Rate |
$136.79 |
| Max. Negotiated Rate |
$439.67 |
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$195.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$175.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$175.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$185.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$195.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$185.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$195.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$146.56
|
| Rate for Payer: Healthfirst Commercial |
$195.41
|
| Rate for Payer: Healthfirst Essential Plan |
$439.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$185.64
|
| Rate for Payer: Healthfirst QHP |
$195.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$136.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$195.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$166.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$136.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$195.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$146.56
|
| Rate for Payer: SOMOS Essential |
$146.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$195.41
|
|
|
CHG CT CERVICAL SPINE W/CONTRAST MATERIAL
|
Professional
|
Both
|
$508.59
|
|
|
Service Code
|
HCPCS 72126 TC
|
| Min. Negotiated Rate |
$93.25 |
| Max. Negotiated Rate |
$299.72 |
| Rate for Payer: Cash Price |
$137.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$133.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$119.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$119.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$126.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$133.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$126.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$133.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$133.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$99.91
|
| Rate for Payer: Healthfirst Commercial |
$133.21
|
| Rate for Payer: Healthfirst Essential Plan |
$299.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$126.55
|
| Rate for Payer: Healthfirst QHP |
$133.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$93.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$133.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$113.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$93.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$133.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$99.91
|
| Rate for Payer: SOMOS Essential |
$99.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$133.21
|
|
|
CHG CT CERVICAL SPINE W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$565.88
|
|
|
Service Code
|
HCPCS 72125
|
| Min. Negotiated Rate |
$105.34 |
| Max. Negotiated Rate |
$338.60 |
| Rate for Payer: Cash Price |
$154.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$150.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$135.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$135.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$142.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$150.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$142.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$112.87
|
| Rate for Payer: Healthfirst Commercial |
$150.49
|
| Rate for Payer: Healthfirst Essential Plan |
$338.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$142.97
|
| Rate for Payer: Healthfirst QHP |
$150.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$105.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$150.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$127.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$105.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$150.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$112.87
|
| Rate for Payer: SOMOS Essential |
$112.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$150.49
|
|
