|
CHG CT CERVICAL SPINE W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$187.95
|
|
|
Service Code
|
HCPCS 72125 26
|
| Min. Negotiated Rate |
$35.63 |
| Max. Negotiated Rate |
$114.53 |
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$50.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$45.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$45.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$48.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$50.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$48.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.17
|
| Rate for Payer: Healthfirst Commercial |
$50.90
|
| Rate for Payer: Healthfirst Essential Plan |
$114.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$48.35
|
| Rate for Payer: Healthfirst QHP |
$50.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$35.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$50.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$43.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$35.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$50.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$38.17
|
| Rate for Payer: SOMOS Essential |
$38.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.90
|
|
|
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
|
|
|
CHG CT CERVICAL SPINE W/O &W/CONTRAST MATERIAL
|
Professional
|
Both
|
$870.80
|
|
|
Service Code
|
HCPCS 72127
|
| Min. Negotiated Rate |
$159.89 |
| Max. Negotiated Rate |
$513.92 |
| Rate for Payer: Cash Price |
$235.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$228.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$205.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$205.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$216.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$228.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$216.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$228.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$228.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$171.31
|
| Rate for Payer: Healthfirst Commercial |
$228.41
|
| Rate for Payer: Healthfirst Essential Plan |
$513.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$216.99
|
| Rate for Payer: Healthfirst QHP |
$228.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$159.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$228.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$194.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$159.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$228.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$171.31
|
| Rate for Payer: SOMOS Essential |
$171.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$228.41
|
|
|
CHG CT CERVICAL SPINE W/O &W/CONTRAST MATERIAL
|
Professional
|
Both
|
$242.90
|
|
|
Service Code
|
HCPCS 72127 26
|
| Min. Negotiated Rate |
$45.45 |
| Max. Negotiated Rate |
$146.09 |
| Rate for Payer: Cash Price |
$65.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$64.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$58.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$61.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$64.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$61.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.70
|
| Rate for Payer: Healthfirst Commercial |
$64.93
|
| Rate for Payer: Healthfirst Essential Plan |
$146.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.68
|
| Rate for Payer: Healthfirst QHP |
$64.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$64.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$55.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$64.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$48.70
|
| Rate for Payer: SOMOS Essential |
$48.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$64.93
|
|
|
CHG CT CERVICAL SPINE W/O &W/CONTRAST MATERIAL
|
Professional
|
Both
|
$627.90
|
|
|
Service Code
|
HCPCS 72127 TC
|
| Min. Negotiated Rate |
$114.44 |
| Max. Negotiated Rate |
$367.85 |
| Rate for Payer: Cash Price |
$169.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$163.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$147.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$147.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$155.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$163.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$155.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$163.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$163.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$122.62
|
| Rate for Payer: Healthfirst Commercial |
$163.49
|
| Rate for Payer: Healthfirst Essential Plan |
$367.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$155.32
|
| Rate for Payer: Healthfirst QHP |
$163.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$114.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$163.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$138.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$114.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$163.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$122.62
|
| Rate for Payer: SOMOS Essential |
$122.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$163.49
|
|
|
CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/CONTRAST
|
Professional
|
Both
|
$767.34
|
|
|
Service Code
|
HCPCS 74262 TC
|
| Min. Negotiated Rate |
$286.05 |
| Max. Negotiated Rate |
$919.44 |
| Rate for Payer: Cash Price |
$427.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$408.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$367.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$367.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$388.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$408.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$388.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$408.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$408.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$306.48
|
| Rate for Payer: Healthfirst Commercial |
$408.64
|
| Rate for Payer: Healthfirst Essential Plan |
$919.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$388.21
|
| Rate for Payer: Healthfirst QHP |
$408.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$286.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$408.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$347.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$286.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$408.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$306.48
|
| Rate for Payer: SOMOS Essential |
$306.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$408.64
|
|
|
CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/CONTRAST
|
Professional
|
Both
|
$1,244.11
|
|
|
Service Code
|
HCPCS 74262
|
| Min. Negotiated Rate |
$376.68 |
| Max. Negotiated Rate |
$1,210.77 |
| Rate for Payer: Cash Price |
$556.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$538.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$484.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$484.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$511.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$538.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$511.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$538.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$538.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$403.59
|
| Rate for Payer: Healthfirst Commercial |
$538.12
|
| Rate for Payer: Healthfirst Essential Plan |
$1,210.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$511.21
|
| Rate for Payer: Healthfirst QHP |
$538.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$376.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$538.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$457.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$376.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$538.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$403.59
|
| Rate for Payer: SOMOS Essential |
$403.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$538.12
|
|
|
CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/CONTRAST
|
Professional
|
Both
|
$476.77
|
|
|
Service Code
|
HCPCS 74262 26
|
| Min. Negotiated Rate |
$90.64 |
| Max. Negotiated Rate |
$291.33 |
| Rate for Payer: Cash Price |
$129.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$129.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$116.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$116.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$123.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$129.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$123.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$129.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$129.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$97.11
|
| Rate for Payer: Healthfirst Commercial |
$129.48
|
| Rate for Payer: Healthfirst Essential Plan |
$291.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$123.01
|
| Rate for Payer: Healthfirst QHP |
$129.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$90.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$129.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$110.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$90.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$129.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$97.11
|
| Rate for Payer: SOMOS Essential |
$97.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$129.48
|
|
|
CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/O CONTRAST
|
Professional
|
Both
|
$458.50
|
|
|
Service Code
|
HCPCS 74261 26
|
| Min. Negotiated Rate |
$87.14 |
| Max. Negotiated Rate |
$280.08 |
| Rate for Payer: Cash Price |
$124.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$124.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$112.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$112.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$118.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$124.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$118.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$124.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$124.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$93.36
|
| Rate for Payer: Healthfirst Commercial |
$124.48
|
| Rate for Payer: Healthfirst Essential Plan |
$280.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$118.26
|
| Rate for Payer: Healthfirst QHP |
$124.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$87.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$124.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$105.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$87.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$124.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$93.36
|
| Rate for Payer: SOMOS Essential |
$93.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$124.48
|
|
|
CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/O CONTRAST
|
Professional
|
Both
|
$912.59
|
|
|
Service Code
|
HCPCS 74261
|
| Min. Negotiated Rate |
$334.88 |
| Max. Negotiated Rate |
$1,076.40 |
| Rate for Payer: Cash Price |
$494.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$478.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$430.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$430.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$454.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$478.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$454.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$478.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$478.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$358.80
|
| Rate for Payer: Healthfirst Commercial |
$478.40
|
| Rate for Payer: Healthfirst Essential Plan |
$1,076.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$454.48
|
| Rate for Payer: Healthfirst QHP |
$478.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$334.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$478.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$406.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$334.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$478.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$358.80
|
| Rate for Payer: SOMOS Essential |
$358.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$478.40
|
|
|
CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/O CONTRAST
|
Professional
|
Both
|
$454.13
|
|
|
Service Code
|
HCPCS 74261 TC
|
| Min. Negotiated Rate |
$247.74 |
| Max. Negotiated Rate |
$796.30 |
| Rate for Payer: Cash Price |
$370.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$353.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$318.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$318.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$336.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$353.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$336.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$353.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$353.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$265.43
|
| Rate for Payer: Healthfirst Commercial |
$353.91
|
| Rate for Payer: Healthfirst Essential Plan |
$796.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$336.21
|
| Rate for Payer: Healthfirst QHP |
$353.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$247.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$353.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$300.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$247.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$353.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$265.43
|
| Rate for Payer: SOMOS Essential |
$265.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$353.91
|
|
|
CHG CT GUIDANCE &MONITORING VISC TISS ABLATION
|
Professional
|
Both
|
$734.90
|
|
|
Service Code
|
HCPCS 77013 26
|
| Min. Negotiated Rate |
$139.10 |
| Max. Negotiated Rate |
$447.10 |
| Rate for Payer: Cash Price |
$199.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$198.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$178.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$178.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$188.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$198.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$188.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$198.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$198.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$149.03
|
| Rate for Payer: Healthfirst Commercial |
$198.71
|
| Rate for Payer: Healthfirst Essential Plan |
$447.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$188.77
|
| Rate for Payer: Healthfirst QHP |
$198.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$139.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$198.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$168.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$139.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$198.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$149.03
|
| Rate for Payer: SOMOS Essential |
$149.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$198.71
|
|
|
CHG CT GUIDANCE NEEDLE PLACEMENT
|
Professional
|
Both
|
$596.02
|
|
|
Service Code
|
HCPCS 77012
|
| Min. Negotiated Rate |
$99.57 |
| Max. Negotiated Rate |
$320.04 |
| Rate for Payer: Cash Price |
$159.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$142.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$128.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$128.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$135.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$142.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$135.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$142.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$142.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$106.68
|
| Rate for Payer: Healthfirst Commercial |
$142.24
|
| Rate for Payer: Healthfirst Essential Plan |
$320.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$135.13
|
| Rate for Payer: Healthfirst QHP |
$142.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$99.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$142.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$120.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$99.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$142.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$106.68
|
| Rate for Payer: SOMOS Essential |
$106.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$142.24
|
|
|
CHG CT GUIDANCE NEEDLE PLACEMENT
|
Professional
|
Both
|
$284.24
|
|
|
Service Code
|
HCPCS 77012 26
|
| Min. Negotiated Rate |
$52.67 |
| Max. Negotiated Rate |
$169.31 |
| Rate for Payer: Cash Price |
$76.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$75.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$67.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$67.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$71.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$75.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$71.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$56.44
|
| Rate for Payer: Healthfirst Commercial |
$75.25
|
| Rate for Payer: Healthfirst Essential Plan |
$169.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$71.49
|
| Rate for Payer: Healthfirst QHP |
$75.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$52.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$75.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$63.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$52.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$75.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$56.44
|
| Rate for Payer: SOMOS Essential |
$56.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$75.25
|
|
|
CHG CT GUIDANCE NEEDLE PLACEMENT
|
Professional
|
Both
|
$311.82
|
|
|
Service Code
|
HCPCS 77012 TC
|
| Min. Negotiated Rate |
$46.89 |
| Max. Negotiated Rate |
$150.73 |
| Rate for Payer: Cash Price |
$83.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$66.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$60.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$63.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$66.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$63.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$66.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$66.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$50.24
|
| Rate for Payer: Healthfirst Commercial |
$66.99
|
| Rate for Payer: Healthfirst Essential Plan |
$150.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$63.64
|
| Rate for Payer: Healthfirst QHP |
$66.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$46.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$66.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$56.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$46.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$66.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$50.24
|
| Rate for Payer: SOMOS Essential |
$50.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$66.99
|
|
|
CHG CT GUIDANCE RADIATION THERAPY FLDS PLACEMENT
|
Professional
|
Both
|
$180.67
|
|
|
Service Code
|
HCPCS 77014 26
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Cash Price |
$49.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$50.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$45.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$45.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$47.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$50.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$47.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$37.50
|
| Rate for Payer: Healthfirst Commercial |
$50.00
|
| Rate for Payer: Healthfirst Essential Plan |
$112.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.50
|
| Rate for Payer: Healthfirst QHP |
$50.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$35.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$50.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$42.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$35.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$50.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$37.50
|
| Rate for Payer: SOMOS Essential |
$37.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.00
|
|
|
CHG CT GUIDANCE RADIATION THERAPY FLDS PLACEMENT
|
Professional
|
Both
|
$509.71
|
|
|
Service Code
|
HCPCS 77014
|
| Min. Negotiated Rate |
$95.48 |
| Max. Negotiated Rate |
$306.90 |
| Rate for Payer: Cash Price |
$138.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$136.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$122.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$122.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$129.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$136.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$129.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$136.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$136.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$102.30
|
| Rate for Payer: Healthfirst Commercial |
$136.40
|
| Rate for Payer: Healthfirst Essential Plan |
$306.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$129.58
|
| Rate for Payer: Healthfirst QHP |
$136.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$95.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$136.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$115.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$95.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$136.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$102.30
|
| Rate for Payer: SOMOS Essential |
$102.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$136.40
|
|
|
CHG CT GUIDANCE RADIATION THERAPY FLDS PLACEMENT
|
Professional
|
Both
|
$329.04
|
|
|
Service Code
|
HCPCS 77014 TC
|
| Min. Negotiated Rate |
$60.48 |
| Max. Negotiated Rate |
$194.40 |
| Rate for Payer: Cash Price |
$89.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$86.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$77.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$77.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$82.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$86.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$82.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.80
|
| Rate for Payer: Healthfirst Commercial |
$86.40
|
| Rate for Payer: Healthfirst Essential Plan |
$194.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$82.08
|
| Rate for Payer: Healthfirst QHP |
$86.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$60.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$86.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$73.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$60.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$86.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$64.80
|
| Rate for Payer: SOMOS Essential |
$64.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$86.40
|
|
|
CHG CT GUIDANCE STEREOTACTIC LOCALIZATION
|
Professional
|
Both
|
$955.29
|
|
|
Service Code
|
HCPCS 77011
|
| Min. Negotiated Rate |
$175.29 |
| Max. Negotiated Rate |
$563.42 |
| Rate for Payer: Cash Price |
$257.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$250.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$225.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$225.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$237.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$250.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$237.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$250.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$250.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$187.81
|
| Rate for Payer: Healthfirst Commercial |
$250.41
|
| Rate for Payer: Healthfirst Essential Plan |
$563.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$237.89
|
| Rate for Payer: Healthfirst QHP |
$250.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$175.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$250.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$212.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$175.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$250.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$187.81
|
| Rate for Payer: SOMOS Essential |
$187.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$250.41
|
|
|
CHG CT GUIDANCE STEREOTACTIC LOCALIZATION
|
Professional
|
Both
|
$251.06
|
|
|
Service Code
|
HCPCS 77011 26
|
| Min. Negotiated Rate |
$47.15 |
| Max. Negotiated Rate |
$151.56 |
| Rate for Payer: Cash Price |
$68.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$67.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$60.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$63.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$67.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$63.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$50.52
|
| Rate for Payer: Healthfirst Commercial |
$67.36
|
| Rate for Payer: Healthfirst Essential Plan |
$151.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$63.99
|
| Rate for Payer: Healthfirst QHP |
$67.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$47.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$67.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$57.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$47.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$67.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$50.52
|
| Rate for Payer: SOMOS Essential |
$50.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$67.36
|
|
|
CHG CT GUIDANCE STEREOTACTIC LOCALIZATION
|
Professional
|
Both
|
$704.24
|
|
|
Service Code
|
HCPCS 77011 TC
|
| Min. Negotiated Rate |
$128.13 |
| Max. Negotiated Rate |
$411.86 |
| Rate for Payer: Cash Price |
$189.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$183.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$164.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$164.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$173.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$183.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$173.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$183.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$183.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$137.29
|
| Rate for Payer: Healthfirst Commercial |
$183.05
|
| Rate for Payer: Healthfirst Essential Plan |
$411.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$173.90
|
| Rate for Payer: Healthfirst QHP |
$183.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$128.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$183.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$155.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$128.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$183.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$137.29
|
| Rate for Payer: SOMOS Essential |
$137.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$183.05
|
|
|
CHG CT HEAD/BRAIN W/CONTRAST MATERIAL
|
Professional
|
Both
|
$647.99
|
|
|
Service Code
|
HCPCS 70460
|
| Min. Negotiated Rate |
$120.48 |
| Max. Negotiated Rate |
$387.27 |
| Rate for Payer: Cash Price |
$175.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$172.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$154.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$154.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$163.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$172.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$163.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$172.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$172.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$129.09
|
| Rate for Payer: Healthfirst Commercial |
$172.12
|
| Rate for Payer: Healthfirst Essential Plan |
$387.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$163.51
|
| Rate for Payer: Healthfirst QHP |
$172.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$120.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$172.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$146.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$120.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$172.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$129.09
|
| Rate for Payer: SOMOS Essential |
$129.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$172.12
|
|
|
CHG CT HEAD/BRAIN W/CONTRAST MATERIAL
|
Professional
|
Both
|
$216.90
|
|
|
Service Code
|
HCPCS 70460 26
|
| Min. Negotiated Rate |
$40.55 |
| Max. Negotiated Rate |
$130.34 |
| Rate for Payer: Cash Price |
$58.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$57.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$52.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$52.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$55.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$57.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$55.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.45
|
| Rate for Payer: Healthfirst Commercial |
$57.93
|
| Rate for Payer: Healthfirst Essential Plan |
$130.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$55.03
|
| Rate for Payer: Healthfirst QHP |
$57.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$40.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$57.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$49.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$40.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$57.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$43.45
|
| Rate for Payer: SOMOS Essential |
$43.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$57.93
|
|
|
CHG CT HEAD/BRAIN W/CONTRAST MATERIAL
|
Professional
|
Both
|
$431.10
|
|
|
Service Code
|
HCPCS 70460 TC
|
| Min. Negotiated Rate |
$79.93 |
| Max. Negotiated Rate |
$256.93 |
| Rate for Payer: Cash Price |
$116.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$114.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$102.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$102.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$108.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$114.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$108.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$114.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$114.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$85.64
|
| Rate for Payer: Healthfirst Commercial |
$114.19
|
| Rate for Payer: Healthfirst Essential Plan |
$256.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$108.48
|
| Rate for Payer: Healthfirst QHP |
$114.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$79.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$114.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$97.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$79.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$114.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$85.64
|
| Rate for Payer: SOMOS Essential |
$85.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$114.19
|
|
|
CHG CT HEAD/BRAIN W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$463.72
|
|
|
Service Code
|
HCPCS 70450
|
| Min. Negotiated Rate |
$86.51 |
| Max. Negotiated Rate |
$278.08 |
| Rate for Payer: Cash Price |
$125.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$123.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$111.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$111.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$117.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$123.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$117.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$123.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$123.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$92.69
|
| Rate for Payer: Healthfirst Commercial |
$123.59
|
| Rate for Payer: Healthfirst Essential Plan |
$278.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$117.41
|
| Rate for Payer: Healthfirst QHP |
$123.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$86.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$123.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$105.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$86.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$123.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$92.69
|
| Rate for Payer: SOMOS Essential |
$92.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$123.59
|
|
