|
CHG CT HEAD/BRAIN W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$161.98
|
|
|
Service Code
|
HCPCS 70450 26
|
| Min. Negotiated Rate |
$30.65 |
| Max. Negotiated Rate |
$98.53 |
| Rate for Payer: Cash Price |
$43.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$43.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.84
|
| Rate for Payer: Healthfirst Commercial |
$43.79
|
| Rate for Payer: Healthfirst Essential Plan |
$98.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.60
|
| Rate for Payer: Healthfirst QHP |
$43.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$43.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.84
|
| Rate for Payer: SOMOS Essential |
$32.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.79
|
|
|
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
|
|
|
CHG CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$764.44
|
|
|
Service Code
|
HCPCS 70470
|
| Min. Negotiated Rate |
$140.87 |
| Max. Negotiated Rate |
$452.79 |
| Rate for Payer: Cash Price |
$206.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$201.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$181.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$181.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$191.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$201.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$191.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$201.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$201.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$150.93
|
| Rate for Payer: Healthfirst Commercial |
$201.24
|
| Rate for Payer: Healthfirst Essential Plan |
$452.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$191.18
|
| Rate for Payer: Healthfirst QHP |
$201.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$140.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$201.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$171.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$140.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$201.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$150.93
|
| Rate for Payer: SOMOS Essential |
$150.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$201.24
|
|
|
CHG CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$244.34
|
|
|
Service Code
|
HCPCS 70470 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 HEAD/BRAIN W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$520.10
|
|
|
Service Code
|
HCPCS 70470 TC
|
| Min. Negotiated Rate |
$95.15 |
| Max. Negotiated Rate |
$305.84 |
| Rate for Payer: Cash Price |
$139.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$135.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$122.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$122.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$129.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$135.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$129.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$135.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$135.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$101.95
|
| Rate for Payer: Healthfirst Commercial |
$135.93
|
| Rate for Payer: Healthfirst Essential Plan |
$305.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$129.13
|
| Rate for Payer: Healthfirst QHP |
$135.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$95.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$135.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$115.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$95.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$135.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$101.95
|
| Rate for Payer: SOMOS Essential |
$101.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$135.93
|
|
|
CHG CT HEART C+ CARDIAC STRUX&MORPH CGEN HRT DS
|
Professional
|
Both
|
$771.37
|
|
|
Service Code
|
HCPCS 75573 TC
|
| Min. Negotiated Rate |
$156.60 |
| Max. Negotiated Rate |
$503.37 |
| Rate for Payer: Cash Price |
$228.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$223.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$201.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$201.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$212.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$223.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$212.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$223.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$223.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$167.79
|
| Rate for Payer: Healthfirst Commercial |
$223.72
|
| Rate for Payer: Healthfirst Essential Plan |
$503.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$212.53
|
| Rate for Payer: Healthfirst QHP |
$223.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$156.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$223.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$190.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$156.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$223.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$167.79
|
| Rate for Payer: SOMOS Essential |
$167.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$223.72
|
|
|
CHG CT HEART C+ CARDIAC STRUX&MORPH CGEN HRT DS
|
Professional
|
Both
|
$481.60
|
|
|
Service Code
|
HCPCS 75573 26
|
| Min. Negotiated Rate |
$91.84 |
| Max. Negotiated Rate |
$295.20 |
| Rate for Payer: Cash Price |
$131.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$131.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$118.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$118.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$124.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$131.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$124.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$131.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$131.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$98.40
|
| Rate for Payer: Healthfirst Commercial |
$131.20
|
| Rate for Payer: Healthfirst Essential Plan |
$295.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$124.64
|
| Rate for Payer: Healthfirst QHP |
$131.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$91.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$131.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$111.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$91.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$131.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$98.40
|
| Rate for Payer: SOMOS Essential |
$98.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$131.20
|
|
|
CHG CT HEART C+ CARDIAC STRUX&MORPH CGEN HRT DS
|
Professional
|
Both
|
$1,252.97
|
|
|
Service Code
|
HCPCS 75573
|
| Min. Negotiated Rate |
$248.45 |
| Max. Negotiated Rate |
$798.59 |
| Rate for Payer: Cash Price |
$359.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$354.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$319.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$319.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$337.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$354.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$337.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$354.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$354.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$266.20
|
| Rate for Payer: Healthfirst Commercial |
$354.93
|
| Rate for Payer: Healthfirst Essential Plan |
$798.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$337.18
|
| Rate for Payer: Healthfirst QHP |
$354.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$248.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$354.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$301.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$248.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$354.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$266.20
|
| Rate for Payer: SOMOS Essential |
$266.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$354.93
|
|
|
CHG CT HEART CONTRAST EVAL CARDIAC STRUCTURE&MORPH
|
Professional
|
Both
|
$663.57
|
|
|
Service Code
|
HCPCS 75572 TC
|
| Min. Negotiated Rate |
$122.75 |
| Max. Negotiated Rate |
$394.56 |
| Rate for Payer: Cash Price |
$180.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$175.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$157.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$157.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$166.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$175.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$166.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$175.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$131.52
|
| Rate for Payer: Healthfirst Commercial |
$175.36
|
| Rate for Payer: Healthfirst Essential Plan |
$394.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$166.59
|
| Rate for Payer: Healthfirst QHP |
$175.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$122.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$175.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$149.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$122.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$175.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$131.52
|
| Rate for Payer: SOMOS Essential |
$131.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$175.36
|
|
|
CHG CT HEART CONTRAST EVAL CARDIAC STRUCTURE&MORPH
|
Professional
|
Both
|
$330.19
|
|
|
Service Code
|
HCPCS 75572 26
|
| Min. Negotiated Rate |
$62.08 |
| Max. Negotiated Rate |
$199.53 |
| Rate for Payer: Cash Price |
$89.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$88.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$79.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$79.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$88.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$84.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$88.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$66.51
|
| Rate for Payer: Healthfirst Commercial |
$88.68
|
| Rate for Payer: Healthfirst Essential Plan |
$199.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$84.25
|
| Rate for Payer: Healthfirst QHP |
$88.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$62.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$88.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$75.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$62.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$88.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$66.51
|
| Rate for Payer: SOMOS Essential |
$66.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$88.68
|
|
|
CHG CT HEART CONTRAST EVAL CARDIAC STRUCTURE&MORPH
|
Professional
|
Both
|
$993.76
|
|
|
Service Code
|
HCPCS 75572
|
| Min. Negotiated Rate |
$184.83 |
| Max. Negotiated Rate |
$594.09 |
| Rate for Payer: Cash Price |
$269.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$264.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$237.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$237.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$250.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$264.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$250.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$264.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$198.03
|
| Rate for Payer: Healthfirst Commercial |
$264.04
|
| Rate for Payer: Healthfirst Essential Plan |
$594.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$250.84
|
| Rate for Payer: Healthfirst QHP |
$264.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$184.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$264.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$224.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$184.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$264.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$198.03
|
| Rate for Payer: SOMOS Essential |
$198.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$264.04
|
|
|
CHG CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM
|
Professional
|
Both
|
$326.17
|
|
|
Service Code
|
HCPCS 75571 TC
|
| Min. Negotiated Rate |
$61.19 |
| Max. Negotiated Rate |
$196.67 |
| Rate for Payer: Cash Price |
$89.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$87.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$78.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$78.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$83.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$87.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$83.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$87.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$87.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$65.56
|
| Rate for Payer: Healthfirst Commercial |
$87.41
|
| Rate for Payer: Healthfirst Essential Plan |
$196.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$83.04
|
| Rate for Payer: Healthfirst QHP |
$87.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$61.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$87.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$74.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$61.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$87.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$65.56
|
| Rate for Payer: SOMOS Essential |
$65.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$87.41
|
|
|
CHG CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM
|
Professional
|
Both
|
$113.79
|
|
|
Service Code
|
HCPCS 75571 26
|
| Min. Negotiated Rate |
$20.99 |
| Max. Negotiated Rate |
$67.48 |
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$28.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.49
|
| Rate for Payer: Healthfirst Commercial |
$29.99
|
| Rate for Payer: Healthfirst Essential Plan |
$67.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.49
|
| Rate for Payer: Healthfirst QHP |
$29.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$25.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.49
|
| Rate for Payer: SOMOS Essential |
$22.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.99
|
|
|
CHG CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM
|
Professional
|
Both
|
$439.95
|
|
|
Service Code
|
HCPCS 75571
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$264.13 |
| Rate for Payer: Cash Price |
$119.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$117.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$105.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$105.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$111.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$117.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$111.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$117.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$117.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.04
|
| Rate for Payer: Healthfirst Commercial |
$117.39
|
| Rate for Payer: Healthfirst Essential Plan |
$264.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$111.52
|
| Rate for Payer: Healthfirst QHP |
$117.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$82.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$117.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$99.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$82.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$117.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$88.04
|
| Rate for Payer: SOMOS Essential |
$88.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$117.39
|
|
|
CHG CT LIMITED/LOCALIZED FOLLOW UP STUDY
|
Professional
|
Both
|
$183.72
|
|
|
Service Code
|
HCPCS 76380 26
|
| Min. Negotiated Rate |
$34.22 |
| Max. Negotiated Rate |
$109.98 |
| Rate for Payer: Cash Price |
$49.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$48.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$46.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$48.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$46.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.66
|
| Rate for Payer: Healthfirst Commercial |
$48.88
|
| Rate for Payer: Healthfirst Essential Plan |
$109.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.44
|
| Rate for Payer: Healthfirst QHP |
$48.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$48.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$48.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36.66
|
| Rate for Payer: SOMOS Essential |
$36.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$48.88
|
|
|
CHG CT LIMITED/LOCALIZED FOLLOW UP STUDY
|
Professional
|
Both
|
$369.29
|
|
|
Service Code
|
HCPCS 76380 TC
|
| Min. Negotiated Rate |
$71.89 |
| Max. Negotiated Rate |
$231.07 |
| Rate for Payer: Cash Price |
$105.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$102.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$92.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$92.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$97.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$102.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$97.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$102.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$102.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$77.03
|
| Rate for Payer: Healthfirst Commercial |
$102.70
|
| Rate for Payer: Healthfirst Essential Plan |
$231.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$97.56
|
| Rate for Payer: Healthfirst QHP |
$102.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$71.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$102.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$87.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$71.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$102.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$77.03
|
| Rate for Payer: SOMOS Essential |
$77.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$102.70
|
|
|
CHG CT LIMITED/LOCALIZED FOLLOW UP STUDY
|
Professional
|
Both
|
$553.04
|
|
|
Service Code
|
HCPCS 76380
|
| Min. Negotiated Rate |
$106.11 |
| Max. Negotiated Rate |
$341.08 |
| Rate for Payer: Cash Price |
$155.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$151.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$136.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$136.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$144.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$151.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$144.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$151.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$151.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$113.69
|
| Rate for Payer: Healthfirst Commercial |
$151.59
|
| Rate for Payer: Healthfirst Essential Plan |
$341.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$144.01
|
| Rate for Payer: Healthfirst QHP |
$151.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$106.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$151.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$128.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$106.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$151.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$113.69
|
| Rate for Payer: SOMOS Essential |
$113.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$151.59
|
|
|
CHG CT LOWER EXTREMITY W/CONTRAST MATERIAL
|
Professional
|
Both
|
$511.46
|
|
|
Service Code
|
HCPCS 73701 TC
|
| Min. Negotiated Rate |
$93.79 |
| Max. Negotiated Rate |
$301.48 |
| Rate for Payer: Cash Price |
$137.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$133.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$120.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$120.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$127.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$133.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$127.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$133.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$133.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$100.49
|
| Rate for Payer: Healthfirst Commercial |
$133.99
|
| Rate for Payer: Healthfirst Essential Plan |
$301.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$127.29
|
| Rate for Payer: Healthfirst QHP |
$133.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$93.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$133.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$113.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$93.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$133.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$100.49
|
| Rate for Payer: SOMOS Essential |
$100.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$133.99
|
|
|
CHG CT LOWER EXTREMITY W/CONTRAST MATERIAL
|
Professional
|
Both
|
$222.08
|
|
|
Service Code
|
HCPCS 73701 26
|
| Min. Negotiated Rate |
$41.55 |
| Max. Negotiated Rate |
$133.54 |
| Rate for Payer: Cash Price |
$60.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$59.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$53.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$56.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$59.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$56.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.51
|
| Rate for Payer: Healthfirst Commercial |
$59.35
|
| Rate for Payer: Healthfirst Essential Plan |
$133.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$56.38
|
| Rate for Payer: Healthfirst QHP |
$59.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$41.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$59.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$50.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$41.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$59.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$44.51
|
| Rate for Payer: SOMOS Essential |
$44.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$59.35
|
|
|
CHG CT LOWER EXTREMITY W/CONTRAST MATERIAL
|
Professional
|
Both
|
$733.57
|
|
|
Service Code
|
HCPCS 73701
|
| Min. Negotiated Rate |
$135.34 |
| Max. Negotiated Rate |
$435.01 |
| Rate for Payer: Cash Price |
$198.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$193.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$174.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$174.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$183.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$193.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$183.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$193.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$193.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$145.00
|
| Rate for Payer: Healthfirst Commercial |
$193.34
|
| Rate for Payer: Healthfirst Essential Plan |
$435.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$183.67
|
| Rate for Payer: Healthfirst QHP |
$193.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$135.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$193.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$164.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$135.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$193.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$145.00
|
| Rate for Payer: SOMOS Essential |
$145.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$193.34
|
|
|
CHG CT LOWER EXTREMITY W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$187.95
|
|
|
Service Code
|
HCPCS 73700 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 LOWER EXTREMITY W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$564.41
|
|
|
Service Code
|
HCPCS 73700
|
| Min. Negotiated Rate |
$105.08 |
| Max. Negotiated Rate |
$337.75 |
| Rate for Payer: Cash Price |
$153.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$150.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$135.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$135.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$142.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$150.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$142.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$112.58
|
| Rate for Payer: Healthfirst Commercial |
$150.11
|
| Rate for Payer: Healthfirst Essential Plan |
$337.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$142.60
|
| Rate for Payer: Healthfirst QHP |
$150.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$105.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$150.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$127.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$105.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$150.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$112.58
|
| Rate for Payer: SOMOS Essential |
$112.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$150.11
|
|
|
CHG CT LOWER EXTREMITY W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$376.50
|
|
|
Service Code
|
HCPCS 73700 TC
|
| Min. Negotiated Rate |
$69.45 |
| Max. Negotiated Rate |
$223.22 |
| Rate for Payer: Cash Price |
$101.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$99.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$89.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$89.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$94.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$99.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$94.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$99.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$99.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$74.41
|
| Rate for Payer: Healthfirst Commercial |
$99.21
|
| Rate for Payer: Healthfirst Essential Plan |
$223.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$94.25
|
| Rate for Payer: Healthfirst QHP |
$99.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$69.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$99.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$84.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$69.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$99.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$74.41
|
| Rate for Payer: SOMOS Essential |
$74.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$99.21
|
|
|
CHG CT LOWER EXTREMITY W/O & W/CONTRAST MATRL
|
Professional
|
Both
|
$231.04
|
|
|
Service Code
|
HCPCS 73702 26
|
| Min. Negotiated Rate |
$43.27 |
| Max. Negotiated Rate |
$139.07 |
| Rate for Payer: Cash Price |
$62.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$61.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$55.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$55.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$58.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$61.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$58.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$61.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$46.36
|
| Rate for Payer: Healthfirst Commercial |
$61.81
|
| Rate for Payer: Healthfirst Essential Plan |
$139.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$58.72
|
| Rate for Payer: Healthfirst QHP |
$61.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$43.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$61.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$52.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$43.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$61.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$46.36
|
| Rate for Payer: SOMOS Essential |
$46.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$61.81
|
|
|
CHG CT LOWER EXTREMITY W/O & W/CONTRAST MATRL
|
Professional
|
Both
|
$629.34
|
|
|
Service Code
|
HCPCS 73702 TC
|
| Min. Negotiated Rate |
$115.53 |
| Max. Negotiated Rate |
$371.34 |
| Rate for Payer: Cash Price |
$169.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$165.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$148.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$148.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$156.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$165.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$156.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$165.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$123.78
|
| Rate for Payer: Healthfirst Commercial |
$165.04
|
| Rate for Payer: Healthfirst Essential Plan |
$371.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$156.79
|
| Rate for Payer: Healthfirst QHP |
$165.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$115.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$165.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$140.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$115.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$165.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$123.78
|
| Rate for Payer: SOMOS Essential |
$123.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$165.04
|
|
