|
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
|
|
|
CHG CT LUMBAR SPINE W/CONTRAST MATERIAL
|
Professional
|
Both
|
$510.02
|
|
|
Service Code
|
HCPCS 72132 TC
|
| Min. Negotiated Rate |
$93.79 |
| Max. Negotiated Rate |
$301.48 |
| Rate for Payer: Cash Price |
$137.60
|
| 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 LUMBAR SPINE W/CONTRAST MATERIAL
|
Professional
|
Both
|
$742.49
|
|
|
Service Code
|
HCPCS 72132
|
| Min. Negotiated Rate |
$137.33 |
| Max. Negotiated Rate |
$441.40 |
| Rate for Payer: Cash Price |
$200.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$196.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$176.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$176.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$186.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$196.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$186.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$196.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$196.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$147.13
|
| Rate for Payer: Healthfirst Commercial |
$196.18
|
| Rate for Payer: Healthfirst Essential Plan |
$441.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$186.37
|
| Rate for Payer: Healthfirst QHP |
$196.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$137.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$196.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$166.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$137.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$196.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$147.13
|
| Rate for Payer: SOMOS Essential |
$147.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$196.18
|
|
|
CHG CT LUMBAR SPINE W/CONTRAST MATERIAL
|
Professional
|
Both
|
$232.47
|
|
|
Service Code
|
HCPCS 72132 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 LUMBAR SPINE W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$562.98
|
|
|
Service Code
|
HCPCS 72131
|
| Min. Negotiated Rate |
$104.80 |
| Max. Negotiated Rate |
$336.87 |
| Rate for Payer: Cash Price |
$152.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$149.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$134.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$134.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$142.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$149.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$142.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$149.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$149.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$112.29
|
| Rate for Payer: Healthfirst Commercial |
$149.72
|
| Rate for Payer: Healthfirst Essential Plan |
$336.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$142.23
|
| Rate for Payer: Healthfirst QHP |
$149.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$104.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$149.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$127.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$104.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$149.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$112.29
|
| Rate for Payer: SOMOS Essential |
$112.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$149.72
|
|
|
CHG CT LUMBAR SPINE W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$375.06
|
|
|
Service Code
|
HCPCS 72131 TC
|
| Min. Negotiated Rate |
$69.17 |
| Max. Negotiated Rate |
$222.34 |
| Rate for Payer: Cash Price |
$101.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$98.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$88.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$88.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$93.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$98.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$93.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$98.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$98.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$74.11
|
| Rate for Payer: Healthfirst Commercial |
$98.82
|
| Rate for Payer: Healthfirst Essential Plan |
$222.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$93.88
|
| Rate for Payer: Healthfirst QHP |
$98.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$69.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$98.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$84.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$69.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$98.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$74.11
|
| Rate for Payer: SOMOS Essential |
$74.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$98.82
|
|
|
CHG CT LUMBAR SPINE W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$187.95
|
|
|
Service Code
|
HCPCS 72131 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 LUMBAR SPINE W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$873.67
|
|
|
Service Code
|
HCPCS 72133
|
| Min. Negotiated Rate |
$160.16 |
| Max. Negotiated Rate |
$514.80 |
| Rate for Payer: Cash Price |
$235.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$228.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$205.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$205.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$217.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$228.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$217.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$228.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$228.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$171.60
|
| Rate for Payer: Healthfirst Commercial |
$228.80
|
| Rate for Payer: Healthfirst Essential Plan |
$514.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$217.36
|
| Rate for Payer: Healthfirst QHP |
$228.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$160.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$228.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$194.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$160.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$228.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$171.60
|
| Rate for Payer: SOMOS Essential |
$171.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$228.80
|
|
|
CHG CT LUMBAR SPINE W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$244.34
|
|
|
Service Code
|
HCPCS 72133 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 LUMBAR SPINE W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$629.34
|
|
|
Service Code
|
HCPCS 72133 TC
|
| Min. Negotiated Rate |
$114.71 |
| Max. Negotiated Rate |
$368.71 |
| Rate for Payer: Cash Price |
$169.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$163.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$147.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$147.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$155.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$163.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$155.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$163.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$163.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$122.90
|
| Rate for Payer: Healthfirst Commercial |
$163.87
|
| Rate for Payer: Healthfirst Essential Plan |
$368.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$155.68
|
| Rate for Payer: Healthfirst QHP |
$163.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$114.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$163.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$139.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$114.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$163.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$122.90
|
| Rate for Payer: SOMOS Essential |
$122.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$163.87
|
|
|
CHG CT MAXILLOFACIAL W/CONTRAST MATERIAL
|
Professional
|
Both
|
$666.68
|
|
|
Service Code
|
HCPCS 70487
|
| Min. Negotiated Rate |
$123.47 |
| Max. Negotiated Rate |
$396.88 |
| Rate for Payer: Cash Price |
$180.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$176.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$158.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$158.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$167.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$176.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$167.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$176.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$176.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$132.29
|
| Rate for Payer: Healthfirst Commercial |
$176.39
|
| Rate for Payer: Healthfirst Essential Plan |
$396.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$167.57
|
| Rate for Payer: Healthfirst QHP |
$176.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$123.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$176.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$149.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$123.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$176.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$132.29
|
| Rate for Payer: SOMOS Essential |
$132.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$176.39
|
|
|
CHG CT MAXILLOFACIAL W/CONTRAST MATERIAL
|
Professional
|
Both
|
$449.79
|
|
|
Service Code
|
HCPCS 70487 TC
|
| Min. Negotiated Rate |
$82.92 |
| Max. Negotiated Rate |
$266.54 |
| Rate for Payer: Cash Price |
$122.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$118.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$106.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$106.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$112.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$118.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$112.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$118.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$118.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.84
|
| Rate for Payer: Healthfirst Commercial |
$118.46
|
| Rate for Payer: Healthfirst Essential Plan |
$266.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$112.54
|
| Rate for Payer: Healthfirst QHP |
$118.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$82.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$118.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$100.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$82.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$118.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$88.84
|
| Rate for Payer: SOMOS Essential |
$88.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$118.46
|
|
|
CHG CT MAXILLOFACIAL W/CONTRAST MATERIAL
|
Professional
|
Both
|
$216.90
|
|
|
Service Code
|
HCPCS 70487 26
|
| Min. Negotiated Rate |
$40.55 |
| Max. Negotiated Rate |
$130.34 |
| Rate for Payer: Cash Price |
$58.48
|
| 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 MAXILLOFACIAL W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$562.91
|
|
|
Service Code
|
HCPCS 70486
|
| Min. Negotiated Rate |
$104.17 |
| Max. Negotiated Rate |
$334.85 |
| Rate for Payer: Cash Price |
$152.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$148.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$133.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$141.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$148.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$141.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$148.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$148.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$111.61
|
| Rate for Payer: Healthfirst Commercial |
$148.82
|
| Rate for Payer: Healthfirst Essential Plan |
$334.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$141.38
|
| Rate for Payer: Healthfirst QHP |
$148.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$104.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$148.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$126.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$104.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$148.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$111.61
|
| Rate for Payer: SOMOS Essential |
$111.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$148.82
|
|
|
CHG CT MAXILLOFACIAL W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$399.49
|
|
|
Service Code
|
HCPCS 70486 TC
|
| Min. Negotiated Rate |
$73.25 |
| Max. Negotiated Rate |
$235.44 |
| Rate for Payer: Cash Price |
$107.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$104.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$94.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$94.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$99.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$104.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$99.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$104.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$104.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$78.48
|
| Rate for Payer: Healthfirst Commercial |
$104.64
|
| Rate for Payer: Healthfirst Essential Plan |
$235.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$99.41
|
| Rate for Payer: Healthfirst QHP |
$104.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$73.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$104.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$88.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$73.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$104.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$78.48
|
| Rate for Payer: SOMOS Essential |
$78.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$104.64
|
|
|
CHG CT MAXILLOFACIAL W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$163.42
|
|
|
Service Code
|
HCPCS 70486 26
|
| Min. Negotiated Rate |
$30.93 |
| Max. Negotiated Rate |
$99.41 |
| Rate for Payer: Cash Price |
$44.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$44.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$44.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.13
|
| Rate for Payer: Healthfirst Commercial |
$44.18
|
| Rate for Payer: Healthfirst Essential Plan |
$99.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.97
|
| Rate for Payer: Healthfirst QHP |
$44.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$44.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$44.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$33.13
|
| Rate for Payer: SOMOS Essential |
$33.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44.18
|
|
|
CHG CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$570.40
|
|
|
Service Code
|
HCPCS 70488 TC
|
| Min. Negotiated Rate |
$104.12 |
| Max. Negotiated Rate |
$334.67 |
| Rate for Payer: Cash Price |
$153.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$148.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$133.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$141.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$148.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$141.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$148.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$148.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$111.56
|
| Rate for Payer: Healthfirst Commercial |
$148.74
|
| Rate for Payer: Healthfirst Essential Plan |
$334.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$141.30
|
| Rate for Payer: Healthfirst QHP |
$148.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$104.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$148.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$126.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$104.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$148.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$111.56
|
| Rate for Payer: SOMOS Essential |
$111.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$148.74
|
|
|
CHG CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$814.77
|
|
|
Service Code
|
HCPCS 70488
|
| Min. Negotiated Rate |
$149.56 |
| Max. Negotiated Rate |
$480.74 |
| Rate for Payer: Cash Price |
$219.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$213.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$192.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$192.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$202.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$213.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$202.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$213.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$213.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$160.25
|
| Rate for Payer: Healthfirst Commercial |
$213.66
|
| Rate for Payer: Healthfirst Essential Plan |
$480.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$202.98
|
| Rate for Payer: Healthfirst QHP |
$213.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$149.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$213.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$181.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$149.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$213.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$160.25
|
| Rate for Payer: SOMOS Essential |
$160.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$213.66
|
|
|
CHG CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$244.34
|
|
|
Service Code
|
HCPCS 70488 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 ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL
|
Professional
|
Both
|
$580.48
|
|
|
Service Code
|
HCPCS 70481 TC
|
| Min. Negotiated Rate |
$106.29 |
| Max. Negotiated Rate |
$341.64 |
| Rate for Payer: Cash Price |
$156.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$151.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$136.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$136.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$144.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$151.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$144.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$151.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$151.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$113.88
|
| Rate for Payer: Healthfirst Commercial |
$151.84
|
| Rate for Payer: Healthfirst Essential Plan |
$341.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$144.25
|
| Rate for Payer: Healthfirst QHP |
$151.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$106.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$151.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$129.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$106.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$151.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$113.88
|
| Rate for Payer: SOMOS Essential |
$113.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$151.84
|
|
|
CHG CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL
|
Professional
|
Both
|
$797.37
|
|
|
Service Code
|
HCPCS 70481
|
| Min. Negotiated Rate |
$146.84 |
| Max. Negotiated Rate |
$471.98 |
| Rate for Payer: Cash Price |
$215.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$209.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$188.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$188.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$199.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$209.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$199.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$157.33
|
| Rate for Payer: Healthfirst Commercial |
$209.77
|
| Rate for Payer: Healthfirst Essential Plan |
$471.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$199.28
|
| Rate for Payer: Healthfirst QHP |
$209.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$146.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$209.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$178.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$146.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$209.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$157.33
|
| Rate for Payer: SOMOS Essential |
$157.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$209.77
|
|
|
CHG CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL
|
Professional
|
Both
|
$216.90
|
|
|
Service Code
|
HCPCS 70481 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 ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL
|
Professional
|
Both
|
$693.95
|
|
|
Service Code
|
HCPCS 70480
|
| Min. Negotiated Rate |
$128.88 |
| Max. Negotiated Rate |
$414.27 |
| Rate for Payer: Cash Price |
$188.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$184.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$165.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$165.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$174.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$184.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$174.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$184.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$184.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$138.09
|
| Rate for Payer: Healthfirst Commercial |
$184.12
|
| Rate for Payer: Healthfirst Essential Plan |
$414.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$174.91
|
| Rate for Payer: Healthfirst QHP |
$184.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$128.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$184.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$156.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$128.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$184.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$138.09
|
| Rate for Payer: SOMOS Essential |
$138.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$184.12
|
|
|
CHG CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL
|
Professional
|
Both
|
$446.92
|
|
|
Service Code
|
HCPCS 70480 TC
|
| Min. Negotiated Rate |
$82.65 |
| Max. Negotiated Rate |
$265.66 |
| Rate for Payer: Cash Price |
$121.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$118.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$106.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$106.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$112.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$118.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$112.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$118.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$118.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.55
|
| Rate for Payer: Healthfirst Commercial |
$118.07
|
| Rate for Payer: Healthfirst Essential Plan |
$265.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$112.17
|
| Rate for Payer: Healthfirst QHP |
$118.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$82.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$118.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$100.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$82.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$118.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$88.55
|
| Rate for Payer: SOMOS Essential |
$88.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$118.07
|
|
|
CHG CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL
|
Professional
|
Both
|
$247.03
|
|
|
Service Code
|
HCPCS 70480 26
|
| Min. Negotiated Rate |
$46.23 |
| Max. Negotiated Rate |
$148.61 |
| Rate for Payer: Cash Price |
$67.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$66.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$59.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$59.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$66.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$66.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$66.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$49.54
|
| Rate for Payer: Healthfirst Commercial |
$66.05
|
| Rate for Payer: Healthfirst Essential Plan |
$148.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.75
|
| Rate for Payer: Healthfirst QHP |
$66.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$46.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$66.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$56.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$46.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$66.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$49.54
|
| Rate for Payer: SOMOS Essential |
$49.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$66.05
|
|
