|
CHG CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR
|
Professional
|
Both
|
$688.28
|
|
|
Service Code
|
HCPCS 70482 TC
|
| Min. Negotiated Rate |
$125.58 |
| Max. Negotiated Rate |
$403.65 |
| Rate for Payer: Cash Price |
$185.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$179.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$161.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$161.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$170.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$179.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$170.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$179.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$179.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$134.55
|
| Rate for Payer: Healthfirst Commercial |
$179.40
|
| Rate for Payer: Healthfirst Essential Plan |
$403.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$170.43
|
| Rate for Payer: Healthfirst QHP |
$179.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$125.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$179.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$152.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$125.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$179.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$134.55
|
| Rate for Payer: SOMOS Essential |
$134.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$179.40
|
|
|
CHG CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR
|
Professional
|
Both
|
$931.18
|
|
|
Service Code
|
HCPCS 70482
|
| Min. Negotiated Rate |
$171.03 |
| Max. Negotiated Rate |
$549.74 |
| Rate for Payer: Cash Price |
$251.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$244.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$219.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$219.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$232.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$244.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$232.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$244.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$244.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$183.25
|
| Rate for Payer: Healthfirst Commercial |
$244.33
|
| Rate for Payer: Healthfirst Essential Plan |
$549.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$232.11
|
| Rate for Payer: Healthfirst QHP |
$244.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$171.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$244.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$207.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$171.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$244.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$183.25
|
| Rate for Payer: SOMOS Essential |
$183.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$244.33
|
|
|
CHG CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR
|
Professional
|
Both
|
$242.90
|
|
|
Service Code
|
HCPCS 70482 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 PELVIS W/CONTRAST MATERIAL
|
Professional
|
Both
|
$222.08
|
|
|
Service Code
|
HCPCS 72193 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 PELVIS W/CONTRAST MATERIAL
|
Professional
|
Both
|
$767.34
|
|
|
Service Code
|
HCPCS 72193 TC
|
| Min. Negotiated Rate |
$143.51 |
| Max. Negotiated Rate |
$461.30 |
| Rate for Payer: Cash Price |
$213.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$205.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$184.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$184.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$194.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$205.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$194.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$205.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$205.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$153.76
|
| Rate for Payer: Healthfirst Commercial |
$205.02
|
| Rate for Payer: Healthfirst Essential Plan |
$461.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$194.77
|
| Rate for Payer: Healthfirst QHP |
$205.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$143.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$205.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$174.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$143.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$205.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$153.76
|
| Rate for Payer: SOMOS Essential |
$153.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$205.02
|
|
|
CHG CT PELVIS W/CONTRAST MATERIAL
|
Professional
|
Both
|
$989.42
|
|
|
Service Code
|
HCPCS 72193
|
| Min. Negotiated Rate |
$185.06 |
| Max. Negotiated Rate |
$594.83 |
| Rate for Payer: Cash Price |
$273.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$264.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$237.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$237.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$251.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$264.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$251.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$264.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$198.28
|
| Rate for Payer: Healthfirst Commercial |
$264.37
|
| Rate for Payer: Healthfirst Essential Plan |
$594.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$251.15
|
| Rate for Payer: Healthfirst QHP |
$264.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$185.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$264.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$224.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$185.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$264.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$198.28
|
| Rate for Payer: SOMOS Essential |
$198.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$264.37
|
|
|
CHG CT PELVIS W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$208.99
|
|
|
Service Code
|
HCPCS 72192 26
|
| Min. Negotiated Rate |
$39.05 |
| Max. Negotiated Rate |
$125.50 |
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$55.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$50.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$50.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$52.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$55.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$52.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.84
|
| Rate for Payer: Healthfirst Commercial |
$55.78
|
| Rate for Payer: Healthfirst Essential Plan |
$125.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$52.99
|
| Rate for Payer: Healthfirst QHP |
$55.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$39.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$55.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$47.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$39.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$55.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$41.84
|
| Rate for Payer: SOMOS Essential |
$41.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.78
|
|
|
CHG CT PELVIS W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$373.63
|
|
|
Service Code
|
HCPCS 72192 TC
|
| Min. Negotiated Rate |
$68.64 |
| Max. Negotiated Rate |
$220.61 |
| Rate for Payer: Cash Price |
$100.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$98.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$88.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$88.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$93.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$98.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$93.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$98.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$98.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.54
|
| Rate for Payer: Healthfirst Commercial |
$98.05
|
| Rate for Payer: Healthfirst Essential Plan |
$220.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$93.15
|
| Rate for Payer: Healthfirst QHP |
$98.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$68.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$98.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$83.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$68.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$98.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$73.54
|
| Rate for Payer: SOMOS Essential |
$73.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$98.05
|
|
|
CHG CT PELVIS W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$582.61
|
|
|
Service Code
|
HCPCS 72192
|
| Min. Negotiated Rate |
$107.67 |
| Max. Negotiated Rate |
$346.10 |
| Rate for Payer: Cash Price |
$157.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$153.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$138.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$138.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$146.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$153.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$146.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$153.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$153.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$115.36
|
| Rate for Payer: Healthfirst Commercial |
$153.82
|
| Rate for Payer: Healthfirst Essential Plan |
$346.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$146.13
|
| Rate for Payer: Healthfirst QHP |
$153.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$107.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$153.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$130.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$107.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$153.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$115.36
|
| Rate for Payer: SOMOS Essential |
$115.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$153.82
|
|
|
CHG CT PELVIS W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$232.47
|
|
|
Service Code
|
HCPCS 72194 26
|
| Min. Negotiated Rate |
$43.54 |
| Max. Negotiated Rate |
$139.95 |
| Rate for Payer: Cash Price |
$62.80
|
| 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 PELVIS W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$1,001.25
|
|
|
Service Code
|
HCPCS 72194
|
| Min. Negotiated Rate |
$204.44 |
| Max. Negotiated Rate |
$657.13 |
| Rate for Payer: Cash Price |
$302.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$292.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$262.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$262.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$277.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$292.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$277.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$292.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$292.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$219.04
|
| Rate for Payer: Healthfirst Commercial |
$292.06
|
| Rate for Payer: Healthfirst Essential Plan |
$657.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$277.46
|
| Rate for Payer: Healthfirst QHP |
$292.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$204.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$292.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$248.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$204.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$292.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$219.04
|
| Rate for Payer: SOMOS Essential |
$219.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$292.06
|
|
|
CHG CT PELVIS W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$768.78
|
|
|
Service Code
|
HCPCS 72194 TC
|
| Min. Negotiated Rate |
$160.90 |
| Max. Negotiated Rate |
$517.18 |
| Rate for Payer: Cash Price |
$239.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$229.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$206.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$206.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$218.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$229.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$218.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$229.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$229.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$172.40
|
| Rate for Payer: Healthfirst Commercial |
$229.86
|
| Rate for Payer: Healthfirst Essential Plan |
$517.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$218.37
|
| Rate for Payer: Healthfirst QHP |
$229.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$160.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$229.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$195.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$160.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$229.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$172.40
|
| Rate for Payer: SOMOS Essential |
$172.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$229.86
|
|
|
CHG CT SOFT TISSUE NECK W/CONTRAST MATERIAL
|
Professional
|
Both
|
$265.30
|
|
|
Service Code
|
HCPCS 70491 26
|
| Min. Negotiated Rate |
$49.46 |
| Max. Negotiated Rate |
$158.99 |
| Rate for Payer: Cash Price |
$71.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$63.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$63.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$67.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$67.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$70.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$52.99
|
| Rate for Payer: Healthfirst Commercial |
$70.66
|
| Rate for Payer: Healthfirst Essential Plan |
$158.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$67.13
|
| Rate for Payer: Healthfirst QHP |
$70.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$49.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$70.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$60.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$49.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$52.99
|
| Rate for Payer: SOMOS Essential |
$52.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.66
|
|
|
CHG CT SOFT TISSUE NECK W/CONTRAST MATERIAL
|
Professional
|
Both
|
$811.27
|
|
|
Service Code
|
HCPCS 70491
|
| Min. Negotiated Rate |
$149.23 |
| Max. Negotiated Rate |
$479.65 |
| Rate for Payer: Cash Price |
$218.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$213.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$191.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$191.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$202.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$213.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$202.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$213.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$213.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$159.88
|
| Rate for Payer: Healthfirst Commercial |
$213.18
|
| Rate for Payer: Healthfirst Essential Plan |
$479.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$202.52
|
| Rate for Payer: Healthfirst QHP |
$213.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$149.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$213.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$181.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$149.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$213.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$159.88
|
| Rate for Payer: SOMOS Essential |
$159.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$213.18
|
|
|
CHG CT SOFT TISSUE NECK W/CONTRAST MATERIAL
|
Professional
|
Both
|
$545.97
|
|
|
Service Code
|
HCPCS 70491 TC
|
| Min. Negotiated Rate |
$99.77 |
| Max. Negotiated Rate |
$320.69 |
| Rate for Payer: Cash Price |
$147.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$142.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$128.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$128.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$135.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$142.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$135.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$142.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$142.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$106.90
|
| Rate for Payer: Healthfirst Commercial |
$142.53
|
| Rate for Payer: Healthfirst Essential Plan |
$320.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$135.40
|
| Rate for Payer: Healthfirst QHP |
$142.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$99.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$142.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$121.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$99.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$142.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$106.90
|
| Rate for Payer: SOMOS Essential |
$106.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$142.53
|
|
|
CHG CT SOFT TISSUE NECK W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$247.03
|
|
|
Service Code
|
HCPCS 70490 26
|
| Min. Negotiated Rate |
$46.23 |
| Max. Negotiated Rate |
$148.61 |
| Rate for Payer: Cash Price |
$66.70
|
| 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
|
|
|
CHG CT SOFT TISSUE NECK W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$656.57
|
|
|
Service Code
|
HCPCS 70490
|
| Min. Negotiated Rate |
$121.39 |
| Max. Negotiated Rate |
$390.17 |
| Rate for Payer: Cash Price |
$177.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$173.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$156.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$156.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$164.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$173.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$164.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$173.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$173.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$130.06
|
| Rate for Payer: Healthfirst Commercial |
$173.41
|
| Rate for Payer: Healthfirst Essential Plan |
$390.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$164.74
|
| Rate for Payer: Healthfirst QHP |
$173.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$121.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$173.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$147.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$121.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$173.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$130.06
|
| Rate for Payer: SOMOS Essential |
$130.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$173.41
|
|
|
CHG CT SOFT TISSUE NECK W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$409.54
|
|
|
Service Code
|
HCPCS 70490 TC
|
| Min. Negotiated Rate |
$75.15 |
| Max. Negotiated Rate |
$241.56 |
| Rate for Payer: Cash Price |
$110.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$107.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$96.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$96.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$101.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$101.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$107.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.52
|
| Rate for Payer: Healthfirst Commercial |
$107.36
|
| Rate for Payer: Healthfirst Essential Plan |
$241.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$101.99
|
| Rate for Payer: Healthfirst QHP |
$107.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$75.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$107.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$91.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$75.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$107.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$80.52
|
| Rate for Payer: SOMOS Essential |
$80.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$107.36
|
|
|
CHG CT SOFT TISSUE NECK W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$666.72
|
|
|
Service Code
|
HCPCS 70492 TC
|
| Min. Negotiated Rate |
$121.23 |
| Max. Negotiated Rate |
$389.68 |
| Rate for Payer: Cash Price |
$178.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$173.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$155.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$155.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$164.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$173.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$164.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$173.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$173.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$129.89
|
| Rate for Payer: Healthfirst Commercial |
$173.19
|
| Rate for Payer: Healthfirst Essential Plan |
$389.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$164.53
|
| Rate for Payer: Healthfirst QHP |
$173.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$121.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$173.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$147.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$121.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$173.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$129.89
|
| Rate for Payer: SOMOS Essential |
$129.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$173.19
|
|
|
CHG CT SOFT TISSUE NECK W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$974.89
|
|
|
Service Code
|
HCPCS 70492
|
| Min. Negotiated Rate |
$179.09 |
| Max. Negotiated Rate |
$575.64 |
| Rate for Payer: Cash Price |
$262.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$255.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$230.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$230.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$243.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$255.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$243.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$255.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$255.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$191.88
|
| Rate for Payer: Healthfirst Commercial |
$255.84
|
| Rate for Payer: Healthfirst Essential Plan |
$575.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$243.05
|
| Rate for Payer: Healthfirst QHP |
$255.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$179.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$255.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$217.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$179.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$255.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$191.88
|
| Rate for Payer: SOMOS Essential |
$191.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$255.84
|
|
|
CHG CT SOFT TISSUE NECK W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$308.18
|
|
|
Service Code
|
HCPCS 70492 26
|
| Min. Negotiated Rate |
$57.85 |
| Max. Negotiated Rate |
$185.96 |
| Rate for Payer: Cash Price |
$83.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$82.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$74.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$74.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$78.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$82.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$78.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$82.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$61.99
|
| Rate for Payer: Healthfirst Commercial |
$82.65
|
| Rate for Payer: Healthfirst Essential Plan |
$185.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$78.52
|
| Rate for Payer: Healthfirst QHP |
$82.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$57.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$82.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$70.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$57.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$82.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$61.99
|
| Rate for Payer: SOMOS Essential |
$61.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$82.65
|
|
|
CHG CT THORACIC SPINE W/CONTRAST MATERIAL
|
Professional
|
Both
|
$748.13
|
|
|
Service Code
|
HCPCS 72129
|
| Min. Negotiated Rate |
$138.31 |
| Max. Negotiated Rate |
$444.56 |
| Rate for Payer: Cash Price |
$202.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$197.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$177.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$177.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$187.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$197.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$187.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$197.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$197.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$148.19
|
| Rate for Payer: Healthfirst Commercial |
$197.58
|
| Rate for Payer: Healthfirst Essential Plan |
$444.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$187.70
|
| Rate for Payer: Healthfirst QHP |
$197.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$138.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$197.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$167.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$138.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$197.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$148.19
|
| Rate for Payer: SOMOS Essential |
$148.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$197.58
|
|
|
CHG CT THORACIC SPINE W/CONTRAST MATERIAL
|
Professional
|
Both
|
$235.20
|
|
|
Service Code
|
HCPCS 72129 26
|
| Min. Negotiated Rate |
$43.97 |
| Max. Negotiated Rate |
$141.34 |
| Rate for Payer: Cash Price |
$63.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$56.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$56.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$59.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$59.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$62.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.12
|
| Rate for Payer: Healthfirst Commercial |
$62.82
|
| Rate for Payer: Healthfirst Essential Plan |
$141.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$59.68
|
| Rate for Payer: Healthfirst QHP |
$62.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$43.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$62.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$53.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$43.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.12
|
| Rate for Payer: SOMOS Essential |
$47.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.82
|
|
|
CHG CT THORACIC SPINE W/CONTRAST MATERIAL
|
Professional
|
Both
|
$512.93
|
|
|
Service Code
|
HCPCS 72129 TC
|
| Min. Negotiated Rate |
$94.33 |
| Max. Negotiated Rate |
$303.21 |
| Rate for Payer: Cash Price |
$138.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$134.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$121.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$121.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$128.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$134.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$128.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$134.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$134.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$101.07
|
| Rate for Payer: Healthfirst Commercial |
$134.76
|
| Rate for Payer: Healthfirst Essential Plan |
$303.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$128.02
|
| Rate for Payer: Healthfirst QHP |
$134.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$94.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$134.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$114.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$94.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$134.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$101.07
|
| Rate for Payer: SOMOS Essential |
$101.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$134.76
|
|
|
CHG CT THORACIC SPINE W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$187.95
|
|
|
Service Code
|
HCPCS 72128 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
|
|
