|
CHG M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR PER SPEC EACH
|
Professional
|
Both
|
$282.52
|
|
|
Service Code
|
HCPCS 88373
|
| Min. Negotiated Rate |
$51.91 |
| Max. Negotiated Rate |
$166.86 |
| Rate for Payer: Cash Price |
$77.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$74.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$66.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$66.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$70.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$74.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$70.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$74.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$55.62
|
| Rate for Payer: Healthfirst Commercial |
$74.16
|
| Rate for Payer: Healthfirst Essential Plan |
$166.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$70.45
|
| Rate for Payer: Healthfirst QHP |
$74.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$51.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$74.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$63.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$51.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$74.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$55.62
|
| Rate for Payer: SOMOS Essential |
$55.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$74.16
|
|
|
CHG M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR PER SPEC EACH
|
Professional
|
Both
|
$94.22
|
|
|
Service Code
|
HCPCS 88373 26
|
| Min. Negotiated Rate |
$18.06 |
| Max. Negotiated Rate |
$58.05 |
| Rate for Payer: Cash Price |
$26.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.35
|
| Rate for Payer: Healthfirst Commercial |
$25.80
|
| Rate for Payer: Healthfirst Essential Plan |
$58.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24.51
|
| Rate for Payer: Healthfirst QHP |
$25.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$25.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$21.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19.35
|
| Rate for Payer: SOMOS Essential |
$19.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.80
|
|
|
CHG M/PHMTRC ALYS ISH QUANT/SEMIQ MNL EACH MULTIPRB
|
Professional
|
Both
|
$1,434.34
|
|
|
Service Code
|
HCPCS 88377 TC
|
| Min. Negotiated Rate |
$265.67 |
| Max. Negotiated Rate |
$853.94 |
| Rate for Payer: Cash Price |
$394.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$379.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$341.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$341.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$360.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$379.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$360.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$379.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$379.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$284.65
|
| Rate for Payer: Healthfirst Commercial |
$379.53
|
| Rate for Payer: Healthfirst Essential Plan |
$853.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$360.55
|
| Rate for Payer: Healthfirst QHP |
$379.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$265.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$379.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$322.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$265.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$379.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$284.65
|
| Rate for Payer: SOMOS Essential |
$284.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$379.53
|
|
|
CHG M/PHMTRC ALYS ISH QUANT/SEMIQ MNL EACH MULTIPRB
|
Professional
|
Both
|
$1,675.66
|
|
|
Service Code
|
HCPCS 88377
|
| Min. Negotiated Rate |
$312.36 |
| Max. Negotiated Rate |
$1,004.02 |
| Rate for Payer: Cash Price |
$460.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$446.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$401.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$401.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$423.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$446.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$423.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$446.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$446.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$334.67
|
| Rate for Payer: Healthfirst Commercial |
$446.23
|
| Rate for Payer: Healthfirst Essential Plan |
$1,004.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$423.92
|
| Rate for Payer: Healthfirst QHP |
$446.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$312.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$446.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$379.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$312.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$446.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$334.67
|
| Rate for Payer: SOMOS Essential |
$334.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$446.23
|
|
|
CHG M/PHMTRC ALYS ISH QUANT/SEMIQ MNL EACH MULTIPRB
|
Professional
|
Both
|
$241.33
|
|
|
Service Code
|
HCPCS 88377 26
|
| Min. Negotiated Rate |
$46.69 |
| Max. Negotiated Rate |
$150.07 |
| Rate for Payer: Cash Price |
$66.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$66.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$60.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$63.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$66.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$63.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$66.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$66.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$50.02
|
| Rate for Payer: Healthfirst Commercial |
$66.70
|
| Rate for Payer: Healthfirst Essential Plan |
$150.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$63.37
|
| Rate for Payer: Healthfirst QHP |
$66.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$46.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$66.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$56.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$46.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$66.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$50.02
|
| Rate for Payer: SOMOS Essential |
$50.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$66.70
|
|
|
CHG M/PHMTRC ALYS ISH QUANT/SEMIQ MNL PER SPEC EACH
|
Professional
|
Both
|
$512.89
|
|
|
Service Code
|
HCPCS 88369
|
| Min. Negotiated Rate |
$104.69 |
| Max. Negotiated Rate |
$336.51 |
| Rate for Payer: Cash Price |
$148.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$149.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$134.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$134.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$142.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$149.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$142.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$149.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$149.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$112.17
|
| Rate for Payer: Healthfirst Commercial |
$149.56
|
| Rate for Payer: Healthfirst Essential Plan |
$336.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$142.08
|
| Rate for Payer: Healthfirst QHP |
$149.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$104.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$149.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$127.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$104.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$149.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$112.17
|
| Rate for Payer: SOMOS Essential |
$112.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$149.56
|
|
|
CHG M/PHMTRC ALYS ISH QUANT/SEMIQ MNL PER SPEC EACH
|
Professional
|
Both
|
$126.35
|
|
|
Service Code
|
HCPCS 88369 26
|
| Min. Negotiated Rate |
$24.92 |
| Max. Negotiated Rate |
$80.10 |
| Rate for Payer: Cash Price |
$35.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.70
|
| Rate for Payer: Healthfirst Commercial |
$35.60
|
| Rate for Payer: Healthfirst Essential Plan |
$80.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.82
|
| Rate for Payer: Healthfirst QHP |
$35.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.70
|
| Rate for Payer: SOMOS Essential |
$26.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.60
|
|
|
CHG M/PHMTRC ALYS ISH QUANT/SEMIQ MNL PER SPEC EACH
|
Professional
|
Both
|
$386.54
|
|
|
Service Code
|
HCPCS 88369 TC
|
| Min. Negotiated Rate |
$79.77 |
| Max. Negotiated Rate |
$256.41 |
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$113.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$102.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$102.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$108.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$113.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$108.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$113.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$113.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$85.47
|
| Rate for Payer: Healthfirst Commercial |
$113.96
|
| Rate for Payer: Healthfirst Essential Plan |
$256.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$108.26
|
| Rate for Payer: Healthfirst QHP |
$113.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$79.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$113.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$96.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$79.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$113.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$85.47
|
| Rate for Payer: SOMOS Essential |
$85.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$113.96
|
|
|
CHG MRA ABDOMEN W/WO CONTRAST MATERIAL
|
Professional
|
Both
|
$1,501.43
|
|
|
Service Code
|
HCPCS 74185
|
| Min. Negotiated Rate |
$275.25 |
| Max. Negotiated Rate |
$884.75 |
| Rate for Payer: Cash Price |
$403.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$393.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$353.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$353.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$373.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$393.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$373.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$393.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$393.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$294.92
|
| Rate for Payer: Healthfirst Commercial |
$393.22
|
| Rate for Payer: Healthfirst Essential Plan |
$884.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$373.56
|
| Rate for Payer: Healthfirst QHP |
$393.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$275.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$393.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$334.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$275.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$393.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$294.92
|
| Rate for Payer: SOMOS Essential |
$294.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$393.22
|
|
|
CHG MRA ABDOMEN W/WO CONTRAST MATERIAL
|
Professional
|
Both
|
$1,158.08
|
|
|
Service Code
|
HCPCS 74185 TC
|
| Min. Negotiated Rate |
$210.68 |
| Max. Negotiated Rate |
$677.18 |
| Rate for Payer: Cash Price |
$310.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$300.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$270.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$270.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$285.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$300.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$285.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$300.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$300.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$225.73
|
| Rate for Payer: Healthfirst Commercial |
$300.97
|
| Rate for Payer: Healthfirst Essential Plan |
$677.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$285.92
|
| Rate for Payer: Healthfirst QHP |
$300.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$210.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$300.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$255.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$210.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$300.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$225.73
|
| Rate for Payer: SOMOS Essential |
$225.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$300.97
|
|
|
CHG MRA ABDOMEN W/WO CONTRAST MATERIAL
|
Professional
|
Both
|
$343.39
|
|
|
Service Code
|
HCPCS 74185 26
|
| Min. Negotiated Rate |
$64.58 |
| Max. Negotiated Rate |
$207.59 |
| Rate for Payer: Cash Price |
$92.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$92.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$83.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$83.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$87.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$92.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$87.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.19
|
| Rate for Payer: Healthfirst Commercial |
$92.26
|
| Rate for Payer: Healthfirst Essential Plan |
$207.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$87.65
|
| Rate for Payer: Healthfirst QHP |
$92.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$92.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$78.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$92.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.19
|
| Rate for Payer: SOMOS Essential |
$69.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$92.26
|
|
|
CHG MRA CHEST W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$344.61
|
|
|
Service Code
|
HCPCS 71555 26
|
| Min. Negotiated Rate |
$64.22 |
| Max. Negotiated Rate |
$206.44 |
| Rate for Payer: Cash Price |
$92.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$91.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$82.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$82.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$87.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$91.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$87.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$91.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$68.81
|
| Rate for Payer: Healthfirst Commercial |
$91.75
|
| Rate for Payer: Healthfirst Essential Plan |
$206.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$87.16
|
| Rate for Payer: Healthfirst QHP |
$91.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$91.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$77.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$91.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$68.81
|
| Rate for Payer: SOMOS Essential |
$68.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$91.75
|
|
|
CHG MRA CHEST W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$1,485.44
|
|
|
Service Code
|
HCPCS 71555
|
| Min. Negotiated Rate |
$271.64 |
| Max. Negotiated Rate |
$873.13 |
| Rate for Payer: Cash Price |
$399.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$388.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$349.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$349.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$368.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$388.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$368.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$388.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$388.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$291.05
|
| Rate for Payer: Healthfirst Commercial |
$388.06
|
| Rate for Payer: Healthfirst Essential Plan |
$873.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$368.66
|
| Rate for Payer: Healthfirst QHP |
$388.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$271.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$388.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$329.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$271.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$388.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$291.05
|
| Rate for Payer: SOMOS Essential |
$291.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$388.06
|
|
|
CHG MRA CHEST W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$1,140.83
|
|
|
Service Code
|
HCPCS 71555 TC
|
| Min. Negotiated Rate |
$207.42 |
| Max. Negotiated Rate |
$666.70 |
| Rate for Payer: Cash Price |
$307.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$296.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$266.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$266.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$281.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$296.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$281.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$296.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$296.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$222.23
|
| Rate for Payer: Healthfirst Commercial |
$296.31
|
| Rate for Payer: Healthfirst Essential Plan |
$666.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$281.49
|
| Rate for Payer: Healthfirst QHP |
$296.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$207.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$296.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$251.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$207.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$296.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$222.23
|
| Rate for Payer: SOMOS Essential |
$222.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$296.31
|
|
|
CHG MRA HEAD W/CONTRAST MATERIAL
|
Professional
|
Both
|
$228.52
|
|
|
Service Code
|
HCPCS 70545 26
|
| Min. Negotiated Rate |
$42.78 |
| Max. Negotiated Rate |
$137.52 |
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$61.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$55.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$55.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$58.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$61.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$58.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$61.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.84
|
| Rate for Payer: Healthfirst Commercial |
$61.12
|
| Rate for Payer: Healthfirst Essential Plan |
$137.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$58.06
|
| Rate for Payer: Healthfirst QHP |
$61.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$42.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$61.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$51.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$42.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$61.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$45.84
|
| Rate for Payer: SOMOS Essential |
$45.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$61.12
|
|
|
CHG MRA HEAD W/CONTRAST MATERIAL
|
Professional
|
Both
|
$782.88
|
|
|
Service Code
|
HCPCS 70545 TC
|
| Min. Negotiated Rate |
$143.13 |
| Max. Negotiated Rate |
$460.06 |
| Rate for Payer: Cash Price |
$210.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$204.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$184.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$184.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$194.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$204.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$194.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$204.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$204.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$153.35
|
| Rate for Payer: Healthfirst Commercial |
$204.47
|
| Rate for Payer: Healthfirst Essential Plan |
$460.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$194.25
|
| Rate for Payer: Healthfirst QHP |
$204.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$143.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$204.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$173.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$143.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$204.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$153.35
|
| Rate for Payer: SOMOS Essential |
$153.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$204.47
|
|
|
CHG MRA HEAD W/CONTRAST MATERIAL
|
Professional
|
Both
|
$1,011.40
|
|
|
Service Code
|
HCPCS 70545
|
| Min. Negotiated Rate |
$185.91 |
| Max. Negotiated Rate |
$597.58 |
| Rate for Payer: Cash Price |
$272.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$265.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$239.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$239.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$252.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$265.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$252.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$265.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$265.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$199.19
|
| Rate for Payer: Healthfirst Commercial |
$265.59
|
| Rate for Payer: Healthfirst Essential Plan |
$597.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$252.31
|
| Rate for Payer: Healthfirst QHP |
$265.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$185.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$265.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$225.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$185.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$265.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$199.19
|
| Rate for Payer: SOMOS Essential |
$199.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$265.59
|
|
|
CHG MRA HEAD W/O CONTRST MATERIAL
|
Professional
|
Both
|
$724.22
|
|
|
Service Code
|
HCPCS 70544 TC
|
| Min. Negotiated Rate |
$133.08 |
| Max. Negotiated Rate |
$427.75 |
| Rate for Payer: Cash Price |
$195.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$190.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$171.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$171.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$180.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$190.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$180.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$190.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$190.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$142.58
|
| Rate for Payer: Healthfirst Commercial |
$190.11
|
| Rate for Payer: Healthfirst Essential Plan |
$427.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$180.60
|
| Rate for Payer: Healthfirst QHP |
$190.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$133.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$190.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$161.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$133.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$190.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$142.58
|
| Rate for Payer: SOMOS Essential |
$142.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$190.11
|
|
|
CHG MRA HEAD W/O CONTRST MATERIAL
|
Professional
|
Both
|
$229.95
|
|
|
Service Code
|
HCPCS 70544 26
|
| Min. Negotiated Rate |
$42.78 |
| Max. Negotiated Rate |
$137.52 |
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$61.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$55.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$55.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$58.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$61.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$58.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$61.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.84
|
| Rate for Payer: Healthfirst Commercial |
$61.12
|
| Rate for Payer: Healthfirst Essential Plan |
$137.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$58.06
|
| Rate for Payer: Healthfirst QHP |
$61.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$42.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$61.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$51.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$42.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$61.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$45.84
|
| Rate for Payer: SOMOS Essential |
$45.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$61.12
|
|
|
CHG MRA HEAD W/O CONTRST MATERIAL
|
Professional
|
Both
|
$954.17
|
|
|
Service Code
|
HCPCS 70544
|
| Min. Negotiated Rate |
$175.86 |
| Max. Negotiated Rate |
$565.27 |
| Rate for Payer: Cash Price |
$258.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$251.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$226.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$226.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$238.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$251.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$238.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$251.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$188.42
|
| Rate for Payer: Healthfirst Commercial |
$251.23
|
| Rate for Payer: Healthfirst Essential Plan |
$565.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$238.67
|
| Rate for Payer: Healthfirst QHP |
$251.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$175.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$251.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$213.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$175.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$251.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$188.42
|
| Rate for Payer: SOMOS Essential |
$188.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$251.23
|
|
|
CHG MRA HEAD W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$283.43
|
|
|
Service Code
|
HCPCS 70546 26
|
| Min. Negotiated Rate |
$53.12 |
| Max. Negotiated Rate |
$170.73 |
| Rate for Payer: Cash Price |
$77.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$75.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$68.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$68.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$72.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$75.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$72.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$56.91
|
| Rate for Payer: Healthfirst Commercial |
$75.88
|
| Rate for Payer: Healthfirst Essential Plan |
$170.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$72.09
|
| Rate for Payer: Healthfirst QHP |
$75.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$53.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$75.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$64.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$53.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$75.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$56.91
|
| Rate for Payer: SOMOS Essential |
$56.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$75.88
|
|
|
CHG MRA HEAD W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$1,183.95
|
|
|
Service Code
|
HCPCS 70546 TC
|
| Min. Negotiated Rate |
$216.92 |
| Max. Negotiated Rate |
$697.25 |
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$309.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$278.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$278.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$309.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$309.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$309.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$232.42
|
| Rate for Payer: Healthfirst Commercial |
$309.89
|
| Rate for Payer: Healthfirst Essential Plan |
$697.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$294.40
|
| Rate for Payer: Healthfirst QHP |
$309.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$216.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$309.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$263.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$216.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$309.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$232.42
|
| Rate for Payer: SOMOS Essential |
$232.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$309.89
|
|
|
CHG MRA HEAD W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$1,467.38
|
|
|
Service Code
|
HCPCS 70546
|
| Min. Negotiated Rate |
$270.05 |
| Max. Negotiated Rate |
$868.00 |
| Rate for Payer: Cash Price |
$396.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$385.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$347.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$347.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$366.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$385.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$366.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$385.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$385.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$289.33
|
| Rate for Payer: Healthfirst Commercial |
$385.78
|
| Rate for Payer: Healthfirst Essential Plan |
$868.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$366.49
|
| Rate for Payer: Healthfirst QHP |
$385.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$270.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$385.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$327.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$270.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$385.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$289.33
|
| Rate for Payer: SOMOS Essential |
$289.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$385.78
|
|
|
CHG MRA LOWER EXTREMITY W/WO CONTRAST MATERIAL
|
Professional
|
Both
|
$344.44
|
|
|
Service Code
|
HCPCS 73725 26
|
| Min. Negotiated Rate |
$65.06 |
| Max. Negotiated Rate |
$209.12 |
| Rate for Payer: Cash Price |
$93.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$92.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$83.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$83.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$88.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$92.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$88.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.70
|
| Rate for Payer: Healthfirst Commercial |
$92.94
|
| Rate for Payer: Healthfirst Essential Plan |
$209.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$88.29
|
| Rate for Payer: Healthfirst QHP |
$92.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$65.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$92.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$79.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$65.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$92.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.70
|
| Rate for Payer: SOMOS Essential |
$69.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$92.94
|
|
|
CHG MRA LOWER EXTREMITY W/WO CONTRAST MATERIAL
|
Professional
|
Both
|
$1,148.00
|
|
|
Service Code
|
HCPCS 73725 TC
|
| Min. Negotiated Rate |
$210.13 |
| Max. Negotiated Rate |
$675.43 |
| Rate for Payer: Cash Price |
$308.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$300.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$270.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$270.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$285.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$300.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$285.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$300.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$300.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$225.14
|
| Rate for Payer: Healthfirst Commercial |
$300.19
|
| Rate for Payer: Healthfirst Essential Plan |
$675.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$285.18
|
| Rate for Payer: Healthfirst QHP |
$300.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$210.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$300.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$255.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$210.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$300.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$225.14
|
| Rate for Payer: SOMOS Essential |
$225.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$300.19
|
|
