|
CHG MRA LOWER EXTREMITY W/WO CONTRAST MATERIAL
|
Professional
|
Both
|
$1,492.44
|
|
|
Service Code
|
HCPCS 73725
|
| Min. Negotiated Rate |
$275.19 |
| Max. Negotiated Rate |
$884.54 |
| Rate for Payer: Cash Price |
$402.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$393.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$353.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$353.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$373.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$393.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$373.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$393.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$393.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$294.85
|
| Rate for Payer: Healthfirst Commercial |
$393.13
|
| Rate for Payer: Healthfirst Essential Plan |
$884.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$373.47
|
| Rate for Payer: Healthfirst QHP |
$393.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$275.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$393.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$334.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$275.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$393.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$294.85
|
| Rate for Payer: SOMOS Essential |
$294.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$393.13
|
|
|
CHG MRA NECK W/CONTRAST MATERIAL
|
Professional
|
Both
|
$804.44
|
|
|
Service Code
|
HCPCS 70548 TC
|
| Min. Negotiated Rate |
$146.94 |
| Max. Negotiated Rate |
$472.30 |
| Rate for Payer: Cash Price |
$216.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$209.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$188.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$188.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$199.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$209.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$199.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$157.43
|
| Rate for Payer: Healthfirst Commercial |
$209.91
|
| Rate for Payer: Healthfirst Essential Plan |
$472.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$199.41
|
| Rate for Payer: Healthfirst QHP |
$209.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$146.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$209.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$178.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$146.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$209.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$157.43
|
| Rate for Payer: SOMOS Essential |
$157.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$209.91
|
|
|
CHG MRA NECK W/CONTRAST MATERIAL
|
Professional
|
Both
|
$287.39
|
|
|
Service Code
|
HCPCS 70548 26
|
| Min. Negotiated Rate |
$53.87 |
| Max. Negotiated Rate |
$173.16 |
| Rate for Payer: Cash Price |
$78.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$76.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$69.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$69.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$73.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$76.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$73.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.72
|
| Rate for Payer: Healthfirst Commercial |
$76.96
|
| Rate for Payer: Healthfirst Essential Plan |
$173.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$73.11
|
| Rate for Payer: Healthfirst QHP |
$76.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$53.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$76.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$65.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$53.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$76.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$57.72
|
| Rate for Payer: SOMOS Essential |
$57.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$76.96
|
|
|
CHG MRA NECK W/CONTRAST MATERIAL
|
Professional
|
Both
|
$1,091.83
|
|
|
Service Code
|
HCPCS 70548
|
| Min. Negotiated Rate |
$200.81 |
| Max. Negotiated Rate |
$645.46 |
| Rate for Payer: Cash Price |
$294.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$286.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$258.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$258.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$272.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$286.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$272.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$286.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$286.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$215.15
|
| Rate for Payer: Healthfirst Commercial |
$286.87
|
| Rate for Payer: Healthfirst Essential Plan |
$645.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$272.53
|
| Rate for Payer: Healthfirst QHP |
$286.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$200.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$286.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$243.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$200.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$286.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$215.15
|
| Rate for Payer: SOMOS Essential |
$215.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$286.87
|
|
|
CHG MRA NECK W/O CONTRST MATERIAL
|
Professional
|
Both
|
$229.95
|
|
|
Service Code
|
HCPCS 70547 26
|
| Min. Negotiated Rate |
$43.06 |
| Max. Negotiated Rate |
$138.40 |
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$61.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$55.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$55.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$58.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$61.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$58.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$61.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$46.13
|
| Rate for Payer: Healthfirst Commercial |
$61.51
|
| Rate for Payer: Healthfirst Essential Plan |
$138.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$58.43
|
| Rate for Payer: Healthfirst QHP |
$61.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$43.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$61.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$52.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$43.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$61.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$46.13
|
| Rate for Payer: SOMOS Essential |
$46.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$61.51
|
|
|
CHG MRA NECK W/O CONTRST MATERIAL
|
Professional
|
Both
|
$955.61
|
|
|
Service Code
|
HCPCS 70547
|
| Min. Negotiated Rate |
$176.41 |
| Max. Negotiated Rate |
$567.02 |
| Rate for Payer: Cash Price |
$258.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$252.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$226.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$226.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$239.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$252.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$239.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$252.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$252.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$189.01
|
| Rate for Payer: Healthfirst Commercial |
$252.01
|
| Rate for Payer: Healthfirst Essential Plan |
$567.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$239.41
|
| Rate for Payer: Healthfirst QHP |
$252.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$176.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$252.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$214.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$176.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$252.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$189.01
|
| Rate for Payer: SOMOS Essential |
$189.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$252.01
|
|
|
CHG MRA NECK W/O CONTRST MATERIAL
|
Professional
|
Both
|
$725.66
|
|
|
Service Code
|
HCPCS 70547 TC
|
| Min. Negotiated Rate |
$133.35 |
| Max. Negotiated Rate |
$428.62 |
| Rate for Payer: Cash Price |
$196.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$190.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$171.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$171.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$180.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$190.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$180.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$190.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$190.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$142.88
|
| Rate for Payer: Healthfirst Commercial |
$190.50
|
| Rate for Payer: Healthfirst Essential Plan |
$428.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$180.97
|
| Rate for Payer: Healthfirst QHP |
$190.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$133.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$190.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$161.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$133.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$190.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$142.88
|
| Rate for Payer: SOMOS Essential |
$142.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$190.50
|
|
|
CHG MRA NECK W/O &W/CONTRAST MATERIAL
|
Professional
|
Both
|
$346.26
|
|
|
Service Code
|
HCPCS 70549 26
|
| Min. Negotiated Rate |
$64.53 |
| Max. Negotiated Rate |
$207.41 |
| Rate for Payer: Cash Price |
$93.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$92.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$82.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$82.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$87.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$92.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$87.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.14
|
| Rate for Payer: Healthfirst Commercial |
$92.18
|
| Rate for Payer: Healthfirst Essential Plan |
$207.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$87.57
|
| Rate for Payer: Healthfirst QHP |
$92.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$92.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$78.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$92.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.14
|
| Rate for Payer: SOMOS Essential |
$69.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$92.18
|
|
|
CHG MRA NECK W/O &W/CONTRAST MATERIAL
|
Professional
|
Both
|
$1,535.94
|
|
|
Service Code
|
HCPCS 70549
|
| Min. Negotiated Rate |
$282.27 |
| Max. Negotiated Rate |
$907.29 |
| Rate for Payer: Cash Price |
$413.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$403.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$362.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$362.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$383.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$403.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$383.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$403.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$403.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$302.43
|
| Rate for Payer: Healthfirst Commercial |
$403.24
|
| Rate for Payer: Healthfirst Essential Plan |
$907.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$383.08
|
| Rate for Payer: Healthfirst QHP |
$403.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$282.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$403.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$342.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$282.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$403.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$302.43
|
| Rate for Payer: SOMOS Essential |
$302.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$403.24
|
|
|
CHG MRA NECK W/O &W/CONTRAST MATERIAL
|
Professional
|
Both
|
$1,189.69
|
|
|
Service Code
|
HCPCS 70549 TC
|
| Min. Negotiated Rate |
$217.74 |
| Max. Negotiated Rate |
$699.88 |
| Rate for Payer: Cash Price |
$320.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$311.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$295.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$311.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$295.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$311.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$311.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$233.29
|
| Rate for Payer: Healthfirst Commercial |
$311.06
|
| Rate for Payer: Healthfirst Essential Plan |
$699.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$295.51
|
| Rate for Payer: Healthfirst QHP |
$311.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$217.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$311.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$264.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$217.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$311.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$233.29
|
| Rate for Payer: SOMOS Essential |
$233.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$311.06
|
|
|
CHG MRA PELVIS W/WO CONTRAST MATERIAL
|
Professional
|
Both
|
$343.39
|
|
|
Service Code
|
HCPCS 72198 26
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$208.44 |
| Rate for Payer: Cash Price |
$92.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$92.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$83.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$83.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$88.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$92.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$88.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.48
|
| Rate for Payer: Healthfirst Commercial |
$92.64
|
| Rate for Payer: Healthfirst Essential Plan |
$208.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$88.01
|
| Rate for Payer: Healthfirst QHP |
$92.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$92.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$78.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$92.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.48
|
| Rate for Payer: SOMOS Essential |
$69.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$92.64
|
|
|
CHG MRA PELVIS W/WO CONTRAST MATERIAL
|
Professional
|
Both
|
$1,504.30
|
|
|
Service Code
|
HCPCS 72198
|
| Min. Negotiated Rate |
$276.61 |
| Max. Negotiated Rate |
$889.11 |
| Rate for Payer: Cash Price |
$404.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$395.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$355.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$355.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$375.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$395.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$375.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$395.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$395.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$296.37
|
| Rate for Payer: Healthfirst Commercial |
$395.16
|
| Rate for Payer: Healthfirst Essential Plan |
$889.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$375.40
|
| Rate for Payer: Healthfirst QHP |
$395.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$276.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$395.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$335.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$276.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$395.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$296.37
|
| Rate for Payer: SOMOS Essential |
$296.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$395.16
|
|
|
CHG MRA PELVIS W/WO CONTRAST MATERIAL
|
Professional
|
Both
|
$1,160.95
|
|
|
Service Code
|
HCPCS 72198 TC
|
| Min. Negotiated Rate |
$211.76 |
| Max. Negotiated Rate |
$680.67 |
| Rate for Payer: Cash Price |
$312.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$302.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$272.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$272.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$287.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$302.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$287.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$302.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$302.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$226.89
|
| Rate for Payer: Healthfirst Commercial |
$302.52
|
| Rate for Payer: Healthfirst Essential Plan |
$680.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$287.39
|
| Rate for Payer: Healthfirst QHP |
$302.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$211.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$302.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$257.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$211.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$302.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$226.89
|
| Rate for Payer: SOMOS Essential |
$226.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$302.52
|
|
|
CHG MRA SPINAL CANAL W/WO CONTRAST MATERIAL
|
Professional
|
Both
|
$1,541.68
|
|
|
Service Code
|
HCPCS 72159
|
| Min. Negotiated Rate |
$278.47 |
| Max. Negotiated Rate |
$895.07 |
| Rate for Payer: Cash Price |
$413.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$397.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$358.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$358.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$377.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$397.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$377.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$397.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$397.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$298.36
|
| Rate for Payer: Healthfirst Commercial |
$397.81
|
| Rate for Payer: Healthfirst Essential Plan |
$895.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$377.92
|
| Rate for Payer: Healthfirst QHP |
$397.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$278.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$397.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$338.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$278.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$397.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$298.36
|
| Rate for Payer: SOMOS Essential |
$298.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$397.81
|
|
|
CHG MRA SPINAL CANAL W/WO CONTRAST MATERIAL
|
Professional
|
Both
|
$1,193.99
|
|
|
Service Code
|
HCPCS 72159 TC
|
| Min. Negotiated Rate |
$213.93 |
| Max. Negotiated Rate |
$687.64 |
| Rate for Payer: Cash Price |
$320.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$305.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$275.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$275.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$290.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$305.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$290.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$305.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$305.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$229.22
|
| Rate for Payer: Healthfirst Commercial |
$305.62
|
| Rate for Payer: Healthfirst Essential Plan |
$687.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$290.34
|
| Rate for Payer: Healthfirst QHP |
$305.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$213.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$305.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$259.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$213.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$305.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$229.22
|
| Rate for Payer: SOMOS Essential |
$229.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$305.62
|
|
|
CHG MRA SPINAL CANAL W/WO CONTRAST MATERIAL
|
Professional
|
Both
|
$347.69
|
|
|
Service Code
|
HCPCS 72159 26
|
| Min. Negotiated Rate |
$64.53 |
| Max. Negotiated Rate |
$207.41 |
| Rate for Payer: Cash Price |
$93.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$92.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$82.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$82.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$87.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$92.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$87.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.14
|
| Rate for Payer: Healthfirst Commercial |
$92.18
|
| Rate for Payer: Healthfirst Essential Plan |
$207.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$87.57
|
| Rate for Payer: Healthfirst QHP |
$92.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$92.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$78.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$92.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.14
|
| Rate for Payer: SOMOS Essential |
$69.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$92.18
|
|
|
CHG MRA UPPER EXTREMITY W/WO CONTRAST MATERIAL
|
Professional
|
Both
|
$334.60
|
|
|
Service Code
|
HCPCS 73225 26
|
| Min. Negotiated Rate |
$60.67 |
| Max. Negotiated Rate |
$195.01 |
| Rate for Payer: Cash Price |
$89.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$86.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$78.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$78.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$82.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$86.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$82.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$65.00
|
| Rate for Payer: Healthfirst Commercial |
$86.67
|
| Rate for Payer: Healthfirst Essential Plan |
$195.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$82.34
|
| Rate for Payer: Healthfirst QHP |
$86.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$60.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$86.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$73.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$60.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$86.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$65.00
|
| Rate for Payer: SOMOS Essential |
$65.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$86.67
|
|
|
CHG MRA UPPER EXTREMITY W/WO CONTRAST MATERIAL
|
Professional
|
Both
|
$1,528.59
|
|
|
Service Code
|
HCPCS 73225
|
| Min. Negotiated Rate |
$265.91 |
| Max. Negotiated Rate |
$854.71 |
| Rate for Payer: Cash Price |
$410.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$379.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$341.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$341.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$360.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$379.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$360.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$379.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$379.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$284.90
|
| Rate for Payer: Healthfirst Commercial |
$379.87
|
| Rate for Payer: Healthfirst Essential Plan |
$854.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$360.88
|
| Rate for Payer: Healthfirst QHP |
$379.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$265.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$379.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$322.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$265.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$379.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$284.90
|
| Rate for Payer: SOMOS Essential |
$284.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$379.87
|
|
|
CHG MRA UPPER EXTREMITY W/WO CONTRAST MATERIAL
|
Professional
|
Both
|
$1,193.99
|
|
|
Service Code
|
HCPCS 73225 TC
|
| Min. Negotiated Rate |
$205.24 |
| Max. Negotiated Rate |
$659.70 |
| Rate for Payer: Cash Price |
$320.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$293.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$263.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$263.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$278.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$293.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$278.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$293.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$293.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$219.90
|
| Rate for Payer: Healthfirst Commercial |
$293.20
|
| Rate for Payer: Healthfirst Essential Plan |
$659.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$278.54
|
| Rate for Payer: Healthfirst QHP |
$293.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$205.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$293.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$249.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$205.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$293.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$219.90
|
| Rate for Payer: SOMOS Essential |
$219.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$293.20
|
|
|
CHG MRI ABDOMEN W/CONTRAST MATERIAL
|
Professional
|
Both
|
$1,351.81
|
|
|
Service Code
|
HCPCS 74182
|
| Min. Negotiated Rate |
$246.18 |
| Max. Negotiated Rate |
$791.30 |
| Rate for Payer: Cash Price |
$361.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$351.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$316.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$316.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$334.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$351.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$334.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$351.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$351.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$263.77
|
| Rate for Payer: Healthfirst Commercial |
$351.69
|
| Rate for Payer: Healthfirst Essential Plan |
$791.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$334.11
|
| Rate for Payer: Healthfirst QHP |
$351.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$246.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$351.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$298.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$246.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$351.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$263.77
|
| Rate for Payer: SOMOS Essential |
$263.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$351.69
|
|
|
CHG MRI ABDOMEN W/CONTRAST MATERIAL
|
Professional
|
Both
|
$1,018.64
|
|
|
Service Code
|
HCPCS 74182 TC
|
| Min. Negotiated Rate |
$184.16 |
| Max. Negotiated Rate |
$591.93 |
| Rate for Payer: Cash Price |
$272.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$263.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$236.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$236.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$249.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$263.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$249.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$263.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$263.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$197.31
|
| Rate for Payer: Healthfirst Commercial |
$263.08
|
| Rate for Payer: Healthfirst Essential Plan |
$591.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$249.93
|
| Rate for Payer: Healthfirst QHP |
$263.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$184.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$263.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$223.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$184.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$263.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$197.31
|
| Rate for Payer: SOMOS Essential |
$197.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$263.08
|
|
|
CHG MRI ABDOMEN W/CONTRAST MATERIAL
|
Professional
|
Both
|
$333.17
|
|
|
Service Code
|
HCPCS 74182 26
|
| Min. Negotiated Rate |
$62.03 |
| Max. Negotiated Rate |
$199.37 |
| Rate for Payer: Cash Price |
$89.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$88.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$79.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$79.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$88.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$84.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$88.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$66.46
|
| Rate for Payer: Healthfirst Commercial |
$88.61
|
| Rate for Payer: Healthfirst Essential Plan |
$199.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$84.18
|
| Rate for Payer: Healthfirst QHP |
$88.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$62.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$88.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$75.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$62.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$88.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$66.46
|
| Rate for Payer: SOMOS Essential |
$66.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$88.61
|
|
|
CHG MRI ABDOMEN W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$867.16
|
|
|
Service Code
|
HCPCS 74181
|
| Min. Negotiated Rate |
$158.66 |
| Max. Negotiated Rate |
$509.96 |
| Rate for Payer: Cash Price |
$233.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$226.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$203.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$203.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$215.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$226.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$215.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$226.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$226.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$169.99
|
| Rate for Payer: Healthfirst Commercial |
$226.65
|
| Rate for Payer: Healthfirst Essential Plan |
$509.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$215.32
|
| Rate for Payer: Healthfirst QHP |
$226.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$158.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$226.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$192.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$158.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$226.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$169.99
|
| Rate for Payer: SOMOS Essential |
$169.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$226.65
|
|
|
CHG MRI ABDOMEN W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$586.22
|
|
|
Service Code
|
HCPCS 74181 TC
|
| Min. Negotiated Rate |
$106.29 |
| Max. Negotiated Rate |
$341.64 |
| Rate for Payer: Cash Price |
$157.24
|
| 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 MRI ABDOMEN W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$280.95
|
|
|
Service Code
|
HCPCS 74181 26
|
| Min. Negotiated Rate |
$52.37 |
| Max. Negotiated Rate |
$168.32 |
| Rate for Payer: Cash Price |
$75.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$74.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$67.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$67.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$71.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$74.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$71.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$74.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$56.11
|
| Rate for Payer: Healthfirst Commercial |
$74.81
|
| Rate for Payer: Healthfirst Essential Plan |
$168.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$71.07
|
| Rate for Payer: Healthfirst QHP |
$74.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$52.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$74.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$63.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$52.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$74.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$56.11
|
| Rate for Payer: SOMOS Essential |
$56.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$74.81
|
|
