|
CHG MRI ABDOMEN W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$419.20
|
|
|
Service Code
|
HCPCS 74183 26
|
| Min. Negotiated Rate |
$79.71 |
| Max. Negotiated Rate |
$256.21 |
| Rate for Payer: Cash Price |
$113.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$113.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$102.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$102.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$108.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$113.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$108.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$113.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$113.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$85.40
|
| Rate for Payer: Healthfirst Commercial |
$113.87
|
| Rate for Payer: Healthfirst Essential Plan |
$256.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$108.18
|
| Rate for Payer: Healthfirst QHP |
$113.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$79.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$113.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$96.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$79.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$113.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$85.40
|
| Rate for Payer: SOMOS Essential |
$85.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$113.87
|
|
|
CHG MRI ABDOMEN W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$1,084.76
|
|
|
Service Code
|
HCPCS 74183 TC
|
| Min. Negotiated Rate |
$195.30 |
| Max. Negotiated Rate |
$627.75 |
| Rate for Payer: Cash Price |
$289.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$279.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$251.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$251.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$265.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$279.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$265.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$279.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$279.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$209.25
|
| Rate for Payer: Healthfirst Commercial |
$279.00
|
| Rate for Payer: Healthfirst Essential Plan |
$627.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$265.05
|
| Rate for Payer: Healthfirst QHP |
$279.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$195.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$279.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$237.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$195.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$279.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$209.25
|
| Rate for Payer: SOMOS Essential |
$209.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$279.00
|
|
|
CHG MRI ABDOMEN W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$1,503.95
|
|
|
Service Code
|
HCPCS 74183
|
| Min. Negotiated Rate |
$275.01 |
| Max. Negotiated Rate |
$883.96 |
| Rate for Payer: Cash Price |
$403.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$392.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$353.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$353.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$373.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$392.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$373.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$392.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$392.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$294.65
|
| Rate for Payer: Healthfirst Commercial |
$392.87
|
| Rate for Payer: Healthfirst Essential Plan |
$883.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$373.23
|
| Rate for Payer: Healthfirst QHP |
$392.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$275.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$392.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$333.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$275.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$392.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$294.65
|
| Rate for Payer: SOMOS Essential |
$294.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$392.87
|
|
|
CHG MRI ANY JT LOWER EXTREM W/CONTRAST MATERIAL
|
Professional
|
Both
|
$1,397.52
|
|
|
Service Code
|
HCPCS 73722
|
| Min. Negotiated Rate |
$254.79 |
| Max. Negotiated Rate |
$818.96 |
| Rate for Payer: Cash Price |
$375.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$363.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$327.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$327.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$345.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$363.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$345.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$363.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$363.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$272.99
|
| Rate for Payer: Healthfirst Commercial |
$363.98
|
| Rate for Payer: Healthfirst Essential Plan |
$818.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$345.78
|
| Rate for Payer: Healthfirst QHP |
$363.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$254.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$363.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$309.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$254.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$363.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$272.99
|
| Rate for Payer: SOMOS Essential |
$272.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$363.98
|
|
|
CHG MRI ANY JT LOWER EXTREM W/CONTRAST MATERIAL
|
Professional
|
Both
|
$1,086.47
|
|
|
Service Code
|
HCPCS 73722 TC
|
| Min. Negotiated Rate |
$196.38 |
| Max. Negotiated Rate |
$631.24 |
| Rate for Payer: Cash Price |
$291.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$280.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$252.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$252.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$266.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$280.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$266.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$280.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$280.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$210.41
|
| Rate for Payer: Healthfirst Commercial |
$280.55
|
| Rate for Payer: Healthfirst Essential Plan |
$631.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$266.52
|
| Rate for Payer: Healthfirst QHP |
$280.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$196.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$280.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$238.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$196.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$280.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$210.41
|
| Rate for Payer: SOMOS Essential |
$210.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$280.55
|
|
|
CHG MRI ANY JT LOWER EXTREM W/CONTRAST MATERIAL
|
Professional
|
Both
|
$311.05
|
|
|
Service Code
|
HCPCS 73722 26
|
| Min. Negotiated Rate |
$58.39 |
| Max. Negotiated Rate |
$187.69 |
| Rate for Payer: Cash Price |
$84.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$83.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$75.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$75.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$79.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$83.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$79.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$62.56
|
| Rate for Payer: Healthfirst Commercial |
$83.42
|
| Rate for Payer: Healthfirst Essential Plan |
$187.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$79.25
|
| Rate for Payer: Healthfirst QHP |
$83.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$58.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$83.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$70.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$58.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$83.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$62.56
|
| Rate for Payer: SOMOS Essential |
$62.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$83.42
|
|
|
CHG MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL
|
Professional
|
Both
|
$633.68
|
|
|
Service Code
|
HCPCS 73721 TC
|
| Min. Negotiated Rate |
$116.77 |
| Max. Negotiated Rate |
$375.35 |
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$166.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$150.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$150.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$158.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$166.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$158.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$166.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$166.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$125.11
|
| Rate for Payer: Healthfirst Commercial |
$166.82
|
| Rate for Payer: Healthfirst Essential Plan |
$375.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$158.48
|
| Rate for Payer: Healthfirst QHP |
$166.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$116.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$166.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$141.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$116.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$166.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$125.11
|
| Rate for Payer: SOMOS Essential |
$125.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$166.82
|
|
|
CHG MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL
|
Professional
|
Both
|
$260.12
|
|
|
Service Code
|
HCPCS 73721 26
|
| Min. Negotiated Rate |
$48.73 |
| Max. Negotiated Rate |
$156.65 |
| Rate for Payer: Cash Price |
$70.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$69.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$62.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$66.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$69.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$66.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$69.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$69.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$52.22
|
| Rate for Payer: Healthfirst Commercial |
$69.62
|
| Rate for Payer: Healthfirst Essential Plan |
$156.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$66.14
|
| Rate for Payer: Healthfirst QHP |
$69.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$48.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$69.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$59.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$48.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$69.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$52.22
|
| Rate for Payer: SOMOS Essential |
$52.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$69.62
|
|
|
CHG MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL
|
Professional
|
Both
|
$893.76
|
|
|
Service Code
|
HCPCS 73721
|
| Min. Negotiated Rate |
$165.51 |
| Max. Negotiated Rate |
$531.99 |
| Rate for Payer: Cash Price |
$241.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$236.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$212.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$212.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$224.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$236.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$224.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$236.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$236.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$177.33
|
| Rate for Payer: Healthfirst Commercial |
$236.44
|
| Rate for Payer: Healthfirst Essential Plan |
$531.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$224.62
|
| Rate for Payer: Healthfirst QHP |
$236.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$165.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$236.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$200.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$165.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$236.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$177.33
|
| Rate for Payer: SOMOS Essential |
$177.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$236.44
|
|
|
CHG MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL
|
Professional
|
Both
|
$1,311.87
|
|
|
Service Code
|
HCPCS 73723 TC
|
| Min. Negotiated Rate |
$234.70 |
| Max. Negotiated Rate |
$754.38 |
| Rate for Payer: Cash Price |
$349.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$335.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$301.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$301.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$318.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$335.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$318.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$335.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$335.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$251.46
|
| Rate for Payer: Healthfirst Commercial |
$335.28
|
| Rate for Payer: Healthfirst Essential Plan |
$754.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$318.52
|
| Rate for Payer: Healthfirst QHP |
$335.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$234.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$335.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$284.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$234.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$335.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$251.46
|
| Rate for Payer: SOMOS Essential |
$251.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$335.28
|
|
|
CHG MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL
|
Professional
|
Both
|
$1,723.37
|
|
|
Service Code
|
HCPCS 73723
|
| Min. Negotiated Rate |
$312.93 |
| Max. Negotiated Rate |
$1,005.84 |
| Rate for Payer: Cash Price |
$461.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$447.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$402.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$402.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$424.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$447.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$424.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$447.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$447.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$335.28
|
| Rate for Payer: Healthfirst Commercial |
$447.04
|
| Rate for Payer: Healthfirst Essential Plan |
$1,005.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$424.69
|
| Rate for Payer: Healthfirst QHP |
$447.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$312.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$447.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$379.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$312.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$447.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$335.28
|
| Rate for Payer: SOMOS Essential |
$335.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$447.04
|
|
|
CHG MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL
|
Professional
|
Both
|
$411.50
|
|
|
Service Code
|
HCPCS 73723 26
|
| Min. Negotiated Rate |
$78.23 |
| Max. Negotiated Rate |
$251.46 |
| Rate for Payer: Cash Price |
$111.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$111.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$100.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$100.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$106.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$111.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$106.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$111.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$83.82
|
| Rate for Payer: Healthfirst Commercial |
$111.76
|
| Rate for Payer: Healthfirst Essential Plan |
$251.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$106.17
|
| Rate for Payer: Healthfirst QHP |
$111.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$78.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$111.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$95.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$78.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$111.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$83.82
|
| Rate for Payer: SOMOS Essential |
$83.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$111.76
|
|
|
CHG MRI ANY JT UPPER EXTREMITY W/CONTRAST MATRL
|
Professional
|
Both
|
$1,396.08
|
|
|
Service Code
|
HCPCS 73222
|
| Min. Negotiated Rate |
$253.42 |
| Max. Negotiated Rate |
$814.57 |
| Rate for Payer: Cash Price |
$375.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$362.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$325.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$325.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$343.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$362.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$343.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$362.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$362.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$271.52
|
| Rate for Payer: Healthfirst Commercial |
$362.03
|
| Rate for Payer: Healthfirst Essential Plan |
$814.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$343.93
|
| Rate for Payer: Healthfirst QHP |
$362.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$253.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$362.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$307.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$253.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$362.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$271.52
|
| Rate for Payer: SOMOS Essential |
$271.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$362.03
|
|
|
CHG MRI ANY JT UPPER EXTREMITY W/CONTRAST MATRL
|
Professional
|
Both
|
$311.05
|
|
|
Service Code
|
HCPCS 73222 26
|
| Min. Negotiated Rate |
$58.39 |
| Max. Negotiated Rate |
$187.69 |
| Rate for Payer: Cash Price |
$84.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$83.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$75.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$75.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$79.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$83.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$79.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$62.56
|
| Rate for Payer: Healthfirst Commercial |
$83.42
|
| Rate for Payer: Healthfirst Essential Plan |
$187.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$79.25
|
| Rate for Payer: Healthfirst QHP |
$83.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$58.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$83.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$70.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$58.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$83.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$62.56
|
| Rate for Payer: SOMOS Essential |
$62.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$83.42
|
|
|
CHG MRI ANY JT UPPER EXTREMITY W/CONTRAST MATRL
|
Professional
|
Both
|
$1,085.04
|
|
|
Service Code
|
HCPCS 73222 TC
|
| Min. Negotiated Rate |
$195.03 |
| Max. Negotiated Rate |
$626.87 |
| Rate for Payer: Cash Price |
$290.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$278.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$250.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$250.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$264.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$278.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$264.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$278.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$208.96
|
| Rate for Payer: Healthfirst Commercial |
$278.61
|
| Rate for Payer: Healthfirst Essential Plan |
$626.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$264.68
|
| Rate for Payer: Healthfirst QHP |
$278.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$195.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$278.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$236.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$195.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$278.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$208.96
|
| Rate for Payer: SOMOS Essential |
$208.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$278.61
|
|
|
CHG MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL
|
Professional
|
Both
|
$633.68
|
|
|
Service Code
|
HCPCS 73221 TC
|
| Min. Negotiated Rate |
$117.05 |
| Max. Negotiated Rate |
$376.22 |
| Rate for Payer: Cash Price |
$171.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$167.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$150.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$150.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$158.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$167.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$158.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$167.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$167.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$125.41
|
| Rate for Payer: Healthfirst Commercial |
$167.21
|
| Rate for Payer: Healthfirst Essential Plan |
$376.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$158.85
|
| Rate for Payer: Healthfirst QHP |
$167.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$117.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$167.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$142.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$117.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$167.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$125.41
|
| Rate for Payer: SOMOS Essential |
$125.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$167.21
|
|
|
CHG MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL
|
Professional
|
Both
|
$895.20
|
|
|
Service Code
|
HCPCS 73221
|
| Min. Negotiated Rate |
$165.78 |
| Max. Negotiated Rate |
$532.87 |
| Rate for Payer: Cash Price |
$242.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$236.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$213.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$213.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$224.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$236.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$224.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$236.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$236.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$177.62
|
| Rate for Payer: Healthfirst Commercial |
$236.83
|
| Rate for Payer: Healthfirst Essential Plan |
$532.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$224.99
|
| Rate for Payer: Healthfirst QHP |
$236.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$165.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$236.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$201.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$165.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$236.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$177.62
|
| Rate for Payer: SOMOS Essential |
$177.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$236.83
|
|
|
CHG MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL
|
Professional
|
Both
|
$261.56
|
|
|
Service Code
|
HCPCS 73221 26
|
| Min. Negotiated Rate |
$48.73 |
| Max. Negotiated Rate |
$156.65 |
| Rate for Payer: Cash Price |
$70.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$69.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$62.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$66.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$69.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$66.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$69.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$69.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$52.22
|
| Rate for Payer: Healthfirst Commercial |
$69.62
|
| Rate for Payer: Healthfirst Essential Plan |
$156.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$66.14
|
| Rate for Payer: Healthfirst QHP |
$69.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$48.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$69.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$59.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$48.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$69.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$52.22
|
| Rate for Payer: SOMOS Essential |
$52.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$69.62
|
|
|
CHG MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL
|
Professional
|
Both
|
$1,729.14
|
|
|
Service Code
|
HCPCS 73223
|
| Min. Negotiated Rate |
$313.75 |
| Max. Negotiated Rate |
$1,008.47 |
| Rate for Payer: Cash Price |
$463.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$448.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$403.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$403.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$425.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$448.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$425.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$448.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$448.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$336.16
|
| Rate for Payer: Healthfirst Commercial |
$448.21
|
| Rate for Payer: Healthfirst Essential Plan |
$1,008.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$425.80
|
| Rate for Payer: Healthfirst QHP |
$448.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$313.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$448.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$380.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$313.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$448.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$336.16
|
| Rate for Payer: SOMOS Essential |
$336.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$448.21
|
|
|
CHG MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL
|
Professional
|
Both
|
$412.93
|
|
|
Service Code
|
HCPCS 73223 26
|
| Min. Negotiated Rate |
$78.23 |
| Max. Negotiated Rate |
$251.46 |
| Rate for Payer: Cash Price |
$112.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$111.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$100.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$100.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$106.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$111.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$106.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$111.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$83.82
|
| Rate for Payer: Healthfirst Commercial |
$111.76
|
| Rate for Payer: Healthfirst Essential Plan |
$251.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$106.17
|
| Rate for Payer: Healthfirst QHP |
$111.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$78.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$111.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$95.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$78.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$111.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$83.82
|
| Rate for Payer: SOMOS Essential |
$83.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$111.76
|
|
|
CHG MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL
|
Professional
|
Both
|
$1,316.18
|
|
|
Service Code
|
HCPCS 73223 TC
|
| Min. Negotiated Rate |
$235.51 |
| Max. Negotiated Rate |
$757.01 |
| Rate for Payer: Cash Price |
$351.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$336.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$302.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$302.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$319.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$336.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$319.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$336.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$336.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$252.34
|
| Rate for Payer: Healthfirst Commercial |
$336.45
|
| Rate for Payer: Healthfirst Essential Plan |
$757.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$319.63
|
| Rate for Payer: Healthfirst QHP |
$336.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$235.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$336.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$285.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$235.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$336.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$252.34
|
| Rate for Payer: SOMOS Essential |
$252.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$336.45
|
|
|
CHG MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL
|
Professional
|
Both
|
$1,201.38
|
|
|
Service Code
|
HCPCS 70552
|
| Min. Negotiated Rate |
$220.22 |
| Max. Negotiated Rate |
$707.85 |
| Rate for Payer: Cash Price |
$322.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$314.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$283.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$283.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$298.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$314.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$298.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$314.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$314.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$235.95
|
| Rate for Payer: Healthfirst Commercial |
$314.60
|
| Rate for Payer: Healthfirst Essential Plan |
$707.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$298.87
|
| Rate for Payer: Healthfirst QHP |
$314.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$220.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$314.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$267.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$220.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$314.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$235.95
|
| Rate for Payer: SOMOS Essential |
$235.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$314.60
|
|
|
CHG MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL
|
Professional
|
Both
|
$857.64
|
|
|
Service Code
|
HCPCS 70552 TC
|
| Min. Negotiated Rate |
$156.17 |
| Max. Negotiated Rate |
$501.98 |
| Rate for Payer: Cash Price |
$230.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$223.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$200.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$200.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$211.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$223.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$211.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$223.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$223.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$167.32
|
| Rate for Payer: Healthfirst Commercial |
$223.10
|
| Rate for Payer: Healthfirst Essential Plan |
$501.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$211.94
|
| Rate for Payer: Healthfirst QHP |
$223.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$156.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$223.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$189.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$156.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$223.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$167.32
|
| Rate for Payer: SOMOS Essential |
$167.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$223.10
|
|
|
CHG MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL
|
Professional
|
Both
|
$343.74
|
|
|
Service Code
|
HCPCS 70552 26
|
| Min. Negotiated Rate |
$64.04 |
| Max. Negotiated Rate |
$205.85 |
| Rate for Payer: Cash Price |
$92.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$91.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$82.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$82.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$86.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$91.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$86.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$91.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$68.62
|
| Rate for Payer: Healthfirst Commercial |
$91.49
|
| Rate for Payer: Healthfirst Essential Plan |
$205.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$86.92
|
| Rate for Payer: Healthfirst QHP |
$91.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$91.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$77.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$91.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$68.62
|
| Rate for Payer: SOMOS Essential |
$68.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$91.49
|
|
|
CHG MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$863.91
|
|
|
Service Code
|
HCPCS 70551
|
| Min. Negotiated Rate |
$159.41 |
| Max. Negotiated Rate |
$512.39 |
| Rate for Payer: Cash Price |
$233.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$227.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$204.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$204.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$216.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$227.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$216.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$227.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$227.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$170.80
|
| Rate for Payer: Healthfirst Commercial |
$227.73
|
| Rate for Payer: Healthfirst Essential Plan |
$512.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$216.34
|
| Rate for Payer: Healthfirst QHP |
$227.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$159.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$227.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$193.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$159.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$227.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$170.80
|
| Rate for Payer: SOMOS Essential |
$170.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$227.73
|
|
