|
CHG MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$284.87
|
|
|
Service Code
|
HCPCS 70551 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 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
|
|
|
CHG MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL
|
Professional
|
Both
|
$438.97
|
|
|
Service Code
|
HCPCS 70553 26
|
| Min. Negotiated Rate |
$83.12 |
| Max. Negotiated Rate |
$267.19 |
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$118.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$106.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$106.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$112.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$118.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$112.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$118.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$118.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$89.06
|
| Rate for Payer: Healthfirst Commercial |
$118.75
|
| Rate for Payer: Healthfirst Essential Plan |
$267.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$112.81
|
| Rate for Payer: Healthfirst QHP |
$118.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$83.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$118.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$100.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$83.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$118.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$89.06
|
| Rate for Payer: SOMOS Essential |
$89.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$118.75
|
|
|
CHG MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL
|
Professional
|
Both
|
$971.18
|
|
|
Service Code
|
HCPCS 70553 TC
|
| Min. Negotiated Rate |
$176.28 |
| Max. Negotiated Rate |
$566.62 |
| Rate for Payer: Cash Price |
$260.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$251.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$226.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$226.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$239.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$251.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$239.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$251.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$188.87
|
| Rate for Payer: Healthfirst Commercial |
$251.83
|
| Rate for Payer: Healthfirst Essential Plan |
$566.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$239.24
|
| Rate for Payer: Healthfirst QHP |
$251.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$176.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$251.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$214.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$176.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$251.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$188.87
|
| Rate for Payer: SOMOS Essential |
$188.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$251.83
|
|
|
CHG MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL
|
Professional
|
Both
|
$1,410.15
|
|
|
Service Code
|
HCPCS 70553
|
| Min. Negotiated Rate |
$259.41 |
| Max. Negotiated Rate |
$833.80 |
| Rate for Payer: Cash Price |
$379.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$370.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$333.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$333.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$352.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$370.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$352.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$370.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$370.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$277.94
|
| Rate for Payer: Healthfirst Commercial |
$370.58
|
| Rate for Payer: Healthfirst Essential Plan |
$833.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$352.05
|
| Rate for Payer: Healthfirst QHP |
$370.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$259.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$370.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$314.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$259.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$370.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$277.94
|
| Rate for Payer: SOMOS Essential |
$277.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$370.58
|
|
|
CHG MRI BRAIN FUNCTIONAL W/O PHYSICIAN ADMNISTRATION
|
Professional
|
Both
|
$1,686.62
|
|
|
Service Code
|
HCPCS 70554
|
| Min. Negotiated Rate |
$310.11 |
| Max. Negotiated Rate |
$996.79 |
| Rate for Payer: Cash Price |
$455.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$443.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$398.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$398.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$420.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$443.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$420.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$443.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$443.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$332.26
|
| Rate for Payer: Healthfirst Commercial |
$443.02
|
| Rate for Payer: Healthfirst Essential Plan |
$996.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$420.87
|
| Rate for Payer: Healthfirst QHP |
$443.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$310.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$443.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$376.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$310.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$443.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$332.26
|
| Rate for Payer: SOMOS Essential |
$332.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$443.02
|
|
|
CHG MRI BRAIN FUNCTIONAL W/O PHYSICIAN ADMNISTRATION
|
Professional
|
Both
|
$406.35
|
|
|
Service Code
|
HCPCS 70554 26
|
| Min. Negotiated Rate |
$77.43 |
| Max. Negotiated Rate |
$248.87 |
| Rate for Payer: Cash Price |
$110.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$110.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$99.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$99.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$105.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$110.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$105.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$110.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$110.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$82.96
|
| Rate for Payer: Healthfirst Commercial |
$110.61
|
| Rate for Payer: Healthfirst Essential Plan |
$248.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$105.08
|
| Rate for Payer: Healthfirst QHP |
$110.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$77.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$110.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$94.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$77.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$110.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$82.96
|
| Rate for Payer: SOMOS Essential |
$82.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$110.61
|
|
|
CHG MRI BRAIN FUNCTIONAL W/O PHYSICIAN ADMNISTRATION
|
Professional
|
Both
|
$1,280.27
|
|
|
Service Code
|
HCPCS 70554 TC
|
| Min. Negotiated Rate |
$232.69 |
| Max. Negotiated Rate |
$747.92 |
| Rate for Payer: Cash Price |
$344.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$332.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$299.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$299.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$315.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$332.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$315.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$332.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$332.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$249.31
|
| Rate for Payer: Healthfirst Commercial |
$332.41
|
| Rate for Payer: Healthfirst Essential Plan |
$747.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$315.79
|
| Rate for Payer: Healthfirst QHP |
$332.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$232.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$332.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$282.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$232.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$332.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$249.31
|
| Rate for Payer: SOMOS Essential |
$249.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$332.41
|
|
|
CHG MRI BRAIN FUNCTIONAL W/PHYSICIAN ADMNISTRATION
|
Professional
|
Both
|
$477.47
|
|
|
Service Code
|
HCPCS 70555 26
|
| Min. Negotiated Rate |
$90.24 |
| Max. Negotiated Rate |
$290.07 |
| Rate for Payer: Cash Price |
$129.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$128.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$116.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$116.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$122.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$128.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$122.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$128.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$128.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$96.69
|
| Rate for Payer: Healthfirst Commercial |
$128.92
|
| Rate for Payer: Healthfirst Essential Plan |
$290.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$122.47
|
| Rate for Payer: Healthfirst QHP |
$128.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$90.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$128.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$109.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$90.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$128.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$96.69
|
| Rate for Payer: SOMOS Essential |
$96.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$128.92
|
|
|
CHG MRI BRAIN OPEN INTRACRANIAL PX W/CONTRAST MATL
|
Professional
|
Both
|
$667.66
|
|
|
Service Code
|
HCPCS 70558 26
|
| Min. Negotiated Rate |
$127.95 |
| Max. Negotiated Rate |
$411.25 |
| Rate for Payer: Cash Price |
$184.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$182.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$164.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$164.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$173.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$182.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$173.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$182.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$182.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$137.09
|
| Rate for Payer: Healthfirst Commercial |
$182.78
|
| Rate for Payer: Healthfirst Essential Plan |
$411.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$173.64
|
| Rate for Payer: Healthfirst QHP |
$182.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$127.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$182.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$155.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$127.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$182.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$137.09
|
| Rate for Payer: SOMOS Essential |
$137.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$182.78
|
|
|
CHG MRI BRAIN OPEN INTRACRANIAL PX W/O CONTRAST MATL
|
Professional
|
Both
|
$710.85
|
|
|
Service Code
|
HCPCS 70557 26
|
| Min. Negotiated Rate |
$115.50 |
| Max. Negotiated Rate |
$371.25 |
| Rate for Payer: Cash Price |
$167.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$165.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$148.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$148.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$156.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$165.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$156.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$165.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$123.75
|
| Rate for Payer: Healthfirst Commercial |
$165.00
|
| Rate for Payer: Healthfirst Essential Plan |
$371.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$156.75
|
| Rate for Payer: Healthfirst QHP |
$165.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$115.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$165.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$140.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$115.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$165.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$123.75
|
| Rate for Payer: SOMOS Essential |
$123.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$165.00
|
|
|
CHG MRI BRAIN OPEN INTRACRANIAL PX W/O & W/CONTRAST
|
Professional
|
Both
|
$659.68
|
|
|
Service Code
|
HCPCS 70559 26
|
| Min. Negotiated Rate |
$122.98 |
| Max. Negotiated Rate |
$395.28 |
| Rate for Payer: Cash Price |
$175.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$175.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$158.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$158.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$166.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$175.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$166.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$175.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$131.76
|
| Rate for Payer: Healthfirst Commercial |
$175.68
|
| Rate for Payer: Healthfirst Essential Plan |
$395.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$166.90
|
| Rate for Payer: Healthfirst QHP |
$175.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$122.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$175.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$149.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$122.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$175.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$131.76
|
| Rate for Payer: SOMOS Essential |
$131.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$175.68
|
|
|
CHG MRI BREAST WITHOUT CONTRAST MATERIAL BILATERAL
|
Professional
|
Both
|
$305.66
|
|
|
Service Code
|
HCPCS 77047 26
|
| Min. Negotiated Rate |
$57.37 |
| Max. Negotiated Rate |
$184.41 |
| Rate for Payer: Cash Price |
$82.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$81.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$73.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$77.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$61.47
|
| Rate for Payer: Healthfirst Commercial |
$81.96
|
| Rate for Payer: Healthfirst Essential Plan |
$184.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$77.86
|
| Rate for Payer: Healthfirst QHP |
$81.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$57.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$81.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$69.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$57.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$61.47
|
| Rate for Payer: SOMOS Essential |
$61.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.96
|
|
|
CHG MRI BREAST WITHOUT CONTRAST MATERIAL BILATERAL
|
Professional
|
Both
|
$665.28
|
|
|
Service Code
|
HCPCS 77047 TC
|
| Min. Negotiated Rate |
$119.88 |
| Max. Negotiated Rate |
$385.31 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$171.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$154.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$154.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$171.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$171.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$171.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$128.44
|
| Rate for Payer: Healthfirst Commercial |
$171.25
|
| Rate for Payer: Healthfirst Essential Plan |
$385.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$162.69
|
| Rate for Payer: Healthfirst QHP |
$171.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$119.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$171.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$145.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$119.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$171.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$128.44
|
| Rate for Payer: SOMOS Essential |
$128.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$171.25
|
|
|
CHG MRI BREAST WITHOUT CONTRAST MATERIAL BILATERAL
|
Professional
|
Both
|
$970.94
|
|
|
Service Code
|
HCPCS 77047
|
| Min. Negotiated Rate |
$177.25 |
| Max. Negotiated Rate |
$569.72 |
| Rate for Payer: Cash Price |
$260.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$253.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$227.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$227.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$240.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$253.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$240.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$253.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$253.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$189.91
|
| Rate for Payer: Healthfirst Commercial |
$253.21
|
| Rate for Payer: Healthfirst Essential Plan |
$569.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$240.55
|
| Rate for Payer: Healthfirst QHP |
$253.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$177.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$253.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$215.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$177.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$253.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$189.91
|
| Rate for Payer: SOMOS Essential |
$189.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$253.21
|
|
|
CHG MRI BREAST WITHOUT CONTRAST MATERIAL UNILATERAL
|
Professional
|
Both
|
$275.52
|
|
|
Service Code
|
HCPCS 77046 26
|
| Min. Negotiated Rate |
$51.69 |
| Max. Negotiated Rate |
$166.14 |
| Rate for Payer: Cash Price |
$74.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$73.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$66.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$66.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$70.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$73.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$70.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$55.38
|
| Rate for Payer: Healthfirst Commercial |
$73.84
|
| Rate for Payer: Healthfirst Essential Plan |
$166.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$70.15
|
| Rate for Payer: Healthfirst QHP |
$73.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$51.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$73.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$62.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$51.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$73.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$55.38
|
| Rate for Payer: SOMOS Essential |
$55.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$73.84
|
|
|
CHG MRI BREAST WITHOUT CONTRAST MATERIAL UNILATERAL
|
Professional
|
Both
|
$937.93
|
|
|
Service Code
|
HCPCS 77046
|
| Min. Negotiated Rate |
$172.11 |
| Max. Negotiated Rate |
$553.21 |
| Rate for Payer: Cash Price |
$253.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$245.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$221.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$221.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$233.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$245.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$233.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$245.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$245.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$184.40
|
| Rate for Payer: Healthfirst Commercial |
$245.87
|
| Rate for Payer: Healthfirst Essential Plan |
$553.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$233.58
|
| Rate for Payer: Healthfirst QHP |
$245.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$172.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$245.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$208.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$172.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$245.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$184.40
|
| Rate for Payer: SOMOS Essential |
$184.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$245.87
|
|
|
CHG MRI BREAST WITHOUT CONTRAST MATERIAL UNILATERAL
|
Professional
|
Both
|
$662.41
|
|
|
Service Code
|
HCPCS 77046 TC
|
| Min. Negotiated Rate |
$120.42 |
| Max. Negotiated Rate |
$387.07 |
| Rate for Payer: Cash Price |
$178.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$172.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$154.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$154.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$163.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$172.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$163.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$172.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$172.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$129.02
|
| Rate for Payer: Healthfirst Commercial |
$172.03
|
| Rate for Payer: Healthfirst Essential Plan |
$387.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$163.43
|
| Rate for Payer: Healthfirst QHP |
$172.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$120.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$172.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$146.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$120.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$172.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$129.02
|
| Rate for Payer: SOMOS Essential |
$129.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$172.03
|
|
|
CHG MRI BREAST WITHOUT&WITH CONTRAST W/CAD BILATERAL
|
Professional
|
Both
|
$1,524.99
|
|
|
Service Code
|
HCPCS 77049
|
| Min. Negotiated Rate |
$278.40 |
| Max. Negotiated Rate |
$894.85 |
| Rate for Payer: Cash Price |
$408.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$397.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$357.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$357.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$377.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$397.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$377.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$397.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$397.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$298.28
|
| Rate for Payer: Healthfirst Commercial |
$397.71
|
| Rate for Payer: Healthfirst Essential Plan |
$894.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$377.82
|
| Rate for Payer: Healthfirst QHP |
$397.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$278.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$397.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$338.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$278.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$397.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$298.28
|
| Rate for Payer: SOMOS Essential |
$298.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$397.71
|
|
|
CHG MRI BREAST WITHOUT&WITH CONTRAST W/CAD BILATERAL
|
Professional
|
Both
|
$1,084.76
|
|
|
Service Code
|
HCPCS 77049 TC
|
| Min. Negotiated Rate |
$194.75 |
| Max. Negotiated Rate |
$626.00 |
| Rate for Payer: Cash Price |
$289.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$278.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$250.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$250.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$264.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$278.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$264.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$278.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$208.66
|
| Rate for Payer: Healthfirst Commercial |
$278.22
|
| Rate for Payer: Healthfirst Essential Plan |
$626.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$264.31
|
| Rate for Payer: Healthfirst QHP |
$278.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$194.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$278.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$236.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$194.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$278.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$208.66
|
| Rate for Payer: SOMOS Essential |
$208.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$278.22
|
|
|
CHG MRI BREAST WITHOUT&WITH CONTRAST W/CAD BILATERAL
|
Professional
|
Both
|
$440.23
|
|
|
Service Code
|
HCPCS 77049 26
|
| Min. Negotiated Rate |
$83.64 |
| Max. Negotiated Rate |
$268.85 |
| Rate for Payer: Cash Price |
$119.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$119.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$107.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$107.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$119.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$119.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$119.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$89.62
|
| Rate for Payer: Healthfirst Commercial |
$119.49
|
| Rate for Payer: Healthfirst Essential Plan |
$268.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$113.52
|
| Rate for Payer: Healthfirst QHP |
$119.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$83.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$119.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$101.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$83.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$119.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$89.62
|
| Rate for Payer: SOMOS Essential |
$89.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$119.49
|
|
|
CHG MRI BREAST W/OUT&WITH CONTRAST W/CAD UNILATERAL
|
Professional
|
Both
|
$1,093.37
|
|
|
Service Code
|
HCPCS 77048 TC
|
| Min. Negotiated Rate |
$197.20 |
| Max. Negotiated Rate |
$633.87 |
| Rate for Payer: Cash Price |
$291.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$281.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$253.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$253.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$267.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$281.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$267.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$281.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$281.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$211.29
|
| Rate for Payer: Healthfirst Commercial |
$281.72
|
| Rate for Payer: Healthfirst Essential Plan |
$633.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$267.63
|
| Rate for Payer: Healthfirst QHP |
$281.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$197.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$281.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$239.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$197.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$281.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$211.29
|
| Rate for Payer: SOMOS Essential |
$211.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$281.72
|
|
|
CHG MRI BREAST W/OUT&WITH CONTRAST W/CAD UNILATERAL
|
Professional
|
Both
|
$402.36
|
|
|
Service Code
|
HCPCS 77048 26
|
| Min. Negotiated Rate |
$76.48 |
| Max. Negotiated Rate |
$245.84 |
| Rate for Payer: Cash Price |
$109.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$109.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$98.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$98.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$103.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$109.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$103.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$109.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$81.94
|
| Rate for Payer: Healthfirst Commercial |
$109.26
|
| Rate for Payer: Healthfirst Essential Plan |
$245.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$103.80
|
| Rate for Payer: Healthfirst QHP |
$109.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$76.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$109.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$92.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$76.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$109.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$81.94
|
| Rate for Payer: SOMOS Essential |
$81.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$109.26
|
|
|
CHG MRI BREAST W/OUT&WITH CONTRAST W/CAD UNILATERAL
|
Professional
|
Both
|
$1,495.76
|
|
|
Service Code
|
HCPCS 77048
|
| Min. Negotiated Rate |
$273.69 |
| Max. Negotiated Rate |
$879.71 |
| Rate for Payer: Cash Price |
$401.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$390.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$351.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$351.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$371.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$390.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$371.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$390.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$390.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$293.24
|
| Rate for Payer: Healthfirst Commercial |
$390.98
|
| Rate for Payer: Healthfirst Essential Plan |
$879.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$371.43
|
| Rate for Payer: Healthfirst QHP |
$390.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$273.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$390.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$332.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$273.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$390.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$293.24
|
| Rate for Payer: SOMOS Essential |
$293.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$390.98
|
|
|
CHG MRI CHEST W/CONTRAST MATERIAL
|
Professional
|
Both
|
$1,675.24
|
|
|
Service Code
|
HCPCS 71551
|
| Min. Negotiated Rate |
$304.87 |
| Max. Negotiated Rate |
$979.94 |
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$435.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$391.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$391.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$413.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$435.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$413.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$435.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$435.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$326.65
|
| Rate for Payer: Healthfirst Commercial |
$435.53
|
| Rate for Payer: Healthfirst Essential Plan |
$979.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$413.75
|
| Rate for Payer: Healthfirst QHP |
$435.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$304.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$435.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$370.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$304.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$435.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$326.65
|
| Rate for Payer: SOMOS Essential |
$326.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$435.53
|
|
