|
CHG MRI CHEST W/CONTRAST MATERIAL
|
Professional
|
Both
|
$1,342.08
|
|
|
Service Code
|
HCPCS 71551 TC
|
| Min. Negotiated Rate |
$242.85 |
| Max. Negotiated Rate |
$780.59 |
| Rate for Payer: Cash Price |
$358.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$346.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$312.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$312.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$329.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$346.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$329.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$346.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$346.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$260.20
|
| Rate for Payer: Healthfirst Commercial |
$346.93
|
| Rate for Payer: Healthfirst Essential Plan |
$780.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$329.58
|
| Rate for Payer: Healthfirst QHP |
$346.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$242.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$346.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$294.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$242.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$346.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$260.20
|
| Rate for Payer: SOMOS Essential |
$260.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$346.93
|
|
|
CHG MRI CHEST W/CONTRAST MATERIAL
|
Professional
|
Both
|
$333.17
|
|
|
Service Code
|
HCPCS 71551 26
|
| Min. Negotiated Rate |
$62.03 |
| Max. Negotiated Rate |
$199.37 |
| Rate for Payer: Cash Price |
$89.93
|
| 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 CHEST W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$1,275.26
|
|
|
Service Code
|
HCPCS 71550
|
| Min. Negotiated Rate |
$274.02 |
| Max. Negotiated Rate |
$880.78 |
| Rate for Payer: Cash Price |
$405.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$391.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$352.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$352.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$371.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$391.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$371.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$391.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$391.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$293.60
|
| Rate for Payer: Healthfirst Commercial |
$391.46
|
| Rate for Payer: Healthfirst Essential Plan |
$880.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$371.89
|
| Rate for Payer: Healthfirst QHP |
$391.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$274.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$391.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$332.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$274.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$391.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$293.60
|
| Rate for Payer: SOMOS Essential |
$293.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$391.46
|
|
|
CHG MRI CHEST W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$994.32
|
|
|
Service Code
|
HCPCS 71550 TC
|
| Min. Negotiated Rate |
$221.38 |
| Max. Negotiated Rate |
$711.59 |
| Rate for Payer: Cash Price |
$329.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$316.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$284.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$284.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$300.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$316.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$300.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$316.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$316.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$237.19
|
| Rate for Payer: Healthfirst Commercial |
$316.26
|
| Rate for Payer: Healthfirst Essential Plan |
$711.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$300.45
|
| Rate for Payer: Healthfirst QHP |
$316.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$221.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$316.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$268.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$221.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$316.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$237.19
|
| Rate for Payer: SOMOS Essential |
$237.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$316.26
|
|
|
CHG MRI CHEST W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$280.95
|
|
|
Service Code
|
HCPCS 71550 26
|
| Min. Negotiated Rate |
$52.63 |
| Max. Negotiated Rate |
$169.18 |
| Rate for Payer: Cash Price |
$75.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$75.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$67.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$67.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$71.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$75.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$71.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$56.39
|
| Rate for Payer: Healthfirst Commercial |
$75.19
|
| Rate for Payer: Healthfirst Essential Plan |
$169.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$71.43
|
| Rate for Payer: Healthfirst QHP |
$75.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$52.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$75.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$63.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$52.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$75.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$56.39
|
| Rate for Payer: SOMOS Essential |
$56.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$75.19
|
|
|
CHG MRI CHEST W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$1,569.19
|
|
|
Service Code
|
HCPCS 71552 TC
|
| Min. Negotiated Rate |
$301.43 |
| Max. Negotiated Rate |
$968.87 |
| Rate for Payer: Cash Price |
$448.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$430.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$387.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$387.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$409.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$430.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$409.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$430.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$430.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$322.96
|
| Rate for Payer: Healthfirst Commercial |
$430.61
|
| Rate for Payer: Healthfirst Essential Plan |
$968.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$409.08
|
| Rate for Payer: Healthfirst QHP |
$430.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$301.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$430.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$366.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$301.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$430.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$322.96
|
| Rate for Payer: SOMOS Essential |
$322.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$430.61
|
|
|
CHG MRI CHEST W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$2,002.95
|
|
|
Service Code
|
HCPCS 71552
|
| Min. Negotiated Rate |
$383.56 |
| Max. Negotiated Rate |
$1,232.87 |
| Rate for Payer: Cash Price |
$565.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$547.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$493.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$493.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$520.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$547.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$520.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$547.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$547.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$410.95
|
| Rate for Payer: Healthfirst Commercial |
$547.94
|
| Rate for Payer: Healthfirst Essential Plan |
$1,232.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$520.54
|
| Rate for Payer: Healthfirst QHP |
$547.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$383.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$547.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$465.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$383.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$547.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$410.95
|
| Rate for Payer: SOMOS Essential |
$410.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$547.94
|
|
|
CHG MRI CHEST W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$433.76
|
|
|
Service Code
|
HCPCS 71552 26
|
| Min. Negotiated Rate |
$82.13 |
| Max. Negotiated Rate |
$263.99 |
| Rate for Payer: Cash Price |
$117.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$117.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$105.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$105.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$111.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$117.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$111.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$117.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$117.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.00
|
| Rate for Payer: Healthfirst Commercial |
$117.33
|
| Rate for Payer: Healthfirst Essential Plan |
$263.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$111.46
|
| Rate for Payer: Healthfirst QHP |
$117.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$82.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$117.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$99.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$82.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$117.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$88.00
|
| Rate for Payer: SOMOS Essential |
$88.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$117.33
|
|
|
CHG MRI GUIDANCE FOR PARENCHYMAL TISSUE ABLATION
|
Professional
|
Both
|
$815.08
|
|
|
Service Code
|
HCPCS 77022 26
|
| Min. Negotiated Rate |
$151.75 |
| Max. Negotiated Rate |
$487.78 |
| Rate for Payer: Cash Price |
$216.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$216.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$195.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$195.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$205.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$216.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$205.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$216.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$216.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$162.59
|
| Rate for Payer: Healthfirst Commercial |
$216.79
|
| Rate for Payer: Healthfirst Essential Plan |
$487.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$205.95
|
| Rate for Payer: Healthfirst QHP |
$216.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$151.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$216.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$184.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$151.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$216.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$162.59
|
| Rate for Payer: SOMOS Essential |
$162.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$216.79
|
|
|
CHG MRI GUIDANCE NEEDLE PLACEMENT RS&I
|
Professional
|
Both
|
$1,832.57
|
|
|
Service Code
|
HCPCS 77021
|
| Min. Negotiated Rate |
$335.52 |
| Max. Negotiated Rate |
$1,078.47 |
| Rate for Payer: Cash Price |
$496.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$479.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$431.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$431.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$455.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$479.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$455.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$479.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$479.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$359.49
|
| Rate for Payer: Healthfirst Commercial |
$479.32
|
| Rate for Payer: Healthfirst Essential Plan |
$1,078.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$455.35
|
| Rate for Payer: Healthfirst QHP |
$479.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$335.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$479.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$407.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$335.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$479.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$359.49
|
| Rate for Payer: SOMOS Essential |
$359.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$479.32
|
|
|
CHG MRI GUIDANCE NEEDLE PLACEMENT RS&I
|
Professional
|
Both
|
$1,550.78
|
|
|
Service Code
|
HCPCS 77021 TC
|
| Min. Negotiated Rate |
$282.25 |
| Max. Negotiated Rate |
$907.22 |
| Rate for Payer: Cash Price |
$419.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$403.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$362.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$362.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$383.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$403.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$383.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$403.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$403.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$302.41
|
| Rate for Payer: Healthfirst Commercial |
$403.21
|
| Rate for Payer: Healthfirst Essential Plan |
$907.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$383.05
|
| Rate for Payer: Healthfirst QHP |
$403.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$282.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$403.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$342.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$282.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$403.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$302.41
|
| Rate for Payer: SOMOS Essential |
$302.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$403.21
|
|
|
CHG MRI GUIDANCE NEEDLE PLACEMENT RS&I
|
Professional
|
Both
|
$281.79
|
|
|
Service Code
|
HCPCS 77021 26
|
| Min. Negotiated Rate |
$53.28 |
| Max. Negotiated Rate |
$171.25 |
| Rate for Payer: Cash Price |
$76.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$76.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$68.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$68.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$72.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$76.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$72.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.08
|
| Rate for Payer: Healthfirst Commercial |
$76.11
|
| Rate for Payer: Healthfirst Essential Plan |
$171.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$72.30
|
| Rate for Payer: Healthfirst QHP |
$76.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$53.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$76.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$64.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$53.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$76.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$57.08
|
| Rate for Payer: SOMOS Essential |
$57.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$76.11
|
|
|
CHG MRI LOWER EXTREM OTH/THN JT W/CONTRAST MATRL
|
Professional
|
Both
|
$855.02
|
|
|
Service Code
|
HCPCS 73719 TC
|
| Min. Negotiated Rate |
$155.63 |
| Max. Negotiated Rate |
$500.24 |
| Rate for Payer: Cash Price |
$230.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$222.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$200.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$200.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$211.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$222.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$211.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$222.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$222.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$166.75
|
| Rate for Payer: Healthfirst Commercial |
$222.33
|
| Rate for Payer: Healthfirst Essential Plan |
$500.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$211.21
|
| Rate for Payer: Healthfirst QHP |
$222.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$155.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$222.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$188.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$155.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$222.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$166.75
|
| Rate for Payer: SOMOS Essential |
$166.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$222.33
|
|
|
CHG MRI LOWER EXTREM OTH/THN JT W/CONTRAST MATRL
|
Professional
|
Both
|
$1,164.63
|
|
|
Service Code
|
HCPCS 73719
|
| Min. Negotiated Rate |
$213.75 |
| Max. Negotiated Rate |
$687.06 |
| Rate for Payer: Cash Price |
$314.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$305.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$274.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$274.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$290.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$305.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$290.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$305.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$305.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$229.02
|
| Rate for Payer: Healthfirst Commercial |
$305.36
|
| Rate for Payer: Healthfirst Essential Plan |
$687.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$290.09
|
| Rate for Payer: Healthfirst QHP |
$305.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$213.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$305.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$259.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$213.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$305.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$229.02
|
| Rate for Payer: SOMOS Essential |
$229.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$305.36
|
|
|
CHG MRI LOWER EXTREM OTH/THN JT W/CONTRAST MATRL
|
Professional
|
Both
|
$309.61
|
|
|
Service Code
|
HCPCS 73719 26
|
| Min. Negotiated Rate |
$58.13 |
| Max. Negotiated Rate |
$186.84 |
| Rate for Payer: Cash Price |
$83.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$83.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$74.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$74.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$78.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$83.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$78.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$62.28
|
| Rate for Payer: Healthfirst Commercial |
$83.04
|
| Rate for Payer: Healthfirst Essential Plan |
$186.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$78.89
|
| Rate for Payer: Healthfirst QHP |
$83.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$58.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$83.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$70.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$58.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$83.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$62.28
|
| Rate for Payer: SOMOS Essential |
$62.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$83.04
|
|
|
CHG MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL
|
Professional
|
Both
|
$258.69
|
|
|
Service Code
|
HCPCS 73718 26
|
| Min. Negotiated Rate |
$48.46 |
| Max. Negotiated Rate |
$155.77 |
| Rate for Payer: Cash Price |
$69.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$69.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$62.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$65.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$69.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$65.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$69.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$69.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51.92
|
| Rate for Payer: Healthfirst Commercial |
$69.23
|
| Rate for Payer: Healthfirst Essential Plan |
$155.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$65.77
|
| Rate for Payer: Healthfirst QHP |
$69.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$48.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$69.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$58.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$48.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$69.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$51.92
|
| Rate for Payer: SOMOS Essential |
$51.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$69.23
|
|
|
CHG MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL
|
Professional
|
Both
|
$992.95
|
|
|
Service Code
|
HCPCS 73718
|
| Min. Negotiated Rate |
$181.11 |
| Max. Negotiated Rate |
$582.14 |
| Rate for Payer: Cash Price |
$266.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$258.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$232.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$232.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$245.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$258.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$245.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$258.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$258.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$194.05
|
| Rate for Payer: Healthfirst Commercial |
$258.73
|
| Rate for Payer: Healthfirst Essential Plan |
$582.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$245.79
|
| Rate for Payer: Healthfirst QHP |
$258.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$181.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$258.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$219.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$181.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$258.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$194.05
|
| Rate for Payer: SOMOS Essential |
$194.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$258.73
|
|
|
CHG MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL
|
Professional
|
Both
|
$734.27
|
|
|
Service Code
|
HCPCS 73718 TC
|
| Min. Negotiated Rate |
$132.64 |
| Max. Negotiated Rate |
$426.35 |
| Rate for Payer: Cash Price |
$196.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$189.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$170.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$170.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$180.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$189.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$180.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$189.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$189.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$142.12
|
| Rate for Payer: Healthfirst Commercial |
$189.49
|
| Rate for Payer: Healthfirst Essential Plan |
$426.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$180.02
|
| Rate for Payer: Healthfirst QHP |
$189.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$132.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$189.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$161.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$132.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$189.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$142.12
|
| Rate for Payer: SOMOS Essential |
$142.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$189.49
|
|
|
CHG MRI LOWER EXTREM OTH/THN JT W/O & W/CONTR MATR
|
Professional
|
Both
|
$1,500.56
|
|
|
Service Code
|
HCPCS 73720
|
| Min. Negotiated Rate |
$274.34 |
| Max. Negotiated Rate |
$881.82 |
| Rate for Payer: Cash Price |
$402.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$391.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$352.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$352.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$372.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$391.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$372.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$391.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$391.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$293.94
|
| Rate for Payer: Healthfirst Commercial |
$391.92
|
| Rate for Payer: Healthfirst Essential Plan |
$881.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$372.32
|
| Rate for Payer: Healthfirst QHP |
$391.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$274.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$391.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$333.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$274.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$391.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$293.94
|
| Rate for Payer: SOMOS Essential |
$293.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$391.92
|
|
|
CHG MRI LOWER EXTREM OTH/THN JT W/O & W/CONTR MATR
|
Professional
|
Both
|
$411.50
|
|
|
Service Code
|
HCPCS 73720 26
|
| Min. Negotiated Rate |
$78.23 |
| Max. Negotiated Rate |
$251.46 |
| Rate for Payer: Cash Price |
$111.33
|
| 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 LOWER EXTREM OTH/THN JT W/O & W/CONTR MATR
|
Professional
|
Both
|
$1,089.06
|
|
|
Service Code
|
HCPCS 73720 TC
|
| Min. Negotiated Rate |
$196.11 |
| Max. Negotiated Rate |
$630.36 |
| Rate for Payer: Cash Price |
$291.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$280.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$252.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$252.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$266.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$280.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$266.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$280.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$280.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$210.12
|
| Rate for Payer: Healthfirst Commercial |
$280.16
|
| Rate for Payer: Healthfirst Essential Plan |
$630.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$266.15
|
| Rate for Payer: Healthfirst QHP |
$280.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$196.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$280.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$238.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$196.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$280.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$210.12
|
| Rate for Payer: SOMOS Essential |
$210.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$280.16
|
|
|
CHG MRI ORBIT FACE & NECK W/CONTRAST MATERIAL
|
Professional
|
Both
|
$1,191.96
|
|
|
Service Code
|
HCPCS 70542
|
| Min. Negotiated Rate |
$217.56 |
| Max. Negotiated Rate |
$699.30 |
| Rate for Payer: Cash Price |
$320.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$310.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$295.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$310.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$295.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$310.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$310.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$233.10
|
| Rate for Payer: Healthfirst Commercial |
$310.80
|
| Rate for Payer: Healthfirst Essential Plan |
$699.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$295.26
|
| Rate for Payer: Healthfirst QHP |
$310.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$217.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$310.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$264.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$217.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$310.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$233.10
|
| Rate for Payer: SOMOS Essential |
$233.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$310.80
|
|
|
CHG MRI ORBIT FACE & NECK W/CONTRAST MATERIAL
|
Professional
|
Both
|
$882.35
|
|
|
Service Code
|
HCPCS 70542 TC
|
| Min. Negotiated Rate |
$159.43 |
| Max. Negotiated Rate |
$512.46 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$227.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$204.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$204.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$216.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$227.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$216.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$227.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$227.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$170.82
|
| Rate for Payer: Healthfirst Commercial |
$227.76
|
| Rate for Payer: Healthfirst Essential Plan |
$512.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$216.37
|
| Rate for Payer: Healthfirst QHP |
$227.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$159.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$227.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$193.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$159.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$227.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$170.82
|
| Rate for Payer: SOMOS Essential |
$170.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$227.76
|
|
|
CHG MRI ORBIT FACE & NECK W/CONTRAST MATERIAL
|
Professional
|
Both
|
$309.61
|
|
|
Service Code
|
HCPCS 70542 26
|
| Min. Negotiated Rate |
$58.13 |
| Max. Negotiated Rate |
$186.84 |
| Rate for Payer: Cash Price |
$83.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$83.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$74.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$74.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$78.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$83.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$78.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$62.28
|
| Rate for Payer: Healthfirst Commercial |
$83.04
|
| Rate for Payer: Healthfirst Essential Plan |
$186.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$78.89
|
| Rate for Payer: Healthfirst QHP |
$83.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$58.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$83.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$70.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$58.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$83.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$62.28
|
| Rate for Payer: SOMOS Essential |
$62.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$83.04
|
|
|
CHG MRI ORBIT FACE &/NECK W/O CONTRAST
|
Professional
|
Both
|
$747.22
|
|
|
Service Code
|
HCPCS 70540 TC
|
| Min. Negotiated Rate |
$135.63 |
| Max. Negotiated Rate |
$435.96 |
| Rate for Payer: Cash Price |
$200.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$193.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$174.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$174.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$184.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$193.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$184.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$193.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$193.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$145.32
|
| Rate for Payer: Healthfirst Commercial |
$193.76
|
| Rate for Payer: Healthfirst Essential Plan |
$435.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$184.07
|
| Rate for Payer: Healthfirst QHP |
$193.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$135.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$193.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$164.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$135.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$193.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$145.32
|
| Rate for Payer: SOMOS Essential |
$145.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$193.76
|
|
