|
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
|
|
|
CHG MRI ORBIT FACE &/NECK W/O CONTRAST
|
Professional
|
Both
|
$257.25
|
|
|
Service Code
|
HCPCS 70540 26
|
| Min. Negotiated Rate |
$48.20 |
| Max. Negotiated Rate |
$154.91 |
| Rate for Payer: Cash Price |
$69.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$68.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$61.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$65.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$68.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$65.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$68.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$68.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51.64
|
| Rate for Payer: Healthfirst Commercial |
$68.85
|
| Rate for Payer: Healthfirst Essential Plan |
$154.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$65.41
|
| Rate for Payer: Healthfirst QHP |
$68.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$48.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$68.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$58.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$48.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$68.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$51.64
|
| Rate for Payer: SOMOS Essential |
$51.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$68.85
|
|
|
CHG MRI ORBIT FACE & NECK W/O & W/CONTRAST MATRL
|
Professional
|
Both
|
$1,506.33
|
|
|
Service Code
|
HCPCS 70543
|
| Min. Negotiated Rate |
$275.98 |
| Max. Negotiated Rate |
$887.06 |
| Rate for Payer: Cash Price |
$404.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$394.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$354.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$354.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$374.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$394.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$374.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$394.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$394.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$295.69
|
| Rate for Payer: Healthfirst Commercial |
$394.25
|
| Rate for Payer: Healthfirst Essential Plan |
$887.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$374.54
|
| Rate for Payer: Healthfirst QHP |
$394.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$275.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$394.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$335.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$275.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$394.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$295.69
|
| Rate for Payer: SOMOS Essential |
$295.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$394.25
|
|
|
CHG MRI ORBIT FACE & NECK W/O & W/CONTRAST MATRL
|
Professional
|
Both
|
$1,096.27
|
|
|
Service Code
|
HCPCS 70543 TC
|
| Min. Negotiated Rate |
$198.02 |
| Max. Negotiated Rate |
$636.48 |
| Rate for Payer: Cash Price |
$293.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$282.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$254.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$254.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$268.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$282.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$268.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$282.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$282.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$212.16
|
| Rate for Payer: Healthfirst Commercial |
$282.88
|
| Rate for Payer: Healthfirst Essential Plan |
$636.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$268.74
|
| Rate for Payer: Healthfirst QHP |
$282.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$198.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$282.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$240.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$198.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$282.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$212.16
|
| Rate for Payer: SOMOS Essential |
$212.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$282.88
|
|
|
CHG MRI ORBIT FACE & NECK W/O & W/CONTRAST MATRL
|
Professional
|
Both
|
$410.06
|
|
|
Service Code
|
HCPCS 70543 26
|
| Min. Negotiated Rate |
$77.96 |
| Max. Negotiated Rate |
$250.58 |
| Rate for Payer: Cash Price |
$111.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$111.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$100.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$100.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$105.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$111.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$105.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$111.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$83.53
|
| Rate for Payer: Healthfirst Commercial |
$111.37
|
| Rate for Payer: Healthfirst Essential Plan |
$250.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$105.80
|
| Rate for Payer: Healthfirst QHP |
$111.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$77.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$111.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$94.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$77.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$111.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$83.53
|
| Rate for Payer: SOMOS Essential |
$83.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$111.37
|
|
|
CHG MRI PELVIS W/CONTRAST MATERIAL
|
Professional
|
Both
|
$334.60
|
|
|
Service Code
|
HCPCS 72196 26
|
| Min. Negotiated Rate |
$62.03 |
| Max. Negotiated Rate |
$199.37 |
| Rate for Payer: Cash Price |
$89.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$88.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$79.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$79.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$88.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$84.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$88.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$66.46
|
| Rate for Payer: Healthfirst Commercial |
$88.61
|
| Rate for Payer: Healthfirst Essential Plan |
$199.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$84.18
|
| Rate for Payer: Healthfirst QHP |
$88.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$62.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$88.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$75.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$62.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$88.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$66.46
|
| Rate for Payer: SOMOS Essential |
$66.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$88.61
|
|
|
CHG MRI PELVIS W/CONTRAST MATERIAL
|
Professional
|
Both
|
$1,193.96
|
|
|
Service Code
|
HCPCS 72196
|
| Min. Negotiated Rate |
$218.47 |
| Max. Negotiated Rate |
$702.23 |
| Rate for Payer: Cash Price |
$320.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$312.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$280.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$280.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$296.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$312.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$296.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$312.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$312.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$234.07
|
| Rate for Payer: Healthfirst Commercial |
$312.10
|
| Rate for Payer: Healthfirst Essential Plan |
$702.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$296.50
|
| Rate for Payer: Healthfirst QHP |
$312.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$218.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$312.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$265.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$218.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$312.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$234.07
|
| Rate for Payer: SOMOS Essential |
$234.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$312.10
|
|
|
CHG MRI PELVIS W/CONTRAST MATERIAL
|
Professional
|
Both
|
$859.36
|
|
|
Service Code
|
HCPCS 72196 TC
|
| Min. Negotiated Rate |
$156.44 |
| Max. Negotiated Rate |
$502.85 |
| Rate for Payer: Cash Price |
$230.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$223.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$201.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$201.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$212.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$223.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$212.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$223.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$223.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$167.62
|
| Rate for Payer: Healthfirst Commercial |
$223.49
|
| Rate for Payer: Healthfirst Essential Plan |
$502.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$212.32
|
| Rate for Payer: Healthfirst QHP |
$223.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$156.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$223.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$189.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$156.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$223.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$167.62
|
| Rate for Payer: SOMOS Essential |
$167.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$223.49
|
|
|
CHG MRI PELVIS W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$735.74
|
|
|
Service Code
|
HCPCS 72195 TC
|
| Min. Negotiated Rate |
$132.92 |
| Max. Negotiated Rate |
$427.23 |
| Rate for Payer: Cash Price |
$197.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$189.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$170.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$170.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$180.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$189.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$180.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$189.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$189.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$142.41
|
| Rate for Payer: Healthfirst Commercial |
$189.88
|
| Rate for Payer: Healthfirst Essential Plan |
$427.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$180.39
|
| Rate for Payer: Healthfirst QHP |
$189.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$132.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$189.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$161.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$132.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$189.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$142.41
|
| Rate for Payer: SOMOS Essential |
$142.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$189.88
|
|
|
CHG MRI PELVIS W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$280.95
|
|
|
Service Code
|
HCPCS 72195 26
|
| Min. Negotiated Rate |
$52.63 |
| Max. Negotiated Rate |
$169.18 |
| Rate for Payer: Cash Price |
$76.35
|
| 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 PELVIS W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$1,016.65
|
|
|
Service Code
|
HCPCS 72195
|
| Min. Negotiated Rate |
$185.56 |
| Max. Negotiated Rate |
$596.43 |
| Rate for Payer: Cash Price |
$273.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$265.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$238.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$238.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$251.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$265.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$251.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$265.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$265.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$198.81
|
| Rate for Payer: Healthfirst Commercial |
$265.08
|
| Rate for Payer: Healthfirst Essential Plan |
$596.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$251.83
|
| Rate for Payer: Healthfirst QHP |
$265.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$185.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$265.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$225.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$185.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$265.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$198.81
|
| Rate for Payer: SOMOS Essential |
$198.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$265.08
|
|
|
CHG MRI PELVIS W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$1,079.02
|
|
|
Service Code
|
HCPCS 72197 TC
|
| Min. Negotiated Rate |
$194.22 |
| Max. Negotiated Rate |
$624.26 |
| Rate for Payer: Cash Price |
$287.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$277.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$249.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$249.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$263.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$277.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$263.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$277.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$277.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$208.09
|
| Rate for Payer: Healthfirst Commercial |
$277.45
|
| Rate for Payer: Healthfirst Essential Plan |
$624.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$263.58
|
| Rate for Payer: Healthfirst QHP |
$277.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$194.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$277.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$235.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$194.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$277.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$208.09
|
| Rate for Payer: SOMOS Essential |
$208.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$277.45
|
|
|
CHG MRI PELVIS W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$1,498.21
|
|
|
Service Code
|
HCPCS 72197
|
| Min. Negotiated Rate |
$273.92 |
| Max. Negotiated Rate |
$880.47 |
| Rate for Payer: Cash Price |
$401.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$391.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$352.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$352.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$371.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$391.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$371.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$391.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$391.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$293.49
|
| Rate for Payer: Healthfirst Commercial |
$391.32
|
| Rate for Payer: Healthfirst Essential Plan |
$880.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$371.75
|
| Rate for Payer: Healthfirst QHP |
$391.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$273.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$391.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$332.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$273.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$391.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$293.49
|
| Rate for Payer: SOMOS Essential |
$293.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$391.32
|
|
|
CHG MRI PELVIS W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$419.20
|
|
|
Service Code
|
HCPCS 72197 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 SPINAL CANAL CERVICAL W/CONTRAST MATRL
|
Professional
|
Both
|
$1,220.35
|
|
|
Service Code
|
HCPCS 72142
|
| Min. Negotiated Rate |
$224.34 |
| Max. Negotiated Rate |
$721.10 |
| Rate for Payer: Cash Price |
$329.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$320.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$288.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$288.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$304.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$320.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$304.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$320.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$320.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$240.37
|
| Rate for Payer: Healthfirst Commercial |
$320.49
|
| Rate for Payer: Healthfirst Essential Plan |
$721.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$304.47
|
| Rate for Payer: Healthfirst QHP |
$320.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$224.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$320.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$272.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$224.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$320.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$240.37
|
| Rate for Payer: SOMOS Essential |
$240.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$320.49
|
|
|
CHG MRI SPINAL CANAL CERVICAL W/CONTRAST MATRL
|
Professional
|
Both
|
$345.17
|
|
|
Service Code
|
HCPCS 72142 26
|
| Min. Negotiated Rate |
$65.18 |
| Max. Negotiated Rate |
$209.52 |
| Rate for Payer: Cash Price |
$93.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$93.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$83.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$83.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$88.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$93.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$88.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.84
|
| Rate for Payer: Healthfirst Commercial |
$93.12
|
| Rate for Payer: Healthfirst Essential Plan |
$209.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$88.46
|
| Rate for Payer: Healthfirst QHP |
$93.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$65.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$93.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$79.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$65.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$93.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.84
|
| Rate for Payer: SOMOS Essential |
$69.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$93.12
|
|
|
CHG MRI SPINAL CANAL CERVICAL W/CONTRAST MATRL
|
Professional
|
Both
|
$875.14
|
|
|
Service Code
|
HCPCS 72142 TC
|
| Min. Negotiated Rate |
$159.16 |
| Max. Negotiated Rate |
$511.58 |
| Rate for Payer: Cash Price |
$235.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$227.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$204.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$204.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$216.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$227.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$216.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$227.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$227.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$170.53
|
| Rate for Payer: Healthfirst Commercial |
$227.37
|
| Rate for Payer: Healthfirst Essential Plan |
$511.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$216.00
|
| Rate for Payer: Healthfirst QHP |
$227.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$159.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$227.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$193.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$159.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$227.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$170.53
|
| Rate for Payer: SOMOS Essential |
$170.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$227.37
|
|
|
CHG MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL
|
Professional
|
Both
|
$284.87
|
|
|
Service Code
|
HCPCS 72141 26
|
| Min. Negotiated Rate |
$53.39 |
| Max. Negotiated Rate |
$171.61 |
| Rate for Payer: Cash Price |
$77.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$76.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$68.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$68.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$72.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$76.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$72.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.20
|
| Rate for Payer: Healthfirst Commercial |
$76.27
|
| Rate for Payer: Healthfirst Essential Plan |
$171.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$72.46
|
| Rate for Payer: Healthfirst QHP |
$76.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$53.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$76.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$64.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$53.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$76.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$57.20
|
| Rate for Payer: SOMOS Essential |
$57.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$76.27
|
|
|
CHG MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL
|
Professional
|
Both
|
$554.61
|
|
|
Service Code
|
HCPCS 72141 TC
|
| Min. Negotiated Rate |
$101.13 |
| Max. Negotiated Rate |
$325.06 |
| Rate for Payer: Cash Price |
$149.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$144.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$130.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$130.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$137.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$144.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$137.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$144.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$144.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$108.35
|
| Rate for Payer: Healthfirst Commercial |
$144.47
|
| Rate for Payer: Healthfirst Essential Plan |
$325.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$137.25
|
| Rate for Payer: Healthfirst QHP |
$144.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$101.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$144.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$122.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$101.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$144.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$108.35
|
| Rate for Payer: SOMOS Essential |
$108.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$144.47
|
|
|
CHG MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL
|
Professional
|
Both
|
$839.48
|
|
|
Service Code
|
HCPCS 72141
|
| Min. Negotiated Rate |
$154.52 |
| Max. Negotiated Rate |
$496.67 |
| Rate for Payer: Cash Price |
$226.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$220.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$198.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$198.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$209.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$220.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$209.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$220.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$220.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.56
|
| Rate for Payer: Healthfirst Commercial |
$220.74
|
| Rate for Payer: Healthfirst Essential Plan |
$496.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.70
|
| Rate for Payer: Healthfirst QHP |
$220.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$154.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$220.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$187.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$154.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$220.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$165.56
|
| Rate for Payer: SOMOS Essential |
$165.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$220.74
|
|
|
CHG MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL
|
Professional
|
Both
|
$978.39
|
|
|
Service Code
|
HCPCS 72156 TC
|
| Min. Negotiated Rate |
$176.82 |
| Max. Negotiated Rate |
$568.35 |
| Rate for Payer: Cash Price |
$262.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$252.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$227.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$227.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$239.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$252.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$239.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$252.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$252.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$189.45
|
| Rate for Payer: Healthfirst Commercial |
$252.60
|
| Rate for Payer: Healthfirst Essential Plan |
$568.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$239.97
|
| Rate for Payer: Healthfirst QHP |
$252.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$176.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$252.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$214.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$176.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$252.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$189.45
|
| Rate for Payer: SOMOS Essential |
$189.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$252.60
|
|
|
CHG MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL
|
Professional
|
Both
|
$1,417.33
|
|
|
Service Code
|
HCPCS 72156
|
| Min. Negotiated Rate |
$260.23 |
| Max. Negotiated Rate |
$836.44 |
| Rate for Payer: Cash Price |
$381.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$371.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$334.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$334.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$353.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$371.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$353.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$371.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$371.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$278.81
|
| Rate for Payer: Healthfirst Commercial |
$371.75
|
| Rate for Payer: Healthfirst Essential Plan |
$836.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$353.16
|
| Rate for Payer: Healthfirst QHP |
$371.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$260.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$371.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$315.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$260.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$371.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$278.81
|
| Rate for Payer: SOMOS Essential |
$278.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$371.75
|
|
|
CHG MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL
|
Professional
|
Both
|
$438.97
|
|
|
Service Code
|
HCPCS 72156 26
|
| Min. Negotiated Rate |
$83.40 |
| Max. Negotiated Rate |
$268.06 |
| Rate for Payer: Cash Price |
$119.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$119.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$107.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$107.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$119.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$119.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$119.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$89.36
|
| Rate for Payer: Healthfirst Commercial |
$119.14
|
| Rate for Payer: Healthfirst Essential Plan |
$268.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$113.18
|
| Rate for Payer: Healthfirst QHP |
$119.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$83.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$119.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$101.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$83.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$119.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$89.36
|
| Rate for Payer: SOMOS Essential |
$89.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$119.14
|
|
|
CHG MRI SPINAL CANAL LUMBAR W/CONTRAST MATERIAL
|
Professional
|
Both
|
$343.74
|
|
|
Service Code
|
HCPCS 72149 26
|
| Min. Negotiated Rate |
$64.91 |
| Max. Negotiated Rate |
$208.64 |
| Rate for Payer: Cash Price |
$93.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$92.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$83.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$83.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$88.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$92.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$88.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.55
|
| Rate for Payer: Healthfirst Commercial |
$92.73
|
| Rate for Payer: Healthfirst Essential Plan |
$208.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$88.09
|
| Rate for Payer: Healthfirst QHP |
$92.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$92.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$78.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$92.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.55
|
| Rate for Payer: SOMOS Essential |
$69.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$92.73
|
|
|
CHG MRI SPINAL CANAL LUMBAR W/CONTRAST MATERIAL
|
Professional
|
Both
|
$855.02
|
|
|
Service Code
|
HCPCS 72149 TC
|
| Min. Negotiated Rate |
$155.36 |
| Max. Negotiated Rate |
$499.37 |
| Rate for Payer: Cash Price |
$230.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$221.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$199.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$199.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$210.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$221.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$210.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$221.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$221.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$166.46
|
| Rate for Payer: Healthfirst Commercial |
$221.94
|
| Rate for Payer: Healthfirst Essential Plan |
$499.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$210.84
|
| Rate for Payer: Healthfirst QHP |
$221.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$155.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$221.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$188.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$155.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$221.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$166.46
|
| Rate for Payer: SOMOS Essential |
$166.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$221.94
|
|
