|
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
|
|
|
CHG MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$842.35
|
|
|
Service Code
|
HCPCS 72148
|
| Min. Negotiated Rate |
$155.06 |
| Max. Negotiated Rate |
$498.40 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$221.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$199.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$199.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$210.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$221.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$210.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$221.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$221.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$166.13
|
| Rate for Payer: Healthfirst Commercial |
$221.51
|
| Rate for Payer: Healthfirst Essential Plan |
$498.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$210.43
|
| Rate for Payer: Healthfirst QHP |
$221.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$155.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$221.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$188.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$155.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$221.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$166.13
|
| Rate for Payer: SOMOS Essential |
$166.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$221.51
|
|
|
CHG MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$284.87
|
|
|
Service Code
|
HCPCS 72148 26
|
| Min. Negotiated Rate |
$53.39 |
| Max. Negotiated Rate |
$171.61 |
| Rate for Payer: Cash Price |
$77.44
|
| 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 LUMBAR W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$557.48
|
|
|
Service Code
|
HCPCS 72148 TC
|
| Min. Negotiated Rate |
$101.67 |
| Max. Negotiated Rate |
$326.79 |
| Rate for Payer: Cash Price |
$150.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$145.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$130.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$130.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$137.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$145.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$137.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$145.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$145.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$108.93
|
| Rate for Payer: Healthfirst Commercial |
$145.24
|
| Rate for Payer: Healthfirst Essential Plan |
$326.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$137.98
|
| Rate for Payer: Healthfirst QHP |
$145.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$101.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$145.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$123.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$101.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$145.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$108.93
|
| Rate for Payer: SOMOS Essential |
$108.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$145.24
|
|
|
CHG MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL
|
Professional
|
Both
|
$438.97
|
|
|
Service Code
|
HCPCS 72158 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/O & W/CONTR MATRL
|
Professional
|
Both
|
$1,414.46
|
|
|
Service Code
|
HCPCS 72158
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$834.68 |
| Rate for Payer: Cash Price |
$380.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$370.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$333.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$333.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$352.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$370.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$352.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$370.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$370.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$278.23
|
| Rate for Payer: Healthfirst Commercial |
$370.97
|
| Rate for Payer: Healthfirst Essential Plan |
$834.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$352.42
|
| Rate for Payer: Healthfirst QHP |
$370.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$259.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$370.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$315.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$259.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$370.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$278.23
|
| Rate for Payer: SOMOS Essential |
$278.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$370.97
|
|
|
CHG MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL
|
Professional
|
Both
|
$975.52
|
|
|
Service Code
|
HCPCS 72158 TC
|
| Min. Negotiated Rate |
$176.28 |
| Max. Negotiated Rate |
$566.62 |
| Rate for Payer: Cash Price |
$261.21
|
| 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 SPINAL CANAL THORACIC W/CONTRAST MATRL
|
Professional
|
Both
|
$866.53
|
|
|
Service Code
|
HCPCS 72147 TC
|
| Min. Negotiated Rate |
$157.53 |
| Max. Negotiated Rate |
$506.36 |
| Rate for Payer: Cash Price |
$233.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$225.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$202.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$202.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$213.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$225.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$213.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$225.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$168.79
|
| Rate for Payer: Healthfirst Commercial |
$225.05
|
| Rate for Payer: Healthfirst Essential Plan |
$506.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$213.80
|
| Rate for Payer: Healthfirst QHP |
$225.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$157.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$225.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$191.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$157.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$225.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$168.79
|
| Rate for Payer: SOMOS Essential |
$168.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$225.05
|
|
|
CHG MRI SPINAL CANAL THORACIC W/CONTRAST MATRL
|
Professional
|
Both
|
$1,210.27
|
|
|
Service Code
|
HCPCS 72147
|
| Min. Negotiated Rate |
$221.58 |
| Max. Negotiated Rate |
$712.22 |
| Rate for Payer: Cash Price |
$325.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$316.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$284.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$284.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$300.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$316.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$300.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$316.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$316.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$237.41
|
| Rate for Payer: Healthfirst Commercial |
$316.54
|
| Rate for Payer: Healthfirst Essential Plan |
$712.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$300.71
|
| Rate for Payer: Healthfirst QHP |
$316.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$221.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$316.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$269.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$221.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$316.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$237.41
|
| Rate for Payer: SOMOS Essential |
$237.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$316.54
|
|
|
CHG MRI SPINAL CANAL THORACIC W/CONTRAST MATRL
|
Professional
|
Both
|
$343.74
|
|
|
Service Code
|
HCPCS 72147 26
|
| Min. Negotiated Rate |
$64.04 |
| Max. Negotiated Rate |
$205.85 |
| Rate for Payer: Cash Price |
$92.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$91.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$82.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$82.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$86.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$91.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$86.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$91.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$68.62
|
| Rate for Payer: Healthfirst Commercial |
$91.49
|
| Rate for Payer: Healthfirst Essential Plan |
$205.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$86.92
|
| Rate for Payer: Healthfirst QHP |
$91.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$91.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$77.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$91.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$68.62
|
| Rate for Payer: SOMOS Essential |
$68.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$91.49
|
|
|
CHG MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL
|
Professional
|
Both
|
$839.48
|
|
|
Service Code
|
HCPCS 72146
|
| Min. Negotiated Rate |
$154.79 |
| Max. Negotiated Rate |
$497.54 |
| Rate for Payer: Cash Price |
$226.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$221.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$199.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$199.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$210.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$221.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$210.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$221.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$221.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.85
|
| Rate for Payer: Healthfirst Commercial |
$221.13
|
| Rate for Payer: Healthfirst Essential Plan |
$497.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$210.07
|
| Rate for Payer: Healthfirst QHP |
$221.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$154.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$221.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$187.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$154.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$221.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$165.85
|
| Rate for Payer: SOMOS Essential |
$165.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$221.13
|
|
|
CHG MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL
|
Professional
|
Both
|
$554.61
|
|
|
Service Code
|
HCPCS 72146 TC
|
| Min. Negotiated Rate |
$101.39 |
| Max. Negotiated Rate |
$325.91 |
| Rate for Payer: Cash Price |
$149.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$144.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$130.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$130.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$137.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$144.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$137.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$144.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$144.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$108.64
|
| Rate for Payer: Healthfirst Commercial |
$144.85
|
| Rate for Payer: Healthfirst Essential Plan |
$325.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$137.61
|
| Rate for Payer: Healthfirst QHP |
$144.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$101.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$144.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$123.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$101.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$144.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$108.64
|
| Rate for Payer: SOMOS Essential |
$108.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$144.85
|
|
|
CHG MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL
|
Professional
|
Both
|
$284.87
|
|
|
Service Code
|
HCPCS 72146 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 THORACIC W/O & W/CONTR MATRL
|
Professional
|
Both
|
$438.97
|
|
|
Service Code
|
HCPCS 72157 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 THORACIC W/O & W/CONTR MATRL
|
Professional
|
Both
|
$1,420.23
|
|
|
Service Code
|
HCPCS 72157
|
| Min. Negotiated Rate |
$260.76 |
| Max. Negotiated Rate |
$838.17 |
| Rate for Payer: Cash Price |
$381.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$372.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$335.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$335.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$353.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$372.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$353.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$372.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$372.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$279.39
|
| Rate for Payer: Healthfirst Commercial |
$372.52
|
| Rate for Payer: Healthfirst Essential Plan |
$838.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$353.89
|
| Rate for Payer: Healthfirst QHP |
$372.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$260.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$372.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$316.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$260.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$372.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$279.39
|
| Rate for Payer: SOMOS Essential |
$279.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$372.52
|
|
|
CHG MRI SPINAL CANAL THORACIC W/O & W/CONTR MATRL
|
Professional
|
Both
|
$981.26
|
|
|
Service Code
|
HCPCS 72157 TC
|
| Min. Negotiated Rate |
$177.37 |
| Max. Negotiated Rate |
$570.11 |
| Rate for Payer: Cash Price |
$262.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$253.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$228.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$228.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$240.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$253.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$240.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$253.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$253.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$190.03
|
| Rate for Payer: Healthfirst Commercial |
$253.38
|
| Rate for Payer: Healthfirst Essential Plan |
$570.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$240.71
|
| Rate for Payer: Healthfirst QHP |
$253.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$177.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$253.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$215.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$177.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$253.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$190.03
|
| Rate for Payer: SOMOS Essential |
$190.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$253.38
|
|
|
CHG MRI TEMPOROMANDIBULAR JOINT
|
Professional
|
Both
|
$898.17
|
|
|
Service Code
|
HCPCS 70336 TC
|
| Min. Negotiated Rate |
$160.79 |
| Max. Negotiated Rate |
$516.83 |
| Rate for Payer: Cash Price |
$239.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$229.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$206.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$206.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$218.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$229.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$218.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$229.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$229.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$172.28
|
| Rate for Payer: Healthfirst Commercial |
$229.70
|
| Rate for Payer: Healthfirst Essential Plan |
$516.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$218.22
|
| Rate for Payer: Healthfirst QHP |
$229.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$160.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$229.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$195.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$160.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$229.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$172.28
|
| Rate for Payer: SOMOS Essential |
$172.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$229.70
|
|
|
CHG MRI TEMPOROMANDIBULAR JOINT
|
Professional
|
Both
|
$1,180.17
|
|
|
Service Code
|
HCPCS 70336
|
| Min. Negotiated Rate |
$213.64 |
| Max. Negotiated Rate |
$686.70 |
| Rate for Payer: Cash Price |
$316.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$305.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$274.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$274.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$289.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$305.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$289.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$305.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$305.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$228.90
|
| Rate for Payer: Healthfirst Commercial |
$305.20
|
| Rate for Payer: Healthfirst Essential Plan |
$686.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$289.94
|
| Rate for Payer: Healthfirst QHP |
$305.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$213.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$305.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$259.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$213.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$305.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$228.90
|
| Rate for Payer: SOMOS Essential |
$228.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$305.20
|
|
|
CHG MRI TEMPOROMANDIBULAR JOINT
|
Professional
|
Both
|
$282.00
|
|
|
Service Code
|
HCPCS 70336 26
|
| Min. Negotiated Rate |
$52.85 |
| Max. Negotiated Rate |
$169.88 |
| Rate for Payer: Cash Price |
$76.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$75.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$67.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$67.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$71.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$75.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$71.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$56.62
|
| Rate for Payer: Healthfirst Commercial |
$75.50
|
| Rate for Payer: Healthfirst Essential Plan |
$169.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$71.72
|
| Rate for Payer: Healthfirst QHP |
$75.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$52.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$75.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$64.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$52.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$75.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$56.62
|
| Rate for Payer: SOMOS Essential |
$56.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$75.50
|
|
|
CHG MRI UPPER EXTREMITY OTH THAN JT W/CONTR MATRL
|
Professional
|
Both
|
$1,484.91
|
|
|
Service Code
|
HCPCS 73219
|
| Min. Negotiated Rate |
$269.19 |
| Max. Negotiated Rate |
$865.24 |
| Rate for Payer: Cash Price |
$397.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$384.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$346.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$346.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$365.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$384.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$365.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$384.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$384.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$288.41
|
| Rate for Payer: Healthfirst Commercial |
$384.55
|
| Rate for Payer: Healthfirst Essential Plan |
$865.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$365.32
|
| Rate for Payer: Healthfirst QHP |
$384.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$269.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$384.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$326.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$269.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$384.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$288.41
|
| Rate for Payer: SOMOS Essential |
$288.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$384.55
|
|
|
CHG MRI UPPER EXTREMITY OTH THAN JT W/CONTR MATRL
|
Professional
|
Both
|
$309.61
|
|
|
Service Code
|
HCPCS 73219 26
|
| Min. Negotiated Rate |
$58.13 |
| Max. Negotiated Rate |
$186.84 |
| Rate for Payer: Cash Price |
$84.29
|
| 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 UPPER EXTREMITY OTH THAN JT W/CONTR MATRL
|
Professional
|
Both
|
$1,175.30
|
|
|
Service Code
|
HCPCS 73219 TC
|
| Min. Negotiated Rate |
$211.06 |
| Max. Negotiated Rate |
$678.40 |
| Rate for Payer: Cash Price |
$313.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$301.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$271.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$271.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$286.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$301.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$286.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$301.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$301.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$226.13
|
| Rate for Payer: Healthfirst Commercial |
$301.51
|
| Rate for Payer: Healthfirst Essential Plan |
$678.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$286.43
|
| Rate for Payer: Healthfirst QHP |
$301.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$211.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$301.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$256.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$211.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$301.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$226.13
|
| Rate for Payer: SOMOS Essential |
$226.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$301.51
|
|
|
CHG MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL
|
Professional
|
Both
|
$1,257.17
|
|
|
Service Code
|
HCPCS 73218
|
| Min. Negotiated Rate |
$246.21 |
| Max. Negotiated Rate |
$791.39 |
| Rate for Payer: Cash Price |
$364.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$351.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$316.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$316.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$334.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$351.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$334.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$351.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$351.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$263.80
|
| Rate for Payer: Healthfirst Commercial |
$351.73
|
| Rate for Payer: Healthfirst Essential Plan |
$791.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$334.14
|
| Rate for Payer: Healthfirst QHP |
$351.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$246.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$351.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$298.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$246.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$351.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$263.80
|
| Rate for Payer: SOMOS Essential |
$263.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$351.73
|
|
|
CHG MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL
|
Professional
|
Both
|
$260.12
|
|
|
Service Code
|
HCPCS 73218 26
|
| Min. Negotiated Rate |
$48.73 |
| Max. Negotiated Rate |
$156.65 |
| Rate for Payer: Cash Price |
$70.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$69.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$62.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$66.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$69.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$66.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$69.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$69.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$52.22
|
| Rate for Payer: Healthfirst Commercial |
$69.62
|
| Rate for Payer: Healthfirst Essential Plan |
$156.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$66.14
|
| Rate for Payer: Healthfirst QHP |
$69.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$48.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$69.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$59.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$48.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$69.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$52.22
|
| Rate for Payer: SOMOS Essential |
$52.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$69.62
|
|
|
CHG MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL
|
Professional
|
Both
|
$997.08
|
|
|
Service Code
|
HCPCS 73218 TC
|
| Min. Negotiated Rate |
$197.47 |
| Max. Negotiated Rate |
$634.73 |
| Rate for Payer: Cash Price |
$293.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$282.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$253.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$253.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$268.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$282.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$268.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$282.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$282.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$211.57
|
| Rate for Payer: Healthfirst Commercial |
$282.10
|
| Rate for Payer: Healthfirst Essential Plan |
$634.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$268.00
|
| Rate for Payer: Healthfirst QHP |
$282.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$197.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$282.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$239.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$197.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$282.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$211.57
|
| Rate for Payer: SOMOS Essential |
$211.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$282.10
|
|
