|
CHG CT ABDOMEN W/CONTRAST MATERIAL
|
Professional
|
$767.34
|
|
|
Service Code
|
HCPCS 74160 TC
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$758.76 |
| Rate for Payer: Cash Price |
$212.26
|
| Rate for Payer: Cash Price |
$212.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$204.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$204.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$216.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$227.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$216.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$227.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$227.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$170.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$216.09
|
| Rate for Payer: Healthfirst QHP |
$227.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$159.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$227.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$193.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$159.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$227.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$575.50
|
| Rate for Payer: SOMOS Essential |
$575.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$227.46
|
|
|
CHG CT ABDOMEN W/O CONTRAST MATERIAL
|
Professional
|
$369.29
|
|
|
Service Code
|
HCPCS 74150 TC
|
| Min. Negotiated Rate |
$45.46 |
| Max. Negotiated Rate |
$447.44 |
| Rate for Payer: Cash Price |
$99.64
|
| Rate for Payer: Cash Price |
$99.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$94.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$94.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$100.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$105.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$100.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$79.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$100.23
|
| Rate for Payer: Healthfirst QHP |
$105.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$73.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$105.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$89.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$73.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$105.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$276.97
|
| Rate for Payer: SOMOS Essential |
$276.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$105.51
|
|
|
CHG CT ABDOMEN W/O CONTRAST MATERIAL
|
Professional
|
$227.29
|
|
|
Service Code
|
HCPCS 74150 26
|
| Min. Negotiated Rate |
$45.46 |
| Max. Negotiated Rate |
$447.44 |
| Rate for Payer: Cash Price |
$61.76
|
| Rate for Payer: Cash Price |
$61.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$58.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$61.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$64.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$61.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.69
|
| Rate for Payer: Healthfirst QHP |
$64.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$64.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$55.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$64.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$170.47
|
| Rate for Payer: SOMOS Essential |
$170.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$64.94
|
|
|
CHG CT ABDOMEN W/O CONTRAST MATERIAL
|
Professional
|
$596.58
|
|
|
Service Code
|
HCPCS 74150
|
| Min. Negotiated Rate |
$45.46 |
| Max. Negotiated Rate |
$447.44 |
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$153.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$153.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$161.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$170.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$161.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$170.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$170.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$127.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$161.93
|
| Rate for Payer: Healthfirst QHP |
$170.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$119.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$170.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$144.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$119.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$170.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$447.44
|
| Rate for Payer: SOMOS Essential |
$447.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$170.45
|
|
|
CHG CT ABDOMEN W/O & W/CONTRAST MATERIAL
|
Professional
|
$1,035.16
|
|
|
Service Code
|
HCPCS 74170
|
| Min. Negotiated Rate |
$53.28 |
| Max. Negotiated Rate |
$776.37 |
| Rate for Payer: Cash Price |
$313.00
|
| Rate for Payer: Cash Price |
$313.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$299.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$299.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$316.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$333.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$316.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$333.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$333.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$249.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$316.47
|
| Rate for Payer: Healthfirst QHP |
$333.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$233.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$333.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$283.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$233.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$333.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$776.37
|
| Rate for Payer: SOMOS Essential |
$776.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$333.13
|
|
|
CHG CT ABDOMEN W/O & W/CONTRAST MATERIAL
|
Professional
|
$266.39
|
|
|
Service Code
|
HCPCS 74170 26
|
| Min. Negotiated Rate |
$53.28 |
| Max. Negotiated Rate |
$776.37 |
| Rate for Payer: Cash Price |
$72.46
|
| Rate for Payer: Cash Price |
$72.46
|
| 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 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 |
$199.79
|
| Rate for Payer: SOMOS Essential |
$199.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$76.11
|
|
|
CHG CT ABDOMEN W/O & W/CONTRAST MATERIAL
|
Professional
|
$768.78
|
|
|
Service Code
|
HCPCS 74170 TC
|
| Min. Negotiated Rate |
$53.28 |
| Max. Negotiated Rate |
$776.37 |
| Rate for Payer: Cash Price |
$240.55
|
| Rate for Payer: Cash Price |
$240.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$231.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$231.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$244.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$257.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$244.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$257.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$257.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$192.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$244.18
|
| Rate for Payer: Healthfirst QHP |
$257.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$179.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$257.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$218.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$179.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$257.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$576.58
|
| Rate for Payer: SOMOS Essential |
$576.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$257.03
|
|
|
CHG CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST
|
Professional
|
$452.87
|
|
|
Service Code
|
HCPCS 75574 26
|
| Min. Negotiated Rate |
$90.57 |
| Max. Negotiated Rate |
$916.16 |
| Rate for Payer: Cash Price |
$123.19
|
| Rate for Payer: Cash Price |
$123.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$116.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$116.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$122.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$129.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$122.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$129.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$129.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$97.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$122.92
|
| Rate for Payer: Healthfirst QHP |
$129.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$90.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$129.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$109.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$90.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$129.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$339.65
|
| Rate for Payer: SOMOS Essential |
$339.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$129.39
|
|
|
CHG CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST
|
Professional
|
$768.64
|
|
|
Service Code
|
HCPCS 75574 TC
|
| Min. Negotiated Rate |
$90.57 |
| Max. Negotiated Rate |
$916.16 |
| Rate for Payer: Cash Price |
$258.69
|
| Rate for Payer: Cash Price |
$258.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$244.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$244.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$257.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$271.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$257.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$271.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$271.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$203.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$257.75
|
| Rate for Payer: Healthfirst QHP |
$271.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$189.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$271.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$230.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$189.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$271.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$576.48
|
| Rate for Payer: SOMOS Essential |
$576.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$271.32
|
|
|
CHG CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST
|
Professional
|
$1,221.54
|
|
|
Service Code
|
HCPCS 75574
|
| Min. Negotiated Rate |
$90.57 |
| Max. Negotiated Rate |
$916.16 |
| Rate for Payer: Cash Price |
$381.88
|
| Rate for Payer: Cash Price |
$381.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$360.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$360.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$380.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$400.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$380.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$400.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$400.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$300.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$380.68
|
| Rate for Payer: Healthfirst QHP |
$400.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$280.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$400.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$340.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$280.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$400.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$916.16
|
| Rate for Payer: SOMOS Essential |
$916.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$400.72
|
|
|
CHG CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG
|
Professional
|
$1,684.94
|
|
|
Service Code
|
HCPCS 74174
|
| Min. Negotiated Rate |
$83.81 |
| Max. Negotiated Rate |
$1,263.70 |
| Rate for Payer: Cash Price |
$454.12
|
| Rate for Payer: Cash Price |
$454.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$433.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$433.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$457.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$481.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$457.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$481.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$481.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$361.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$457.34
|
| Rate for Payer: Healthfirst QHP |
$481.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$336.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$481.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$409.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$336.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$481.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,263.70
|
| Rate for Payer: SOMOS Essential |
$1,263.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$481.41
|
|
|
CHG CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG
|
Professional
|
$1,265.88
|
|
|
Service Code
|
HCPCS 74174 TC
|
| Min. Negotiated Rate |
$83.81 |
| Max. Negotiated Rate |
$1,263.70 |
| Rate for Payer: Cash Price |
$340.42
|
| Rate for Payer: Cash Price |
$340.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$325.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$325.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$343.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$361.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$343.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$361.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$361.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$271.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$343.60
|
| Rate for Payer: Healthfirst QHP |
$361.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$253.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$361.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$307.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$253.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$361.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$949.41
|
| Rate for Payer: SOMOS Essential |
$949.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$361.68
|
|
|
CHG CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG
|
Professional
|
$419.06
|
|
|
Service Code
|
HCPCS 74174 26
|
| Min. Negotiated Rate |
$83.81 |
| Max. Negotiated Rate |
$1,263.70 |
| Rate for Payer: Cash Price |
$113.70
|
| Rate for Payer: Cash Price |
$113.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$107.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$107.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$119.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$119.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$119.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$89.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$113.74
|
| Rate for Payer: Healthfirst QHP |
$119.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$83.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$119.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$101.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$83.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$119.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$314.30
|
| Rate for Payer: SOMOS Essential |
$314.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$119.73
|
|
|
CHG CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST
|
Professional
|
$1,115.94
|
|
|
Service Code
|
HCPCS 74175
|
| Min. Negotiated Rate |
$69.46 |
| Max. Negotiated Rate |
$836.96 |
| Rate for Payer: Cash Price |
$364.73
|
| Rate for Payer: Cash Price |
$364.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$349.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$349.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$368.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$388.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$368.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$388.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$388.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$291.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$368.81
|
| Rate for Payer: Healthfirst QHP |
$388.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$271.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$388.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$329.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$271.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$388.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$836.96
|
| Rate for Payer: SOMOS Essential |
$836.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$388.22
|
|
|
CHG CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST
|
Professional
|
$768.64
|
|
|
Service Code
|
HCPCS 74175 TC
|
| Min. Negotiated Rate |
$69.46 |
| Max. Negotiated Rate |
$836.96 |
| Rate for Payer: Cash Price |
$270.64
|
| Rate for Payer: Cash Price |
$270.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$260.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$260.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$274.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$288.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$274.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$288.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$288.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$216.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$274.53
|
| Rate for Payer: Healthfirst QHP |
$288.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$202.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$288.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$245.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$202.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$288.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$576.48
|
| Rate for Payer: SOMOS Essential |
$576.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$288.98
|
|
|
CHG CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST
|
Professional
|
$347.31
|
|
|
Service Code
|
HCPCS 74175 26
|
| Min. Negotiated Rate |
$69.46 |
| Max. Negotiated Rate |
$836.96 |
| Rate for Payer: Cash Price |
$94.09
|
| Rate for Payer: Cash Price |
$94.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$89.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$89.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$94.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$99.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$94.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$99.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$99.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$74.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$94.27
|
| Rate for Payer: Healthfirst QHP |
$99.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$69.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$99.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$84.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$69.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$99.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$260.48
|
| Rate for Payer: SOMOS Essential |
$260.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$99.23
|
|
|
CHG CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST
|
Professional
|
$1,117.41
|
|
|
Service Code
|
HCPCS 71275
|
| Min. Negotiated Rate |
$69.75 |
| Max. Negotiated Rate |
$838.06 |
| Rate for Payer: Cash Price |
$335.26
|
| Rate for Payer: Cash Price |
$335.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$319.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$319.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$337.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$354.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$337.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$354.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$354.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$266.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$337.20
|
| Rate for Payer: Healthfirst QHP |
$354.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$248.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$354.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$301.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$248.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$354.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$838.06
|
| Rate for Payer: SOMOS Essential |
$838.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$354.95
|
|
|
CHG CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST
|
Professional
|
$348.74
|
|
|
Service Code
|
HCPCS 71275 26
|
| Min. Negotiated Rate |
$69.75 |
| Max. Negotiated Rate |
$838.06 |
| Rate for Payer: Cash Price |
$94.48
|
| Rate for Payer: Cash Price |
$94.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$89.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$89.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$94.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$99.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$94.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$99.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$99.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$74.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$94.66
|
| Rate for Payer: Healthfirst QHP |
$99.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$69.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$99.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$84.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$69.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$99.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$261.56
|
| Rate for Payer: SOMOS Essential |
$261.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$99.64
|
|
|
CHG CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST
|
Professional
|
$768.64
|
|
|
Service Code
|
HCPCS 71275 TC
|
| Min. Negotiated Rate |
$69.75 |
| Max. Negotiated Rate |
$838.06 |
| Rate for Payer: Cash Price |
$240.78
|
| Rate for Payer: Cash Price |
$240.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$229.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$229.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$242.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$255.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$242.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$255.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$255.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$191.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$242.54
|
| Rate for Payer: Healthfirst QHP |
$255.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$178.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$255.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$217.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$178.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$255.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$576.48
|
| Rate for Payer: SOMOS Essential |
$576.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$255.30
|
|
|
CHG CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST
|
Professional
|
$1,105.76
|
|
|
Service Code
|
HCPCS 70496
|
| Min. Negotiated Rate |
$67.42 |
| Max. Negotiated Rate |
$829.32 |
| Rate for Payer: Cash Price |
$328.66
|
| Rate for Payer: Cash Price |
$328.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$313.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$313.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$331.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$348.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$331.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$348.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$348.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$261.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$331.31
|
| Rate for Payer: Healthfirst QHP |
$348.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$244.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$348.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$296.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$244.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$348.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$829.32
|
| Rate for Payer: SOMOS Essential |
$829.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$348.75
|
|
|
CHG CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST
|
Professional
|
$337.12
|
|
|
Service Code
|
HCPCS 70496 26
|
| Min. Negotiated Rate |
$67.42 |
| Max. Negotiated Rate |
$829.32 |
| Rate for Payer: Cash Price |
$90.63
|
| Rate for Payer: Cash Price |
$90.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$86.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$86.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$91.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$96.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$91.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$96.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$96.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$91.50
|
| Rate for Payer: Healthfirst QHP |
$96.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$67.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$96.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$81.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$67.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$96.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$252.84
|
| Rate for Payer: SOMOS Essential |
$252.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$96.32
|
|
|
CHG CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST
|
Professional
|
$768.64
|
|
|
Service Code
|
HCPCS 70496 TC
|
| Min. Negotiated Rate |
$67.42 |
| Max. Negotiated Rate |
$829.32 |
| Rate for Payer: Cash Price |
$238.03
|
| Rate for Payer: Cash Price |
$238.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$227.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$227.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$239.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$252.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$239.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$252.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$252.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$189.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$239.81
|
| Rate for Payer: Healthfirst QHP |
$252.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$176.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$252.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$214.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$176.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$252.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$576.48
|
| Rate for Payer: SOMOS Essential |
$576.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$252.43
|
|
|
CHG CT ANGIOGRAPHY LOWER EXTREMITY
|
Professional
|
$1,128.86
|
|
|
Service Code
|
HCPCS 73706
|
| Min. Negotiated Rate |
$72.04 |
| Max. Negotiated Rate |
$846.64 |
| Rate for Payer: Cash Price |
$385.43
|
| Rate for Payer: Cash Price |
$385.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$368.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$368.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$388.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$409.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$388.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$409.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$409.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$306.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$388.69
|
| Rate for Payer: Healthfirst QHP |
$409.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$286.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$409.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$347.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$286.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$409.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$846.64
|
| Rate for Payer: SOMOS Essential |
$846.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$409.15
|
|
|
CHG CT ANGIOGRAPHY LOWER EXTREMITY
|
Professional
|
$360.22
|
|
|
Service Code
|
HCPCS 73706 26
|
| Min. Negotiated Rate |
$72.04 |
| Max. Negotiated Rate |
$846.64 |
| Rate for Payer: Cash Price |
$97.66
|
| Rate for Payer: Cash Price |
$97.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$92.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$92.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$97.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$102.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$97.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$102.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$102.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$77.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$97.77
|
| Rate for Payer: Healthfirst QHP |
$102.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$72.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$102.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$87.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$72.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$102.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$270.16
|
| Rate for Payer: SOMOS Essential |
$270.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$102.92
|
|
|
CHG CT ANGIOGRAPHY LOWER EXTREMITY
|
Professional
|
$768.64
|
|
|
Service Code
|
HCPCS 73706 TC
|
| Min. Negotiated Rate |
$72.04 |
| Max. Negotiated Rate |
$846.64 |
| Rate for Payer: Cash Price |
$287.77
|
| Rate for Payer: Cash Price |
$287.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$275.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$275.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$290.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$306.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$290.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$306.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$306.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$229.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$290.92
|
| Rate for Payer: Healthfirst QHP |
$306.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$214.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$306.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$260.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$214.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$306.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$576.48
|
| Rate for Payer: SOMOS Essential |
$576.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$306.23
|
|
