|
CHG CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST
|
Professional
|
$1,105.76
|
|
|
Service Code
|
HCPCS 70498
|
| Min. Negotiated Rate |
$67.42 |
| Max. Negotiated Rate |
$829.32 |
| Rate for Payer: Cash Price |
$328.26
|
| Rate for Payer: Cash Price |
$328.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$313.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$313.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$330.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$348.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$330.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$348.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$348.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$261.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$330.92
|
| Rate for Payer: Healthfirst QHP |
$348.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$243.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$348.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$296.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$243.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$348.34
|
| 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 |
$348.34
|
|
|
CHG CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST
|
Professional
|
$337.12
|
|
|
Service Code
|
HCPCS 70498 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 NECK W/CONTRAST/NONCONTRAST
|
Professional
|
$768.64
|
|
|
Service Code
|
HCPCS 70498 TC
|
| Min. Negotiated Rate |
$67.42 |
| Max. Negotiated Rate |
$829.32 |
| Rate for Payer: Cash Price |
$237.64
|
| Rate for Payer: Cash Price |
$237.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$226.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$226.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$239.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$252.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$239.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$252.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$252.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$189.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$239.42
|
| Rate for Payer: Healthfirst QHP |
$252.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$176.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$252.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$214.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$176.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$252.02
|
| 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 |
$252.02
|
|
|
CHG CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST
|
Professional
|
$1,111.85
|
|
|
Service Code
|
HCPCS 72191
|
| Min. Negotiated Rate |
$68.64 |
| Max. Negotiated Rate |
$833.89 |
| Rate for Payer: Cash Price |
$363.20
|
| Rate for Payer: Cash Price |
$363.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$347.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$347.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$366.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$386.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$366.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$386.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$386.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$289.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$366.90
|
| Rate for Payer: Healthfirst QHP |
$386.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$270.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$386.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$328.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$270.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$386.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$833.89
|
| Rate for Payer: SOMOS Essential |
$833.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$386.21
|
|
|
CHG CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST
|
Professional
|
$768.64
|
|
|
Service Code
|
HCPCS 72191 TC
|
| Min. Negotiated Rate |
$68.64 |
| Max. Negotiated Rate |
$833.89 |
| Rate for Payer: Cash Price |
$270.25
|
| Rate for Payer: Cash Price |
$270.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$259.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$259.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$273.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$288.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$273.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$288.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$288.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$216.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$273.75
|
| Rate for Payer: Healthfirst QHP |
$288.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$201.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$288.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$244.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$201.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$288.16
|
| 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 |
$288.16
|
|
|
CHG CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST
|
Professional
|
$343.18
|
|
|
Service Code
|
HCPCS 72191 26
|
| Min. Negotiated Rate |
$68.64 |
| Max. Negotiated Rate |
$833.89 |
| Rate for Payer: Cash Price |
$92.95
|
| Rate for Payer: Cash Price |
$92.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$88.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$88.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$93.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$98.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$93.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$98.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$98.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$93.15
|
| Rate for Payer: Healthfirst QHP |
$98.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$68.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$98.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$83.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$68.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$98.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$257.38
|
| Rate for Payer: SOMOS Essential |
$257.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$98.05
|
|
|
CHG CT ANGIOGRAPHY UPPER EXTREMITY
|
Professional
|
$768.64
|
|
|
Service Code
|
HCPCS 73206 TC
|
| Min. Negotiated Rate |
$68.64 |
| Max. Negotiated Rate |
$833.89 |
| Rate for Payer: Cash Price |
$261.21
|
| Rate for Payer: Cash Price |
$261.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$250.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$250.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$264.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$278.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$264.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$278.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$208.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$264.38
|
| Rate for Payer: Healthfirst QHP |
$278.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$194.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$278.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$236.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$194.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$278.30
|
| 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 |
$278.30
|
|
|
CHG CT ANGIOGRAPHY UPPER EXTREMITY
|
Professional
|
$1,111.85
|
|
|
Service Code
|
HCPCS 73206
|
| Min. Negotiated Rate |
$68.64 |
| Max. Negotiated Rate |
$833.89 |
| Rate for Payer: Cash Price |
$354.16
|
| Rate for Payer: Cash Price |
$354.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$338.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$338.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$357.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$376.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$357.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$376.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$376.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$282.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$357.54
|
| Rate for Payer: Healthfirst QHP |
$376.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$263.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$376.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$319.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$263.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$376.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$833.89
|
| Rate for Payer: SOMOS Essential |
$833.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$376.36
|
|
|
CHG CT ANGIOGRAPHY UPPER EXTREMITY
|
Professional
|
$343.18
|
|
|
Service Code
|
HCPCS 73206 26
|
| Min. Negotiated Rate |
$68.64 |
| Max. Negotiated Rate |
$833.89 |
| Rate for Payer: Cash Price |
$92.95
|
| Rate for Payer: Cash Price |
$92.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$88.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$88.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$93.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$98.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$93.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$98.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$98.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$93.15
|
| Rate for Payer: Healthfirst QHP |
$98.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$68.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$98.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$83.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$68.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$98.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$257.38
|
| Rate for Payer: SOMOS Essential |
$257.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$98.05
|
|
|
CHG CT BONE MINERL DENSITY STUDY 1/> SITS AXIAL SKE
|
Professional
|
$369.29
|
|
|
Service Code
|
HCPCS 77078 TC
|
| Min. Negotiated Rate |
$9.39 |
| Max. Negotiated Rate |
$312.22 |
| Rate for Payer: Cash Price |
$108.29
|
| Rate for Payer: Cash Price |
$108.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$103.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$103.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$109.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$115.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$109.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$115.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$115.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$86.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$109.60
|
| Rate for Payer: Healthfirst QHP |
$115.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$80.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$115.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$98.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$80.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$115.37
|
| 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 |
$115.37
|
|
|
CHG CT BONE MINERL DENSITY STUDY 1/> SITS AXIAL SKE
|
Professional
|
$46.97
|
|
|
Service Code
|
HCPCS 77078 26
|
| Min. Negotiated Rate |
$9.39 |
| Max. Negotiated Rate |
$312.22 |
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.75
|
| Rate for Payer: Healthfirst QHP |
$13.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$13.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$11.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35.23
|
| Rate for Payer: SOMOS Essential |
$35.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.42
|
|
|
CHG CT BONE MINERL DENSITY STUDY 1/> SITS AXIAL SKE
|
Professional
|
$416.29
|
|
|
Service Code
|
HCPCS 77078
|
| Min. Negotiated Rate |
$9.39 |
| Max. Negotiated Rate |
$312.22 |
| Rate for Payer: Cash Price |
$121.17
|
| Rate for Payer: Cash Price |
$121.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$115.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$115.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$122.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$128.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$122.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$128.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$128.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$96.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$122.36
|
| Rate for Payer: Healthfirst QHP |
$128.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$90.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$128.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$109.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$90.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$128.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$312.22
|
| Rate for Payer: SOMOS Essential |
$312.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$128.80
|
|
|
CHG CT CERVICAL SPINE W/CONTRAST MATERIAL
|
Professional
|
$741.06
|
|
|
Service Code
|
HCPCS 72126
|
| Min. Negotiated Rate |
$46.49 |
| Max. Negotiated Rate |
$555.80 |
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$190.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$190.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$201.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$211.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$201.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$211.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$211.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$158.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$201.14
|
| Rate for Payer: Healthfirst QHP |
$211.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$148.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$211.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$179.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$148.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$211.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$555.80
|
| Rate for Payer: SOMOS Essential |
$555.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$211.73
|
|
|
CHG CT CERVICAL SPINE W/CONTRAST MATERIAL
|
Professional
|
$508.59
|
|
|
Service Code
|
HCPCS 72126 TC
|
| Min. Negotiated Rate |
$46.49 |
| Max. Negotiated Rate |
$555.80 |
| Rate for Payer: Cash Price |
$137.21
|
| Rate for Payer: Cash Price |
$137.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$130.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$130.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$138.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$145.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$138.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$145.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$145.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$108.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$138.04
|
| Rate for Payer: Healthfirst QHP |
$145.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$101.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$145.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$123.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$101.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$145.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$381.44
|
| Rate for Payer: SOMOS Essential |
$381.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$145.31
|
|
|
CHG CT CERVICAL SPINE W/CONTRAST MATERIAL
|
Professional
|
$232.47
|
|
|
Service Code
|
HCPCS 72126 26
|
| Min. Negotiated Rate |
$46.49 |
| Max. Negotiated Rate |
$555.80 |
| Rate for Payer: Cash Price |
$63.19
|
| Rate for Payer: Cash Price |
$63.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$59.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$59.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$63.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$66.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$63.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$66.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$66.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$49.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$63.10
|
| Rate for Payer: Healthfirst QHP |
$66.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$46.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$66.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$56.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$46.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$66.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$174.35
|
| Rate for Payer: SOMOS Essential |
$174.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$66.42
|
|
|
CHG CT CERVICAL SPINE W/O CONTRAST MATERIAL
|
Professional
|
$187.95
|
|
|
Service Code
|
HCPCS 72125 26
|
| Min. Negotiated Rate |
$37.59 |
| Max. Negotiated Rate |
$424.41 |
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$48.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$48.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$51.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$53.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$51.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$51.02
|
| Rate for Payer: Healthfirst QHP |
$53.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$53.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$45.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$53.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$140.96
|
| Rate for Payer: SOMOS Essential |
$140.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.70
|
|
|
CHG CT CERVICAL SPINE W/O CONTRAST MATERIAL
|
Professional
|
$565.88
|
|
|
Service Code
|
HCPCS 72125
|
| Min. Negotiated Rate |
$37.59 |
| Max. Negotiated Rate |
$424.41 |
| Rate for Payer: Cash Price |
$154.15
|
| Rate for Payer: Cash Price |
$154.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$145.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$145.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$153.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$161.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$153.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$161.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$161.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$121.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$153.60
|
| Rate for Payer: Healthfirst QHP |
$161.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$113.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$161.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$137.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$113.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$161.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$424.41
|
| Rate for Payer: SOMOS Essential |
$424.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$161.68
|
|
|
CHG CT CERVICAL SPINE W/O CONTRAST MATERIAL
|
Professional
|
$377.93
|
|
|
Service Code
|
HCPCS 72125 TC
|
| Min. Negotiated Rate |
$37.59 |
| Max. Negotiated Rate |
$424.41 |
| Rate for Payer: Cash Price |
$102.39
|
| Rate for Payer: Cash Price |
$102.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$97.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$97.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$102.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$102.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$107.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$102.58
|
| Rate for Payer: Healthfirst QHP |
$107.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$75.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$107.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$91.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$75.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$107.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$283.45
|
| Rate for Payer: SOMOS Essential |
$283.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$107.98
|
|
|
CHG CT CERVICAL SPINE W/O &W/CONTRAST MATERIAL
|
Professional
|
$627.90
|
|
|
Service Code
|
HCPCS 72127 TC
|
| Min. Negotiated Rate |
$48.58 |
| Max. Negotiated Rate |
$653.10 |
| Rate for Payer: Cash Price |
$169.43
|
| Rate for Payer: Cash Price |
$169.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$161.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$161.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$170.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$179.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$170.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$179.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$179.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$134.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$170.43
|
| Rate for Payer: Healthfirst QHP |
$179.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$125.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$179.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$152.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$125.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$179.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$470.92
|
| Rate for Payer: SOMOS Essential |
$470.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$179.40
|
|
|
CHG CT CERVICAL SPINE W/O &W/CONTRAST MATERIAL
|
Professional
|
$870.80
|
|
|
Service Code
|
HCPCS 72127
|
| Min. Negotiated Rate |
$48.58 |
| Max. Negotiated Rate |
$653.10 |
| Rate for Payer: Cash Price |
$235.38
|
| Rate for Payer: Cash Price |
$235.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$223.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$223.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$236.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$248.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$236.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$248.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$248.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$186.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$236.36
|
| Rate for Payer: Healthfirst QHP |
$248.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$174.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$248.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$211.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$174.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$248.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$653.10
|
| Rate for Payer: SOMOS Essential |
$653.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$248.80
|
|
|
CHG CT CERVICAL SPINE W/O &W/CONTRAST MATERIAL
|
Professional
|
$242.90
|
|
|
Service Code
|
HCPCS 72127 26
|
| Min. Negotiated Rate |
$48.58 |
| Max. Negotiated Rate |
$653.10 |
| Rate for Payer: Cash Price |
$65.96
|
| Rate for Payer: Cash Price |
$65.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$62.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$65.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$69.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$65.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$69.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$69.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$52.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$65.93
|
| Rate for Payer: Healthfirst QHP |
$69.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$48.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$69.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$58.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$48.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$69.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$182.18
|
| Rate for Payer: SOMOS Essential |
$182.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$69.40
|
|
|
CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/CONTRAST
|
Professional
|
$767.34
|
|
|
Service Code
|
HCPCS 74262 TC
|
| Min. Negotiated Rate |
$95.35 |
| Max. Negotiated Rate |
$933.08 |
| Rate for Payer: Cash Price |
$427.03
|
| Rate for Payer: Cash Price |
$427.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$414.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$414.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$437.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$460.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$437.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$460.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$460.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$345.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$437.24
|
| Rate for Payer: Healthfirst QHP |
$460.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$322.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$460.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$391.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$322.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$460.25
|
| 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 |
$460.25
|
|
|
CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/CONTRAST
|
Professional
|
$476.77
|
|
|
Service Code
|
HCPCS 74262 26
|
| Min. Negotiated Rate |
$95.35 |
| Max. Negotiated Rate |
$933.08 |
| Rate for Payer: Cash Price |
$129.89
|
| Rate for Payer: Cash Price |
$129.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$122.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$122.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$129.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$136.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$129.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$136.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$136.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$102.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$129.41
|
| Rate for Payer: Healthfirst QHP |
$136.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$95.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$136.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$115.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$95.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$136.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$357.58
|
| Rate for Payer: SOMOS Essential |
$357.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$136.22
|
|
|
CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/CONTRAST
|
Professional
|
$1,244.11
|
|
|
Service Code
|
HCPCS 74262
|
| Min. Negotiated Rate |
$95.35 |
| Max. Negotiated Rate |
$933.08 |
| Rate for Payer: Cash Price |
$556.92
|
| Rate for Payer: Cash Price |
$556.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$536.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$536.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$566.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$596.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$566.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$596.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$596.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$447.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$566.65
|
| Rate for Payer: Healthfirst QHP |
$596.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$417.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$596.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$507.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$417.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$596.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$933.08
|
| Rate for Payer: SOMOS Essential |
$933.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$596.47
|
|
|
CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/O CONTRAST
|
Professional
|
$454.13
|
|
|
Service Code
|
HCPCS 74261 TC
|
| Min. Negotiated Rate |
$91.70 |
| Max. Negotiated Rate |
$684.44 |
| Rate for Payer: Cash Price |
$370.05
|
| Rate for Payer: Cash Price |
$370.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$358.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$358.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$378.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$398.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$378.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$398.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$398.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$298.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$378.32
|
| Rate for Payer: Healthfirst QHP |
$398.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$278.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$398.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$338.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$278.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$398.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$340.60
|
| Rate for Payer: SOMOS Essential |
$340.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$398.23
|
|
