|
CHG CT HEART C+ CARDIAC STRUX&MORPH CGEN HRT DS
|
Professional
|
$481.60
|
|
|
Service Code
|
HCPCS 75573 26
|
| Min. Negotiated Rate |
$96.32 |
| Max. Negotiated Rate |
$939.73 |
| Rate for Payer: Cash Price |
$131.01
|
| Rate for Payer: Cash Price |
$131.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$123.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$123.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$130.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$137.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$130.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$137.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$137.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$103.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$130.72
|
| Rate for Payer: Healthfirst QHP |
$137.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$96.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$137.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$116.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$96.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$137.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$361.20
|
| Rate for Payer: SOMOS Essential |
$361.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$137.60
|
|
|
CHG CT HEART CONTRAST EVAL CARDIAC STRUCTURE&MORPH
|
Professional
|
$663.57
|
|
|
Service Code
|
HCPCS 75572 TC
|
| Min. Negotiated Rate |
$66.04 |
| Max. Negotiated Rate |
$745.32 |
| Rate for Payer: Cash Price |
$180.27
|
| Rate for Payer: Cash Price |
$180.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$170.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$170.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$180.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$189.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$180.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$189.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$189.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$142.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$180.11
|
| Rate for Payer: Healthfirst QHP |
$189.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$132.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$189.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$161.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$132.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$189.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$497.68
|
| Rate for Payer: SOMOS Essential |
$497.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$189.59
|
|
|
CHG CT HEART CONTRAST EVAL CARDIAC STRUCTURE&MORPH
|
Professional
|
$330.19
|
|
|
Service Code
|
HCPCS 75572 26
|
| Min. Negotiated Rate |
$66.04 |
| Max. Negotiated Rate |
$745.32 |
| Rate for Payer: Cash Price |
$89.61
|
| Rate for Payer: Cash Price |
$89.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$84.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$84.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$89.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$94.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$89.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$94.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$94.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$70.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$89.62
|
| Rate for Payer: Healthfirst QHP |
$94.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$66.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$94.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$80.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$66.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$94.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$247.64
|
| Rate for Payer: SOMOS Essential |
$247.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$94.34
|
|
|
CHG CT HEART CONTRAST EVAL CARDIAC STRUCTURE&MORPH
|
Professional
|
$993.76
|
|
|
Service Code
|
HCPCS 75572
|
| Min. Negotiated Rate |
$66.04 |
| Max. Negotiated Rate |
$745.32 |
| Rate for Payer: Cash Price |
$269.88
|
| Rate for Payer: Cash Price |
$269.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$255.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$255.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$269.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$283.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$269.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$283.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$283.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$212.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$269.73
|
| Rate for Payer: Healthfirst QHP |
$283.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$198.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$283.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$241.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$198.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$283.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$745.32
|
| Rate for Payer: SOMOS Essential |
$745.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$283.93
|
|
|
CHG CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM
|
Professional
|
$326.17
|
|
|
Service Code
|
HCPCS 75571 TC
|
| Min. Negotiated Rate |
$22.76 |
| Max. Negotiated Rate |
$329.96 |
| Rate for Payer: Cash Price |
$89.27
|
| Rate for Payer: Cash Price |
$89.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$83.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$83.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$88.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$93.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$88.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$88.53
|
| Rate for Payer: Healthfirst QHP |
$93.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$65.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$93.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$79.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$65.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$93.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$244.63
|
| Rate for Payer: SOMOS Essential |
$244.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$93.19
|
|
|
CHG CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM
|
Professional
|
$439.95
|
|
|
Service Code
|
HCPCS 75571
|
| Min. Negotiated Rate |
$22.76 |
| Max. Negotiated Rate |
$329.96 |
| Rate for Payer: Cash Price |
$119.23
|
| Rate for Payer: Cash Price |
$119.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$113.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$113.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$119.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$125.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$119.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$94.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$119.42
|
| Rate for Payer: Healthfirst QHP |
$125.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$87.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$125.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$106.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$87.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$125.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$329.96
|
| Rate for Payer: SOMOS Essential |
$329.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$125.70
|
|
|
CHG CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM
|
Professional
|
$113.79
|
|
|
Service Code
|
HCPCS 75571 26
|
| Min. Negotiated Rate |
$22.76 |
| Max. Negotiated Rate |
$329.96 |
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.88
|
| Rate for Payer: Healthfirst QHP |
$32.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$85.34
|
| Rate for Payer: SOMOS Essential |
$85.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.51
|
|
|
CHG CT LIMITED/LOCALIZED FOLLOW UP STUDY
|
Professional
|
$183.72
|
|
|
Service Code
|
HCPCS 76380 26
|
| Min. Negotiated Rate |
$36.74 |
| Max. Negotiated Rate |
$414.78 |
| Rate for Payer: Cash Price |
$49.72
|
| Rate for Payer: Cash Price |
$49.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.87
|
| Rate for Payer: Healthfirst QHP |
$52.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$137.79
|
| Rate for Payer: SOMOS Essential |
$137.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.49
|
|
|
CHG CT LIMITED/LOCALIZED FOLLOW UP STUDY
|
Professional
|
$369.29
|
|
|
Service Code
|
HCPCS 76380 TC
|
| Min. Negotiated Rate |
$36.74 |
| Max. Negotiated Rate |
$414.78 |
| Rate for Payer: Cash Price |
$105.54
|
| Rate for Payer: Cash Price |
$105.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$101.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$101.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$106.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$112.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$106.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$112.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$84.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$106.88
|
| Rate for Payer: Healthfirst QHP |
$112.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$78.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$112.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$95.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$78.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$112.50
|
| 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 |
$112.50
|
|
|
CHG CT LIMITED/LOCALIZED FOLLOW UP STUDY
|
Professional
|
$553.04
|
|
|
Service Code
|
HCPCS 76380
|
| Min. Negotiated Rate |
$36.74 |
| Max. Negotiated Rate |
$414.78 |
| Rate for Payer: Cash Price |
$155.26
|
| Rate for Payer: Cash Price |
$155.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$148.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$148.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$156.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$164.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$156.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$164.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$164.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$123.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$156.74
|
| Rate for Payer: Healthfirst QHP |
$164.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$115.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$164.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$140.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$115.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$164.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$414.78
|
| Rate for Payer: SOMOS Essential |
$414.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$164.99
|
|
|
CHG CT LOWER EXTREMITY W/CONTRAST MATERIAL
|
Professional
|
$733.57
|
|
|
Service Code
|
HCPCS 73701
|
| Min. Negotiated Rate |
$44.42 |
| Max. Negotiated Rate |
$550.18 |
| Rate for Payer: Cash Price |
$198.31
|
| Rate for Payer: Cash Price |
$198.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$188.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$188.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$199.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$209.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$199.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$157.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$199.11
|
| Rate for Payer: Healthfirst QHP |
$209.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$146.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$209.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$178.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$146.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$209.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$550.18
|
| Rate for Payer: SOMOS Essential |
$550.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$209.59
|
|
|
CHG CT LOWER EXTREMITY W/CONTRAST MATERIAL
|
Professional
|
$222.08
|
|
|
Service Code
|
HCPCS 73701 26
|
| Min. Negotiated Rate |
$44.42 |
| Max. Negotiated Rate |
$550.18 |
| Rate for Payer: Cash Price |
$60.32
|
| Rate for Payer: Cash Price |
$60.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$57.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$57.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$60.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$63.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$60.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.28
|
| Rate for Payer: Healthfirst QHP |
$63.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$44.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$63.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$53.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$44.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$63.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$166.56
|
| Rate for Payer: SOMOS Essential |
$166.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$63.45
|
|
|
CHG CT LOWER EXTREMITY W/CONTRAST MATERIAL
|
Professional
|
$511.46
|
|
|
Service Code
|
HCPCS 73701 TC
|
| Min. Negotiated Rate |
$44.42 |
| Max. Negotiated Rate |
$550.18 |
| Rate for Payer: Cash Price |
$137.99
|
| Rate for Payer: Cash Price |
$137.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$131.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$131.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$138.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$146.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$138.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$146.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$146.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$109.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$138.82
|
| Rate for Payer: Healthfirst QHP |
$146.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$102.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$146.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$124.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$102.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$146.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$383.60
|
| Rate for Payer: SOMOS Essential |
$383.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$146.13
|
|
|
CHG CT LOWER EXTREMITY W/O CONTRAST MATERIAL
|
Professional
|
$376.50
|
|
|
Service Code
|
HCPCS 73700 TC
|
| Min. Negotiated Rate |
$37.59 |
| Max. Negotiated Rate |
$423.31 |
| Rate for Payer: Cash Price |
$101.61
|
| Rate for Payer: Cash Price |
$101.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$96.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$96.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$102.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$102.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$107.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$102.19
|
| Rate for Payer: Healthfirst QHP |
$107.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$75.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$107.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$91.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$75.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$107.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$282.38
|
| Rate for Payer: SOMOS Essential |
$282.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$107.57
|
|
|
CHG CT LOWER EXTREMITY W/O CONTRAST MATERIAL
|
Professional
|
$564.41
|
|
|
Service Code
|
HCPCS 73700
|
| Min. Negotiated Rate |
$37.59 |
| Max. Negotiated Rate |
$423.31 |
| Rate for Payer: Cash Price |
$153.36
|
| Rate for Payer: Cash Price |
$153.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$145.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$145.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$153.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$161.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$153.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$161.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$161.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$120.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$153.20
|
| Rate for Payer: Healthfirst QHP |
$161.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$112.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$161.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$137.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$112.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$161.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$423.31
|
| Rate for Payer: SOMOS Essential |
$423.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$161.26
|
|
|
CHG CT LOWER EXTREMITY W/O CONTRAST MATERIAL
|
Professional
|
$187.95
|
|
|
Service Code
|
HCPCS 73700 26
|
| Min. Negotiated Rate |
$37.59 |
| Max. Negotiated Rate |
$423.31 |
| 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 LOWER EXTREMITY W/O & W/CONTRAST MATRL
|
Professional
|
$860.37
|
|
|
Service Code
|
HCPCS 73702
|
| Min. Negotiated Rate |
$46.21 |
| Max. Negotiated Rate |
$645.28 |
| Rate for Payer: Cash Price |
$232.62
|
| Rate for Payer: Cash Price |
$232.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$221.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$221.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$233.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$245.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$233.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$245.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$245.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$184.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$233.53
|
| Rate for Payer: Healthfirst QHP |
$245.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$172.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$245.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$208.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$172.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$245.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$645.28
|
| Rate for Payer: SOMOS Essential |
$645.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$245.82
|
|
|
CHG CT LOWER EXTREMITY W/O & W/CONTRAST MATRL
|
Professional
|
$231.04
|
|
|
Service Code
|
HCPCS 73702 26
|
| Min. Negotiated Rate |
$46.21 |
| Max. Negotiated Rate |
$645.28 |
| Rate for Payer: Cash Price |
$62.80
|
| Rate for Payer: Cash Price |
$62.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$59.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$59.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$66.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$66.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$66.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$49.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.71
|
| Rate for Payer: Healthfirst QHP |
$66.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$46.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$66.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$56.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$46.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$66.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$173.28
|
| Rate for Payer: SOMOS Essential |
$173.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$66.01
|
|
|
CHG CT LOWER EXTREMITY W/O & W/CONTRAST MATRL
|
Professional
|
$629.34
|
|
|
Service Code
|
HCPCS 73702 TC
|
| Min. Negotiated Rate |
$46.21 |
| Max. Negotiated Rate |
$645.28 |
| Rate for Payer: Cash Price |
$169.82
|
| Rate for Payer: Cash Price |
$169.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$161.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$161.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$170.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$179.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$170.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$179.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$179.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$134.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$170.82
|
| Rate for Payer: Healthfirst QHP |
$179.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$125.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$179.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$152.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$125.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$179.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$472.00
|
| Rate for Payer: SOMOS Essential |
$472.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$179.81
|
|
|
CHG CT LUMBAR SPINE W/CONTRAST MATERIAL
|
Professional
|
$510.02
|
|
|
Service Code
|
HCPCS 72132 TC
|
| Min. Negotiated Rate |
$46.49 |
| Max. Negotiated Rate |
$556.87 |
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$131.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$131.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$138.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$145.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$138.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$145.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$145.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$109.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$138.43
|
| Rate for Payer: Healthfirst QHP |
$145.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$102.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$145.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$123.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$102.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$145.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$382.52
|
| Rate for Payer: SOMOS Essential |
$382.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$145.72
|
|
|
CHG CT LUMBAR SPINE W/CONTRAST MATERIAL
|
Professional
|
$232.47
|
|
|
Service Code
|
HCPCS 72132 26
|
| Min. Negotiated Rate |
$46.49 |
| Max. Negotiated Rate |
$556.87 |
| 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 LUMBAR SPINE W/CONTRAST MATERIAL
|
Professional
|
$742.49
|
|
|
Service Code
|
HCPCS 72132
|
| Min. Negotiated Rate |
$46.49 |
| Max. Negotiated Rate |
$556.87 |
| Rate for Payer: Cash Price |
$200.79
|
| Rate for Payer: Cash Price |
$200.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$190.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$190.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$201.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$212.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$201.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$212.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$212.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$159.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$201.53
|
| Rate for Payer: Healthfirst QHP |
$212.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$148.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$212.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$180.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$148.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$212.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$556.87
|
| Rate for Payer: SOMOS Essential |
$556.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$212.14
|
|
|
CHG CT LUMBAR SPINE W/O CONTRAST MATERIAL
|
Professional
|
$375.06
|
|
|
Service Code
|
HCPCS 72131 TC
|
| Min. Negotiated Rate |
$37.59 |
| Max. Negotiated Rate |
$422.24 |
| Rate for Payer: Cash Price |
$101.22
|
| Rate for Payer: Cash Price |
$101.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$96.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$96.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$101.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$101.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$107.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$101.80
|
| Rate for Payer: Healthfirst QHP |
$107.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$75.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$107.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$91.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$75.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$107.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$281.30
|
| Rate for Payer: SOMOS Essential |
$281.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$107.16
|
|
|
CHG CT LUMBAR SPINE W/O CONTRAST MATERIAL
|
Professional
|
$562.98
|
|
|
Service Code
|
HCPCS 72131
|
| Min. Negotiated Rate |
$37.59 |
| Max. Negotiated Rate |
$422.24 |
| Rate for Payer: Cash Price |
$152.97
|
| Rate for Payer: Cash Price |
$152.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$144.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$144.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$152.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$160.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$152.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$160.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$160.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$120.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$152.81
|
| Rate for Payer: Healthfirst QHP |
$160.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$112.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$160.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$136.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$112.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$160.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$422.24
|
| Rate for Payer: SOMOS Essential |
$422.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$160.85
|
|
|
CHG CT LUMBAR SPINE W/O CONTRAST MATERIAL
|
Professional
|
$187.95
|
|
|
Service Code
|
HCPCS 72131 26
|
| Min. Negotiated Rate |
$37.59 |
| Max. Negotiated Rate |
$422.24 |
| 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
|
|
