|
CHG CT PELVIS W/O CONTRAST MATERIAL
|
Professional
|
$208.99
|
|
|
Service Code
|
HCPCS 72192 26
|
| Min. Negotiated Rate |
$41.80 |
| Max. Negotiated Rate |
$436.96 |
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$53.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$56.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$59.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$56.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$56.72
|
| Rate for Payer: Healthfirst QHP |
$59.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$41.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$59.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$50.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$41.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$59.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$156.74
|
| Rate for Payer: SOMOS Essential |
$156.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$59.71
|
|
|
CHG CT PELVIS W/O CONTRAST MATERIAL
|
Professional
|
$373.63
|
|
|
Service Code
|
HCPCS 72192 TC
|
| Min. Negotiated Rate |
$41.80 |
| Max. Negotiated Rate |
$436.96 |
| Rate for Payer: Cash Price |
$100.82
|
| Rate for Payer: Cash Price |
$100.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$96.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$96.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$101.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$106.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$101.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$106.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$101.41
|
| Rate for Payer: Healthfirst QHP |
$106.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$74.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$106.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$90.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$74.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$106.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$280.22
|
| Rate for Payer: SOMOS Essential |
$280.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$106.75
|
|
|
CHG CT PELVIS W/O & W/CONTRAST MATERIAL
|
Professional
|
$768.78
|
|
|
Service Code
|
HCPCS 72194 TC
|
| Min. Negotiated Rate |
$46.49 |
| Max. Negotiated Rate |
$750.94 |
| Rate for Payer: Cash Price |
$239.37
|
| Rate for Payer: Cash Price |
$239.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$230.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$230.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$243.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$255.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$243.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$255.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$255.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$191.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$243.00
|
| Rate for Payer: Healthfirst QHP |
$255.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$179.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$255.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$217.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$179.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$255.79
|
| 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 |
$255.79
|
|
|
CHG CT PELVIS W/O & W/CONTRAST MATERIAL
|
Professional
|
$232.47
|
|
|
Service Code
|
HCPCS 72194 26
|
| Min. Negotiated Rate |
$46.49 |
| Max. Negotiated Rate |
$750.94 |
| Rate for Payer: Cash Price |
$62.80
|
| Rate for Payer: Cash Price |
$62.80
|
| 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 PELVIS W/O & W/CONTRAST MATERIAL
|
Professional
|
$1,001.25
|
|
|
Service Code
|
HCPCS 72194
|
| Min. Negotiated Rate |
$46.49 |
| Max. Negotiated Rate |
$750.94 |
| Rate for Payer: Cash Price |
$302.17
|
| Rate for Payer: Cash Price |
$302.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$289.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$289.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$306.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$322.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$306.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$322.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$322.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$241.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$306.10
|
| Rate for Payer: Healthfirst QHP |
$322.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$225.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$322.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$273.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$225.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$322.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$750.94
|
| Rate for Payer: SOMOS Essential |
$750.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$322.21
|
|
|
CHG CT SOFT TISSUE NECK W/CONTRAST MATERIAL
|
Professional
|
$811.27
|
|
|
Service Code
|
HCPCS 70491
|
| Min. Negotiated Rate |
$53.06 |
| Max. Negotiated Rate |
$608.45 |
| Rate for Payer: Cash Price |
$218.79
|
| Rate for Payer: Cash Price |
$218.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$208.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$208.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$220.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$220.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$231.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$173.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$220.20
|
| Rate for Payer: Healthfirst QHP |
$231.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$162.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$231.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$197.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$162.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$608.45
|
| Rate for Payer: SOMOS Essential |
$608.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.79
|
|
|
CHG CT SOFT TISSUE NECK W/CONTRAST MATERIAL
|
Professional
|
$265.30
|
|
|
Service Code
|
HCPCS 70491 26
|
| Min. Negotiated Rate |
$53.06 |
| Max. Negotiated Rate |
$608.45 |
| Rate for Payer: Cash Price |
$71.76
|
| Rate for Payer: Cash Price |
$71.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$68.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$68.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$72.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$75.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$72.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$56.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$72.01
|
| Rate for Payer: Healthfirst QHP |
$75.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$53.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$75.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$64.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$53.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$75.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$198.98
|
| Rate for Payer: SOMOS Essential |
$198.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$75.80
|
|
|
CHG CT SOFT TISSUE NECK W/CONTRAST MATERIAL
|
Professional
|
$545.97
|
|
|
Service Code
|
HCPCS 70491 TC
|
| Min. Negotiated Rate |
$53.06 |
| Max. Negotiated Rate |
$608.45 |
| Rate for Payer: Cash Price |
$147.03
|
| Rate for Payer: Cash Price |
$147.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$140.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$140.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$148.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$155.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$148.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$155.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$155.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$116.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$148.19
|
| Rate for Payer: Healthfirst QHP |
$155.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$109.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$155.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$132.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$109.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$155.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$409.48
|
| Rate for Payer: SOMOS Essential |
$409.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$155.99
|
|
|
CHG CT SOFT TISSUE NECK W/O CONTRAST MATERIAL
|
Professional
|
$656.57
|
|
|
Service Code
|
HCPCS 70490
|
| Min. Negotiated Rate |
$49.41 |
| Max. Negotiated Rate |
$492.43 |
| Rate for Payer: Cash Price |
$177.35
|
| Rate for Payer: Cash Price |
$177.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$168.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$168.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$178.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$187.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$178.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$187.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$187.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$140.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$178.21
|
| Rate for Payer: Healthfirst QHP |
$187.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$131.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$187.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$159.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$131.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$187.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$492.43
|
| Rate for Payer: SOMOS Essential |
$492.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$187.59
|
|
|
CHG CT SOFT TISSUE NECK W/O CONTRAST MATERIAL
|
Professional
|
$247.03
|
|
|
Service Code
|
HCPCS 70490 26
|
| Min. Negotiated Rate |
$49.41 |
| Max. Negotiated Rate |
$492.43 |
| Rate for Payer: Cash Price |
$66.70
|
| Rate for Payer: Cash Price |
$66.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$63.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$63.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$67.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$67.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$70.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$52.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$67.05
|
| Rate for Payer: Healthfirst QHP |
$70.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$49.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$70.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$59.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$49.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$185.27
|
| Rate for Payer: SOMOS Essential |
$185.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.58
|
|
|
CHG CT SOFT TISSUE NECK W/O CONTRAST MATERIAL
|
Professional
|
$409.54
|
|
|
Service Code
|
HCPCS 70490 TC
|
| Min. Negotiated Rate |
$49.41 |
| Max. Negotiated Rate |
$492.43 |
| Rate for Payer: Cash Price |
$110.65
|
| Rate for Payer: Cash Price |
$110.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$105.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$105.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$111.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$117.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$111.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$117.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$117.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$87.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$111.16
|
| Rate for Payer: Healthfirst QHP |
$117.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$81.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$117.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$99.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$81.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$117.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$307.16
|
| Rate for Payer: SOMOS Essential |
$307.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$117.01
|
|
|
CHG CT SOFT TISSUE NECK W/O & W/CONTRAST MATERIAL
|
Professional
|
$308.18
|
|
|
Service Code
|
HCPCS 70492 26
|
| Min. Negotiated Rate |
$61.64 |
| Max. Negotiated Rate |
$731.17 |
| Rate for Payer: Cash Price |
$83.50
|
| Rate for Payer: Cash Price |
$83.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$79.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$79.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$83.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$88.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$83.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$88.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$66.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$83.65
|
| Rate for Payer: Healthfirst QHP |
$88.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$61.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$88.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$74.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$61.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$88.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$231.14
|
| Rate for Payer: SOMOS Essential |
$231.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$88.05
|
|
|
CHG CT SOFT TISSUE NECK W/O & W/CONTRAST MATERIAL
|
Professional
|
$974.89
|
|
|
Service Code
|
HCPCS 70492
|
| Min. Negotiated Rate |
$61.64 |
| Max. Negotiated Rate |
$731.17 |
| Rate for Payer: Cash Price |
$262.36
|
| Rate for Payer: Cash Price |
$262.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$250.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$250.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$264.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$278.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$264.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$278.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$208.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$264.61
|
| Rate for Payer: Healthfirst QHP |
$278.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$194.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$278.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$236.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$194.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$278.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$731.17
|
| Rate for Payer: SOMOS Essential |
$731.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$278.54
|
|
|
CHG CT SOFT TISSUE NECK W/O & W/CONTRAST MATERIAL
|
Professional
|
$666.72
|
|
|
Service Code
|
HCPCS 70492 TC
|
| Min. Negotiated Rate |
$61.64 |
| Max. Negotiated Rate |
$731.17 |
| Rate for Payer: Cash Price |
$178.86
|
| Rate for Payer: Cash Price |
$178.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$171.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$171.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$180.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$190.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$180.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$190.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$190.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$142.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$180.97
|
| Rate for Payer: Healthfirst QHP |
$190.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$133.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$190.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$161.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$133.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$190.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$500.04
|
| Rate for Payer: SOMOS Essential |
$500.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$190.49
|
|
|
CHG CT THORACIC SPINE W/CONTRAST MATERIAL
|
Professional
|
$748.13
|
|
|
Service Code
|
HCPCS 72129
|
| Min. Negotiated Rate |
$47.04 |
| Max. Negotiated Rate |
$561.10 |
| Rate for Payer: Cash Price |
$202.20
|
| Rate for Payer: Cash Price |
$202.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$192.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$192.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$203.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$213.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$203.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$213.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$213.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$160.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$203.06
|
| Rate for Payer: Healthfirst QHP |
$213.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$149.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$213.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$181.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$149.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$213.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$561.10
|
| Rate for Payer: SOMOS Essential |
$561.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$213.75
|
|
|
CHG CT THORACIC SPINE W/CONTRAST MATERIAL
|
Professional
|
$235.20
|
|
|
Service Code
|
HCPCS 72129 26
|
| Min. Negotiated Rate |
$47.04 |
| Max. Negotiated Rate |
$561.10 |
| Rate for Payer: Cash Price |
$63.82
|
| Rate for Payer: Cash Price |
$63.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$60.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$63.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$67.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$63.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$50.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$63.84
|
| Rate for Payer: Healthfirst QHP |
$67.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$47.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$67.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$57.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$47.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$67.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$176.40
|
| Rate for Payer: SOMOS Essential |
$176.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$67.20
|
|
|
CHG CT THORACIC SPINE W/CONTRAST MATERIAL
|
Professional
|
$512.93
|
|
|
Service Code
|
HCPCS 72129 TC
|
| Min. Negotiated Rate |
$47.04 |
| Max. Negotiated Rate |
$561.10 |
| Rate for Payer: Cash Price |
$138.38
|
| Rate for Payer: Cash Price |
$138.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$131.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$131.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$139.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$146.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$139.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$146.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$146.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$109.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$139.22
|
| Rate for Payer: Healthfirst QHP |
$146.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$102.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$146.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$124.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$102.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$146.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$384.70
|
| Rate for Payer: SOMOS Essential |
$384.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$146.55
|
|
|
CHG CT THORACIC SPINE W/O CONTRAST MATERIAL
|
Professional
|
$565.88
|
|
|
Service Code
|
HCPCS 72128
|
| Min. Negotiated Rate |
$37.59 |
| Max. Negotiated Rate |
$424.41 |
| Rate for Payer: Cash Price |
$153.76
|
| Rate for Payer: Cash Price |
$153.76
|
| 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 THORACIC SPINE W/O CONTRAST MATERIAL
|
Professional
|
$187.95
|
|
|
Service Code
|
HCPCS 72128 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 THORACIC SPINE W/O CONTRAST MATERIAL
|
Professional
|
$377.93
|
|
|
Service Code
|
HCPCS 72128 TC
|
| Min. Negotiated Rate |
$37.59 |
| Max. Negotiated Rate |
$424.41 |
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| 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 THORACIC SPINE W/O & W/CONTRAST MATERIAL
|
Professional
|
$635.11
|
|
|
Service Code
|
HCPCS 72130 TC
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$659.59 |
| Rate for Payer: Cash Price |
$170.60
|
| Rate for Payer: Cash Price |
$170.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$163.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$163.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$172.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$181.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$172.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$181.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$181.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$136.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$172.39
|
| Rate for Payer: Healthfirst QHP |
$181.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$127.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$181.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$154.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$127.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$181.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$476.33
|
| Rate for Payer: SOMOS Essential |
$476.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$181.46
|
|
|
CHG CT THORACIC SPINE W/O & W/CONTRAST MATERIAL
|
Professional
|
$879.45
|
|
|
Service Code
|
HCPCS 72130
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$659.59 |
| Rate for Payer: Cash Price |
$236.95
|
| Rate for Payer: Cash Price |
$236.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$226.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$226.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$238.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$251.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$238.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$251.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$188.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$238.71
|
| Rate for Payer: Healthfirst QHP |
$251.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$175.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$251.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$213.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$175.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$251.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$659.59
|
| Rate for Payer: SOMOS Essential |
$659.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$251.27
|
|
|
CHG CT THORACIC SPINE W/O & W/CONTRAST MATERIAL
|
Professional
|
$244.34
|
|
|
Service Code
|
HCPCS 72130 26
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$659.59 |
| Rate for Payer: Cash Price |
$66.35
|
| Rate for Payer: Cash Price |
$66.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$62.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$66.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$69.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$66.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$69.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$69.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$52.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$66.32
|
| Rate for Payer: Healthfirst QHP |
$69.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$48.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$69.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$59.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$48.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$69.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$183.26
|
| Rate for Payer: SOMOS Essential |
$183.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$69.81
|
|
|
CHG CT UPPER EXTREMITY W/CONTRAST MATERIAL
|
Professional
|
$669.59
|
|
|
Service Code
|
HCPCS 73201 TC
|
| Min. Negotiated Rate |
$44.42 |
| Max. Negotiated Rate |
$668.74 |
| Rate for Payer: Cash Price |
$179.25
|
| Rate for Payer: Cash Price |
$179.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$172.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$172.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$181.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$191.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$181.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$191.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$143.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$181.74
|
| Rate for Payer: Healthfirst QHP |
$191.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$133.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$191.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$162.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$133.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$191.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$502.19
|
| Rate for Payer: SOMOS Essential |
$502.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$191.31
|
|
|
CHG CT UPPER EXTREMITY W/CONTRAST MATERIAL
|
Professional
|
$891.66
|
|
|
Service Code
|
HCPCS 73201
|
| Min. Negotiated Rate |
$44.42 |
| Max. Negotiated Rate |
$668.74 |
| Rate for Payer: Cash Price |
$239.57
|
| Rate for Payer: Cash Price |
$239.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$229.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$229.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$242.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$254.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$242.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$254.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$254.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$191.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$242.02
|
| Rate for Payer: Healthfirst QHP |
$254.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$178.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$254.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$216.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$178.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$254.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$668.74
|
| Rate for Payer: SOMOS Essential |
$668.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$254.76
|
|
