|
CHG M/PHMTRC ALYS ISH QUANT/SEMIQ MNL PER SPEC EACH
|
Professional
|
$512.89
|
|
|
Service Code
|
HCPCS 88369
|
| Min. Negotiated Rate |
$25.27 |
| Max. Negotiated Rate |
$384.67 |
| Rate for Payer: Cash Price |
$148.65
|
| Rate for Payer: Cash Price |
$148.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$131.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$131.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$139.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$146.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$139.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$146.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$146.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$109.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$139.21
|
| Rate for Payer: Healthfirst QHP |
$146.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$102.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$146.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$124.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$102.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$146.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$384.67
|
| Rate for Payer: SOMOS Essential |
$384.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$146.54
|
|
|
CHG M/PHMTRC ALYS ISH QUANT/SEMIQ MNL PER SPEC EACH
|
Professional
|
$126.35
|
|
|
Service Code
|
HCPCS 88369 26
|
| Min. Negotiated Rate |
$25.27 |
| Max. Negotiated Rate |
$384.67 |
| Rate for Payer: Cash Price |
$35.25
|
| Rate for Payer: Cash Price |
$35.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.30
|
| Rate for Payer: Healthfirst QHP |
$36.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$36.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$94.76
|
| Rate for Payer: SOMOS Essential |
$94.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.10
|
|
|
CHG MRA ABDOMEN W/WO CONTRAST MATERIAL
|
Professional
|
$1,158.08
|
|
|
Service Code
|
HCPCS 74185 TC
|
| Min. Negotiated Rate |
$68.68 |
| Max. Negotiated Rate |
$1,126.07 |
| Rate for Payer: Cash Price |
$310.95
|
| Rate for Payer: Cash Price |
$310.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$297.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$297.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$314.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$330.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$314.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$330.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$330.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$248.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$314.34
|
| Rate for Payer: Healthfirst QHP |
$330.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$231.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$330.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$281.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$231.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$330.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$868.56
|
| Rate for Payer: SOMOS Essential |
$868.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$330.88
|
|
|
CHG MRA ABDOMEN W/WO CONTRAST MATERIAL
|
Professional
|
$343.39
|
|
|
Service Code
|
HCPCS 74185 26
|
| Min. Negotiated Rate |
$68.68 |
| Max. Negotiated Rate |
$1,126.07 |
| Rate for Payer: Cash Price |
$92.37
|
| Rate for Payer: Cash Price |
$92.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$88.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$88.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$93.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$98.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$93.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$98.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$98.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$93.20
|
| Rate for Payer: Healthfirst QHP |
$98.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$68.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$98.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$83.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$68.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$98.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$257.54
|
| Rate for Payer: SOMOS Essential |
$257.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$98.11
|
|
|
CHG MRA ABDOMEN W/WO CONTRAST MATERIAL
|
Professional
|
$1,501.43
|
|
|
Service Code
|
HCPCS 74185
|
| Min. Negotiated Rate |
$68.68 |
| Max. Negotiated Rate |
$1,126.07 |
| Rate for Payer: Cash Price |
$403.32
|
| Rate for Payer: Cash Price |
$403.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$386.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$386.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$407.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$428.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$407.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$428.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$428.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$321.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$407.53
|
| Rate for Payer: Healthfirst QHP |
$428.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$300.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$428.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$364.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$300.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$428.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,126.07
|
| Rate for Payer: SOMOS Essential |
$1,126.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$428.98
|
|
|
CHG MRA CHEST W/O & W/CONTRAST MATERIAL
|
Professional
|
$1,140.83
|
|
|
Service Code
|
HCPCS 71555 TC
|
| Min. Negotiated Rate |
$68.92 |
| Max. Negotiated Rate |
$1,114.08 |
| Rate for Payer: Cash Price |
$307.02
|
| Rate for Payer: Cash Price |
$307.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$293.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$293.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$309.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$325.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$309.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$325.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$325.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$244.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$309.65
|
| Rate for Payer: Healthfirst QHP |
$325.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$228.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$325.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$277.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$228.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$325.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$855.62
|
| Rate for Payer: SOMOS Essential |
$855.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$325.95
|
|
|
CHG MRA CHEST W/O & W/CONTRAST MATERIAL
|
Professional
|
$1,485.44
|
|
|
Service Code
|
HCPCS 71555
|
| Min. Negotiated Rate |
$68.92 |
| Max. Negotiated Rate |
$1,114.08 |
| Rate for Payer: Cash Price |
$399.74
|
| Rate for Payer: Cash Price |
$399.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$381.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$381.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$403.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$424.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$403.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$424.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$424.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$318.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$403.19
|
| Rate for Payer: Healthfirst QHP |
$424.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$297.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$424.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$360.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$297.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$424.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,114.08
|
| Rate for Payer: SOMOS Essential |
$1,114.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$424.41
|
|
|
CHG MRA CHEST W/O & W/CONTRAST MATERIAL
|
Professional
|
$344.61
|
|
|
Service Code
|
HCPCS 71555 26
|
| Min. Negotiated Rate |
$68.92 |
| Max. Negotiated Rate |
$1,114.08 |
| Rate for Payer: Cash Price |
$92.72
|
| Rate for Payer: Cash Price |
$92.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$88.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$88.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$93.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$98.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$93.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$98.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$98.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$93.54
|
| Rate for Payer: Healthfirst QHP |
$98.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$68.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$98.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$83.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$68.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$98.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$258.46
|
| Rate for Payer: SOMOS Essential |
$258.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$98.46
|
|
|
CHG MRA HEAD W/CONTRAST MATERIAL
|
Professional
|
$1,011.40
|
|
|
Service Code
|
HCPCS 70545
|
| Min. Negotiated Rate |
$45.70 |
| Max. Negotiated Rate |
$758.55 |
| Rate for Payer: Cash Price |
$272.23
|
| Rate for Payer: Cash Price |
$272.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$260.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$260.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$274.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$288.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$274.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$288.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$288.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$216.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$274.52
|
| Rate for Payer: Healthfirst QHP |
$288.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$202.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$288.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$245.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$202.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$288.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$758.55
|
| Rate for Payer: SOMOS Essential |
$758.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$288.97
|
|
|
CHG MRA HEAD W/CONTRAST MATERIAL
|
Professional
|
$782.88
|
|
|
Service Code
|
HCPCS 70545 TC
|
| Min. Negotiated Rate |
$45.70 |
| Max. Negotiated Rate |
$758.55 |
| Rate for Payer: Cash Price |
$210.13
|
| Rate for Payer: Cash Price |
$210.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$201.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$201.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$212.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$223.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$212.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$223.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$223.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$167.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$212.50
|
| Rate for Payer: Healthfirst QHP |
$223.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$156.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$223.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$190.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$156.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$223.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$587.16
|
| Rate for Payer: SOMOS Essential |
$587.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$223.68
|
|
|
CHG MRA HEAD W/CONTRAST MATERIAL
|
Professional
|
$228.52
|
|
|
Service Code
|
HCPCS 70545 26
|
| Min. Negotiated Rate |
$45.70 |
| Max. Negotiated Rate |
$758.55 |
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$58.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$65.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.03
|
| Rate for Payer: Healthfirst QHP |
$65.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$65.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$55.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$65.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$171.39
|
| Rate for Payer: SOMOS Essential |
$171.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.29
|
|
|
CHG MRA HEAD W/O CONTRST MATERIAL
|
Professional
|
$229.95
|
|
|
Service Code
|
HCPCS 70544 26
|
| Min. Negotiated Rate |
$45.99 |
| Max. Negotiated Rate |
$715.63 |
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$59.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$59.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$65.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$49.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.42
|
| Rate for Payer: Healthfirst QHP |
$65.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$65.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$55.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$65.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$172.46
|
| Rate for Payer: SOMOS Essential |
$172.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.70
|
|
|
CHG MRA HEAD W/O CONTRST MATERIAL
|
Professional
|
$724.22
|
|
|
Service Code
|
HCPCS 70544 TC
|
| Min. Negotiated Rate |
$45.99 |
| Max. Negotiated Rate |
$715.63 |
| Rate for Payer: Cash Price |
$195.98
|
| Rate for Payer: Cash Price |
$195.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$186.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$186.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$196.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$206.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$196.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$206.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$206.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$155.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$196.57
|
| Rate for Payer: Healthfirst QHP |
$206.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$144.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$206.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$175.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$144.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$206.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$543.16
|
| Rate for Payer: SOMOS Essential |
$543.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$206.92
|
|
|
CHG MRA HEAD W/O CONTRST MATERIAL
|
Professional
|
$954.17
|
|
|
Service Code
|
HCPCS 70544
|
| Min. Negotiated Rate |
$45.99 |
| Max. Negotiated Rate |
$715.63 |
| Rate for Payer: Cash Price |
$258.09
|
| Rate for Payer: Cash Price |
$258.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$245.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$245.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$258.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$272.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$258.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$272.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$272.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$204.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$258.99
|
| Rate for Payer: Healthfirst QHP |
$272.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$190.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$272.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$231.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$190.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$272.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$715.63
|
| Rate for Payer: SOMOS Essential |
$715.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$272.62
|
|
|
CHG MRA HEAD W/O & W/CONTRAST MATERIAL
|
Professional
|
$283.43
|
|
|
Service Code
|
HCPCS 70546 26
|
| Min. Negotiated Rate |
$56.69 |
| Max. Negotiated Rate |
$1,100.54 |
| Rate for Payer: Cash Price |
$77.05
|
| Rate for Payer: Cash Price |
$77.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$72.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$72.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$76.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$80.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$76.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$76.93
|
| Rate for Payer: Healthfirst QHP |
$80.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$56.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$80.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$68.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$56.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$80.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$212.57
|
| Rate for Payer: SOMOS Essential |
$212.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$80.98
|
|
|
CHG MRA HEAD W/O & W/CONTRAST MATERIAL
|
Professional
|
$1,467.38
|
|
|
Service Code
|
HCPCS 70546
|
| Min. Negotiated Rate |
$56.69 |
| Max. Negotiated Rate |
$1,100.54 |
| Rate for Payer: Cash Price |
$396.25
|
| Rate for Payer: Cash Price |
$396.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$377.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$377.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$398.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$419.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$398.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$419.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$419.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$314.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$398.29
|
| Rate for Payer: Healthfirst QHP |
$419.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$293.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$419.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$356.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$293.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$419.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,100.54
|
| Rate for Payer: SOMOS Essential |
$1,100.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$419.25
|
|
|
CHG MRA HEAD W/O & W/CONTRAST MATERIAL
|
Professional
|
$1,183.95
|
|
|
Service Code
|
HCPCS 70546 TC
|
| Min. Negotiated Rate |
$56.69 |
| Max. Negotiated Rate |
$1,100.54 |
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$304.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$304.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$321.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$338.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$321.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$338.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$338.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$253.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$321.36
|
| Rate for Payer: Healthfirst QHP |
$338.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$236.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$338.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$287.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$236.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$338.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$887.96
|
| Rate for Payer: SOMOS Essential |
$887.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$338.27
|
|
|
CHG MRA LOWER EXTREMITY W/WO CONTRAST MATERIAL
|
Professional
|
$344.44
|
|
|
Service Code
|
HCPCS 73725 26
|
| Min. Negotiated Rate |
$68.89 |
| Max. Negotiated Rate |
$1,119.33 |
| Rate for Payer: Cash Price |
$93.30
|
| Rate for Payer: Cash Price |
$93.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$88.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$88.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$93.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$98.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$93.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$98.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$98.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$93.49
|
| Rate for Payer: Healthfirst QHP |
$98.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$68.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$98.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$83.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$68.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$98.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$258.33
|
| Rate for Payer: SOMOS Essential |
$258.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$98.41
|
|
|
CHG MRA LOWER EXTREMITY W/WO CONTRAST MATERIAL
|
Professional
|
$1,492.44
|
|
|
Service Code
|
HCPCS 73725
|
| Min. Negotiated Rate |
$68.89 |
| Max. Negotiated Rate |
$1,119.33 |
| Rate for Payer: Cash Price |
$402.29
|
| Rate for Payer: Cash Price |
$402.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$383.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$383.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$405.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$426.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$405.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$426.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$426.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$319.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$405.09
|
| Rate for Payer: Healthfirst QHP |
$426.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$298.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$426.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$362.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$298.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$426.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,119.33
|
| Rate for Payer: SOMOS Essential |
$1,119.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$426.41
|
|
|
CHG MRA LOWER EXTREMITY W/WO CONTRAST MATERIAL
|
Professional
|
$1,148.00
|
|
|
Service Code
|
HCPCS 73725 TC
|
| Min. Negotiated Rate |
$68.89 |
| Max. Negotiated Rate |
$1,119.33 |
| Rate for Payer: Cash Price |
$308.99
|
| Rate for Payer: Cash Price |
$308.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$295.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$295.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$311.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$328.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$311.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$328.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$328.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$246.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$311.60
|
| Rate for Payer: Healthfirst QHP |
$328.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$229.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$328.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$278.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$229.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$328.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$861.00
|
| Rate for Payer: SOMOS Essential |
$861.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$328.00
|
|
|
CHG MRA NECK W/CONTRAST MATERIAL
|
Professional
|
$804.44
|
|
|
Service Code
|
HCPCS 70548 TC
|
| Min. Negotiated Rate |
$57.48 |
| Max. Negotiated Rate |
$818.87 |
| Rate for Payer: Cash Price |
$216.02
|
| Rate for Payer: Cash Price |
$216.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$206.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$206.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$218.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$229.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$218.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$229.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$229.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$172.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$218.35
|
| Rate for Payer: Healthfirst QHP |
$229.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$160.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$229.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$195.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$160.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$229.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$603.33
|
| Rate for Payer: SOMOS Essential |
$603.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$229.84
|
|
|
CHG MRA NECK W/CONTRAST MATERIAL
|
Professional
|
$1,091.83
|
|
|
Service Code
|
HCPCS 70548
|
| Min. Negotiated Rate |
$57.48 |
| Max. Negotiated Rate |
$818.87 |
| Rate for Payer: Cash Price |
$294.16
|
| Rate for Payer: Cash Price |
$294.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$280.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$280.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$296.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$311.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$296.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$311.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$311.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$233.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$296.35
|
| Rate for Payer: Healthfirst QHP |
$311.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$218.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$311.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$265.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$218.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$311.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$818.87
|
| Rate for Payer: SOMOS Essential |
$818.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$311.95
|
|
|
CHG MRA NECK W/CONTRAST MATERIAL
|
Professional
|
$287.39
|
|
|
Service Code
|
HCPCS 70548 26
|
| Min. Negotiated Rate |
$57.48 |
| Max. Negotiated Rate |
$818.87 |
| Rate for Payer: Cash Price |
$78.14
|
| Rate for Payer: Cash Price |
$78.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$73.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$78.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$82.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$78.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$82.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$61.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$78.00
|
| Rate for Payer: Healthfirst QHP |
$82.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$57.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$82.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$69.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$57.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$82.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$215.54
|
| Rate for Payer: SOMOS Essential |
$215.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$82.11
|
|
|
CHG MRA NECK W/O CONTRST MATERIAL
|
Professional
|
$955.61
|
|
|
Service Code
|
HCPCS 70547
|
| Min. Negotiated Rate |
$45.99 |
| Max. Negotiated Rate |
$716.71 |
| Rate for Payer: Cash Price |
$258.48
|
| Rate for Payer: Cash Price |
$258.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$245.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$245.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$259.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$273.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$259.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$273.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$273.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$204.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$259.38
|
| Rate for Payer: Healthfirst QHP |
$273.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$191.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$273.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$232.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$191.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$273.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$716.71
|
| Rate for Payer: SOMOS Essential |
$716.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$273.03
|
|
|
CHG MRA NECK W/O CONTRST MATERIAL
|
Professional
|
$229.95
|
|
|
Service Code
|
HCPCS 70547 26
|
| Min. Negotiated Rate |
$45.99 |
| Max. Negotiated Rate |
$716.71 |
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$59.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$59.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$65.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$49.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.42
|
| Rate for Payer: Healthfirst QHP |
$65.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$65.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$55.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$65.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$172.46
|
| Rate for Payer: SOMOS Essential |
$172.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.70
|
|
