|
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 &W/CONTRAST MATERIAL
|
Professional
|
$346.26
|
|
|
Service Code
|
HCPCS 70549 26
|
| Min. Negotiated Rate |
$69.25 |
| Max. Negotiated Rate |
$1,151.96 |
| Rate for Payer: Cash Price |
$93.16
|
| Rate for Payer: Cash Price |
$93.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$89.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$89.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$93.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$98.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$93.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$98.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$98.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$74.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$93.98
|
| Rate for Payer: Healthfirst QHP |
$98.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$69.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$98.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$84.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$69.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$98.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$259.70
|
| Rate for Payer: SOMOS Essential |
$259.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$98.93
|
|
|
CHG MRA NECK W/O &W/CONTRAST MATERIAL
|
Professional
|
$1,535.94
|
|
|
Service Code
|
HCPCS 70549
|
| Min. Negotiated Rate |
$69.25 |
| Max. Negotiated Rate |
$1,151.96 |
| Rate for Payer: Cash Price |
$413.93
|
| Rate for Payer: Cash Price |
$413.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$394.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$394.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$416.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$438.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$416.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$438.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$438.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$329.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$416.90
|
| Rate for Payer: Healthfirst QHP |
$438.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$307.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$438.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$373.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$307.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$438.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,151.96
|
| Rate for Payer: SOMOS Essential |
$1,151.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$438.84
|
|
|
CHG MRA NECK W/O &W/CONTRAST MATERIAL
|
Professional
|
$1,189.69
|
|
|
Service Code
|
HCPCS 70549 TC
|
| Min. Negotiated Rate |
$69.25 |
| Max. Negotiated Rate |
$1,151.96 |
| Rate for Payer: Cash Price |
$320.78
|
| Rate for Payer: Cash Price |
$320.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$305.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$305.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$322.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$339.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$322.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$339.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$339.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$254.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$322.91
|
| Rate for Payer: Healthfirst QHP |
$339.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$237.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$339.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$288.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$237.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$339.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$892.27
|
| Rate for Payer: SOMOS Essential |
$892.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$339.91
|
|
|
CHG MRA PELVIS W/WO CONTRAST MATERIAL
|
Professional
|
$1,504.30
|
|
|
Service Code
|
HCPCS 72198
|
| Min. Negotiated Rate |
$68.68 |
| Max. Negotiated Rate |
$1,128.22 |
| Rate for Payer: Cash Price |
$404.90
|
| Rate for Payer: Cash Price |
$404.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$386.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$386.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$408.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$429.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$408.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$429.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$429.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$322.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$408.31
|
| Rate for Payer: Healthfirst QHP |
$429.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$300.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$429.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$365.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$300.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$429.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,128.22
|
| Rate for Payer: SOMOS Essential |
$1,128.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$429.80
|
|
|
CHG MRA PELVIS W/WO CONTRAST MATERIAL
|
Professional
|
$1,160.95
|
|
|
Service Code
|
HCPCS 72198 TC
|
| Min. Negotiated Rate |
$68.68 |
| Max. Negotiated Rate |
$1,128.22 |
| Rate for Payer: Cash Price |
$312.53
|
| Rate for Payer: Cash Price |
$312.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$298.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$298.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$315.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$331.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$315.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$331.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$331.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$248.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$315.12
|
| Rate for Payer: Healthfirst QHP |
$331.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$232.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$331.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$281.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$232.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$331.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$870.71
|
| Rate for Payer: SOMOS Essential |
$870.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$331.70
|
|
|
CHG MRA PELVIS W/WO CONTRAST MATERIAL
|
Professional
|
$343.39
|
|
|
Service Code
|
HCPCS 72198 26
|
| Min. Negotiated Rate |
$68.68 |
| Max. Negotiated Rate |
$1,128.22 |
| 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 SPINAL CANAL W/WO CONTRAST MATERIAL
|
Professional
|
$1,193.99
|
|
|
Service Code
|
HCPCS 72159 TC
|
| Min. Negotiated Rate |
$69.54 |
| Max. Negotiated Rate |
$1,156.26 |
| Rate for Payer: Cash Price |
$320.38
|
| Rate for Payer: Cash Price |
$320.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$307.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$307.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$324.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$341.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$324.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$341.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$341.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$255.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$324.08
|
| Rate for Payer: Healthfirst QHP |
$341.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$238.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$341.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$289.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$238.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$341.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$895.49
|
| Rate for Payer: SOMOS Essential |
$895.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$341.14
|
|
|
CHG MRA SPINAL CANAL W/WO CONTRAST MATERIAL
|
Professional
|
$1,541.68
|
|
|
Service Code
|
HCPCS 72159
|
| Min. Negotiated Rate |
$69.54 |
| Max. Negotiated Rate |
$1,156.26 |
| Rate for Payer: Cash Price |
$413.93
|
| Rate for Payer: Cash Price |
$413.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$396.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$396.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$418.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$440.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$418.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$440.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$440.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$330.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$418.46
|
| Rate for Payer: Healthfirst QHP |
$440.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$308.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$440.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$374.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$308.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$440.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,156.26
|
| Rate for Payer: SOMOS Essential |
$1,156.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$440.48
|
|
|
CHG MRA SPINAL CANAL W/WO CONTRAST MATERIAL
|
Professional
|
$347.69
|
|
|
Service Code
|
HCPCS 72159 26
|
| Min. Negotiated Rate |
$69.54 |
| Max. Negotiated Rate |
$1,156.26 |
| Rate for Payer: Cash Price |
$93.55
|
| Rate for Payer: Cash Price |
$93.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$89.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$89.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$94.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$99.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$94.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$99.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$99.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$74.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$94.37
|
| Rate for Payer: Healthfirst QHP |
$99.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$69.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$99.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$84.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$69.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$99.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$260.77
|
| Rate for Payer: SOMOS Essential |
$260.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$99.34
|
|
|
CHG MRA UPPER EXTREMITY W/WO CONTRAST MATERIAL
|
Professional
|
$1,193.99
|
|
|
Service Code
|
HCPCS 73225 TC
|
| Min. Negotiated Rate |
$66.92 |
| Max. Negotiated Rate |
$1,146.44 |
| Rate for Payer: Cash Price |
$320.38
|
| Rate for Payer: Cash Price |
$320.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$307.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$307.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$324.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$341.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$324.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$341.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$341.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$255.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$324.08
|
| Rate for Payer: Healthfirst QHP |
$341.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$238.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$341.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$289.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$238.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$341.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$895.49
|
| Rate for Payer: SOMOS Essential |
$895.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$341.14
|
|
|
CHG MRA UPPER EXTREMITY W/WO CONTRAST MATERIAL
|
Professional
|
$1,528.59
|
|
|
Service Code
|
HCPCS 73225
|
| Min. Negotiated Rate |
$66.92 |
| Max. Negotiated Rate |
$1,146.44 |
| Rate for Payer: Cash Price |
$410.31
|
| Rate for Payer: Cash Price |
$410.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$393.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$393.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$414.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$436.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$414.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$436.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$436.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$327.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$414.90
|
| Rate for Payer: Healthfirst QHP |
$436.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$305.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$436.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$371.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$305.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$436.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,146.44
|
| Rate for Payer: SOMOS Essential |
$1,146.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$436.74
|
|
|
CHG MRA UPPER EXTREMITY W/WO CONTRAST MATERIAL
|
Professional
|
$334.60
|
|
|
Service Code
|
HCPCS 73225 26
|
| Min. Negotiated Rate |
$66.92 |
| Max. Negotiated Rate |
$1,146.44 |
| Rate for Payer: Cash Price |
$89.93
|
| Rate for Payer: Cash Price |
$89.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$86.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$86.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$90.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$95.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$90.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$95.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$95.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$71.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$90.82
|
| Rate for Payer: Healthfirst QHP |
$95.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$66.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$95.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$81.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$66.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$95.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$250.95
|
| Rate for Payer: SOMOS Essential |
$250.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$95.60
|
|
|
CHG MRI ABDOMEN W/CONTRAST MATERIAL
|
Professional
|
$1,018.64
|
|
|
Service Code
|
HCPCS 74182 TC
|
| Min. Negotiated Rate |
$66.63 |
| Max. Negotiated Rate |
$1,013.86 |
| Rate for Payer: Cash Price |
$272.21
|
| Rate for Payer: Cash Price |
$272.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$261.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$261.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$276.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$291.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$276.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$291.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$291.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$218.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$276.49
|
| Rate for Payer: Healthfirst QHP |
$291.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$203.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$291.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$247.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$203.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$291.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$763.98
|
| Rate for Payer: SOMOS Essential |
$763.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$291.04
|
|
|
CHG MRI ABDOMEN W/CONTRAST MATERIAL
|
Professional
|
$1,351.81
|
|
|
Service Code
|
HCPCS 74182
|
| Min. Negotiated Rate |
$66.63 |
| Max. Negotiated Rate |
$1,013.86 |
| Rate for Payer: Cash Price |
$361.75
|
| Rate for Payer: Cash Price |
$361.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$347.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$347.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$366.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$386.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$366.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$386.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$386.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$289.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$366.92
|
| Rate for Payer: Healthfirst QHP |
$386.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$270.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$386.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$328.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$270.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$386.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,013.86
|
| Rate for Payer: SOMOS Essential |
$1,013.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$386.23
|
|
|
CHG MRI ABDOMEN W/CONTRAST MATERIAL
|
Professional
|
$333.17
|
|
|
Service Code
|
HCPCS 74182 26
|
| Min. Negotiated Rate |
$66.63 |
| Max. Negotiated Rate |
$1,013.86 |
| Rate for Payer: Cash Price |
$89.54
|
| Rate for Payer: Cash Price |
$89.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$85.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$85.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$90.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$95.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$90.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$95.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$95.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$71.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$90.43
|
| Rate for Payer: Healthfirst QHP |
$95.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$66.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$95.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$80.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$66.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$95.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$249.88
|
| Rate for Payer: SOMOS Essential |
$249.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$95.19
|
|
|
CHG MRI ABDOMEN W/O CONTRAST MATERIAL
|
Professional
|
$280.95
|
|
|
Service Code
|
HCPCS 74181 26
|
| Min. Negotiated Rate |
$56.19 |
| Max. Negotiated Rate |
$650.37 |
| Rate for Payer: Cash Price |
$75.96
|
| Rate for Payer: Cash Price |
$75.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$72.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$72.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$76.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$80.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$76.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$76.26
|
| Rate for Payer: Healthfirst QHP |
$80.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$56.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$80.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$68.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$56.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$80.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$210.71
|
| Rate for Payer: SOMOS Essential |
$210.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$80.27
|
|
|
CHG MRI ABDOMEN W/O CONTRAST MATERIAL
|
Professional
|
$867.16
|
|
|
Service Code
|
HCPCS 74181
|
| Min. Negotiated Rate |
$56.19 |
| Max. Negotiated Rate |
$650.37 |
| Rate for Payer: Cash Price |
$233.20
|
| Rate for Payer: Cash Price |
$233.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$222.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$222.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$235.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$247.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$235.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$247.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$247.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$185.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$235.37
|
| Rate for Payer: Healthfirst QHP |
$247.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$173.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$247.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$210.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$173.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$247.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$650.37
|
| Rate for Payer: SOMOS Essential |
$650.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$247.76
|
|
|
CHG MRI ABDOMEN W/O CONTRAST MATERIAL
|
Professional
|
$586.22
|
|
|
Service Code
|
HCPCS 74181 TC
|
| Min. Negotiated Rate |
$56.19 |
| Max. Negotiated Rate |
$650.37 |
| Rate for Payer: Cash Price |
$157.24
|
| Rate for Payer: Cash Price |
$157.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$150.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$150.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$159.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$167.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$159.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$167.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$167.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$125.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$159.12
|
| Rate for Payer: Healthfirst QHP |
$167.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$117.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$167.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$142.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$117.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$167.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$439.66
|
| Rate for Payer: SOMOS Essential |
$439.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$167.49
|
|
|
CHG MRI ABDOMEN W/O & W/CONTRAST MATERIAL
|
Professional
|
$1,084.76
|
|
|
Service Code
|
HCPCS 74183 TC
|
| Min. Negotiated Rate |
$83.84 |
| Max. Negotiated Rate |
$1,127.96 |
| Rate for Payer: Cash Price |
$289.50
|
| Rate for Payer: Cash Price |
$289.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$278.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$278.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$309.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$309.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$309.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$232.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$294.43
|
| Rate for Payer: Healthfirst QHP |
$309.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$216.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$309.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$263.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$216.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$309.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$813.57
|
| Rate for Payer: SOMOS Essential |
$813.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$309.93
|
|
|
CHG MRI ABDOMEN W/O & W/CONTRAST MATERIAL
|
Professional
|
$419.20
|
|
|
Service Code
|
HCPCS 74183 26
|
| Min. Negotiated Rate |
$83.84 |
| Max. Negotiated Rate |
$1,127.96 |
| Rate for Payer: Cash Price |
$113.86
|
| Rate for Payer: Cash Price |
$113.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$107.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$107.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$119.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$119.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$119.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$89.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$113.78
|
| Rate for Payer: Healthfirst QHP |
$119.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$83.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$119.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$101.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$83.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$119.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$314.40
|
| Rate for Payer: SOMOS Essential |
$314.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$119.77
|
|
|
CHG MRI ABDOMEN W/O & W/CONTRAST MATERIAL
|
Professional
|
$1,503.95
|
|
|
Service Code
|
HCPCS 74183
|
| Min. Negotiated Rate |
$83.84 |
| Max. Negotiated Rate |
$1,127.96 |
| Rate for Payer: Cash Price |
$403.36
|
| Rate for Payer: Cash Price |
$403.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$386.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$386.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$408.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$429.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$408.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$429.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$429.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$322.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$408.22
|
| Rate for Payer: Healthfirst QHP |
$429.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$300.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$429.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$365.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$300.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$429.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,127.96
|
| Rate for Payer: SOMOS Essential |
$1,127.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$429.70
|
|
|
CHG MRI ANY JT LOWER EXTREM W/CONTRAST MATERIAL
|
Professional
|
$1,086.47
|
|
|
Service Code
|
HCPCS 73722 TC
|
| Min. Negotiated Rate |
$62.21 |
| Max. Negotiated Rate |
$1,048.14 |
| Rate for Payer: Cash Price |
$291.47
|
| Rate for Payer: Cash Price |
$291.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$310.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$310.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$310.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$232.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$294.90
|
| Rate for Payer: Healthfirst QHP |
$310.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$217.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$310.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$263.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$217.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$310.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$814.85
|
| Rate for Payer: SOMOS Essential |
$814.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$310.42
|
|
|
CHG MRI ANY JT LOWER EXTREM W/CONTRAST MATERIAL
|
Professional
|
$311.05
|
|
|
Service Code
|
HCPCS 73722 26
|
| Min. Negotiated Rate |
$62.21 |
| Max. Negotiated Rate |
$1,048.14 |
| Rate for Payer: Cash Price |
$84.29
|
| Rate for Payer: Cash Price |
$84.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$79.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$79.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$88.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$84.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$88.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$66.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$84.43
|
| Rate for Payer: Healthfirst QHP |
$88.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$62.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$88.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$75.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$62.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$88.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$233.29
|
| Rate for Payer: SOMOS Essential |
$233.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$88.87
|
|
|
CHG MRI ANY JT LOWER EXTREM W/CONTRAST MATERIAL
|
Professional
|
$1,397.52
|
|
|
Service Code
|
HCPCS 73722
|
| Min. Negotiated Rate |
$62.21 |
| Max. Negotiated Rate |
$1,048.14 |
| Rate for Payer: Cash Price |
$375.76
|
| Rate for Payer: Cash Price |
$375.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$359.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$359.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$379.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$399.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$379.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$399.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$399.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$299.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$379.33
|
| Rate for Payer: Healthfirst QHP |
$399.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$279.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$399.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$339.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$279.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$399.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,048.14
|
| Rate for Payer: SOMOS Essential |
$1,048.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$399.29
|
|
