|
CHG MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL
|
Professional
|
$893.76
|
|
|
Service Code
|
HCPCS 73721
|
| Min. Negotiated Rate |
$52.02 |
| Max. Negotiated Rate |
$670.32 |
| Rate for Payer: Cash Price |
$241.71
|
| Rate for Payer: Cash Price |
$241.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$229.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$229.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$242.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$255.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$242.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$255.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$255.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$191.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$242.59
|
| Rate for Payer: Healthfirst QHP |
$255.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$178.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$255.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$217.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$178.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$255.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$670.32
|
| Rate for Payer: SOMOS Essential |
$670.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$255.36
|
|
|
CHG MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL
|
Professional
|
$633.68
|
|
|
Service Code
|
HCPCS 73721 TC
|
| Min. Negotiated Rate |
$52.02 |
| Max. Negotiated Rate |
$670.32 |
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$162.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$162.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$172.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$181.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$172.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$181.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$181.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$135.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$172.00
|
| Rate for Payer: Healthfirst QHP |
$181.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$126.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$181.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$153.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$126.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$181.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$475.26
|
| Rate for Payer: SOMOS Essential |
$475.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$181.05
|
|
|
CHG MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL
|
Professional
|
$260.12
|
|
|
Service Code
|
HCPCS 73721 26
|
| Min. Negotiated Rate |
$52.02 |
| Max. Negotiated Rate |
$670.32 |
| Rate for Payer: Cash Price |
$70.71
|
| Rate for Payer: Cash Price |
$70.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$66.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$66.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$70.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$74.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$70.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$74.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$55.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$70.60
|
| Rate for Payer: Healthfirst QHP |
$74.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$52.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$74.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$63.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$52.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$74.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$195.09
|
| Rate for Payer: SOMOS Essential |
$195.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$74.32
|
|
|
CHG MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL
|
Professional
|
$411.50
|
|
|
Service Code
|
HCPCS 73723 26
|
| Min. Negotiated Rate |
$82.30 |
| Max. Negotiated Rate |
$1,292.53 |
| Rate for Payer: Cash Price |
$111.72
|
| Rate for Payer: Cash Price |
$111.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$105.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$105.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$111.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$117.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$111.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$117.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$117.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$111.69
|
| Rate for Payer: Healthfirst QHP |
$117.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$82.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$117.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$99.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$82.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$117.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$308.62
|
| Rate for Payer: SOMOS Essential |
$308.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$117.57
|
|
|
CHG MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL
|
Professional
|
$1,723.37
|
|
|
Service Code
|
HCPCS 73723
|
| Min. Negotiated Rate |
$82.30 |
| Max. Negotiated Rate |
$1,292.53 |
| Rate for Payer: Cash Price |
$461.34
|
| Rate for Payer: Cash Price |
$461.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$443.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$443.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$467.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$492.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$467.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$492.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$492.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$369.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$467.77
|
| Rate for Payer: Healthfirst QHP |
$492.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$344.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$492.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$418.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$344.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$492.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,292.53
|
| Rate for Payer: SOMOS Essential |
$1,292.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$492.39
|
|
|
CHG MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL
|
Professional
|
$1,311.87
|
|
|
Service Code
|
HCPCS 73723 TC
|
| Min. Negotiated Rate |
$82.30 |
| Max. Negotiated Rate |
$1,292.53 |
| Rate for Payer: Cash Price |
$349.62
|
| Rate for Payer: Cash Price |
$349.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$337.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$337.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$356.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$374.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$356.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$374.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$374.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$281.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$356.08
|
| Rate for Payer: Healthfirst QHP |
$374.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$262.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$374.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$318.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$262.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$374.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$983.90
|
| Rate for Payer: SOMOS Essential |
$983.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$374.82
|
|
|
CHG MRI ANY JT UPPER EXTREMITY W/CONTRAST MATRL
|
Professional
|
$1,085.04
|
|
|
Service Code
|
HCPCS 73222 TC
|
| Min. Negotiated Rate |
$62.21 |
| Max. Negotiated Rate |
$1,047.06 |
| Rate for Payer: Cash Price |
$290.68
|
| Rate for Payer: Cash Price |
$290.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$310.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$310.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$310.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$232.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$294.51
|
| Rate for Payer: Healthfirst QHP |
$310.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$217.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$310.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$263.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$217.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$310.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$813.78
|
| Rate for Payer: SOMOS Essential |
$813.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$310.01
|
|
|
CHG MRI ANY JT UPPER EXTREMITY W/CONTRAST MATRL
|
Professional
|
$311.05
|
|
|
Service Code
|
HCPCS 73222 26
|
| Min. Negotiated Rate |
$62.21 |
| Max. Negotiated Rate |
$1,047.06 |
| Rate for Payer: Cash Price |
$84.68
|
| Rate for Payer: Cash Price |
$84.68
|
| 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 UPPER EXTREMITY W/CONTRAST MATRL
|
Professional
|
$1,396.08
|
|
|
Service Code
|
HCPCS 73222
|
| Min. Negotiated Rate |
$62.21 |
| Max. Negotiated Rate |
$1,047.06 |
| Rate for Payer: Cash Price |
$375.36
|
| Rate for Payer: Cash Price |
$375.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$358.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$358.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$378.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$398.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$378.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$398.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$398.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$299.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$378.94
|
| Rate for Payer: Healthfirst QHP |
$398.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$279.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$398.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$339.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$279.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$398.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,047.06
|
| Rate for Payer: SOMOS Essential |
$1,047.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$398.88
|
|
|
CHG MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL
|
Professional
|
$895.20
|
|
|
Service Code
|
HCPCS 73221
|
| Min. Negotiated Rate |
$52.31 |
| Max. Negotiated Rate |
$671.40 |
| Rate for Payer: Cash Price |
$242.10
|
| Rate for Payer: Cash Price |
$242.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$230.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$230.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$242.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$255.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$242.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$255.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$255.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$191.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$242.98
|
| Rate for Payer: Healthfirst QHP |
$255.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$179.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$255.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$217.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$179.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$255.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$671.40
|
| Rate for Payer: SOMOS Essential |
$671.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$255.77
|
|
|
CHG MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL
|
Professional
|
$633.68
|
|
|
Service Code
|
HCPCS 73221 TC
|
| Min. Negotiated Rate |
$52.31 |
| Max. Negotiated Rate |
$671.40 |
| Rate for Payer: Cash Price |
$171.39
|
| Rate for Payer: Cash Price |
$171.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$162.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$162.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$172.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$181.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$172.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$181.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$181.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$135.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$172.00
|
| Rate for Payer: Healthfirst QHP |
$181.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$126.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$181.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$153.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$126.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$181.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$475.26
|
| Rate for Payer: SOMOS Essential |
$475.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$181.05
|
|
|
CHG MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL
|
Professional
|
$261.56
|
|
|
Service Code
|
HCPCS 73221 26
|
| Min. Negotiated Rate |
$52.31 |
| Max. Negotiated Rate |
$671.40 |
| Rate for Payer: Cash Price |
$70.71
|
| Rate for Payer: Cash Price |
$70.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$67.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$67.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$70.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$74.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$70.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$74.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$56.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$70.99
|
| Rate for Payer: Healthfirst QHP |
$74.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$52.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$74.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$63.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$52.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$74.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$196.17
|
| Rate for Payer: SOMOS Essential |
$196.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$74.73
|
|
|
CHG MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL
|
Professional
|
$1,316.18
|
|
|
Service Code
|
HCPCS 73223 TC
|
| Min. Negotiated Rate |
$82.59 |
| Max. Negotiated Rate |
$1,296.86 |
| Rate for Payer: Cash Price |
$351.19
|
| Rate for Payer: Cash Price |
$351.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$338.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$338.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$357.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$376.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$357.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$376.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$376.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$282.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$357.25
|
| Rate for Payer: Healthfirst QHP |
$376.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$263.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$376.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$319.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$263.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$376.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$987.14
|
| Rate for Payer: SOMOS Essential |
$987.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$376.05
|
|
|
CHG MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL
|
Professional
|
$412.93
|
|
|
Service Code
|
HCPCS 73223 26
|
| Min. Negotiated Rate |
$82.59 |
| Max. Negotiated Rate |
$1,296.86 |
| Rate for Payer: Cash Price |
$112.11
|
| Rate for Payer: Cash Price |
$112.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$106.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$106.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$112.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$117.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$112.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$117.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$117.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$112.08
|
| Rate for Payer: Healthfirst QHP |
$117.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$82.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$117.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$100.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$82.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$117.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$309.70
|
| Rate for Payer: SOMOS Essential |
$309.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$117.98
|
|
|
CHG MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL
|
Professional
|
$1,729.14
|
|
|
Service Code
|
HCPCS 73223
|
| Min. Negotiated Rate |
$82.59 |
| Max. Negotiated Rate |
$1,296.86 |
| Rate for Payer: Cash Price |
$463.31
|
| Rate for Payer: Cash Price |
$463.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$444.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$444.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$469.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$494.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$469.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$494.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$494.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$370.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$469.34
|
| Rate for Payer: Healthfirst QHP |
$494.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$345.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$494.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$419.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$345.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$494.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,296.86
|
| Rate for Payer: SOMOS Essential |
$1,296.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$494.04
|
|
|
CHG MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL
|
Professional
|
$1,201.38
|
|
|
Service Code
|
HCPCS 70552
|
| Min. Negotiated Rate |
$68.75 |
| Max. Negotiated Rate |
$901.04 |
| Rate for Payer: Cash Price |
$322.63
|
| Rate for Payer: Cash Price |
$322.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$308.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$308.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$326.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$343.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$326.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$343.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$343.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$257.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$326.09
|
| Rate for Payer: Healthfirst QHP |
$343.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$240.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$343.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$291.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$240.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$343.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$901.04
|
| Rate for Payer: SOMOS Essential |
$901.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$343.25
|
|
|
CHG MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL
|
Professional
|
$857.64
|
|
|
Service Code
|
HCPCS 70552 TC
|
| Min. Negotiated Rate |
$68.75 |
| Max. Negotiated Rate |
$901.04 |
| Rate for Payer: Cash Price |
$230.17
|
| Rate for Payer: Cash Price |
$230.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$220.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$220.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$232.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$245.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$232.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$245.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$245.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$183.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$232.79
|
| Rate for Payer: Healthfirst QHP |
$245.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$171.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$245.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$208.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$171.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$245.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$643.23
|
| Rate for Payer: SOMOS Essential |
$643.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$245.04
|
|
|
CHG MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL
|
Professional
|
$343.74
|
|
|
Service Code
|
HCPCS 70552 26
|
| Min. Negotiated Rate |
$68.75 |
| Max. Negotiated Rate |
$901.04 |
| Rate for Payer: Cash Price |
$92.46
|
| Rate for Payer: Cash Price |
$92.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$88.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$88.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$93.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$98.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$93.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$98.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$98.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$93.30
|
| Rate for Payer: Healthfirst QHP |
$98.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$68.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$98.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$83.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$68.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$98.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$257.80
|
| Rate for Payer: SOMOS Essential |
$257.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$98.21
|
|
|
CHG MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL
|
Professional
|
$284.87
|
|
|
Service Code
|
HCPCS 70551 26
|
| Min. Negotiated Rate |
$56.97 |
| Max. Negotiated Rate |
$647.93 |
| Rate for Payer: Cash Price |
$77.05
|
| Rate for Payer: Cash Price |
$77.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$73.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$77.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$61.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$77.32
|
| Rate for Payer: Healthfirst QHP |
$81.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$56.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$81.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$69.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$56.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$213.65
|
| Rate for Payer: SOMOS Essential |
$213.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.39
|
|
|
CHG MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL
|
Professional
|
$863.91
|
|
|
Service Code
|
HCPCS 70551
|
| Min. Negotiated Rate |
$56.97 |
| Max. Negotiated Rate |
$647.93 |
| Rate for Payer: Cash Price |
$233.51
|
| Rate for Payer: Cash Price |
$233.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$222.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$222.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$234.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$234.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$246.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$185.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$234.49
|
| Rate for Payer: Healthfirst QHP |
$246.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$172.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$246.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$209.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$172.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$647.93
|
| Rate for Payer: SOMOS Essential |
$647.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.83
|
|
|
CHG MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL
|
Professional
|
$579.04
|
|
|
Service Code
|
HCPCS 70551 TC
|
| Min. Negotiated Rate |
$56.97 |
| Max. Negotiated Rate |
$647.93 |
| Rate for Payer: Cash Price |
$156.46
|
| Rate for Payer: Cash Price |
$156.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$148.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$148.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$157.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$165.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$157.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$165.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$124.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$157.17
|
| Rate for Payer: Healthfirst QHP |
$165.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$115.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$165.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$140.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$115.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$165.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$434.28
|
| Rate for Payer: SOMOS Essential |
$434.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$165.44
|
|
|
CHG MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL
|
Professional
|
$1,410.15
|
|
|
Service Code
|
HCPCS 70553
|
| Min. Negotiated Rate |
$87.79 |
| Max. Negotiated Rate |
$1,057.61 |
| Rate for Payer: Cash Price |
$379.23
|
| Rate for Payer: Cash Price |
$379.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$362.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$362.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$382.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$402.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$382.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$402.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$402.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$302.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$382.76
|
| Rate for Payer: Healthfirst QHP |
$402.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$282.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$402.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$342.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$282.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$402.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,057.61
|
| Rate for Payer: SOMOS Essential |
$1,057.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$402.90
|
|
|
CHG MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL
|
Professional
|
$971.18
|
|
|
Service Code
|
HCPCS 70553 TC
|
| Min. Negotiated Rate |
$87.79 |
| Max. Negotiated Rate |
$1,057.61 |
| Rate for Payer: Cash Price |
$260.43
|
| Rate for Payer: Cash Price |
$260.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$249.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$249.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$263.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$277.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$263.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$277.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$277.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$208.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$263.61
|
| Rate for Payer: Healthfirst QHP |
$277.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$194.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$277.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$235.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$194.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$277.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$728.38
|
| Rate for Payer: SOMOS Essential |
$728.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$277.48
|
|
|
CHG MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL
|
Professional
|
$438.97
|
|
|
Service Code
|
HCPCS 70553 26
|
| Min. Negotiated Rate |
$87.79 |
| Max. Negotiated Rate |
$1,057.61 |
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$112.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$112.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$119.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$125.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$119.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$94.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$119.15
|
| Rate for Payer: Healthfirst QHP |
$125.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$87.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$125.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$106.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$87.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$125.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$329.23
|
| Rate for Payer: SOMOS Essential |
$329.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$125.42
|
|
|
CHG MRI BRAIN FUNCTIONAL W/O PHYSICIAN ADMNISTRATION
|
Professional
|
$1,686.62
|
|
|
Service Code
|
HCPCS 70554
|
| Min. Negotiated Rate |
$81.27 |
| Max. Negotiated Rate |
$1,264.96 |
| Rate for Payer: Cash Price |
$455.31
|
| Rate for Payer: Cash Price |
$455.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$433.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$433.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$457.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$481.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$457.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$481.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$481.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$361.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$457.80
|
| Rate for Payer: Healthfirst QHP |
$481.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$337.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$481.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$409.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$337.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$481.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,264.96
|
| Rate for Payer: SOMOS Essential |
$1,264.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$481.89
|
|
