|
CHG MRI ORBIT FACE & NECK W/CONTRAST MATERIAL
|
Professional
|
$309.61
|
|
|
Service Code
|
HCPCS 70542 26
|
| Min. Negotiated Rate |
$61.92 |
| Max. Negotiated Rate |
$893.97 |
| Rate for Payer: Cash Price |
$83.90
|
| Rate for Payer: Cash Price |
$83.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$79.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$79.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$88.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$84.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$88.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$66.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$84.04
|
| Rate for Payer: Healthfirst QHP |
$88.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$61.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$88.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$75.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$61.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$88.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$232.21
|
| Rate for Payer: SOMOS Essential |
$232.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$88.46
|
|
|
CHG MRI ORBIT FACE & NECK W/CONTRAST MATERIAL
|
Professional
|
$1,191.96
|
|
|
Service Code
|
HCPCS 70542
|
| Min. Negotiated Rate |
$61.92 |
| Max. Negotiated Rate |
$893.97 |
| Rate for Payer: Cash Price |
$320.75
|
| Rate for Payer: Cash Price |
$320.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$306.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$306.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$323.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$340.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$323.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$340.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$340.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$255.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$323.53
|
| Rate for Payer: Healthfirst QHP |
$340.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$238.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$340.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$289.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$238.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$340.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$893.97
|
| Rate for Payer: SOMOS Essential |
$893.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$340.56
|
|
|
CHG MRI ORBIT FACE & NECK W/CONTRAST MATERIAL
|
Professional
|
$882.35
|
|
|
Service Code
|
HCPCS 70542 TC
|
| Min. Negotiated Rate |
$61.92 |
| Max. Negotiated Rate |
$893.97 |
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$226.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$226.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$239.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$252.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$239.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$252.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$252.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$189.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$239.50
|
| Rate for Payer: Healthfirst QHP |
$252.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$176.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$252.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$214.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$176.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$252.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$661.76
|
| Rate for Payer: SOMOS Essential |
$661.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$252.10
|
|
|
CHG MRI ORBIT FACE &/NECK W/O CONTRAST
|
Professional
|
$747.22
|
|
|
Service Code
|
HCPCS 70540 TC
|
| Min. Negotiated Rate |
$51.45 |
| Max. Negotiated Rate |
$753.35 |
| Rate for Payer: Cash Price |
$200.47
|
| Rate for Payer: Cash Price |
$200.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$192.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$192.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$202.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$213.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$202.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$213.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$213.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$160.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$202.82
|
| Rate for Payer: Healthfirst QHP |
$213.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$149.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$213.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$181.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$149.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$213.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$560.42
|
| Rate for Payer: SOMOS Essential |
$560.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$213.49
|
|
|
CHG MRI ORBIT FACE &/NECK W/O CONTRAST
|
Professional
|
$1,004.47
|
|
|
Service Code
|
HCPCS 70540
|
| Min. Negotiated Rate |
$51.45 |
| Max. Negotiated Rate |
$753.35 |
| Rate for Payer: Cash Price |
$270.39
|
| Rate for Payer: Cash Price |
$270.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$258.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$258.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$272.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$286.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$272.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$286.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$286.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$215.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$272.64
|
| Rate for Payer: Healthfirst QHP |
$286.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$200.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$286.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$243.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$200.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$286.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$753.35
|
| Rate for Payer: SOMOS Essential |
$753.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$286.99
|
|
|
CHG MRI ORBIT FACE &/NECK W/O CONTRAST
|
Professional
|
$257.25
|
|
|
Service Code
|
HCPCS 70540 26
|
| Min. Negotiated Rate |
$51.45 |
| Max. Negotiated Rate |
$753.35 |
| Rate for Payer: Cash Price |
$69.93
|
| Rate for Payer: Cash Price |
$69.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$66.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$66.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$69.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$73.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$69.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$55.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.82
|
| Rate for Payer: Healthfirst QHP |
$73.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$51.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$73.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$62.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$51.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$73.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$192.94
|
| Rate for Payer: SOMOS Essential |
$192.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$73.50
|
|
|
CHG MRI ORBIT FACE & NECK W/O & W/CONTRAST MATRL
|
Professional
|
$1,506.33
|
|
|
Service Code
|
HCPCS 70543
|
| Min. Negotiated Rate |
$82.01 |
| Max. Negotiated Rate |
$1,129.75 |
| Rate for Payer: Cash Price |
$404.37
|
| Rate for Payer: Cash Price |
$404.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$387.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$387.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$408.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$430.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$408.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$430.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$430.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$322.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$408.86
|
| Rate for Payer: Healthfirst QHP |
$430.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$301.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$430.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$365.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$301.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$430.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,129.75
|
| Rate for Payer: SOMOS Essential |
$1,129.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$430.38
|
|
|
CHG MRI ORBIT FACE & NECK W/O & W/CONTRAST MATRL
|
Professional
|
$410.06
|
|
|
Service Code
|
HCPCS 70543 26
|
| Min. Negotiated Rate |
$82.01 |
| Max. Negotiated Rate |
$1,129.75 |
| Rate for Payer: Cash Price |
$111.33
|
| Rate for Payer: Cash Price |
$111.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$105.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$105.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$111.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$117.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$111.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$117.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$117.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$87.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$111.30
|
| Rate for Payer: Healthfirst QHP |
$117.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$82.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$117.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$99.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$82.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$117.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$307.54
|
| Rate for Payer: SOMOS Essential |
$307.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$117.16
|
|
|
CHG MRI ORBIT FACE & NECK W/O & W/CONTRAST MATRL
|
Professional
|
$1,096.27
|
|
|
Service Code
|
HCPCS 70543 TC
|
| Min. Negotiated Rate |
$82.01 |
| Max. Negotiated Rate |
$1,129.75 |
| Rate for Payer: Cash Price |
$293.04
|
| Rate for Payer: Cash Price |
$293.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$281.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$281.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$297.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$313.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$297.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$313.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$313.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$234.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$297.56
|
| Rate for Payer: Healthfirst QHP |
$313.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$219.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$313.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$266.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$219.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$313.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$822.20
|
| Rate for Payer: SOMOS Essential |
$822.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$313.22
|
|
|
CHG MRI PELVIS W/CONTRAST MATERIAL
|
Professional
|
$334.60
|
|
|
Service Code
|
HCPCS 72196 26
|
| Min. Negotiated Rate |
$66.92 |
| Max. Negotiated Rate |
$895.47 |
| Rate for Payer: Cash Price |
$89.54
|
| Rate for Payer: Cash Price |
$89.54
|
| 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 PELVIS W/CONTRAST MATERIAL
|
Professional
|
$1,193.96
|
|
|
Service Code
|
HCPCS 72196
|
| Min. Negotiated Rate |
$66.92 |
| Max. Negotiated Rate |
$895.47 |
| Rate for Payer: Cash Price |
$320.49
|
| Rate for Payer: Cash Price |
$320.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$307.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$307.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$324.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$341.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$324.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$341.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$341.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$255.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$324.07
|
| Rate for Payer: Healthfirst QHP |
$341.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$238.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$341.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$289.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$238.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$341.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$895.47
|
| Rate for Payer: SOMOS Essential |
$895.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$341.13
|
|
|
CHG MRI PELVIS W/CONTRAST MATERIAL
|
Professional
|
$859.36
|
|
|
Service Code
|
HCPCS 72196 TC
|
| Min. Negotiated Rate |
$66.92 |
| Max. Negotiated Rate |
$895.47 |
| Rate for Payer: Cash Price |
$230.96
|
| Rate for Payer: Cash Price |
$230.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$220.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$220.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$233.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$245.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$233.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$245.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$245.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$184.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$233.25
|
| Rate for Payer: Healthfirst QHP |
$245.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$171.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$245.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$208.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$171.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$245.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$644.52
|
| Rate for Payer: SOMOS Essential |
$644.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$245.53
|
|
|
CHG MRI PELVIS W/O CONTRAST MATERIAL
|
Professional
|
$735.74
|
|
|
Service Code
|
HCPCS 72195 TC
|
| Min. Negotiated Rate |
$56.19 |
| Max. Negotiated Rate |
$762.49 |
| Rate for Payer: Cash Price |
$197.32
|
| Rate for Payer: Cash Price |
$197.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$189.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$189.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$199.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$210.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$199.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$210.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$210.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$157.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$199.70
|
| Rate for Payer: Healthfirst QHP |
$210.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$147.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$210.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$178.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$147.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$210.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$551.80
|
| Rate for Payer: SOMOS Essential |
$551.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$210.21
|
|
|
CHG MRI PELVIS W/O CONTRAST MATERIAL
|
Professional
|
$1,016.65
|
|
|
Service Code
|
HCPCS 72195
|
| Min. Negotiated Rate |
$56.19 |
| Max. Negotiated Rate |
$762.49 |
| Rate for Payer: Cash Price |
$273.68
|
| Rate for Payer: Cash Price |
$273.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$261.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$261.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$275.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$290.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$275.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$290.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$290.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$217.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$275.95
|
| Rate for Payer: Healthfirst QHP |
$290.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$203.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$290.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$246.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$203.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$290.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$762.49
|
| Rate for Payer: SOMOS Essential |
$762.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$290.47
|
|
|
CHG MRI PELVIS W/O CONTRAST MATERIAL
|
Professional
|
$280.95
|
|
|
Service Code
|
HCPCS 72195 26
|
| Min. Negotiated Rate |
$56.19 |
| Max. Negotiated Rate |
$762.49 |
| Rate for Payer: Cash Price |
$76.35
|
| Rate for Payer: Cash Price |
$76.35
|
| 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 PELVIS W/O & W/CONTRAST MATERIAL
|
Professional
|
$419.20
|
|
|
Service Code
|
HCPCS 72197 26
|
| Min. Negotiated Rate |
$83.84 |
| Max. Negotiated Rate |
$1,123.66 |
| 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 PELVIS W/O & W/CONTRAST MATERIAL
|
Professional
|
$1,079.02
|
|
|
Service Code
|
HCPCS 72197 TC
|
| Min. Negotiated Rate |
$83.84 |
| Max. Negotiated Rate |
$1,123.66 |
| Rate for Payer: Cash Price |
$287.93
|
| Rate for Payer: Cash Price |
$287.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$277.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$277.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$292.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$308.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$292.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$308.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$308.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$231.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$292.88
|
| Rate for Payer: Healthfirst QHP |
$308.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$215.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$308.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$262.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$215.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$308.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$809.26
|
| Rate for Payer: SOMOS Essential |
$809.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$308.29
|
|
|
CHG MRI PELVIS W/O & W/CONTRAST MATERIAL
|
Professional
|
$1,498.21
|
|
|
Service Code
|
HCPCS 72197
|
| Min. Negotiated Rate |
$83.84 |
| Max. Negotiated Rate |
$1,123.66 |
| Rate for Payer: Cash Price |
$401.79
|
| Rate for Payer: Cash Price |
$401.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$385.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$385.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$406.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$428.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$406.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$428.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$428.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$321.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$406.66
|
| Rate for Payer: Healthfirst QHP |
$428.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$299.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$428.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$363.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$299.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$428.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,123.66
|
| Rate for Payer: SOMOS Essential |
$1,123.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$428.06
|
|
|
CHG MRI SPINAL CANAL CERVICAL W/CONTRAST MATRL
|
Professional
|
$875.14
|
|
|
Service Code
|
HCPCS 72142 TC
|
| Min. Negotiated Rate |
$69.03 |
| Max. Negotiated Rate |
$915.26 |
| Rate for Payer: Cash Price |
$235.67
|
| Rate for Payer: Cash Price |
$235.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$225.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$225.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$237.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$250.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$237.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$250.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$250.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$187.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$237.54
|
| Rate for Payer: Healthfirst QHP |
$250.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$175.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$250.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$212.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$175.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$250.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$656.36
|
| Rate for Payer: SOMOS Essential |
$656.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$250.04
|
|
|
CHG MRI SPINAL CANAL CERVICAL W/CONTRAST MATRL
|
Professional
|
$345.17
|
|
|
Service Code
|
HCPCS 72142 26
|
| Min. Negotiated Rate |
$69.03 |
| Max. Negotiated Rate |
$915.26 |
| Rate for Payer: Cash Price |
$93.48
|
| Rate for Payer: Cash Price |
$93.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$88.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$88.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$93.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$98.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$93.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$98.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$98.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$93.69
|
| Rate for Payer: Healthfirst QHP |
$98.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$69.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$98.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$83.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$69.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$98.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$258.88
|
| Rate for Payer: SOMOS Essential |
$258.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$98.62
|
|
|
CHG MRI SPINAL CANAL CERVICAL W/CONTRAST MATRL
|
Professional
|
$1,220.35
|
|
|
Service Code
|
HCPCS 72142
|
| Min. Negotiated Rate |
$69.03 |
| Max. Negotiated Rate |
$915.26 |
| Rate for Payer: Cash Price |
$329.15
|
| Rate for Payer: Cash Price |
$329.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$313.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$313.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$331.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$348.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$331.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$348.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$348.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$261.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$331.24
|
| Rate for Payer: Healthfirst QHP |
$348.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$244.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$348.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$296.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$244.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$348.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$915.26
|
| Rate for Payer: SOMOS Essential |
$915.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$348.67
|
|
|
CHG MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL
|
Professional
|
$554.61
|
|
|
Service Code
|
HCPCS 72141 TC
|
| Min. Negotiated Rate |
$56.97 |
| Max. Negotiated Rate |
$629.61 |
| Rate for Payer: Cash Price |
$149.78
|
| Rate for Payer: Cash Price |
$149.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$142.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$142.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$150.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$158.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$150.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$158.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$158.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$118.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$150.54
|
| Rate for Payer: Healthfirst QHP |
$158.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$110.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$158.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$134.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$110.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$158.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$415.96
|
| Rate for Payer: SOMOS Essential |
$415.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$158.46
|
|
|
CHG MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL
|
Professional
|
$284.87
|
|
|
Service Code
|
HCPCS 72141 26
|
| Min. Negotiated Rate |
$56.97 |
| Max. Negotiated Rate |
$629.61 |
| 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 SPINAL CANAL CERVICAL W/O CONTRAST MATRL
|
Professional
|
$839.48
|
|
|
Service Code
|
HCPCS 72141
|
| Min. Negotiated Rate |
$56.97 |
| Max. Negotiated Rate |
$629.61 |
| Rate for Payer: Cash Price |
$226.83
|
| Rate for Payer: Cash Price |
$226.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$215.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$215.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$227.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$239.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$227.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$239.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$239.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$179.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$227.86
|
| Rate for Payer: Healthfirst QHP |
$239.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$167.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$239.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$203.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$167.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$239.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$629.61
|
| Rate for Payer: SOMOS Essential |
$629.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$239.85
|
|
|
CHG MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL
|
Professional
|
$1,417.33
|
|
|
Service Code
|
HCPCS 72156
|
| Min. Negotiated Rate |
$87.79 |
| Max. Negotiated Rate |
$1,063.00 |
| Rate for Payer: Cash Price |
$381.19
|
| Rate for Payer: Cash Price |
$381.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$364.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$364.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$384.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$404.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$384.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$404.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$404.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$303.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$384.70
|
| Rate for Payer: Healthfirst QHP |
$404.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$283.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$404.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$344.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$283.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$404.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,063.00
|
| Rate for Payer: SOMOS Essential |
$1,063.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$404.95
|
|
