|
CHG MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL
|
Professional
|
$978.39
|
|
|
Service Code
|
HCPCS 72156 TC
|
| Min. Negotiated Rate |
$87.79 |
| Max. Negotiated Rate |
$1,063.00 |
| Rate for Payer: Cash Price |
$262.00
|
| Rate for Payer: Cash Price |
$262.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$251.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$251.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$265.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$279.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$265.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$279.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$279.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$209.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$265.56
|
| Rate for Payer: Healthfirst QHP |
$279.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$195.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$279.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$237.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$195.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$279.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$733.79
|
| Rate for Payer: SOMOS Essential |
$733.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$279.54
|
|
|
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
|
|
|
CHG MRI SPINAL CANAL LUMBAR W/CONTRAST MATERIAL
|
Professional
|
$343.74
|
|
|
Service Code
|
HCPCS 72149 26
|
| Min. Negotiated Rate |
$68.75 |
| Max. Negotiated Rate |
$899.09 |
| Rate for Payer: Cash Price |
$93.09
|
| Rate for Payer: Cash Price |
$93.09
|
| 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 SPINAL CANAL LUMBAR W/CONTRAST MATERIAL
|
Professional
|
$855.02
|
|
|
Service Code
|
HCPCS 72149 TC
|
| Min. Negotiated Rate |
$68.75 |
| Max. Negotiated Rate |
$899.09 |
| Rate for Payer: Cash Price |
$230.17
|
| Rate for Payer: Cash Price |
$230.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$219.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$219.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$232.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$244.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$232.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$244.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$244.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$183.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$232.08
|
| Rate for Payer: Healthfirst QHP |
$244.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$171.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$244.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$207.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$171.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$244.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$641.26
|
| Rate for Payer: SOMOS Essential |
$641.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$244.29
|
|
|
CHG MRI SPINAL CANAL LUMBAR W/CONTRAST MATERIAL
|
Professional
|
$1,198.79
|
|
|
Service Code
|
HCPCS 72149
|
| Min. Negotiated Rate |
$68.75 |
| Max. Negotiated Rate |
$899.09 |
| Rate for Payer: Cash Price |
$323.25
|
| Rate for Payer: Cash Price |
$323.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$308.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$308.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$325.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$342.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$325.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$342.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$342.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$256.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$325.38
|
| Rate for Payer: Healthfirst QHP |
$342.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$239.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$342.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$291.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$239.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$342.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$899.09
|
| Rate for Payer: SOMOS Essential |
$899.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$342.51
|
|
|
CHG MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL
|
Professional
|
$284.87
|
|
|
Service Code
|
HCPCS 72148 26
|
| Min. Negotiated Rate |
$56.97 |
| Max. Negotiated Rate |
$631.76 |
| Rate for Payer: Cash Price |
$77.44
|
| Rate for Payer: Cash Price |
$77.44
|
| 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 LUMBAR W/O CONTRAST MATERIAL
|
Professional
|
$842.35
|
|
|
Service Code
|
HCPCS 72148
|
| Min. Negotiated Rate |
$56.97 |
| Max. Negotiated Rate |
$631.76 |
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$216.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$216.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$228.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$240.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$228.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$240.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$240.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$180.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$228.64
|
| Rate for Payer: Healthfirst QHP |
$240.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$168.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$240.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$204.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$168.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$240.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$631.76
|
| Rate for Payer: SOMOS Essential |
$631.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$240.67
|
|
|
CHG MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL
|
Professional
|
$557.48
|
|
|
Service Code
|
HCPCS 72148 TC
|
| Min. Negotiated Rate |
$56.97 |
| Max. Negotiated Rate |
$631.76 |
| Rate for Payer: Cash Price |
$150.17
|
| Rate for Payer: Cash Price |
$150.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$143.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$143.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$151.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$159.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$151.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$159.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$159.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$119.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$151.32
|
| Rate for Payer: Healthfirst QHP |
$159.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$111.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$159.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$135.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$111.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$159.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$418.11
|
| Rate for Payer: SOMOS Essential |
$418.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$159.28
|
|
|
CHG MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL
|
Professional
|
$1,414.46
|
|
|
Service Code
|
HCPCS 72158
|
| Min. Negotiated Rate |
$87.79 |
| Max. Negotiated Rate |
$1,060.84 |
| Rate for Payer: Cash Price |
$380.41
|
| Rate for Payer: Cash Price |
$380.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$363.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$363.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$383.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$404.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$383.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$404.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$404.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$303.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$383.92
|
| Rate for Payer: Healthfirst QHP |
$404.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$282.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$404.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$343.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$282.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$404.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,060.84
|
| Rate for Payer: SOMOS Essential |
$1,060.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$404.13
|
|
|
CHG MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL
|
Professional
|
$438.97
|
|
|
Service Code
|
HCPCS 72158 26
|
| Min. Negotiated Rate |
$87.79 |
| Max. Negotiated Rate |
$1,060.84 |
| Rate for Payer: Cash Price |
$119.19
|
| Rate for Payer: Cash Price |
$119.19
|
| 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 SPINAL CANAL LUMBAR W/O & W/CONTR MATRL
|
Professional
|
$975.52
|
|
|
Service Code
|
HCPCS 72158 TC
|
| Min. Negotiated Rate |
$87.79 |
| Max. Negotiated Rate |
$1,060.84 |
| Rate for Payer: Cash Price |
$261.21
|
| Rate for Payer: Cash Price |
$261.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$250.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$250.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$264.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$278.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$264.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$278.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$209.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$264.78
|
| Rate for Payer: Healthfirst QHP |
$278.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$195.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$278.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$236.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$195.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$278.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$731.64
|
| Rate for Payer: SOMOS Essential |
$731.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$278.72
|
|
|
CHG MRI SPINAL CANAL THORACIC W/CONTRAST MATRL
|
Professional
|
$866.53
|
|
|
Service Code
|
HCPCS 72147 TC
|
| Min. Negotiated Rate |
$68.75 |
| Max. Negotiated Rate |
$907.70 |
| Rate for Payer: Cash Price |
$233.31
|
| Rate for Payer: Cash Price |
$233.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$222.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$222.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$235.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$247.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$235.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$247.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$247.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$185.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$235.20
|
| Rate for Payer: Healthfirst QHP |
$247.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$173.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$247.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$210.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$173.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$247.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$649.90
|
| Rate for Payer: SOMOS Essential |
$649.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$247.58
|
|
|
CHG MRI SPINAL CANAL THORACIC W/CONTRAST MATRL
|
Professional
|
$343.74
|
|
|
Service Code
|
HCPCS 72147 26
|
| Min. Negotiated Rate |
$68.75 |
| Max. Negotiated Rate |
$907.70 |
| 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 SPINAL CANAL THORACIC W/CONTRAST MATRL
|
Professional
|
$1,210.27
|
|
|
Service Code
|
HCPCS 72147
|
| Min. Negotiated Rate |
$68.75 |
| Max. Negotiated Rate |
$907.70 |
| Rate for Payer: Cash Price |
$325.77
|
| Rate for Payer: Cash Price |
$325.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$311.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$311.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$328.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$345.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$328.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$345.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$345.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$259.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$328.50
|
| Rate for Payer: Healthfirst QHP |
$345.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$242.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$345.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$293.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$242.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$345.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$907.70
|
| Rate for Payer: SOMOS Essential |
$907.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$345.79
|
|
|
CHG MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL
|
Professional
|
$284.87
|
|
|
Service Code
|
HCPCS 72146 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 THORACIC W/O CONTRAST MATRL
|
Professional
|
$839.48
|
|
|
Service Code
|
HCPCS 72146
|
| Min. Negotiated Rate |
$56.97 |
| Max. Negotiated Rate |
$629.61 |
| Rate for Payer: Cash Price |
$226.44
|
| Rate for Payer: Cash Price |
$226.44
|
| 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 THORACIC W/O CONTRAST MATRL
|
Professional
|
$554.61
|
|
|
Service Code
|
HCPCS 72146 TC
|
| Min. Negotiated Rate |
$56.97 |
| Max. Negotiated Rate |
$629.61 |
| Rate for Payer: Cash Price |
$149.39
|
| Rate for Payer: Cash Price |
$149.39
|
| 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 THORACIC W/O & W/CONTR MATRL
|
Professional
|
$438.97
|
|
|
Service Code
|
HCPCS 72157 26
|
| Min. Negotiated Rate |
$87.79 |
| Max. Negotiated Rate |
$1,065.17 |
| Rate for Payer: Cash Price |
$119.19
|
| Rate for Payer: Cash Price |
$119.19
|
| 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 SPINAL CANAL THORACIC W/O & W/CONTR MATRL
|
Professional
|
$1,420.23
|
|
|
Service Code
|
HCPCS 72157
|
| Min. Negotiated Rate |
$87.79 |
| Max. Negotiated Rate |
$1,065.17 |
| Rate for Payer: Cash Price |
$381.98
|
| Rate for Payer: Cash Price |
$381.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$365.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$365.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$385.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$405.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$385.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$405.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$405.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$304.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$385.49
|
| Rate for Payer: Healthfirst QHP |
$405.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$284.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$405.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$344.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$284.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$405.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,065.17
|
| Rate for Payer: SOMOS Essential |
$1,065.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$405.78
|
|
|
CHG MRI SPINAL CANAL THORACIC W/O & W/CONTR MATRL
|
Professional
|
$981.26
|
|
|
Service Code
|
HCPCS 72157 TC
|
| Min. Negotiated Rate |
$87.79 |
| Max. Negotiated Rate |
$1,065.17 |
| Rate for Payer: Cash Price |
$262.78
|
| Rate for Payer: Cash Price |
$262.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$252.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$252.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$266.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$280.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$266.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$280.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$280.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$210.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$266.34
|
| Rate for Payer: Healthfirst QHP |
$280.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$196.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$280.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$238.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$196.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$280.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$735.94
|
| Rate for Payer: SOMOS Essential |
$735.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$280.36
|
|
|
CHG MRI TEMPOROMANDIBULAR JOINT
|
Professional
|
$1,180.17
|
|
|
Service Code
|
HCPCS 70336
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$885.13 |
| Rate for Payer: Cash Price |
$316.02
|
| Rate for Payer: Cash Price |
$316.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$303.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$303.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$320.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$337.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$320.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$337.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$337.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$252.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$320.33
|
| Rate for Payer: Healthfirst QHP |
$337.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$236.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$337.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$286.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$236.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$337.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$885.13
|
| Rate for Payer: SOMOS Essential |
$885.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$337.19
|
|
|
CHG MRI TEMPOROMANDIBULAR JOINT
|
Professional
|
$898.17
|
|
|
Service Code
|
HCPCS 70336 TC
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$885.13 |
| Rate for Payer: Cash Price |
$239.37
|
| Rate for Payer: Cash Price |
$239.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$230.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$230.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$243.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$256.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$243.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$256.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$256.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$192.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$243.79
|
| Rate for Payer: Healthfirst QHP |
$256.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$179.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$256.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$218.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$179.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$256.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$673.63
|
| Rate for Payer: SOMOS Essential |
$673.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$256.62
|
|
|
CHG MRI TEMPOROMANDIBULAR JOINT
|
Professional
|
$282.00
|
|
|
Service Code
|
HCPCS 70336 26
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$885.13 |
| Rate for Payer: Cash Price |
$76.66
|
| Rate for Payer: Cash Price |
$76.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$72.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$72.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$76.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$80.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$76.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$76.54
|
| Rate for Payer: Healthfirst QHP |
$80.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$56.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$80.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$68.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$56.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$80.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$211.50
|
| Rate for Payer: SOMOS Essential |
$211.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$80.57
|
|
|
CHG MRI UPPER EXTREMITY OTH THAN JT W/CONTR MATRL
|
Professional
|
$1,484.91
|
|
|
Service Code
|
HCPCS 73219
|
| Min. Negotiated Rate |
$61.92 |
| Max. Negotiated Rate |
$1,113.68 |
| Rate for Payer: Cash Price |
$397.37
|
| Rate for Payer: Cash Price |
$397.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$381.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$381.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$403.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$424.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$403.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$424.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$424.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$318.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$403.05
|
| Rate for Payer: Healthfirst QHP |
$424.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$296.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$424.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$360.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$296.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$424.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,113.68
|
| Rate for Payer: SOMOS Essential |
$1,113.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$424.26
|
|
|
CHG MRI UPPER EXTREMITY OTH THAN JT W/CONTR MATRL
|
Professional
|
$309.61
|
|
|
Service Code
|
HCPCS 73219 26
|
| Min. Negotiated Rate |
$61.92 |
| Max. Negotiated Rate |
$1,113.68 |
| Rate for Payer: Cash Price |
$84.29
|
| Rate for Payer: Cash Price |
$84.29
|
| 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
|
|
