|
CHG PULMONARY VENTILATION & PERFUSION IMAGING
|
Professional
|
Both
|
$196.70
|
|
|
Service Code
|
HCPCS 78582 26
|
| Min. Negotiated Rate |
$37.32 |
| Max. Negotiated Rate |
$119.95 |
| Rate for Payer: Cash Price |
$54.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$53.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$53.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.98
|
| Rate for Payer: Healthfirst Commercial |
$53.31
|
| Rate for Payer: Healthfirst Essential Plan |
$119.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.64
|
| Rate for Payer: Healthfirst QHP |
$53.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$53.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$45.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$53.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.98
|
| Rate for Payer: SOMOS Essential |
$39.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.31
|
|
|
CHG QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING
|
Professional
|
Both
|
$669.31
|
|
|
Service Code
|
HCPCS 78597 TC
|
| Min. Negotiated Rate |
$121.12 |
| Max. Negotiated Rate |
$389.32 |
| Rate for Payer: Cash Price |
$178.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$173.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$155.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$155.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$164.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$173.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$164.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$173.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$173.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$129.77
|
| Rate for Payer: Healthfirst Commercial |
$173.03
|
| Rate for Payer: Healthfirst Essential Plan |
$389.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$164.38
|
| Rate for Payer: Healthfirst QHP |
$173.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$121.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$173.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$147.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$121.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$173.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$129.77
|
| Rate for Payer: SOMOS Essential |
$129.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$173.03
|
|
|
CHG QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING
|
Professional
|
Both
|
$805.84
|
|
|
Service Code
|
HCPCS 78597
|
| Min. Negotiated Rate |
$146.48 |
| Max. Negotiated Rate |
$470.83 |
| Rate for Payer: Cash Price |
$214.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$209.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$188.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$188.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$198.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$209.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$198.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$156.94
|
| Rate for Payer: Healthfirst Commercial |
$209.26
|
| Rate for Payer: Healthfirst Essential Plan |
$470.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$198.80
|
| Rate for Payer: Healthfirst QHP |
$209.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$146.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$209.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$177.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$146.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$209.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$156.94
|
| Rate for Payer: SOMOS Essential |
$156.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$209.26
|
|
|
CHG QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING
|
Professional
|
Both
|
$136.50
|
|
|
Service Code
|
HCPCS 78597 26
|
| Min. Negotiated Rate |
$25.36 |
| Max. Negotiated Rate |
$81.52 |
| Rate for Payer: Cash Price |
$36.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$36.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.17
|
| Rate for Payer: Healthfirst Commercial |
$36.23
|
| Rate for Payer: Healthfirst Essential Plan |
$81.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.42
|
| Rate for Payer: Healthfirst QHP |
$36.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$36.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.17
|
| Rate for Payer: SOMOS Essential |
$27.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.23
|
|
|
CHG QUANT DIFF PULM PRFUSION & VENTLAJ W/WO IMAGIN
|
Professional
|
Both
|
$1,051.68
|
|
|
Service Code
|
HCPCS 78598 TC
|
| Min. Negotiated Rate |
$188.67 |
| Max. Negotiated Rate |
$606.44 |
| Rate for Payer: Cash Price |
$280.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$269.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$242.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$242.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$256.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$269.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$256.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$269.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$269.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$202.15
|
| Rate for Payer: Healthfirst Commercial |
$269.53
|
| Rate for Payer: Healthfirst Essential Plan |
$606.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$256.05
|
| Rate for Payer: Healthfirst QHP |
$269.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$188.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$269.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$229.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$188.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$269.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$202.15
|
| Rate for Payer: SOMOS Essential |
$202.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$269.53
|
|
|
CHG QUANT DIFF PULM PRFUSION & VENTLAJ W/WO IMAGIN
|
Professional
|
Both
|
$156.21
|
|
|
Service Code
|
HCPCS 78598 26
|
| Min. Negotiated Rate |
$28.86 |
| Max. Negotiated Rate |
$92.77 |
| Rate for Payer: Cash Price |
$41.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$41.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$39.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.92
|
| Rate for Payer: Healthfirst Commercial |
$41.23
|
| Rate for Payer: Healthfirst Essential Plan |
$92.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.17
|
| Rate for Payer: Healthfirst QHP |
$41.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$41.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$35.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$30.92
|
| Rate for Payer: SOMOS Essential |
$30.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.23
|
|
|
CHG QUANT DIFF PULM PRFUSION & VENTLAJ W/WO IMAGIN
|
Professional
|
Both
|
$1,207.92
|
|
|
Service Code
|
HCPCS 78598
|
| Min. Negotiated Rate |
$217.53 |
| Max. Negotiated Rate |
$699.19 |
| Rate for Payer: Cash Price |
$322.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$310.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$295.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$310.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$295.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$310.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$310.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$233.06
|
| Rate for Payer: Healthfirst Commercial |
$310.75
|
| Rate for Payer: Healthfirst Essential Plan |
$699.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$295.21
|
| Rate for Payer: Healthfirst QHP |
$310.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$217.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$310.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$264.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$217.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$310.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$233.06
|
| Rate for Payer: SOMOS Essential |
$233.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$310.75
|
|
|
CHG RADEX 1 PLNE BODY SECTION OTH/THN W/UROGRAPY
|
Professional
|
Both
|
$268.66
|
|
|
Service Code
|
HCPCS 76100 TC
|
| Min. Negotiated Rate |
$49.77 |
| Max. Negotiated Rate |
$159.97 |
| Rate for Payer: Cash Price |
$73.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$71.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$63.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$63.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$67.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$71.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$67.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$71.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$71.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$53.33
|
| Rate for Payer: Healthfirst Commercial |
$71.10
|
| Rate for Payer: Healthfirst Essential Plan |
$159.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$67.55
|
| Rate for Payer: Healthfirst QHP |
$71.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$49.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$71.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$60.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$49.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$71.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$53.33
|
| Rate for Payer: SOMOS Essential |
$53.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$71.10
|
|
|
CHG RADEX 1 PLNE BODY SECTION OTH/THN W/UROGRAPY
|
Professional
|
Both
|
$383.88
|
|
|
Service Code
|
HCPCS 76100
|
| Min. Negotiated Rate |
$70.76 |
| Max. Negotiated Rate |
$227.45 |
| Rate for Payer: Cash Price |
$103.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$101.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$90.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$90.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$96.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$101.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$96.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$101.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$101.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$75.82
|
| Rate for Payer: Healthfirst Commercial |
$101.09
|
| Rate for Payer: Healthfirst Essential Plan |
$227.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$96.04
|
| Rate for Payer: Healthfirst QHP |
$101.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$70.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$101.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$85.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$70.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$101.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$75.82
|
| Rate for Payer: SOMOS Essential |
$75.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$101.09
|
|
|
CHG RADEX 1 PLNE BODY SECTION OTH/THN W/UROGRAPY
|
Professional
|
Both
|
$115.22
|
|
|
Service Code
|
HCPCS 76100 26
|
| Min. Negotiated Rate |
$20.99 |
| Max. Negotiated Rate |
$67.48 |
| Rate for Payer: Cash Price |
$30.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$28.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.49
|
| Rate for Payer: Healthfirst Commercial |
$29.99
|
| Rate for Payer: Healthfirst Essential Plan |
$67.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.49
|
| Rate for Payer: Healthfirst QHP |
$29.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$25.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.49
|
| Rate for Payer: SOMOS Essential |
$22.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.99
|
|
|
CHG RADEX ABSCESS/FISTULA/SINUS TRACT RS&I
|
Professional
|
Both
|
$255.26
|
|
|
Service Code
|
HCPCS 76080
|
| Min. Negotiated Rate |
$48.06 |
| Max. Negotiated Rate |
$154.49 |
| Rate for Payer: Cash Price |
$69.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$68.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$61.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$65.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$68.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$65.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$68.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$68.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51.49
|
| Rate for Payer: Healthfirst Commercial |
$68.66
|
| Rate for Payer: Healthfirst Essential Plan |
$154.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$65.23
|
| Rate for Payer: Healthfirst QHP |
$68.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$48.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$68.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$58.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$48.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$68.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$51.49
|
| Rate for Payer: SOMOS Essential |
$51.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$68.66
|
|
|
CHG RADEX ABSCESS/FISTULA/SINUS TRACT RS&I
|
Professional
|
Both
|
$101.57
|
|
|
Service Code
|
HCPCS 76080 26
|
| Min. Negotiated Rate |
$19.10 |
| Max. Negotiated Rate |
$61.40 |
| Rate for Payer: Cash Price |
$27.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.47
|
| Rate for Payer: Healthfirst Commercial |
$27.29
|
| Rate for Payer: Healthfirst Essential Plan |
$61.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.93
|
| Rate for Payer: Healthfirst QHP |
$27.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$27.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.47
|
| Rate for Payer: SOMOS Essential |
$20.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.29
|
|
|
CHG RADEX ABSCESS/FISTULA/SINUS TRACT RS&I
|
Professional
|
Both
|
$153.69
|
|
|
Service Code
|
HCPCS 76080 TC
|
| Min. Negotiated Rate |
$28.96 |
| Max. Negotiated Rate |
$93.08 |
| Rate for Payer: Cash Price |
$41.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$41.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$39.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.03
|
| Rate for Payer: Healthfirst Commercial |
$41.37
|
| Rate for Payer: Healthfirst Essential Plan |
$93.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.30
|
| Rate for Payer: Healthfirst QHP |
$41.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$41.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$35.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31.03
|
| Rate for Payer: SOMOS Essential |
$31.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.37
|
|
|
CHG RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ
|
Professional
|
Both
|
$36.79
|
|
|
Service Code
|
HCPCS 73050 26
|
| Min. Negotiated Rate |
$6.94 |
| Max. Negotiated Rate |
$22.32 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.44
|
| Rate for Payer: Healthfirst Commercial |
$9.92
|
| Rate for Payer: Healthfirst Essential Plan |
$22.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.42
|
| Rate for Payer: Healthfirst QHP |
$9.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.44
|
| Rate for Payer: SOMOS Essential |
$7.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.92
|
|
|
CHG RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ
|
Professional
|
Both
|
$122.89
|
|
|
Service Code
|
HCPCS 73050
|
| Min. Negotiated Rate |
$23.41 |
| Max. Negotiated Rate |
$75.24 |
| Rate for Payer: Cash Price |
$33.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.08
|
| Rate for Payer: Healthfirst Commercial |
$33.44
|
| Rate for Payer: Healthfirst Essential Plan |
$75.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.77
|
| Rate for Payer: Healthfirst QHP |
$33.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$33.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.08
|
| Rate for Payer: SOMOS Essential |
$25.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.44
|
|
|
CHG RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ
|
Professional
|
Both
|
$86.10
|
|
|
Service Code
|
HCPCS 73050 TC
|
| Min. Negotiated Rate |
$16.46 |
| Max. Negotiated Rate |
$52.92 |
| Rate for Payer: Cash Price |
$23.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$23.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$23.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.64
|
| Rate for Payer: Healthfirst Commercial |
$23.52
|
| Rate for Payer: Healthfirst Essential Plan |
$52.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.34
|
| Rate for Payer: Healthfirst QHP |
$23.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$16.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$23.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$19.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$16.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$17.64
|
| Rate for Payer: SOMOS Essential |
$17.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.52
|
|
|
CHG RADEX ANKLE ARTHROGRAPHY RS&I
|
Professional
|
Both
|
$111.65
|
|
|
Service Code
|
HCPCS 73615 26
|
| Min. Negotiated Rate |
$20.84 |
| Max. Negotiated Rate |
$66.98 |
| Rate for Payer: Cash Price |
$30.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$28.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.33
|
| Rate for Payer: Healthfirst Commercial |
$29.77
|
| Rate for Payer: Healthfirst Essential Plan |
$66.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.28
|
| Rate for Payer: Healthfirst QHP |
$29.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$25.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.33
|
| Rate for Payer: SOMOS Essential |
$22.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.77
|
|
|
CHG RADEX ANKLE ARTHROGRAPHY RS&I
|
Professional
|
Both
|
$445.48
|
|
|
Service Code
|
HCPCS 73615 TC
|
| Min. Negotiated Rate |
$79.50 |
| Max. Negotiated Rate |
$255.53 |
| Rate for Payer: Cash Price |
$119.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$113.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$102.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$102.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$107.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$113.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$107.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$113.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$113.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$85.18
|
| Rate for Payer: Healthfirst Commercial |
$113.57
|
| Rate for Payer: Healthfirst Essential Plan |
$255.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$107.89
|
| Rate for Payer: Healthfirst QHP |
$113.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$79.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$113.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$96.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$79.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$113.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$85.18
|
| Rate for Payer: SOMOS Essential |
$85.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$113.57
|
|
|
CHG RADEX ANKLE ARTHROGRAPHY RS&I
|
Professional
|
Both
|
$557.13
|
|
|
Service Code
|
HCPCS 73615
|
| Min. Negotiated Rate |
$100.34 |
| Max. Negotiated Rate |
$322.51 |
| Rate for Payer: Cash Price |
$149.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$143.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$129.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$129.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$136.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$143.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$136.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$143.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$143.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$107.50
|
| Rate for Payer: Healthfirst Commercial |
$143.34
|
| Rate for Payer: Healthfirst Essential Plan |
$322.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$136.17
|
| Rate for Payer: Healthfirst QHP |
$143.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$100.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$143.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$121.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$100.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$143.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$107.50
|
| Rate for Payer: SOMOS Essential |
$107.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$143.34
|
|
|
CHG RADEX ANKLE COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$34.09
|
|
|
Service Code
|
HCPCS 73610 26
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$20.68 |
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.89
|
| Rate for Payer: Healthfirst Commercial |
$9.19
|
| Rate for Payer: Healthfirst Essential Plan |
$20.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.73
|
| Rate for Payer: Healthfirst QHP |
$9.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.89
|
| Rate for Payer: SOMOS Essential |
$6.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.19
|
|
|
CHG RADEX ANKLE COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$124.92
|
|
|
Service Code
|
HCPCS 73610 TC
|
| Min. Negotiated Rate |
$22.99 |
| Max. Negotiated Rate |
$73.89 |
| Rate for Payer: Cash Price |
$33.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.63
|
| Rate for Payer: Healthfirst Commercial |
$32.84
|
| Rate for Payer: Healthfirst Essential Plan |
$73.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.20
|
| Rate for Payer: Healthfirst QHP |
$32.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.63
|
| Rate for Payer: SOMOS Essential |
$24.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.84
|
|
|
CHG RADEX ANKLE COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$159.01
|
|
|
Service Code
|
HCPCS 73610
|
| Min. Negotiated Rate |
$29.42 |
| Max. Negotiated Rate |
$94.57 |
| Rate for Payer: Cash Price |
$42.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$42.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$39.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$42.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.52
|
| Rate for Payer: Healthfirst Commercial |
$42.03
|
| Rate for Payer: Healthfirst Essential Plan |
$94.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.93
|
| Rate for Payer: Healthfirst QHP |
$42.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$42.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$35.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$42.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31.52
|
| Rate for Payer: SOMOS Essential |
$31.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.03
|
|
|
CHG RADEX CALCANEUS MINIMUM 2 VIEWS
|
Professional
|
Both
|
$91.88
|
|
|
Service Code
|
HCPCS 73650 TC
|
| Min. Negotiated Rate |
$17.01 |
| Max. Negotiated Rate |
$54.67 |
| Rate for Payer: Cash Price |
$24.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.23
|
| Rate for Payer: Healthfirst Commercial |
$24.30
|
| Rate for Payer: Healthfirst Essential Plan |
$54.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23.09
|
| Rate for Payer: Healthfirst QHP |
$24.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$24.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$20.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18.23
|
| Rate for Payer: SOMOS Essential |
$18.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.30
|
|
|
CHG RADEX CALCANEUS MINIMUM 2 VIEWS
|
Professional
|
Both
|
$123.27
|
|
|
Service Code
|
HCPCS 73650
|
| Min. Negotiated Rate |
$22.93 |
| Max. Negotiated Rate |
$73.69 |
| Rate for Payer: Cash Price |
$33.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.56
|
| Rate for Payer: Healthfirst Commercial |
$32.75
|
| Rate for Payer: Healthfirst Essential Plan |
$73.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.11
|
| Rate for Payer: Healthfirst QHP |
$32.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.56
|
| Rate for Payer: SOMOS Essential |
$24.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.75
|
|
|
CHG RADEX CALCANEUS MINIMUM 2 VIEWS
|
Professional
|
Both
|
$31.40
|
|
|
Service Code
|
HCPCS 73650 26
|
| Min. Negotiated Rate |
$5.92 |
| Max. Negotiated Rate |
$19.04 |
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.34
|
| Rate for Payer: Healthfirst Commercial |
$8.46
|
| Rate for Payer: Healthfirst Essential Plan |
$19.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.04
|
| Rate for Payer: Healthfirst QHP |
$8.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$5.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$5.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.34
|
| Rate for Payer: SOMOS Essential |
$6.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.46
|
|
