|
CHG RADEX CLAVICLE COMPLETE
|
Professional
|
Both
|
$139.09
|
|
|
Service Code
|
HCPCS 73000
|
| Min. Negotiated Rate |
$26.46 |
| Max. Negotiated Rate |
$85.05 |
| Rate for Payer: Cash Price |
$38.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.35
|
| Rate for Payer: Healthfirst Commercial |
$37.80
|
| Rate for Payer: Healthfirst Essential Plan |
$85.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.91
|
| Rate for Payer: Healthfirst QHP |
$37.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.35
|
| Rate for Payer: SOMOS Essential |
$28.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.80
|
|
|
CHG RADEX CLAVICLE COMPLETE
|
Professional
|
Both
|
$106.23
|
|
|
Service Code
|
HCPCS 73000 TC
|
| Min. Negotiated Rate |
$20.27 |
| Max. Negotiated Rate |
$65.14 |
| Rate for Payer: Cash Price |
$29.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.71
|
| Rate for Payer: Healthfirst Commercial |
$28.95
|
| Rate for Payer: Healthfirst Essential Plan |
$65.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.50
|
| Rate for Payer: Healthfirst QHP |
$28.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.71
|
| Rate for Payer: SOMOS Essential |
$21.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.95
|
|
|
CHG RADEX CLAVICLE COMPLETE
|
Professional
|
Both
|
$32.83
|
|
|
Service Code
|
HCPCS 73000 26
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$19.91 |
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.64
|
| Rate for Payer: Healthfirst Commercial |
$8.85
|
| Rate for Payer: Healthfirst Essential Plan |
$19.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.41
|
| Rate for Payer: Healthfirst QHP |
$8.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.64
|
| Rate for Payer: SOMOS Essential |
$6.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.85
|
|
|
CHG RADEX ELBOW 2 VIEWS
|
Professional
|
Both
|
$126.14
|
|
|
Service Code
|
HCPCS 73070
|
| Min. Negotiated Rate |
$23.74 |
| Max. Negotiated Rate |
$76.32 |
| Rate for Payer: Cash Price |
$34.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.44
|
| Rate for Payer: Healthfirst Commercial |
$33.92
|
| Rate for Payer: Healthfirst Essential Plan |
$76.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.22
|
| Rate for Payer: Healthfirst QHP |
$33.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$33.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.44
|
| Rate for Payer: SOMOS Essential |
$25.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.92
|
|
|
CHG RADEX ELBOW 2 VIEWS
|
Professional
|
Both
|
$93.31
|
|
|
Service Code
|
HCPCS 73070 TC
|
| Min. Negotiated Rate |
$17.55 |
| Max. Negotiated Rate |
$56.41 |
| Rate for Payer: Cash Price |
$25.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.80
|
| Rate for Payer: Healthfirst Commercial |
$25.07
|
| Rate for Payer: Healthfirst Essential Plan |
$56.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23.82
|
| Rate for Payer: Healthfirst QHP |
$25.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$25.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$21.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18.80
|
| Rate for Payer: SOMOS Essential |
$18.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.07
|
|
|
CHG RADEX ELBOW 2 VIEWS
|
Professional
|
Both
|
$32.83
|
|
|
Service Code
|
HCPCS 73070 26
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$19.91 |
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.64
|
| Rate for Payer: Healthfirst Commercial |
$8.85
|
| Rate for Payer: Healthfirst Essential Plan |
$19.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.41
|
| Rate for Payer: Healthfirst QHP |
$8.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.64
|
| Rate for Payer: SOMOS Essential |
$6.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.85
|
|
|
CHG RADEX ELBOW ARTHROGRAPHY RS&I
|
Professional
|
Both
|
$367.85
|
|
|
Service Code
|
HCPCS 73085 TC
|
| Min. Negotiated Rate |
$59.12 |
| Max. Negotiated Rate |
$190.03 |
| Rate for Payer: Cash Price |
$88.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$84.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$76.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$76.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$80.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$84.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$80.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$84.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$84.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$63.34
|
| Rate for Payer: Healthfirst Commercial |
$84.46
|
| Rate for Payer: Healthfirst Essential Plan |
$190.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$80.24
|
| Rate for Payer: Healthfirst QHP |
$84.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$59.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$84.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$71.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$59.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$84.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$63.34
|
| Rate for Payer: SOMOS Essential |
$63.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$84.46
|
|
|
CHG RADEX ELBOW ARTHROGRAPHY RS&I
|
Professional
|
Both
|
$111.65
|
|
|
Service Code
|
HCPCS 73085 26
|
| Min. Negotiated Rate |
$19.75 |
| Max. Negotiated Rate |
$63.49 |
| Rate for Payer: Cash Price |
$28.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.16
|
| Rate for Payer: Healthfirst Commercial |
$28.22
|
| Rate for Payer: Healthfirst Essential Plan |
$63.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.81
|
| Rate for Payer: Healthfirst QHP |
$28.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.16
|
| Rate for Payer: SOMOS Essential |
$21.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.22
|
|
|
CHG RADEX ELBOW ARTHROGRAPHY RS&I
|
Professional
|
Both
|
$479.50
|
|
|
Service Code
|
HCPCS 73085
|
| Min. Negotiated Rate |
$78.88 |
| Max. Negotiated Rate |
$253.53 |
| Rate for Payer: Cash Price |
$116.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$112.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$101.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$101.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$107.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$112.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$107.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$112.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$84.51
|
| Rate for Payer: Healthfirst Commercial |
$112.68
|
| Rate for Payer: Healthfirst Essential Plan |
$253.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$107.05
|
| Rate for Payer: Healthfirst QHP |
$112.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$78.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$112.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$95.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$78.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$112.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$84.51
|
| Rate for Payer: SOMOS Essential |
$84.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$112.68
|
|
|
CHG RADEX ELBOW COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$140.32
|
|
|
Service Code
|
HCPCS 73080
|
| Min. Negotiated Rate |
$26.43 |
| Max. Negotiated Rate |
$84.96 |
| Rate for Payer: Cash Price |
$38.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.32
|
| Rate for Payer: Healthfirst Commercial |
$37.76
|
| Rate for Payer: Healthfirst Essential Plan |
$84.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.87
|
| Rate for Payer: Healthfirst QHP |
$37.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.32
|
| Rate for Payer: SOMOS Essential |
$28.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.76
|
|
|
CHG RADEX ELBOW COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$34.09
|
|
|
Service Code
|
HCPCS 73080 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 ELBOW COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$106.23
|
|
|
Service Code
|
HCPCS 73080 TC
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$64.28 |
| Rate for Payer: Cash Price |
$29.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.43
|
| Rate for Payer: Healthfirst Commercial |
$28.57
|
| Rate for Payer: Healthfirst Essential Plan |
$64.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.14
|
| Rate for Payer: Healthfirst QHP |
$28.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.43
|
| Rate for Payer: SOMOS Essential |
$21.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.57
|
|
|
CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 1 VW
|
Professional
|
Both
|
$181.79
|
|
|
Service Code
|
HCPCS 72081
|
| Min. Negotiated Rate |
$34.58 |
| Max. Negotiated Rate |
$111.15 |
| Rate for Payer: Cash Price |
$49.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$49.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$44.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$44.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$46.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$49.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$46.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$37.05
|
| Rate for Payer: Healthfirst Commercial |
$49.40
|
| Rate for Payer: Healthfirst Essential Plan |
$111.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.93
|
| Rate for Payer: Healthfirst QHP |
$49.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$49.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$49.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$37.05
|
| Rate for Payer: SOMOS Essential |
$37.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$49.40
|
|
|
CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 1 VW
|
Professional
|
Both
|
$132.13
|
|
|
Service Code
|
HCPCS 72081 TC
|
| Min. Negotiated Rate |
$25.16 |
| Max. Negotiated Rate |
$80.86 |
| Rate for Payer: Cash Price |
$35.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.95
|
| Rate for Payer: Healthfirst Commercial |
$35.94
|
| Rate for Payer: Healthfirst Essential Plan |
$80.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.14
|
| Rate for Payer: Healthfirst QHP |
$35.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.95
|
| Rate for Payer: SOMOS Essential |
$26.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.94
|
|
|
CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 1 VW
|
Professional
|
Both
|
$49.67
|
|
|
Service Code
|
HCPCS 72081 26
|
| Min. Negotiated Rate |
$9.42 |
| Max. Negotiated Rate |
$30.29 |
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.10
|
| Rate for Payer: Healthfirst Commercial |
$13.46
|
| Rate for Payer: Healthfirst Essential Plan |
$30.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.79
|
| Rate for Payer: Healthfirst QHP |
$13.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$13.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$11.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$10.10
|
| Rate for Payer: SOMOS Essential |
$10.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.46
|
|
|
CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 2/3 VW
|
Professional
|
Both
|
$239.93
|
|
|
Service Code
|
HCPCS 72082 TC
|
| Min. Negotiated Rate |
$45.26 |
| Max. Negotiated Rate |
$145.49 |
| Rate for Payer: Cash Price |
$65.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$64.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$58.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$61.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$64.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$61.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.49
|
| Rate for Payer: Healthfirst Commercial |
$64.66
|
| Rate for Payer: Healthfirst Essential Plan |
$145.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.43
|
| Rate for Payer: Healthfirst QHP |
$64.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$64.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$54.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$64.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$48.49
|
| Rate for Payer: SOMOS Essential |
$48.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$64.66
|
|
|
CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 2/3 VW
|
Professional
|
Both
|
$301.46
|
|
|
Service Code
|
HCPCS 72082
|
| Min. Negotiated Rate |
$56.87 |
| Max. Negotiated Rate |
$182.79 |
| Rate for Payer: Cash Price |
$82.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$81.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$73.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$77.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.93
|
| Rate for Payer: Healthfirst Commercial |
$81.24
|
| Rate for Payer: Healthfirst Essential Plan |
$182.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$77.18
|
| Rate for Payer: Healthfirst QHP |
$81.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$56.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$81.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$69.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$56.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$60.93
|
| Rate for Payer: SOMOS Essential |
$60.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.24
|
|
|
CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 2/3 VW
|
Professional
|
Both
|
$61.57
|
|
|
Service Code
|
HCPCS 72082 26
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$37.28 |
| Rate for Payer: Cash Price |
$16.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.43
|
| Rate for Payer: Healthfirst Commercial |
$16.57
|
| Rate for Payer: Healthfirst Essential Plan |
$37.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.74
|
| Rate for Payer: Healthfirst QHP |
$16.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$14.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.43
|
| Rate for Payer: SOMOS Essential |
$12.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.57
|
|
|
CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 4/5 VW
|
Professional
|
Both
|
$68.15
|
|
|
Service Code
|
HCPCS 72083 26
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$41.62 |
| Rate for Payer: Cash Price |
$18.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.88
|
| Rate for Payer: Healthfirst Commercial |
$18.50
|
| Rate for Payer: Healthfirst Essential Plan |
$41.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.57
|
| Rate for Payer: Healthfirst QHP |
$18.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$12.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$18.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$15.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$12.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$13.88
|
| Rate for Payer: SOMOS Essential |
$13.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.50
|
|
|
CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 4/5 VW
|
Professional
|
Both
|
$268.66
|
|
|
Service Code
|
HCPCS 72083 TC
|
| Min. Negotiated Rate |
$51.67 |
| Max. Negotiated Rate |
$166.09 |
| Rate for Payer: Cash Price |
$73.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$73.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$66.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$66.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$70.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$73.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$70.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$55.37
|
| Rate for Payer: Healthfirst Commercial |
$73.82
|
| Rate for Payer: Healthfirst Essential Plan |
$166.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$70.13
|
| Rate for Payer: Healthfirst QHP |
$73.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$51.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$73.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$62.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$51.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$73.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$55.37
|
| Rate for Payer: SOMOS Essential |
$55.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$73.82
|
|
|
CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 4/5 VW
|
Professional
|
Both
|
$336.81
|
|
|
Service Code
|
HCPCS 72083
|
| Min. Negotiated Rate |
$64.62 |
| Max. Negotiated Rate |
$207.72 |
| Rate for Payer: Cash Price |
$92.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$92.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$83.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$83.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$87.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$92.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$87.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.24
|
| Rate for Payer: Healthfirst Commercial |
$92.32
|
| Rate for Payer: Healthfirst Essential Plan |
$207.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$87.70
|
| Rate for Payer: Healthfirst QHP |
$92.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$92.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$78.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$92.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.24
|
| Rate for Payer: SOMOS Essential |
$69.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$92.32
|
|
|
CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 6/> VW
|
Professional
|
Both
|
$81.27
|
|
|
Service Code
|
HCPCS 72084 26
|
| Min. Negotiated Rate |
$15.37 |
| Max. Negotiated Rate |
$49.41 |
| Rate for Payer: Cash Price |
$21.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$19.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$20.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.47
|
| Rate for Payer: Healthfirst Commercial |
$21.96
|
| Rate for Payer: Healthfirst Essential Plan |
$49.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20.86
|
| Rate for Payer: Healthfirst QHP |
$21.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$15.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$21.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$18.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$16.47
|
| Rate for Payer: SOMOS Essential |
$16.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.96
|
|
|
CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 6/> VW
|
Professional
|
Both
|
$344.72
|
|
|
Service Code
|
HCPCS 72084 TC
|
| Min. Negotiated Rate |
$64.18 |
| Max. Negotiated Rate |
$206.28 |
| Rate for Payer: Cash Price |
$93.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$91.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$82.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$82.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$87.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$91.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$87.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$91.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$68.76
|
| Rate for Payer: Healthfirst Commercial |
$91.68
|
| Rate for Payer: Healthfirst Essential Plan |
$206.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$87.10
|
| Rate for Payer: Healthfirst QHP |
$91.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$91.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$77.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$91.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$68.76
|
| Rate for Payer: SOMOS Essential |
$68.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$91.68
|
|
|
CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 6/> VW
|
Professional
|
Both
|
$425.99
|
|
|
Service Code
|
HCPCS 72084
|
| Min. Negotiated Rate |
$79.55 |
| Max. Negotiated Rate |
$255.69 |
| Rate for Payer: Cash Price |
$115.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$113.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$102.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$102.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$107.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$113.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$107.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$113.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$113.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$85.23
|
| Rate for Payer: Healthfirst Commercial |
$113.64
|
| Rate for Payer: Healthfirst Essential Plan |
$255.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$107.96
|
| Rate for Payer: Healthfirst QHP |
$113.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$79.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$113.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$96.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$79.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$113.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$85.23
|
| Rate for Payer: SOMOS Essential |
$85.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$113.64
|
|
|
CHG RADEX FACIAL BONES < 3 VIEWS
|
Professional
|
Both
|
$39.48
|
|
|
Service Code
|
HCPCS 70140 26
|
| Min. Negotiated Rate |
$7.46 |
| Max. Negotiated Rate |
$23.98 |
| Rate for Payer: Cash Price |
$10.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.00
|
| Rate for Payer: Healthfirst Commercial |
$10.66
|
| Rate for Payer: Healthfirst Essential Plan |
$23.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.13
|
| Rate for Payer: Healthfirst QHP |
$10.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$7.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$10.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$9.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.00
|
| Rate for Payer: SOMOS Essential |
$8.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.66
|
|
