|
CHG RADEX FACIAL BONES < 3 VIEWS
|
Professional
|
Both
|
$99.05
|
|
|
Service Code
|
HCPCS 70140 TC
|
| Min. Negotiated Rate |
$18.37 |
| Max. Negotiated Rate |
$59.04 |
| Rate for Payer: Cash Price |
$26.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.68
|
| Rate for Payer: Healthfirst Commercial |
$26.24
|
| Rate for Payer: Healthfirst Essential Plan |
$59.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24.93
|
| Rate for Payer: Healthfirst QHP |
$26.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19.68
|
| Rate for Payer: SOMOS Essential |
$19.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.24
|
|
|
CHG RADEX FACIAL BONES < 3 VIEWS
|
Professional
|
Both
|
$138.53
|
|
|
Service Code
|
HCPCS 70140
|
| Min. Negotiated Rate |
$25.82 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: Cash Price |
$37.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$36.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.67
|
| Rate for Payer: Healthfirst Commercial |
$36.89
|
| Rate for Payer: Healthfirst Essential Plan |
$83.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.05
|
| Rate for Payer: Healthfirst QHP |
$36.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$36.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$31.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.67
|
| Rate for Payer: SOMOS Essential |
$27.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.89
|
|
|
CHG RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$49.67
|
|
|
Service Code
|
HCPCS 70150 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 FACIAL BONES COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$200.48
|
|
|
Service Code
|
HCPCS 70150
|
| Min. Negotiated Rate |
$37.57 |
| Max. Negotiated Rate |
$120.76 |
| Rate for Payer: Cash Price |
$55.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$53.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$48.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$48.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$53.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.25
|
| Rate for Payer: Healthfirst Commercial |
$53.67
|
| Rate for Payer: Healthfirst Essential Plan |
$120.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.99
|
| Rate for Payer: Healthfirst QHP |
$53.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$53.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$45.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$53.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.25
|
| Rate for Payer: SOMOS Essential |
$40.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.67
|
|
|
CHG RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$150.82
|
|
|
Service Code
|
HCPCS 70150 TC
|
| Min. Negotiated Rate |
$28.15 |
| Max. Negotiated Rate |
$90.47 |
| Rate for Payer: Cash Price |
$41.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$40.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.16
|
| Rate for Payer: Healthfirst Commercial |
$40.21
|
| Rate for Payer: Healthfirst Essential Plan |
$90.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.20
|
| Rate for Payer: Healthfirst QHP |
$40.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$40.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$30.16
|
| Rate for Payer: SOMOS Essential |
$30.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.21
|
|
|
CHG RADEX FINGR MINIMUM 2 VIEWS
|
Professional
|
Both
|
$27.65
|
|
|
Service Code
|
HCPCS 73140 26
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$16.72 |
| Rate for Payer: Cash Price |
$7.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.57
|
| Rate for Payer: Healthfirst Commercial |
$7.43
|
| Rate for Payer: Healthfirst Essential Plan |
$16.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.06
|
| Rate for Payer: Healthfirst QHP |
$7.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$5.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$7.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$6.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$5.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5.57
|
| Rate for Payer: SOMOS Essential |
$5.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.43
|
|
|
CHG RADEX FINGR MINIMUM 2 VIEWS
|
Professional
|
Both
|
$136.43
|
|
|
Service Code
|
HCPCS 73140 TC
|
| Min. Negotiated Rate |
$25.97 |
| Max. Negotiated Rate |
$83.47 |
| Rate for Payer: Cash Price |
$37.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.82
|
| Rate for Payer: Healthfirst Commercial |
$37.10
|
| Rate for Payer: Healthfirst Essential Plan |
$83.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.24
|
| Rate for Payer: Healthfirst QHP |
$37.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$31.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.82
|
| Rate for Payer: SOMOS Essential |
$27.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.10
|
|
|
CHG RADEX FINGR MINIMUM 2 VIEWS
|
Professional
|
Both
|
$164.08
|
|
|
Service Code
|
HCPCS 73140
|
| Min. Negotiated Rate |
$31.17 |
| Max. Negotiated Rate |
$100.19 |
| Rate for Payer: Cash Price |
$45.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$44.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$44.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.40
|
| Rate for Payer: Healthfirst Commercial |
$44.53
|
| Rate for Payer: Healthfirst Essential Plan |
$100.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42.30
|
| Rate for Payer: Healthfirst QHP |
$44.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$44.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$44.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$33.40
|
| Rate for Payer: SOMOS Essential |
$33.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44.53
|
|
|
CHG RADEX FOOT COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$32.66
|
|
|
Service Code
|
HCPCS 73630 26
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$19.80 |
| Rate for Payer: Cash Price |
$8.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.60
|
| Rate for Payer: Healthfirst Commercial |
$8.80
|
| Rate for Payer: Healthfirst Essential Plan |
$19.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.36
|
| Rate for Payer: Healthfirst QHP |
$8.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.60
|
| Rate for Payer: SOMOS Essential |
$6.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.80
|
|
|
CHG RADEX FOOT COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$147.53
|
|
|
Service Code
|
HCPCS 73630
|
| Min. Negotiated Rate |
$27.52 |
| Max. Negotiated Rate |
$88.45 |
| Rate for Payer: Cash Price |
$40.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$39.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.48
|
| Rate for Payer: Healthfirst Commercial |
$39.31
|
| Rate for Payer: Healthfirst Essential Plan |
$88.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.34
|
| Rate for Payer: Healthfirst QHP |
$39.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$39.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.48
|
| Rate for Payer: SOMOS Essential |
$29.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.31
|
|
|
CHG RADEX FOOT COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$114.87
|
|
|
Service Code
|
HCPCS 73630 TC
|
| Min. Negotiated Rate |
$21.36 |
| Max. Negotiated Rate |
$68.65 |
| Rate for Payer: Cash Price |
$31.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$27.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$28.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$30.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.88
|
| Rate for Payer: Healthfirst Commercial |
$30.51
|
| Rate for Payer: Healthfirst Essential Plan |
$68.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.98
|
| Rate for Payer: Healthfirst QHP |
$30.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$30.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$25.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.88
|
| Rate for Payer: SOMOS Essential |
$22.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.51
|
|
|
CHG RADEX FOREARM 2 VIEWS
|
Professional
|
Both
|
$31.40
|
|
|
Service Code
|
HCPCS 73090 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
|
|
|
CHG RADEX FOREARM 2 VIEWS
|
Professional
|
Both
|
$94.75
|
|
|
Service Code
|
HCPCS 73090 TC
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$57.28 |
| Rate for Payer: Cash Price |
$25.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.09
|
| Rate for Payer: Healthfirst Commercial |
$25.46
|
| Rate for Payer: Healthfirst Essential Plan |
$57.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24.19
|
| Rate for Payer: Healthfirst QHP |
$25.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$25.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$21.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19.09
|
| Rate for Payer: SOMOS Essential |
$19.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.46
|
|
|
CHG RADEX FOREARM 2 VIEWS
|
Professional
|
Both
|
$126.14
|
|
|
Service Code
|
HCPCS 73090
|
| 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 FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD
|
Professional
|
Both
|
$93.31
|
|
|
Service Code
|
HCPCS 76010 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 FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD
|
Professional
|
Both
|
$35.35
|
|
|
Service Code
|
HCPCS 76010 26
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$21.46 |
| Rate for Payer: Cash Price |
$9.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.16
|
| Rate for Payer: Healthfirst Commercial |
$9.54
|
| Rate for Payer: Healthfirst Essential Plan |
$21.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.06
|
| Rate for Payer: Healthfirst QHP |
$9.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.16
|
| Rate for Payer: SOMOS Essential |
$7.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.54
|
|
|
CHG RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD
|
Professional
|
Both
|
$128.63
|
|
|
Service Code
|
HCPCS 76010
|
| Min. Negotiated Rate |
$23.68 |
| Max. Negotiated Rate |
$76.12 |
| Rate for Payer: Cash Price |
$34.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.37
|
| Rate for Payer: Healthfirst Commercial |
$33.83
|
| Rate for Payer: Healthfirst Essential Plan |
$76.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.14
|
| Rate for Payer: Healthfirst QHP |
$33.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$33.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.37
|
| Rate for Payer: SOMOS Essential |
$25.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.83
|
|
|
CHG RADEX HAND 2 VIEWS
|
Professional
|
Both
|
$32.83
|
|
|
Service Code
|
HCPCS 73120 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 HAND 2 VIEWS
|
Professional
|
Both
|
$134.75
|
|
|
Service Code
|
HCPCS 73120
|
| Min. Negotiated Rate |
$25.38 |
| Max. Negotiated Rate |
$81.56 |
| Rate for Payer: Cash Price |
$37.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$36.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.19
|
| Rate for Payer: Healthfirst Commercial |
$36.25
|
| Rate for Payer: Healthfirst Essential Plan |
$81.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.44
|
| Rate for Payer: Healthfirst QHP |
$36.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$36.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.19
|
| Rate for Payer: SOMOS Essential |
$27.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.25
|
|
|
CHG RADEX HAND 2 VIEWS
|
Professional
|
Both
|
$101.92
|
|
|
Service Code
|
HCPCS 73120 TC
|
| Min. Negotiated Rate |
$19.18 |
| Max. Negotiated Rate |
$61.65 |
| Rate for Payer: Cash Price |
$28.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.55
|
| Rate for Payer: Healthfirst Commercial |
$27.40
|
| Rate for Payer: Healthfirst Essential Plan |
$61.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.03
|
| Rate for Payer: Healthfirst QHP |
$27.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$27.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.55
|
| Rate for Payer: SOMOS Essential |
$20.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.40
|
|
|
CHG RADEX HAND MINIMUM 3 VIEWS
|
Professional
|
Both
|
$159.01
|
|
|
Service Code
|
HCPCS 73130
|
| Min. Negotiated Rate |
$30.23 |
| Max. Negotiated Rate |
$97.18 |
| Rate for Payer: Cash Price |
$43.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$43.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.39
|
| Rate for Payer: Healthfirst Commercial |
$43.19
|
| Rate for Payer: Healthfirst Essential Plan |
$97.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.03
|
| Rate for Payer: Healthfirst QHP |
$43.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$43.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$36.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.39
|
| Rate for Payer: SOMOS Essential |
$32.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.19
|
|
|
CHG RADEX HAND MINIMUM 3 VIEWS
|
Professional
|
Both
|
$34.09
|
|
|
Service Code
|
HCPCS 73130 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 HAND MINIMUM 3 VIEWS
|
Professional
|
Both
|
$124.92
|
|
|
Service Code
|
HCPCS 73130 TC
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Cash Price |
$34.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.50
|
| Rate for Payer: Healthfirst Commercial |
$34.00
|
| Rate for Payer: Healthfirst Essential Plan |
$76.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.30
|
| Rate for Payer: Healthfirst QHP |
$34.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.50
|
| Rate for Payer: SOMOS Essential |
$25.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.00
|
|
|
CHG RADEX HIP ARTHROGRAPHY RS&I
|
Professional
|
Both
|
$561.44
|
|
|
Service Code
|
HCPCS 73525
|
| Min. Negotiated Rate |
$100.77 |
| Max. Negotiated Rate |
$323.91 |
| Rate for Payer: Cash Price |
$151.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$143.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$129.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$129.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$136.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$143.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$136.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$143.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$143.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$107.97
|
| Rate for Payer: Healthfirst Commercial |
$143.96
|
| Rate for Payer: Healthfirst Essential Plan |
$323.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$136.76
|
| Rate for Payer: Healthfirst QHP |
$143.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$100.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$143.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$122.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$100.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$143.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$107.97
|
| Rate for Payer: SOMOS Essential |
$107.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$143.96
|
|
|
CHG RADEX HIP ARTHROGRAPHY RS&I
|
Professional
|
Both
|
$114.52
|
|
|
Service Code
|
HCPCS 73525 26
|
| Min. Negotiated Rate |
$21.55 |
| Max. Negotiated Rate |
$69.25 |
| Rate for Payer: Cash Price |
$31.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$27.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$30.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.09
|
| Rate for Payer: Healthfirst Commercial |
$30.78
|
| Rate for Payer: Healthfirst Essential Plan |
$69.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.24
|
| Rate for Payer: Healthfirst QHP |
$30.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$30.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.09
|
| Rate for Payer: SOMOS Essential |
$23.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.78
|
|
