|
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 HIPS BILATERAL WITH PELVIS 2 VIEWS
|
Professional
|
Both
|
$133.56
|
|
|
Service Code
|
HCPCS 73521 TC
|
| Min. Negotiated Rate |
$25.16 |
| Max. Negotiated Rate |
$80.86 |
| Rate for Payer: Cash Price |
$36.38
|
| 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 HIPS BILATERAL WITH PELVIS 2 VIEWS
|
Professional
|
Both
|
$176.79
|
|
|
Service Code
|
HCPCS 73521
|
| Min. Negotiated Rate |
$33.34 |
| Max. Negotiated Rate |
$107.17 |
| Rate for Payer: Cash Price |
$48.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$42.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.72
|
| Rate for Payer: Healthfirst Commercial |
$47.63
|
| Rate for Payer: Healthfirst Essential Plan |
$107.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$45.25
|
| Rate for Payer: Healthfirst QHP |
$47.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$47.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$40.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35.72
|
| Rate for Payer: SOMOS Essential |
$35.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.63
|
|
|
CHG RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS
|
Professional
|
Both
|
$43.23
|
|
|
Service Code
|
HCPCS 73521 26
|
| Min. Negotiated Rate |
$8.18 |
| Max. Negotiated Rate |
$26.30 |
| Rate for Payer: Cash Price |
$11.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.77
|
| Rate for Payer: Healthfirst Commercial |
$11.69
|
| Rate for Payer: Healthfirst Essential Plan |
$26.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.11
|
| Rate for Payer: Healthfirst QHP |
$11.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$11.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$9.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.77
|
| Rate for Payer: SOMOS Essential |
$8.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.69
|
|
|
CHG RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS
|
Professional
|
Both
|
$172.38
|
|
|
Service Code
|
HCPCS 73522 TC
|
| Min. Negotiated Rate |
$32.77 |
| Max. Negotiated Rate |
$105.32 |
| Rate for Payer: Cash Price |
$47.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$42.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$44.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$44.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.11
|
| Rate for Payer: Healthfirst Commercial |
$46.81
|
| Rate for Payer: Healthfirst Essential Plan |
$105.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.47
|
| Rate for Payer: Healthfirst QHP |
$46.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$46.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35.11
|
| Rate for Payer: SOMOS Essential |
$35.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.81
|
|
|
CHG RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS
|
Professional
|
Both
|
$56.32
|
|
|
Service Code
|
HCPCS 73522 26
|
| Min. Negotiated Rate |
$10.69 |
| Max. Negotiated Rate |
$34.36 |
| Rate for Payer: Cash Price |
$15.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.45
|
| Rate for Payer: Healthfirst Commercial |
$15.27
|
| Rate for Payer: Healthfirst Essential Plan |
$34.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.51
|
| Rate for Payer: Healthfirst QHP |
$15.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$10.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$15.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$12.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$11.45
|
| Rate for Payer: SOMOS Essential |
$11.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.27
|
|
|
CHG RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS
|
Professional
|
Both
|
$228.66
|
|
|
Service Code
|
HCPCS 73522
|
| Min. Negotiated Rate |
$43.46 |
| Max. Negotiated Rate |
$139.68 |
| Rate for Payer: Cash Price |
$62.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$55.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$55.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$58.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$58.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$62.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$46.56
|
| Rate for Payer: Healthfirst Commercial |
$62.08
|
| Rate for Payer: Healthfirst Essential Plan |
$139.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$58.98
|
| Rate for Payer: Healthfirst QHP |
$62.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$43.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$62.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$52.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$43.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$46.56
|
| Rate for Payer: SOMOS Essential |
$46.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.08
|
|
|
CHG RADEX HIPS BILATERAL WITH PELVIS MINIMUM 5 VIEWS
|
Professional
|
Both
|
$203.98
|
|
|
Service Code
|
HCPCS 73523 TC
|
| Min. Negotiated Rate |
$38.47 |
| Max. Negotiated Rate |
$123.66 |
| Rate for Payer: Cash Price |
$55.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$54.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$49.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$49.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$52.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$54.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$52.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.22
|
| Rate for Payer: Healthfirst Commercial |
$54.96
|
| Rate for Payer: Healthfirst Essential Plan |
$123.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$52.21
|
| Rate for Payer: Healthfirst QHP |
$54.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$38.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$54.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$46.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$38.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$54.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$41.22
|
| Rate for Payer: SOMOS Essential |
$41.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.96
|
|
|
CHG RADEX HIPS BILATERAL WITH PELVIS MINIMUM 5 VIEWS
|
Professional
|
Both
|
$265.55
|
|
|
Service Code
|
HCPCS 73523
|
| Min. Negotiated Rate |
$50.07 |
| Max. Negotiated Rate |
$160.94 |
| Rate for Payer: Cash Price |
$72.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$71.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$64.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$64.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$67.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$71.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$67.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$71.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$71.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$53.65
|
| Rate for Payer: Healthfirst Commercial |
$71.53
|
| Rate for Payer: Healthfirst Essential Plan |
$160.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$67.95
|
| Rate for Payer: Healthfirst QHP |
$71.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$50.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$71.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$60.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$50.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$71.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$53.65
|
| Rate for Payer: SOMOS Essential |
$53.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$71.53
|
|
|
CHG RADEX HIPS BILATERAL WITH PELVIS MINIMUM 5 VIEWS
|
Professional
|
Both
|
$61.57
|
|
|
Service Code
|
HCPCS 73523 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 HIP UNILATERAL WITH PELVIS 1 VIEW
|
Professional
|
Both
|
$141.58
|
|
|
Service Code
|
HCPCS 73501
|
| Min. Negotiated Rate |
$26.94 |
| Max. Negotiated Rate |
$86.60 |
| Rate for Payer: Cash Price |
$38.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.87
|
| Rate for Payer: Healthfirst Commercial |
$38.49
|
| Rate for Payer: Healthfirst Essential Plan |
$86.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.57
|
| Rate for Payer: Healthfirst QHP |
$38.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.87
|
| Rate for Payer: SOMOS Essential |
$28.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.49
|
|
|
CHG RADEX HIP UNILATERAL WITH PELVIS 1 VIEW
|
Professional
|
Both
|
$36.79
|
|
|
Service Code
|
HCPCS 73501 26
|
| Min. Negotiated Rate |
$6.94 |
| Max. Negotiated Rate |
$22.32 |
| Rate for Payer: Cash Price |
$10.05
|
| 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 HIP UNILATERAL WITH PELVIS 1 VIEW
|
Professional
|
Both
|
$104.79
|
|
|
Service Code
|
HCPCS 73501 TC
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$64.28 |
| Rate for Payer: Cash Price |
$28.52
|
| 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 HIP UNILATERAL WITH PELVIS 2-3 VIEWS
|
Professional
|
Both
|
$157.99
|
|
|
Service Code
|
HCPCS 73502 TC
|
| Min. Negotiated Rate |
$30.32 |
| Max. Negotiated Rate |
$97.47 |
| Rate for Payer: Cash Price |
$43.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$43.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.49
|
| Rate for Payer: Healthfirst Commercial |
$43.32
|
| Rate for Payer: Healthfirst Essential Plan |
$97.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.15
|
| Rate for Payer: Healthfirst QHP |
$43.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$43.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$36.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.49
|
| Rate for Payer: SOMOS Essential |
$32.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.32
|
|
|
CHG RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS
|
Professional
|
Both
|
$201.22
|
|
|
Service Code
|
HCPCS 73502
|
| Min. Negotiated Rate |
$38.51 |
| Max. Negotiated Rate |
$123.77 |
| Rate for Payer: Cash Price |
$55.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$55.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$49.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$49.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$52.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$55.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$52.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.26
|
| Rate for Payer: Healthfirst Commercial |
$55.01
|
| Rate for Payer: Healthfirst Essential Plan |
$123.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$52.26
|
| Rate for Payer: Healthfirst QHP |
$55.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$38.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$55.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$46.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$38.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$55.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$41.26
|
| Rate for Payer: SOMOS Essential |
$41.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.01
|
|
|
CHG RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS
|
Professional
|
Both
|
$43.23
|
|
|
Service Code
|
HCPCS 73502 26
|
| Min. Negotiated Rate |
$8.18 |
| Max. Negotiated Rate |
$26.30 |
| Rate for Payer: Cash Price |
$11.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.77
|
| Rate for Payer: Healthfirst Commercial |
$11.69
|
| Rate for Payer: Healthfirst Essential Plan |
$26.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.11
|
| Rate for Payer: Healthfirst QHP |
$11.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$11.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$9.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.77
|
| Rate for Payer: SOMOS Essential |
$8.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.69
|
|
|
CHG RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS
|
Professional
|
Both
|
$253.47
|
|
|
Service Code
|
HCPCS 73503
|
| Min. Negotiated Rate |
$49.11 |
| Max. Negotiated Rate |
$157.86 |
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$63.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$63.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$66.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$66.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$70.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$52.62
|
| Rate for Payer: Healthfirst Commercial |
$70.16
|
| Rate for Payer: Healthfirst Essential Plan |
$157.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$66.65
|
| Rate for Payer: Healthfirst QHP |
$70.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$49.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$70.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$59.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$49.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$52.62
|
| Rate for Payer: SOMOS Essential |
$52.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.16
|
|
|
CHG RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS
|
Professional
|
Both
|
$201.11
|
|
|
Service Code
|
HCPCS 73503 TC
|
| Min. Negotiated Rate |
$38.74 |
| Max. Negotiated Rate |
$124.54 |
| Rate for Payer: Cash Price |
$55.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$55.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$49.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$49.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$52.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$55.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$52.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.51
|
| Rate for Payer: Healthfirst Commercial |
$55.35
|
| Rate for Payer: Healthfirst Essential Plan |
$124.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$52.58
|
| Rate for Payer: Healthfirst QHP |
$55.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$38.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$55.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$47.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$38.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$55.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$41.51
|
| Rate for Payer: SOMOS Essential |
$41.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.35
|
|
|
CHG RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS
|
Professional
|
Both
|
$52.36
|
|
|
Service Code
|
HCPCS 73503 26
|
| Min. Negotiated Rate |
$10.37 |
| Max. Negotiated Rate |
$33.32 |
| Rate for Payer: Cash Price |
$14.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.11
|
| Rate for Payer: Healthfirst Commercial |
$14.81
|
| Rate for Payer: Healthfirst Essential Plan |
$33.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.07
|
| Rate for Payer: Healthfirst QHP |
$14.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$10.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$14.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$12.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$11.11
|
| Rate for Payer: SOMOS Essential |
$11.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.81
|
|
|
CHG RADEX HUMERUS MINIMUM 2 VIEWS
|
Professional
|
Both
|
$106.23
|
|
|
Service Code
|
HCPCS 73060 TC
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$64.28 |
| Rate for Payer: Cash Price |
$28.92
|
| 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 HUMERUS MINIMUM 2 VIEWS
|
Professional
|
Both
|
$139.09
|
|
|
Service Code
|
HCPCS 73060
|
| Min. Negotiated Rate |
$25.91 |
| Max. Negotiated Rate |
$83.30 |
| Rate for Payer: Cash Price |
$37.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.77
|
| Rate for Payer: Healthfirst Commercial |
$37.02
|
| Rate for Payer: Healthfirst Essential Plan |
$83.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.17
|
| Rate for Payer: Healthfirst QHP |
$37.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$31.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.77
|
| Rate for Payer: SOMOS Essential |
$27.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.02
|
|
|
CHG RADEX HUMERUS MINIMUM 2 VIEWS
|
Professional
|
Both
|
$32.83
|
|
|
Service Code
|
HCPCS 73060 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 INTERNAL AUDITORY MEATI COMPLETE
|
Professional
|
Both
|
$68.32
|
|
|
Service Code
|
HCPCS 70134 26
|
| Min. Negotiated Rate |
$12.98 |
| Max. Negotiated Rate |
$41.72 |
| Rate for Payer: Cash Price |
$18.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.90
|
| Rate for Payer: Healthfirst Commercial |
$18.54
|
| Rate for Payer: Healthfirst Essential Plan |
$41.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.61
|
| Rate for Payer: Healthfirst QHP |
$18.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$12.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$18.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$15.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$12.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$13.90
|
| Rate for Payer: SOMOS Essential |
$13.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.54
|
|
|
CHG RADEX INTERNAL AUDITORY MEATI COMPLETE
|
Professional
|
Both
|
$193.94
|
|
|
Service Code
|
HCPCS 70134 TC
|
| Min. Negotiated Rate |
$36.30 |
| Max. Negotiated Rate |
$116.66 |
| Rate for Payer: Cash Price |
$53.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$51.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$46.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$46.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$51.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.89
|
| Rate for Payer: Healthfirst Commercial |
$51.85
|
| Rate for Payer: Healthfirst Essential Plan |
$116.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.26
|
| Rate for Payer: Healthfirst QHP |
$51.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$51.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$51.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$38.89
|
| Rate for Payer: SOMOS Essential |
$38.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$51.85
|
|
|
CHG RADEX INTERNAL AUDITORY MEATI COMPLETE
|
Professional
|
Both
|
$262.26
|
|
|
Service Code
|
HCPCS 70134
|
| Min. Negotiated Rate |
$49.28 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Cash Price |
$72.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$63.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$63.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$66.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$66.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$70.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$52.80
|
| Rate for Payer: Healthfirst Commercial |
$70.40
|
| Rate for Payer: Healthfirst Essential Plan |
$158.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$66.88
|
| Rate for Payer: Healthfirst QHP |
$70.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$49.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$70.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$59.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$49.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$52.80
|
| Rate for Payer: SOMOS Essential |
$52.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.40
|
|
