|
CHG RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS
|
Professional
|
Both
|
$31.40
|
|
|
Service Code
|
HCPCS 73592 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 LOWER EXTREMITY INFANT MINIMUM 2 VIEWS
|
Professional
|
Both
|
$104.79
|
|
|
Service Code
|
HCPCS 73592 TC
|
| Min. Negotiated Rate |
$19.45 |
| Max. Negotiated Rate |
$62.53 |
| Rate for Payer: Cash Price |
$28.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.84
|
| Rate for Payer: Healthfirst Commercial |
$27.79
|
| Rate for Payer: Healthfirst Essential Plan |
$62.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.40
|
| Rate for Payer: Healthfirst QHP |
$27.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$27.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.84
|
| Rate for Payer: SOMOS Essential |
$20.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.79
|
|
|
CHG RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS
|
Professional
|
Both
|
$136.19
|
|
|
Service Code
|
HCPCS 73592
|
| 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 MASTOIDS COMPL MINIMUM 3 VIEWS PR SIDE
|
Professional
|
Both
|
$201.11
|
|
|
Service Code
|
HCPCS 70130 TC
|
| Min. Negotiated Rate |
$37.66 |
| Max. Negotiated Rate |
$121.05 |
| Rate for Payer: Cash Price |
$54.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$53.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$48.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$48.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$51.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$53.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$51.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.35
|
| Rate for Payer: Healthfirst Commercial |
$53.80
|
| Rate for Payer: Healthfirst Essential Plan |
$121.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$51.11
|
| Rate for Payer: Healthfirst QHP |
$53.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$53.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$45.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$53.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.35
|
| Rate for Payer: SOMOS Essential |
$40.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.80
|
|
|
CHG RADEX MASTOIDS COMPL MINIMUM 3 VIEWS PR SIDE
|
Professional
|
Both
|
$66.75
|
|
|
Service Code
|
HCPCS 70130 26
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.50
|
| Rate for Payer: Healthfirst Commercial |
$18.00
|
| Rate for Payer: Healthfirst Essential Plan |
$40.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.10
|
| Rate for Payer: Healthfirst QHP |
$18.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$12.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$18.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$15.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$12.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$13.50
|
| Rate for Payer: SOMOS Essential |
$13.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.00
|
|
|
CHG RADEX MASTOIDS COMPL MINIMUM 3 VIEWS PR SIDE
|
Professional
|
Both
|
$267.86
|
|
|
Service Code
|
HCPCS 70130
|
| Min. Negotiated Rate |
$50.25 |
| Max. Negotiated Rate |
$161.53 |
| Rate for Payer: Cash Price |
$72.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$71.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$64.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$64.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$68.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$71.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$68.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$71.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$71.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$53.84
|
| Rate for Payer: Healthfirst Commercial |
$71.79
|
| Rate for Payer: Healthfirst Essential Plan |
$161.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$68.20
|
| Rate for Payer: Healthfirst QHP |
$71.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$50.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$71.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$61.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$50.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$71.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$53.84
|
| Rate for Payer: SOMOS Essential |
$53.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$71.79
|
|
|
CHG RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$130.69
|
|
|
Service Code
|
HCPCS 70160 TC
|
| Min. Negotiated Rate |
$24.07 |
| Max. Negotiated Rate |
$77.38 |
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.79
|
| Rate for Payer: Healthfirst Commercial |
$34.39
|
| Rate for Payer: Healthfirst Essential Plan |
$77.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.67
|
| Rate for Payer: Healthfirst QHP |
$34.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.79
|
| Rate for Payer: SOMOS Essential |
$25.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.39
|
|
|
CHG RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$164.78
|
|
|
Service Code
|
HCPCS 70160
|
| Min. Negotiated Rate |
$30.51 |
| Max. Negotiated Rate |
$98.06 |
| Rate for Payer: Cash Price |
$44.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$43.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.69
|
| Rate for Payer: Healthfirst Commercial |
$43.58
|
| Rate for Payer: Healthfirst Essential Plan |
$98.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.40
|
| Rate for Payer: Healthfirst QHP |
$43.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$43.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.69
|
| Rate for Payer: SOMOS Essential |
$32.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.58
|
|
|
CHG RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$34.09
|
|
|
Service Code
|
HCPCS 70160 26
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$20.68 |
| Rate for Payer: Cash Price |
$8.91
|
| 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 OPTIC FORAMINA
|
Professional
|
Both
|
$161.14
|
|
|
Service Code
|
HCPCS 70190
|
| Min. Negotiated Rate |
$30.11 |
| Max. Negotiated Rate |
$96.80 |
| Rate for Payer: Cash Price |
$43.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$43.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$40.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.27
|
| Rate for Payer: Healthfirst Commercial |
$43.02
|
| Rate for Payer: Healthfirst Essential Plan |
$96.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.87
|
| Rate for Payer: Healthfirst QHP |
$43.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$43.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$36.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.27
|
| Rate for Payer: SOMOS Essential |
$32.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.02
|
|
|
CHG RADEX OPTIC FORAMINA
|
Professional
|
Both
|
$43.40
|
|
|
Service Code
|
HCPCS 70190 26
|
| Min. Negotiated Rate |
$8.21 |
| Max. Negotiated Rate |
$26.39 |
| Rate for Payer: Cash Price |
$11.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.80
|
| Rate for Payer: Healthfirst Commercial |
$11.73
|
| Rate for Payer: Healthfirst Essential Plan |
$26.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.14
|
| Rate for Payer: Healthfirst QHP |
$11.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$11.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$9.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.80
|
| Rate for Payer: SOMOS Essential |
$8.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.73
|
|
|
CHG RADEX OPTIC FORAMINA
|
Professional
|
Both
|
$117.74
|
|
|
Service Code
|
HCPCS 70190 TC
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$70.38 |
| Rate for Payer: Cash Price |
$32.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.46
|
| Rate for Payer: Healthfirst Commercial |
$31.28
|
| Rate for Payer: Healthfirst Essential Plan |
$70.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.72
|
| Rate for Payer: Healthfirst QHP |
$31.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$31.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.46
|
| Rate for Payer: SOMOS Essential |
$23.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.28
|
|
|
CHG RADEX ORBITS COMPLETE MINIMUM 4 VIEWS
|
Professional
|
Both
|
$204.40
|
|
|
Service Code
|
HCPCS 70200
|
| Min. Negotiated Rate |
$38.32 |
| Max. Negotiated Rate |
$123.17 |
| Rate for Payer: Cash Price |
$55.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$54.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$49.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$49.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$52.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$54.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$52.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.05
|
| Rate for Payer: Healthfirst Commercial |
$54.74
|
| Rate for Payer: Healthfirst Essential Plan |
$123.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$52.00
|
| Rate for Payer: Healthfirst QHP |
$54.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$38.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$54.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$46.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$38.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$54.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$41.05
|
| Rate for Payer: SOMOS Essential |
$41.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.74
|
|
|
CHG RADEX ORBITS COMPLETE MINIMUM 4 VIEWS
|
Professional
|
Both
|
$53.62
|
|
|
Service Code
|
HCPCS 70200 26
|
| Min. Negotiated Rate |
$10.17 |
| Max. Negotiated Rate |
$32.69 |
| Rate for Payer: Cash Price |
$14.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.90
|
| Rate for Payer: Healthfirst Commercial |
$14.53
|
| Rate for Payer: Healthfirst Essential Plan |
$32.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.80
|
| Rate for Payer: Healthfirst QHP |
$14.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$10.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$14.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$12.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$10.90
|
| Rate for Payer: SOMOS Essential |
$10.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.53
|
|
|
CHG RADEX ORBITS COMPLETE MINIMUM 4 VIEWS
|
Professional
|
Both
|
$150.82
|
|
|
Service Code
|
HCPCS 70200 TC
|
| Min. Negotiated Rate |
$28.15 |
| Max. Negotiated Rate |
$90.47 |
| Rate for Payer: Cash Price |
$41.10
|
| 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 PHARYNX/LARX W/FLUOR&/MAGNIFICATION TQ
|
Professional
|
Both
|
$369.29
|
|
|
Service Code
|
HCPCS 70370 TC
|
| Min. Negotiated Rate |
$71.62 |
| Max. Negotiated Rate |
$230.22 |
| Rate for Payer: Cash Price |
$106.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$102.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$92.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$92.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$97.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$102.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$97.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$102.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$102.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$76.74
|
| Rate for Payer: Healthfirst Commercial |
$102.32
|
| Rate for Payer: Healthfirst Essential Plan |
$230.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$97.20
|
| Rate for Payer: Healthfirst QHP |
$102.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$71.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$102.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$86.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$71.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$102.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$76.74
|
| Rate for Payer: SOMOS Essential |
$76.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$102.32
|
|
|
CHG RADEX PHARYNX/LARX W/FLUOR&/MAGNIFICATION TQ
|
Professional
|
Both
|
$59.92
|
|
|
Service Code
|
HCPCS 70370 26
|
| Min. Negotiated Rate |
$11.57 |
| Max. Negotiated Rate |
$37.19 |
| Rate for Payer: Cash Price |
$16.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.40
|
| Rate for Payer: Healthfirst Commercial |
$16.53
|
| Rate for Payer: Healthfirst Essential Plan |
$37.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.70
|
| Rate for Payer: Healthfirst QHP |
$16.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$14.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.40
|
| Rate for Payer: SOMOS Essential |
$12.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.53
|
|
|
CHG RADEX PHARYNX/LARX W/FLUOR&/MAGNIFICATION TQ
|
Professional
|
Both
|
$429.24
|
|
|
Service Code
|
HCPCS 70370
|
| Min. Negotiated Rate |
$83.19 |
| Max. Negotiated Rate |
$267.41 |
| Rate for Payer: Cash Price |
$123.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$118.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$106.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$106.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$112.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$118.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$112.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$118.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$118.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$89.14
|
| Rate for Payer: Healthfirst Commercial |
$118.85
|
| Rate for Payer: Healthfirst Essential Plan |
$267.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$112.91
|
| Rate for Payer: Healthfirst QHP |
$118.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$83.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$118.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$101.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$83.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$118.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$89.14
|
| Rate for Payer: SOMOS Essential |
$89.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$118.85
|
|
|
CHG RADEX RENAL CYST STUDY TRANSLUMBAR RS&I
|
Professional
|
Both
|
$103.01
|
|
|
Service Code
|
HCPCS 74470 26
|
| Min. Negotiated Rate |
$19.21 |
| Max. Negotiated Rate |
$61.74 |
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.58
|
| Rate for Payer: Healthfirst Commercial |
$27.44
|
| Rate for Payer: Healthfirst Essential Plan |
$61.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.07
|
| Rate for Payer: Healthfirst QHP |
$27.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$27.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.58
|
| Rate for Payer: SOMOS Essential |
$20.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.44
|
|
|
CHG RADEX RIBS BILATERAL 3 VIEWS
|
Professional
|
Both
|
$132.13
|
|
|
Service Code
|
HCPCS 71110 TC
|
| Min. Negotiated Rate |
$24.61 |
| Max. Negotiated Rate |
$79.11 |
| Rate for Payer: Cash Price |
$35.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.37
|
| Rate for Payer: Healthfirst Commercial |
$35.16
|
| Rate for Payer: Healthfirst Essential Plan |
$79.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.40
|
| Rate for Payer: Healthfirst QHP |
$35.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.37
|
| Rate for Payer: SOMOS Essential |
$26.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.16
|
|
|
CHG RADEX RIBS BILATERAL 3 VIEWS
|
Professional
|
Both
|
$186.97
|
|
|
Service Code
|
HCPCS 71110
|
| Min. Negotiated Rate |
$35.03 |
| Max. Negotiated Rate |
$112.59 |
| Rate for Payer: Cash Price |
$51.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$50.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$45.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$45.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$47.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$50.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$47.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$37.53
|
| Rate for Payer: Healthfirst Commercial |
$50.04
|
| Rate for Payer: Healthfirst Essential Plan |
$112.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.54
|
| Rate for Payer: Healthfirst QHP |
$50.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$35.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$50.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$42.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$35.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$50.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$37.53
|
| Rate for Payer: SOMOS Essential |
$37.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.04
|
|
|
CHG RADEX RIBS BILATERAL 3 VIEWS
|
Professional
|
Both
|
$54.88
|
|
|
Service Code
|
HCPCS 71110 26
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$33.48 |
| Rate for Payer: Cash Price |
$15.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.16
|
| Rate for Payer: Healthfirst Commercial |
$14.88
|
| Rate for Payer: Healthfirst Essential Plan |
$33.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.14
|
| Rate for Payer: Healthfirst QHP |
$14.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$10.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$14.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$12.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$11.16
|
| Rate for Payer: SOMOS Essential |
$11.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.88
|
|
|
CHG RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS
|
Professional
|
Both
|
$62.79
|
|
|
Service Code
|
HCPCS 71111 26
|
| Min. Negotiated Rate |
$11.84 |
| Max. Negotiated Rate |
$38.07 |
| Rate for Payer: Cash Price |
$17.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.69
|
| Rate for Payer: Healthfirst Commercial |
$16.92
|
| Rate for Payer: Healthfirst Essential Plan |
$38.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.07
|
| Rate for Payer: Healthfirst QHP |
$16.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$14.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.69
|
| Rate for Payer: SOMOS Essential |
$12.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.92
|
|
|
CHG RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS
|
Professional
|
Both
|
$162.30
|
|
|
Service Code
|
HCPCS 71111 TC
|
| Min. Negotiated Rate |
$30.32 |
| Max. Negotiated Rate |
$97.47 |
| Rate for Payer: Cash Price |
$44.24
|
| 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 RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS
|
Professional
|
Both
|
$225.09
|
|
|
Service Code
|
HCPCS 71111
|
| Min. Negotiated Rate |
$42.16 |
| Max. Negotiated Rate |
$135.52 |
| Rate for Payer: Cash Price |
$61.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$60.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$54.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$54.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$57.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$60.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$57.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.17
|
| Rate for Payer: Healthfirst Commercial |
$60.23
|
| Rate for Payer: Healthfirst Essential Plan |
$135.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$57.22
|
| Rate for Payer: Healthfirst QHP |
$60.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$42.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$60.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$51.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$42.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$60.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$45.17
|
| Rate for Payer: SOMOS Essential |
$45.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$60.23
|
|
