|
CHG RADEX RIBS UNILATERAL 2 VIEWS
|
Professional
|
Both
|
$158.10
|
|
|
Service Code
|
HCPCS 71100
|
| Min. Negotiated Rate |
$29.54 |
| Max. Negotiated Rate |
$94.95 |
| Rate for Payer: Cash Price |
$42.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$42.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$42.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$40.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.65
|
| Rate for Payer: Healthfirst Commercial |
$42.20
|
| Rate for Payer: Healthfirst Essential Plan |
$94.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.09
|
| Rate for Payer: Healthfirst QHP |
$42.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$42.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$35.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$42.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31.65
|
| Rate for Payer: SOMOS Essential |
$31.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.20
|
|
|
CHG RADEX RIBS UNILATERAL 2 VIEWS
|
Professional
|
Both
|
$43.23
|
|
|
Service Code
|
HCPCS 71100 26
|
| Min. Negotiated Rate |
$8.18 |
| Max. Negotiated Rate |
$26.30 |
| Rate for Payer: Cash Price |
$11.44
|
| 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 RIBS UNILATERAL 2 VIEWS
|
Professional
|
Both
|
$114.87
|
|
|
Service Code
|
HCPCS 71100 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 RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS
|
Professional
|
Both
|
$50.93
|
|
|
Service Code
|
HCPCS 71101 26
|
| Min. Negotiated Rate |
$9.66 |
| Max. Negotiated Rate |
$31.05 |
| Rate for Payer: Cash Price |
$13.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.35
|
| Rate for Payer: Healthfirst Commercial |
$13.80
|
| Rate for Payer: Healthfirst Essential Plan |
$31.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.11
|
| Rate for Payer: Healthfirst QHP |
$13.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$13.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$11.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$10.35
|
| Rate for Payer: SOMOS Essential |
$10.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.80
|
|
|
CHG RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS
|
Professional
|
Both
|
$129.22
|
|
|
Service Code
|
HCPCS 71101 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 RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS
|
Professional
|
Both
|
$180.18
|
|
|
Service Code
|
HCPCS 71101
|
| Min. Negotiated Rate |
$33.73 |
| Max. Negotiated Rate |
$108.43 |
| Rate for Payer: Cash Price |
$49.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$48.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$48.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.14
|
| Rate for Payer: Healthfirst Commercial |
$48.19
|
| Rate for Payer: Healthfirst Essential Plan |
$108.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$45.78
|
| Rate for Payer: Healthfirst QHP |
$48.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$48.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$40.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$48.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36.14
|
| Rate for Payer: SOMOS Essential |
$36.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$48.19
|
|
|
CHG RADEX SACRUM & COCCYX MINIMUM 2 VIEWS
|
Professional
|
Both
|
$106.23
|
|
|
Service Code
|
HCPCS 72220 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 SACRUM & COCCYX MINIMUM 2 VIEWS
|
Professional
|
Both
|
$140.32
|
|
|
Service Code
|
HCPCS 72220
|
| Min. Negotiated Rate |
$26.43 |
| Max. Negotiated Rate |
$84.96 |
| Rate for Payer: Cash Price |
$38.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.32
|
| Rate for Payer: Healthfirst Commercial |
$37.76
|
| Rate for Payer: Healthfirst Essential Plan |
$84.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.87
|
| Rate for Payer: Healthfirst QHP |
$37.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.32
|
| Rate for Payer: SOMOS Essential |
$28.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.76
|
|
|
CHG RADEX SACRUM & COCCYX MINIMUM 2 VIEWS
|
Professional
|
Both
|
$34.09
|
|
|
Service Code
|
HCPCS 72220 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 SCAPULA COMPLETE
|
Professional
|
Both
|
$65.98
|
|
|
Service Code
|
HCPCS 73010 TC
|
| Min. Negotiated Rate |
$12.66 |
| Max. Negotiated Rate |
$40.70 |
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.57
|
| Rate for Payer: Healthfirst Commercial |
$18.09
|
| Rate for Payer: Healthfirst Essential Plan |
$40.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.19
|
| Rate for Payer: Healthfirst QHP |
$18.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$12.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$18.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$15.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$12.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$13.57
|
| Rate for Payer: SOMOS Essential |
$13.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.09
|
|
|
CHG RADEX SCAPULA COMPLETE
|
Professional
|
Both
|
$101.50
|
|
|
Service Code
|
HCPCS 73010
|
| Min. Negotiated Rate |
$19.36 |
| Max. Negotiated Rate |
$62.23 |
| Rate for Payer: Cash Price |
$28.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.75
|
| Rate for Payer: Healthfirst Commercial |
$27.66
|
| Rate for Payer: Healthfirst Essential Plan |
$62.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.28
|
| Rate for Payer: Healthfirst QHP |
$27.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$27.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.75
|
| Rate for Payer: SOMOS Essential |
$20.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.66
|
|
|
CHG RADEX SCAPULA COMPLETE
|
Professional
|
Both
|
$35.53
|
|
|
Service Code
|
HCPCS 73010 26
|
| Min. Negotiated Rate |
$6.71 |
| Max. Negotiated Rate |
$21.55 |
| Rate for Payer: Cash Price |
$9.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.18
|
| Rate for Payer: Healthfirst Commercial |
$9.58
|
| Rate for Payer: Healthfirst Essential Plan |
$21.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.10
|
| Rate for Payer: Healthfirst QHP |
$9.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.18
|
| Rate for Payer: SOMOS Essential |
$7.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.58
|
|
|
CHG RADEX SHOULDER 1 VIEW
|
Professional
|
Both
|
$93.28
|
|
|
Service Code
|
HCPCS 73020
|
| Min. Negotiated Rate |
$17.53 |
| Max. Negotiated Rate |
$56.34 |
| Rate for Payer: Cash Price |
$25.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.78
|
| Rate for Payer: Healthfirst Commercial |
$25.04
|
| Rate for Payer: Healthfirst Essential Plan |
$56.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23.79
|
| Rate for Payer: Healthfirst QHP |
$25.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$25.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$21.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18.78
|
| Rate for Payer: SOMOS Essential |
$18.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.04
|
|
|
CHG RADEX SHOULDER 1 VIEW
|
Professional
|
Both
|
$30.14
|
|
|
Service Code
|
HCPCS 73020 26
|
| Min. Negotiated Rate |
$5.68 |
| Max. Negotiated Rate |
$18.25 |
| Rate for Payer: Cash Price |
$8.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.08
|
| Rate for Payer: Healthfirst Commercial |
$8.11
|
| Rate for Payer: Healthfirst Essential Plan |
$18.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.70
|
| Rate for Payer: Healthfirst QHP |
$8.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$5.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$6.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$5.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.08
|
| Rate for Payer: SOMOS Essential |
$6.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.11
|
|
|
CHG RADEX SHOULDER 1 VIEW
|
Professional
|
Both
|
$63.11
|
|
|
Service Code
|
HCPCS 73020 TC
|
| 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 SHOULDER ARTHROGRAPHY RS&I
|
Professional
|
Both
|
$455.56
|
|
|
Service Code
|
HCPCS 73040 TC
|
| Min. Negotiated Rate |
$83.85 |
| Max. Negotiated Rate |
$269.50 |
| Rate for Payer: Cash Price |
$124.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$119.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$107.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$107.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$119.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$119.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$119.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$89.83
|
| Rate for Payer: Healthfirst Commercial |
$119.78
|
| Rate for Payer: Healthfirst Essential Plan |
$269.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$113.79
|
| Rate for Payer: Healthfirst QHP |
$119.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$83.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$119.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$101.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$83.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$119.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$89.83
|
| Rate for Payer: SOMOS Essential |
$89.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$119.78
|
|
|
CHG RADEX SHOULDER ARTHROGRAPHY RS&I
|
Professional
|
Both
|
$110.22
|
|
|
Service Code
|
HCPCS 73040 26
|
| Min. Negotiated Rate |
$20.57 |
| Max. Negotiated Rate |
$66.11 |
| Rate for Payer: Cash Price |
$29.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.04
|
| Rate for Payer: Healthfirst Commercial |
$29.38
|
| Rate for Payer: Healthfirst Essential Plan |
$66.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.91
|
| Rate for Payer: Healthfirst QHP |
$29.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.04
|
| Rate for Payer: SOMOS Essential |
$22.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.38
|
|
|
CHG RADEX SHOULDER ARTHROGRAPHY RS&I
|
Professional
|
Both
|
$565.74
|
|
|
Service Code
|
HCPCS 73040
|
| Min. Negotiated Rate |
$104.42 |
| Max. Negotiated Rate |
$335.63 |
| Rate for Payer: Cash Price |
$153.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$149.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$134.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$134.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$141.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$149.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$141.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$149.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$149.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$111.88
|
| Rate for Payer: Healthfirst Commercial |
$149.17
|
| Rate for Payer: Healthfirst Essential Plan |
$335.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$141.71
|
| Rate for Payer: Healthfirst QHP |
$149.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$104.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$149.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$126.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$104.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$149.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$111.88
|
| Rate for Payer: SOMOS Essential |
$111.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$149.17
|
|
|
CHG RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 73030 TC
|
| Min. Negotiated Rate |
$21.08 |
| Max. Negotiated Rate |
$67.77 |
| Rate for Payer: Cash Price |
$30.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$27.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$28.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$30.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.59
|
| Rate for Payer: Healthfirst Commercial |
$30.12
|
| Rate for Payer: Healthfirst Essential Plan |
$67.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.61
|
| Rate for Payer: Healthfirst QHP |
$30.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$30.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$25.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.59
|
| Rate for Payer: SOMOS Essential |
$22.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.12
|
|
|
CHG RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS
|
Professional
|
Both
|
$148.75
|
|
|
Service Code
|
HCPCS 73030
|
| Min. Negotiated Rate |
$28.03 |
| Max. Negotiated Rate |
$90.09 |
| Rate for Payer: Cash Price |
$40.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$40.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.03
|
| Rate for Payer: Healthfirst Commercial |
$40.04
|
| Rate for Payer: Healthfirst Essential Plan |
$90.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.04
|
| Rate for Payer: Healthfirst QHP |
$40.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$40.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$30.03
|
| Rate for Payer: SOMOS Essential |
$30.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.04
|
|
|
CHG RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS
|
Professional
|
Both
|
$36.79
|
|
|
Service Code
|
HCPCS 73030 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 SINUSES PARANASAL <3 VIEWS
|
Professional
|
Both
|
$138.88
|
|
|
Service Code
|
HCPCS 70210
|
| Min. Negotiated Rate |
$26.16 |
| Max. Negotiated Rate |
$84.08 |
| Rate for Payer: Cash Price |
$37.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.03
|
| Rate for Payer: Healthfirst Commercial |
$37.37
|
| Rate for Payer: Healthfirst Essential Plan |
$84.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.50
|
| Rate for Payer: Healthfirst QHP |
$37.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$31.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.03
|
| Rate for Payer: SOMOS Essential |
$28.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.37
|
|
|
CHG RADEX SINUSES PARANASAL <3 VIEWS
|
Professional
|
Both
|
$104.79
|
|
|
Service Code
|
HCPCS 70210 TC
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$63.41 |
| Rate for Payer: Cash Price |
$28.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.14
|
| Rate for Payer: Healthfirst Commercial |
$28.18
|
| Rate for Payer: Healthfirst Essential Plan |
$63.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.77
|
| Rate for Payer: Healthfirst QHP |
$28.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.14
|
| Rate for Payer: SOMOS Essential |
$21.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.18
|
|
|
CHG RADEX SINUSES PARANASAL <3 VIEWS
|
Professional
|
Both
|
$34.09
|
|
|
Service Code
|
HCPCS 70210 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 SINUSES PARANASAL COMPL MINIMUM 3 VIEWS
|
Professional
|
Both
|
$160.97
|
|
|
Service Code
|
HCPCS 70220
|
| Min. Negotiated Rate |
$30.35 |
| Max. Negotiated Rate |
$97.56 |
| Rate for Payer: Cash Price |
$43.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$43.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.52
|
| Rate for Payer: Healthfirst Commercial |
$43.36
|
| Rate for Payer: Healthfirst Essential Plan |
$97.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.19
|
| Rate for Payer: Healthfirst QHP |
$43.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$43.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$36.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.52
|
| Rate for Payer: SOMOS Essential |
$32.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.36
|
|
