|
CHG RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS
|
Professional
|
Both
|
$119.18
|
|
|
Service Code
|
HCPCS 70220 TC
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$72.14 |
| Rate for Payer: Cash Price |
$32.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.05
|
| Rate for Payer: Healthfirst Commercial |
$32.06
|
| Rate for Payer: Healthfirst Essential Plan |
$72.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.46
|
| Rate for Payer: Healthfirst QHP |
$32.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.05
|
| Rate for Payer: SOMOS Essential |
$24.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.06
|
|
|
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
|
|
|
CHG RADEX SPINE 1 VIEW SPECIFY LEVEL
|
Professional
|
Both
|
$31.40
|
|
|
Service Code
|
HCPCS 72020 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 SPINE 1 VIEW SPECIFY LEVEL
|
Professional
|
Both
|
$106.02
|
|
|
Service Code
|
HCPCS 72020
|
| Min. Negotiated Rate |
$19.67 |
| Max. Negotiated Rate |
$63.23 |
| Rate for Payer: Cash Price |
$28.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.07
|
| Rate for Payer: Healthfirst Commercial |
$28.10
|
| Rate for Payer: Healthfirst Essential Plan |
$63.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.70
|
| Rate for Payer: Healthfirst QHP |
$28.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.07
|
| Rate for Payer: SOMOS Essential |
$21.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.10
|
|
|
CHG RADEX SPINE 1 VIEW SPECIFY LEVEL
|
Professional
|
Both
|
$74.62
|
|
|
Service Code
|
HCPCS 72020 TC
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$44.19 |
| Rate for Payer: Cash Price |
$19.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.73
|
| Rate for Payer: Healthfirst Commercial |
$19.64
|
| Rate for Payer: Healthfirst Essential Plan |
$44.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.66
|
| Rate for Payer: Healthfirst QHP |
$19.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$14.73
|
| Rate for Payer: SOMOS Essential |
$14.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.64
|
|
|
CHG RADEX SPINE CERVICAL 2 OR 3 VIEWS
|
Professional
|
Both
|
$169.58
|
|
|
Service Code
|
HCPCS 72040
|
| Min. Negotiated Rate |
$31.98 |
| Max. Negotiated Rate |
$102.80 |
| Rate for Payer: Cash Price |
$46.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$45.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$45.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.27
|
| Rate for Payer: Healthfirst Commercial |
$45.69
|
| Rate for Payer: Healthfirst Essential Plan |
$102.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43.41
|
| Rate for Payer: Healthfirst QHP |
$45.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$45.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$38.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$34.27
|
| Rate for Payer: SOMOS Essential |
$34.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.69
|
|
|
CHG RADEX SPINE CERVICAL 2 OR 3 VIEWS
|
Professional
|
Both
|
$43.23
|
|
|
Service Code
|
HCPCS 72040 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 SPINE CERVICAL 2 OR 3 VIEWS
|
Professional
|
Both
|
$126.35
|
|
|
Service Code
|
HCPCS 72040 TC
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Cash Price |
$34.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.50
|
| Rate for Payer: Healthfirst Commercial |
$34.00
|
| Rate for Payer: Healthfirst Essential Plan |
$76.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.30
|
| Rate for Payer: Healthfirst QHP |
$34.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.50
|
| Rate for Payer: SOMOS Essential |
$25.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.00
|
|
|
CHG RADEX SPINE CERVICAL 4 OR 5 VIEWS
|
Professional
|
Both
|
$227.61
|
|
|
Service Code
|
HCPCS 72050
|
| Min. Negotiated Rate |
$43.51 |
| Max. Negotiated Rate |
$139.86 |
| Rate for Payer: Cash Price |
$62.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$55.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$55.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$59.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$59.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$62.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$46.62
|
| Rate for Payer: Healthfirst Commercial |
$62.16
|
| Rate for Payer: Healthfirst Essential Plan |
$139.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$59.05
|
| Rate for Payer: Healthfirst QHP |
$62.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$43.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$62.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$52.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$43.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$46.62
|
| Rate for Payer: SOMOS Essential |
$46.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.16
|
|
|
CHG RADEX SPINE CERVICAL 4 OR 5 VIEWS
|
Professional
|
Both
|
$52.36
|
|
|
Service Code
|
HCPCS 72050 26
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$31.93 |
| Rate for Payer: Cash Price |
$13.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.64
|
| Rate for Payer: Healthfirst Commercial |
$14.19
|
| Rate for Payer: Healthfirst Essential Plan |
$31.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.48
|
| Rate for Payer: Healthfirst QHP |
$14.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$14.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$12.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$10.64
|
| Rate for Payer: SOMOS Essential |
$10.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.19
|
|
|
CHG RADEX SPINE CERVICAL 4 OR 5 VIEWS
|
Professional
|
Both
|
$175.25
|
|
|
Service Code
|
HCPCS 72050 TC
|
| Min. Negotiated Rate |
$33.58 |
| Max. Negotiated Rate |
$107.93 |
| Rate for Payer: Cash Price |
$48.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.98
|
| Rate for Payer: Healthfirst Commercial |
$47.97
|
| Rate for Payer: Healthfirst Essential Plan |
$107.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$45.57
|
| Rate for Payer: Healthfirst QHP |
$47.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$47.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$40.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35.98
|
| Rate for Payer: SOMOS Essential |
$35.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.97
|
|
|
CHG RADEX SPINE CERVICAL 6 OR MORE VIEWS
|
Professional
|
Both
|
$58.87
|
|
|
Service Code
|
HCPCS 72052 26
|
| Min. Negotiated Rate |
$11.09 |
| Max. Negotiated Rate |
$35.64 |
| Rate for Payer: Cash Price |
$16.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.88
|
| Rate for Payer: Healthfirst Commercial |
$15.84
|
| Rate for Payer: Healthfirst Essential Plan |
$35.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.05
|
| Rate for Payer: Healthfirst QHP |
$15.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$15.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$13.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$11.88
|
| Rate for Payer: SOMOS Essential |
$11.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.84
|
|
|
CHG RADEX SPINE CERVICAL 6 OR MORE VIEWS
|
Professional
|
Both
|
$208.29
|
|
|
Service Code
|
HCPCS 72052 TC
|
| Min. Negotiated Rate |
$39.02 |
| Max. Negotiated Rate |
$125.42 |
| Rate for Payer: Cash Price |
$57.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$55.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$50.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$50.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$52.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$55.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$52.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.80
|
| Rate for Payer: Healthfirst Commercial |
$55.74
|
| Rate for Payer: Healthfirst Essential Plan |
$125.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$52.95
|
| Rate for Payer: Healthfirst QHP |
$55.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$39.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$55.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$47.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$39.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$55.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$41.80
|
| Rate for Payer: SOMOS Essential |
$41.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.74
|
|
|
CHG RADEX SPINE CERVICAL 6 OR MORE VIEWS
|
Professional
|
Both
|
$267.16
|
|
|
Service Code
|
HCPCS 72052
|
| Min. Negotiated Rate |
$50.11 |
| Max. Negotiated Rate |
$161.06 |
| Rate for Payer: Cash Price |
$73.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$71.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$64.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$64.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$68.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$71.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$68.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$71.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$71.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$53.69
|
| Rate for Payer: Healthfirst Commercial |
$71.58
|
| Rate for Payer: Healthfirst Essential Plan |
$161.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$68.00
|
| Rate for Payer: Healthfirst QHP |
$71.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$50.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$71.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$60.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$50.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$71.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$53.69
|
| Rate for Payer: SOMOS Essential |
$53.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$71.58
|
|
|
CHG RADEX SPINE LUMBOSACRAL 2/3 VIEWS
|
Professional
|
Both
|
$43.23
|
|
|
Service Code
|
HCPCS 72100 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 SPINE LUMBOSACRAL 2/3 VIEWS
|
Professional
|
Both
|
$171.01
|
|
|
Service Code
|
HCPCS 72100
|
| Min. Negotiated Rate |
$31.98 |
| Max. Negotiated Rate |
$102.80 |
| Rate for Payer: Cash Price |
$46.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$45.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$45.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.27
|
| Rate for Payer: Healthfirst Commercial |
$45.69
|
| Rate for Payer: Healthfirst Essential Plan |
$102.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43.41
|
| Rate for Payer: Healthfirst QHP |
$45.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$45.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$38.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$34.27
|
| Rate for Payer: SOMOS Essential |
$34.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.69
|
|
|
CHG RADEX SPINE LUMBOSACRAL 2/3 VIEWS
|
Professional
|
Both
|
$127.79
|
|
|
Service Code
|
HCPCS 72100 TC
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Cash Price |
$34.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.50
|
| Rate for Payer: Healthfirst Commercial |
$34.00
|
| Rate for Payer: Healthfirst Essential Plan |
$76.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.30
|
| Rate for Payer: Healthfirst QHP |
$34.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.50
|
| Rate for Payer: SOMOS Essential |
$25.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.00
|
|
|
CHG RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS
|
Professional
|
Both
|
$169.47
|
|
|
Service Code
|
HCPCS 72110 TC
|
| Min. Negotiated Rate |
$32.22 |
| Max. Negotiated Rate |
$103.57 |
| Rate for Payer: Cash Price |
$46.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.52
|
| Rate for Payer: Healthfirst Commercial |
$46.03
|
| Rate for Payer: Healthfirst Essential Plan |
$103.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43.73
|
| Rate for Payer: Healthfirst QHP |
$46.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$46.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$34.52
|
| Rate for Payer: SOMOS Essential |
$34.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.03
|
|
|
CHG RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS
|
Professional
|
Both
|
$219.17
|
|
|
Service Code
|
HCPCS 72110
|
| Min. Negotiated Rate |
$41.92 |
| Max. Negotiated Rate |
$134.73 |
| Rate for Payer: Cash Price |
$60.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$59.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$53.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$56.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$59.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$56.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.91
|
| Rate for Payer: Healthfirst Commercial |
$59.88
|
| Rate for Payer: Healthfirst Essential Plan |
$134.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$56.89
|
| Rate for Payer: Healthfirst QHP |
$59.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$41.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$59.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$50.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$41.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$59.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$44.91
|
| Rate for Payer: SOMOS Essential |
$44.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$59.88
|
|
|
CHG RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS
|
Professional
|
Both
|
$49.67
|
|
|
Service Code
|
HCPCS 72110 26
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$31.14 |
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.38
|
| Rate for Payer: Healthfirst Commercial |
$13.84
|
| Rate for Payer: Healthfirst Essential Plan |
$31.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.15
|
| Rate for Payer: Healthfirst QHP |
$13.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$13.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$11.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$10.38
|
| Rate for Payer: SOMOS Essential |
$10.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.84
|
|
|
CHG RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS
|
Professional
|
Both
|
$43.23
|
|
|
Service Code
|
HCPCS 72120 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 SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS
|
Professional
|
Both
|
$173.92
|
|
|
Service Code
|
HCPCS 72120
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$105.41 |
| Rate for Payer: Cash Price |
$47.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$42.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$44.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$44.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.14
|
| Rate for Payer: Healthfirst Commercial |
$46.85
|
| Rate for Payer: Healthfirst Essential Plan |
$105.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.51
|
| Rate for Payer: Healthfirst QHP |
$46.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$46.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35.14
|
| Rate for Payer: SOMOS Essential |
$35.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.85
|
|
|
CHG RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS
|
Professional
|
Both
|
$130.69
|
|
|
Service Code
|
HCPCS 72120 TC
|
| Min. Negotiated Rate |
$24.61 |
| Max. Negotiated Rate |
$79.11 |
| Rate for Payer: Cash Price |
$35.60
|
| 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 SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6
|
Professional
|
Both
|
$205.42
|
|
|
Service Code
|
HCPCS 72114 TC
|
| Min. Negotiated Rate |
$38.20 |
| Max. Negotiated Rate |
$122.78 |
| Rate for Payer: Cash Price |
$55.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$54.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$49.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$49.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$51.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$54.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$51.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.93
|
| Rate for Payer: Healthfirst Commercial |
$54.57
|
| Rate for Payer: Healthfirst Essential Plan |
$122.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$51.84
|
| Rate for Payer: Healthfirst QHP |
$54.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$38.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$54.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$46.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$38.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$54.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.93
|
| Rate for Payer: SOMOS Essential |
$40.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.57
|
|
|
CHG RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6
|
Professional
|
Both
|
$265.72
|
|
|
Service Code
|
HCPCS 72114
|
| Min. Negotiated Rate |
$49.56 |
| Max. Negotiated Rate |
$159.30 |
| Rate for Payer: Cash Price |
$71.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$63.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$63.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$67.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$67.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$70.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$53.10
|
| Rate for Payer: Healthfirst Commercial |
$70.80
|
| Rate for Payer: Healthfirst Essential Plan |
$159.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$67.26
|
| Rate for Payer: Healthfirst QHP |
$70.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$49.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$70.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$60.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$49.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$53.10
|
| Rate for Payer: SOMOS Essential |
$53.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.80
|
|
