|
CHG RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6
|
Professional
|
Both
|
$60.31
|
|
|
Service Code
|
HCPCS 72114 26
|
| Min. Negotiated Rate |
$11.36 |
| Max. Negotiated Rate |
$36.52 |
| Rate for Payer: Cash Price |
$16.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.17
|
| Rate for Payer: Healthfirst Commercial |
$16.23
|
| Rate for Payer: Healthfirst Essential Plan |
$36.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.42
|
| Rate for Payer: Healthfirst QHP |
$16.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$13.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.17
|
| Rate for Payer: SOMOS Essential |
$12.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.23
|
|
|
CHG RADEX SPINE THORACIC 2 VIEWS
|
Professional
|
Both
|
$101.92
|
|
|
Service Code
|
HCPCS 72070 TC
|
| Min. Negotiated Rate |
$19.18 |
| Max. Negotiated Rate |
$61.65 |
| Rate for Payer: Cash Price |
$27.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.55
|
| Rate for Payer: Healthfirst Commercial |
$27.40
|
| Rate for Payer: Healthfirst Essential Plan |
$61.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.03
|
| Rate for Payer: Healthfirst QHP |
$27.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$27.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.55
|
| Rate for Payer: SOMOS Essential |
$20.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.40
|
|
|
CHG RADEX SPINE THORACIC 2 VIEWS
|
Professional
|
Both
|
$141.23
|
|
|
Service Code
|
HCPCS 72070
|
| Min. Negotiated Rate |
$26.61 |
| Max. Negotiated Rate |
$85.52 |
| Rate for Payer: Cash Price |
$38.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.51
|
| Rate for Payer: Healthfirst Commercial |
$38.01
|
| Rate for Payer: Healthfirst Essential Plan |
$85.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.11
|
| Rate for Payer: Healthfirst QHP |
$38.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.51
|
| Rate for Payer: SOMOS Essential |
$28.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.01
|
|
|
CHG RADEX SPINE THORACIC 2 VIEWS
|
Professional
|
Both
|
$39.27
|
|
|
Service Code
|
HCPCS 72070 26
|
| Min. Negotiated Rate |
$7.43 |
| Max. Negotiated Rate |
$23.87 |
| Rate for Payer: Cash Price |
$10.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.96
|
| Rate for Payer: Healthfirst Commercial |
$10.61
|
| Rate for Payer: Healthfirst Essential Plan |
$23.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.08
|
| Rate for Payer: Healthfirst QHP |
$10.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$7.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$10.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$9.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.96
|
| Rate for Payer: SOMOS Essential |
$7.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.61
|
|
|
CHG RADEX SPINE THORACIC 3 VIEWS
|
Professional
|
Both
|
$43.05
|
|
|
Service Code
|
HCPCS 72072 26
|
| Min. Negotiated Rate |
$8.15 |
| Max. Negotiated Rate |
$26.21 |
| Rate for Payer: Cash Price |
$11.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.74
|
| Rate for Payer: Healthfirst Commercial |
$11.65
|
| Rate for Payer: Healthfirst Essential Plan |
$26.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.07
|
| Rate for Payer: Healthfirst QHP |
$11.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$11.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$9.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.74
|
| Rate for Payer: SOMOS Essential |
$8.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.65
|
|
|
CHG RADEX SPINE THORACIC 3 VIEWS
|
Professional
|
Both
|
$167.97
|
|
|
Service Code
|
HCPCS 72072
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$101.83 |
| Rate for Payer: Cash Price |
$46.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$45.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$45.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.95
|
| Rate for Payer: Healthfirst Commercial |
$45.26
|
| Rate for Payer: Healthfirst Essential Plan |
$101.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43.00
|
| Rate for Payer: Healthfirst QHP |
$45.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$45.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$38.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$33.95
|
| Rate for Payer: SOMOS Essential |
$33.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.26
|
|
|
CHG RADEX SPINE THORACIC 3 VIEWS
|
Professional
|
Both
|
$124.92
|
|
|
Service Code
|
HCPCS 72072 TC
|
| Min. Negotiated Rate |
$23.53 |
| Max. Negotiated Rate |
$75.62 |
| Rate for Payer: Cash Price |
$34.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.21
|
| Rate for Payer: Healthfirst Commercial |
$33.61
|
| Rate for Payer: Healthfirst Essential Plan |
$75.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.93
|
| Rate for Payer: Healthfirst QHP |
$33.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$33.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.21
|
| Rate for Payer: SOMOS Essential |
$25.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.61
|
|
|
CHG RADEX SPINE THORACIC MINIMUM 4 VIEWS
|
Professional
|
Both
|
$142.17
|
|
|
Service Code
|
HCPCS 72074 TC
|
| Min. Negotiated Rate |
$27.06 |
| Max. Negotiated Rate |
$86.98 |
| Rate for Payer: Cash Price |
$39.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.00
|
| Rate for Payer: Healthfirst Commercial |
$38.66
|
| Rate for Payer: Healthfirst Essential Plan |
$86.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.73
|
| Rate for Payer: Healthfirst QHP |
$38.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.00
|
| Rate for Payer: SOMOS Essential |
$29.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.66
|
|
|
CHG RADEX SPINE THORACIC MINIMUM 4 VIEWS
|
Professional
|
Both
|
$189.18
|
|
|
Service Code
|
HCPCS 72074
|
| Min. Negotiated Rate |
$35.97 |
| Max. Negotiated Rate |
$115.61 |
| Rate for Payer: Cash Price |
$52.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$51.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$46.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$46.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$48.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$51.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$48.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.53
|
| Rate for Payer: Healthfirst Commercial |
$51.38
|
| Rate for Payer: Healthfirst Essential Plan |
$115.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$48.81
|
| Rate for Payer: Healthfirst QHP |
$51.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$35.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$51.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$43.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$35.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$51.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$38.53
|
| Rate for Payer: SOMOS Essential |
$38.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$51.38
|
|
|
CHG RADEX SPINE THORACIC MINIMUM 4 VIEWS
|
Professional
|
Both
|
$46.97
|
|
|
Service Code
|
HCPCS 72074 26
|
| Min. Negotiated Rate |
$8.90 |
| Max. Negotiated Rate |
$28.62 |
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.54
|
| Rate for Payer: Healthfirst Commercial |
$12.72
|
| Rate for Payer: Healthfirst Essential Plan |
$28.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.08
|
| Rate for Payer: Healthfirst QHP |
$12.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$12.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$10.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.54
|
| Rate for Payer: SOMOS Essential |
$9.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.72
|
|
|
CHG RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS
|
Professional
|
Both
|
$148.23
|
|
|
Service Code
|
HCPCS 72080
|
| Min. Negotiated Rate |
$27.94 |
| Max. Negotiated Rate |
$89.80 |
| Rate for Payer: Cash Price |
$40.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$39.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.93
|
| Rate for Payer: Healthfirst Commercial |
$39.91
|
| Rate for Payer: Healthfirst Essential Plan |
$89.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.91
|
| Rate for Payer: Healthfirst QHP |
$39.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$39.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.93
|
| Rate for Payer: SOMOS Essential |
$29.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.91
|
|
|
CHG RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS
|
Professional
|
Both
|
$40.53
|
|
|
Service Code
|
HCPCS 72080 26
|
| Min. Negotiated Rate |
$7.67 |
| Max. Negotiated Rate |
$24.66 |
| Rate for Payer: Cash Price |
$11.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.22
|
| Rate for Payer: Healthfirst Commercial |
$10.96
|
| Rate for Payer: Healthfirst Essential Plan |
$24.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.41
|
| Rate for Payer: Healthfirst QHP |
$10.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$7.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$10.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$9.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.22
|
| Rate for Payer: SOMOS Essential |
$8.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.96
|
|
|
CHG RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS
|
Professional
|
Both
|
$107.66
|
|
|
Service Code
|
HCPCS 72080 TC
|
| Min. Negotiated Rate |
$20.27 |
| Max. Negotiated Rate |
$65.14 |
| Rate for Payer: Cash Price |
$29.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.71
|
| Rate for Payer: Healthfirst Commercial |
$28.95
|
| Rate for Payer: Healthfirst Essential Plan |
$65.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.50
|
| Rate for Payer: Healthfirst QHP |
$28.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.71
|
| Rate for Payer: SOMOS Essential |
$21.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.95
|
|
|
CHG RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS
|
Professional
|
Both
|
$176.79
|
|
|
Service Code
|
HCPCS 71130
|
| Min. Negotiated Rate |
$33.07 |
| Max. Negotiated Rate |
$106.29 |
| Rate for Payer: Cash Price |
$48.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$42.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$44.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$44.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.43
|
| Rate for Payer: Healthfirst Commercial |
$47.24
|
| Rate for Payer: Healthfirst Essential Plan |
$106.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.88
|
| Rate for Payer: Healthfirst QHP |
$47.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$47.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$40.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35.43
|
| Rate for Payer: SOMOS Essential |
$35.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.24
|
|
|
CHG RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS
|
Professional
|
Both
|
$41.79
|
|
|
Service Code
|
HCPCS 71130 26
|
| Min. Negotiated Rate |
$7.91 |
| Max. Negotiated Rate |
$25.43 |
| Rate for Payer: Cash Price |
$11.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.47
|
| Rate for Payer: Healthfirst Commercial |
$11.30
|
| Rate for Payer: Healthfirst Essential Plan |
$25.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.73
|
| Rate for Payer: Healthfirst QHP |
$11.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$7.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$11.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$9.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.47
|
| Rate for Payer: SOMOS Essential |
$8.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.30
|
|
|
CHG RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
HCPCS 71130 TC
|
| Min. Negotiated Rate |
$25.16 |
| Max. Negotiated Rate |
$80.86 |
| Rate for Payer: Cash Price |
$36.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.95
|
| Rate for Payer: Healthfirst Commercial |
$35.94
|
| Rate for Payer: Healthfirst Essential Plan |
$80.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.14
|
| Rate for Payer: Healthfirst QHP |
$35.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.95
|
| Rate for Payer: SOMOS Essential |
$26.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.94
|
|
|
CHG RADEX STERNUM MINIMUM 2 VIEWS
|
Professional
|
Both
|
$37.84
|
|
|
Service Code
|
HCPCS 71120 26
|
| Min. Negotiated Rate |
$7.16 |
| Max. Negotiated Rate |
$23.02 |
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.67
|
| Rate for Payer: Healthfirst Commercial |
$10.23
|
| Rate for Payer: Healthfirst Essential Plan |
$23.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.72
|
| Rate for Payer: Healthfirst QHP |
$10.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$7.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$10.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.67
|
| Rate for Payer: SOMOS Essential |
$7.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.23
|
|
|
CHG RADEX STERNUM MINIMUM 2 VIEWS
|
Professional
|
Both
|
$144.10
|
|
|
Service Code
|
HCPCS 71120
|
| Min. Negotiated Rate |
$26.88 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Cash Price |
$39.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.80
|
| Rate for Payer: Healthfirst Commercial |
$38.40
|
| Rate for Payer: Healthfirst Essential Plan |
$86.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.48
|
| Rate for Payer: Healthfirst QHP |
$38.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.80
|
| Rate for Payer: SOMOS Essential |
$28.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.40
|
|
|
CHG RADEX STERNUM MINIMUM 2 VIEWS
|
Professional
|
Both
|
$106.23
|
|
|
Service Code
|
HCPCS 71120 TC
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$63.41 |
| Rate for Payer: Cash Price |
$28.92
|
| 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 TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT
|
Professional
|
Both
|
$180.99
|
|
|
Service Code
|
HCPCS 70330 TC
|
| Min. Negotiated Rate |
$34.12 |
| Max. Negotiated Rate |
$109.69 |
| Rate for Payer: Cash Price |
$49.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$48.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$46.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$48.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$46.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.56
|
| Rate for Payer: Healthfirst Commercial |
$48.75
|
| Rate for Payer: Healthfirst Essential Plan |
$109.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.31
|
| Rate for Payer: Healthfirst QHP |
$48.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$48.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$48.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36.56
|
| Rate for Payer: SOMOS Essential |
$36.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$48.75
|
|
|
CHG RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT
|
Professional
|
Both
|
$226.73
|
|
|
Service Code
|
HCPCS 70330
|
| Min. Negotiated Rate |
$42.79 |
| Max. Negotiated Rate |
$137.54 |
| Rate for Payer: Cash Price |
$61.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$61.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$55.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$55.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$58.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$61.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$58.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$61.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.85
|
| Rate for Payer: Healthfirst Commercial |
$61.13
|
| Rate for Payer: Healthfirst Essential Plan |
$137.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$58.07
|
| Rate for Payer: Healthfirst QHP |
$61.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$42.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$61.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$51.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$42.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$61.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$45.85
|
| Rate for Payer: SOMOS Essential |
$45.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$61.13
|
|
|
CHG RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT
|
Professional
|
Both
|
$45.75
|
|
|
Service Code
|
HCPCS 70330 26
|
| Min. Negotiated Rate |
$8.67 |
| Max. Negotiated Rate |
$27.86 |
| Rate for Payer: Cash Price |
$12.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.29
|
| Rate for Payer: Healthfirst Commercial |
$12.38
|
| Rate for Payer: Healthfirst Essential Plan |
$27.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.76
|
| Rate for Payer: Healthfirst QHP |
$12.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$12.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$10.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.29
|
| Rate for Payer: SOMOS Essential |
$9.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.38
|
|
|
CHG RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH UNILAT
|
Professional
|
Both
|
$113.44
|
|
|
Service Code
|
HCPCS 70328 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 TEMPOROMANDBLE JT OPN & CLSD MOUTH UNILAT
|
Professional
|
Both
|
$35.35
|
|
|
Service Code
|
HCPCS 70328 26
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$21.46 |
| Rate for Payer: Cash Price |
$9.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.16
|
| Rate for Payer: Healthfirst Commercial |
$9.54
|
| Rate for Payer: Healthfirst Essential Plan |
$21.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.06
|
| Rate for Payer: Healthfirst QHP |
$9.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.16
|
| Rate for Payer: SOMOS Essential |
$7.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.54
|
|
|
CHG RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH UNILAT
|
Professional
|
Both
|
$148.75
|
|
|
Service Code
|
HCPCS 70328
|
| Min. Negotiated Rate |
$27.75 |
| Max. Negotiated Rate |
$89.21 |
| Rate for Payer: Cash Price |
$40.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$39.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.74
|
| Rate for Payer: Healthfirst Commercial |
$39.65
|
| Rate for Payer: Healthfirst Essential Plan |
$89.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.67
|
| Rate for Payer: Healthfirst QHP |
$39.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$39.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.74
|
| Rate for Payer: SOMOS Essential |
$29.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.65
|
|
