|
CHG RADEX TOE MINIMUM 2 VIEWS
|
Professional
|
Both
|
$100.49
|
|
|
Service Code
|
HCPCS 73660 TC
|
| Min. Negotiated Rate |
$18.63 |
| Max. Negotiated Rate |
$59.90 |
| Rate for Payer: Cash Price |
$27.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.96
|
| Rate for Payer: Healthfirst Commercial |
$26.62
|
| Rate for Payer: Healthfirst Essential Plan |
$59.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.29
|
| Rate for Payer: Healthfirst QHP |
$26.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19.96
|
| Rate for Payer: SOMOS Essential |
$19.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.62
|
|
|
CHG RADEX TOE MINIMUM 2 VIEWS
|
Professional
|
Both
|
$26.22
|
|
|
Service Code
|
HCPCS 73660 26
|
| Min. Negotiated Rate |
$4.93 |
| Max. Negotiated Rate |
$15.84 |
| Rate for Payer: Cash Price |
$7.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.28
|
| Rate for Payer: Healthfirst Commercial |
$7.04
|
| Rate for Payer: Healthfirst Essential Plan |
$15.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.69
|
| Rate for Payer: Healthfirst QHP |
$7.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$4.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$7.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$5.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$4.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5.28
|
| Rate for Payer: SOMOS Essential |
$5.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.04
|
|
|
CHG RADEX TOE MINIMUM 2 VIEWS
|
Professional
|
Both
|
$126.70
|
|
|
Service Code
|
HCPCS 73660
|
| Min. Negotiated Rate |
$23.56 |
| Max. Negotiated Rate |
$75.73 |
| Rate for Payer: Cash Price |
$34.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.25
|
| Rate for Payer: Healthfirst Commercial |
$33.66
|
| Rate for Payer: Healthfirst Essential Plan |
$75.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.98
|
| Rate for Payer: Healthfirst QHP |
$33.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$33.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.25
|
| Rate for Payer: SOMOS Essential |
$25.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.66
|
|
|
CHG RADEX UPPER EXTREMITY INFANT MINIMUM 2 VIEWS
|
Professional
|
Both
|
$136.19
|
|
|
Service Code
|
HCPCS 73092
|
| Min. Negotiated Rate |
$25.38 |
| Max. Negotiated Rate |
$81.56 |
| Rate for Payer: Cash Price |
$37.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$36.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.19
|
| Rate for Payer: Healthfirst Commercial |
$36.25
|
| Rate for Payer: Healthfirst Essential Plan |
$81.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.44
|
| Rate for Payer: Healthfirst QHP |
$36.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$36.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.19
|
| Rate for Payer: SOMOS Essential |
$27.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.25
|
|
|
CHG RADEX UPPER EXTREMITY INFANT MINIMUM 2 VIEWS
|
Professional
|
Both
|
$31.40
|
|
|
Service Code
|
HCPCS 73092 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 UPPER EXTREMITY INFANT MINIMUM 2 VIEWS
|
Professional
|
Both
|
$104.79
|
|
|
Service Code
|
HCPCS 73092 TC
|
| Min. Negotiated Rate |
$19.45 |
| Max. Negotiated Rate |
$62.53 |
| Rate for Payer: Cash Price |
$28.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.84
|
| Rate for Payer: Healthfirst Commercial |
$27.79
|
| Rate for Payer: Healthfirst Essential Plan |
$62.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.40
|
| Rate for Payer: Healthfirst QHP |
$27.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$27.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.84
|
| Rate for Payer: SOMOS Essential |
$20.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.79
|
|
|
CHG RADEX WRIST 2 VIEWS
|
Professional
|
Both
|
$113.44
|
|
|
Service Code
|
HCPCS 73100 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 WRIST 2 VIEWS
|
Professional
|
Both
|
$146.27
|
|
|
Service Code
|
HCPCS 73100
|
| Min. Negotiated Rate |
$27.28 |
| Max. Negotiated Rate |
$87.68 |
| Rate for Payer: Cash Price |
$39.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.23
|
| Rate for Payer: Healthfirst Commercial |
$38.97
|
| Rate for Payer: Healthfirst Essential Plan |
$87.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.02
|
| Rate for Payer: Healthfirst QHP |
$38.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.23
|
| Rate for Payer: SOMOS Essential |
$29.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.97
|
|
|
CHG RADEX WRIST 2 VIEWS
|
Professional
|
Both
|
$32.83
|
|
|
Service Code
|
HCPCS 73100 26
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$19.91 |
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.64
|
| Rate for Payer: Healthfirst Commercial |
$8.85
|
| Rate for Payer: Healthfirst Essential Plan |
$19.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.41
|
| Rate for Payer: Healthfirst QHP |
$8.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.64
|
| Rate for Payer: SOMOS Essential |
$6.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.85
|
|
|
CHG RADEX WRIST ARTHROGRAPHY RS&I
|
Professional
|
Both
|
$583.00
|
|
|
Service Code
|
HCPCS 73115
|
| Min. Negotiated Rate |
$105.94 |
| Max. Negotiated Rate |
$340.51 |
| Rate for Payer: Cash Price |
$157.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$151.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$136.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$136.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$143.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$151.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$143.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$151.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$151.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$113.50
|
| Rate for Payer: Healthfirst Commercial |
$151.34
|
| Rate for Payer: Healthfirst Essential Plan |
$340.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$143.77
|
| Rate for Payer: Healthfirst QHP |
$151.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$105.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$151.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$128.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$105.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$151.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$113.50
|
| Rate for Payer: SOMOS Essential |
$113.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$151.34
|
|
|
CHG RADEX WRIST ARTHROGRAPHY RS&I
|
Professional
|
Both
|
$471.35
|
|
|
Service Code
|
HCPCS 73115 TC
|
| Min. Negotiated Rate |
$84.94 |
| Max. Negotiated Rate |
$273.01 |
| Rate for Payer: Cash Price |
$127.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$121.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$109.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$109.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$115.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$121.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$115.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$121.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$121.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$91.00
|
| Rate for Payer: Healthfirst Commercial |
$121.34
|
| Rate for Payer: Healthfirst Essential Plan |
$273.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$115.27
|
| Rate for Payer: Healthfirst QHP |
$121.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$84.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$121.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$103.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$84.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$121.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$91.00
|
| Rate for Payer: SOMOS Essential |
$91.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$121.34
|
|
|
CHG RADEX WRIST ARTHROGRAPHY RS&I
|
Professional
|
Both
|
$111.65
|
|
|
Service Code
|
HCPCS 73115 26
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Cash Price |
$29.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$27.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$28.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$30.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.50
|
| Rate for Payer: Healthfirst Commercial |
$30.00
|
| Rate for Payer: Healthfirst Essential Plan |
$67.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.50
|
| Rate for Payer: Healthfirst QHP |
$30.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$30.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$25.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.50
|
| Rate for Payer: SOMOS Essential |
$22.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.00
|
|
|
CHG RADEX WRIST COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$142.17
|
|
|
Service Code
|
HCPCS 73110 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 WRIST COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$176.26
|
|
|
Service Code
|
HCPCS 73110
|
| Min. Negotiated Rate |
$33.49 |
| Max. Negotiated Rate |
$107.66 |
| Rate for Payer: Cash Price |
$48.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.89
|
| Rate for Payer: Healthfirst Commercial |
$47.85
|
| Rate for Payer: Healthfirst Essential Plan |
$107.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$45.46
|
| Rate for Payer: Healthfirst QHP |
$47.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$47.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$40.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35.89
|
| Rate for Payer: SOMOS Essential |
$35.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.85
|
|
|
CHG RADEX WRIST COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$34.09
|
|
|
Service Code
|
HCPCS 73110 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 RADIATION DELIVERY STEREOTACTIC CRANIAL LINEAR
|
Professional
|
Both
|
$4,184.78
|
|
|
Service Code
|
HCPCS 77372
|
| Min. Negotiated Rate |
$762.81 |
| Max. Negotiated Rate |
$2,451.89 |
| Rate for Payer: Cash Price |
$1,128.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,089.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$980.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$980.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,035.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,089.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,035.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,089.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,089.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$817.30
|
| Rate for Payer: Healthfirst Commercial |
$1,089.73
|
| Rate for Payer: Healthfirst Essential Plan |
$2,451.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,035.24
|
| Rate for Payer: Healthfirst QHP |
$1,089.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$762.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,089.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$926.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$762.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,089.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$817.30
|
| Rate for Payer: SOMOS Essential |
$817.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,089.73
|
|
|
CHG RADIATION THERAPY MGMT 1/2 FRACTIONS ONLY
|
Professional
|
Both
|
$443.24
|
|
|
Service Code
|
HCPCS 77431
|
| Min. Negotiated Rate |
$86.16 |
| Max. Negotiated Rate |
$276.95 |
| Rate for Payer: Cash Price |
$122.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$123.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$110.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$110.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$116.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$123.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$116.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$123.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$123.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$92.32
|
| Rate for Payer: Healthfirst Commercial |
$123.09
|
| Rate for Payer: Healthfirst Essential Plan |
$276.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$116.94
|
| Rate for Payer: Healthfirst QHP |
$123.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$86.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$123.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$104.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$86.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$123.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$92.32
|
| Rate for Payer: SOMOS Essential |
$92.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$123.09
|
|
|
CHG RADIATION TREATMENT MANAGEMENT 5 TREATMENTS
|
Professional
|
Both
|
$789.36
|
|
|
Service Code
|
HCPCS 77427
|
| Min. Negotiated Rate |
$151.91 |
| Max. Negotiated Rate |
$488.27 |
| Rate for Payer: Cash Price |
$215.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$217.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$195.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$195.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$217.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$217.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$217.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$162.76
|
| Rate for Payer: Healthfirst Commercial |
$217.01
|
| Rate for Payer: Healthfirst Essential Plan |
$488.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$206.16
|
| Rate for Payer: Healthfirst QHP |
$217.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$151.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$217.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$184.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$151.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$217.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$162.76
|
| Rate for Payer: SOMOS Essential |
$162.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$217.01
|
|
|
CHG RADIATION TX DELIVERY SUPERFICIAL&/ORTHO VOLTA
|
Professional
|
Both
|
$178.12
|
|
|
Service Code
|
HCPCS 77401
|
| Min. Negotiated Rate |
$33.58 |
| Max. Negotiated Rate |
$107.93 |
| Rate for Payer: Cash Price |
$49.35
|
| 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 RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS
|
Professional
|
Both
|
$46.97
|
|
|
Service Code
|
HCPCS 70110 26
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$29.50 |
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.83
|
| Rate for Payer: Healthfirst Commercial |
$13.11
|
| Rate for Payer: Healthfirst Essential Plan |
$29.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.45
|
| Rate for Payer: Healthfirst QHP |
$13.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$13.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$11.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.83
|
| Rate for Payer: SOMOS Essential |
$9.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.11
|
|
|
CHG RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS
|
Professional
|
Both
|
$137.87
|
|
|
Service Code
|
HCPCS 70110 TC
|
| Min. Negotiated Rate |
$25.97 |
| Max. Negotiated Rate |
$83.47 |
| Rate for Payer: Cash Price |
$37.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.82
|
| Rate for Payer: Healthfirst Commercial |
$37.10
|
| Rate for Payer: Healthfirst Essential Plan |
$83.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.24
|
| Rate for Payer: Healthfirst QHP |
$37.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$31.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.82
|
| Rate for Payer: SOMOS Essential |
$27.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.10
|
|
|
CHG RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS
|
Professional
|
Both
|
$184.84
|
|
|
Service Code
|
HCPCS 70110
|
| Min. Negotiated Rate |
$35.15 |
| Max. Negotiated Rate |
$113.00 |
| Rate for Payer: Cash Price |
$50.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$50.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$45.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$45.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$47.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$50.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$47.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$37.66
|
| Rate for Payer: Healthfirst Commercial |
$50.22
|
| Rate for Payer: Healthfirst Essential Plan |
$113.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.71
|
| Rate for Payer: Healthfirst QHP |
$50.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$35.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$50.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$42.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$35.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$50.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$37.66
|
| Rate for Payer: SOMOS Essential |
$37.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.22
|
|
|
CHG RADIOLOGICAL EXAMINATION SURGICAL SPECIMEN
|
Professional
|
Both
|
$179.27
|
|
|
Service Code
|
HCPCS 76098
|
| Min. Negotiated Rate |
$34.59 |
| Max. Negotiated Rate |
$111.17 |
| Rate for Payer: Cash Price |
$49.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$49.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$44.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$44.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$46.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$49.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$46.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$37.06
|
| Rate for Payer: Healthfirst Commercial |
$49.41
|
| Rate for Payer: Healthfirst Essential Plan |
$111.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.94
|
| Rate for Payer: Healthfirst QHP |
$49.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$49.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$42.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$49.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$37.06
|
| Rate for Payer: SOMOS Essential |
$37.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$49.41
|
|
|
CHG RADIOLOGICAL EXAMINATION SURGICAL SPECIMEN
|
Professional
|
Both
|
$61.57
|
|
|
Service Code
|
HCPCS 76098 26
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$37.28 |
| Rate for Payer: Cash Price |
$16.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.43
|
| Rate for Payer: Healthfirst Commercial |
$16.57
|
| Rate for Payer: Healthfirst Essential Plan |
$37.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.74
|
| Rate for Payer: Healthfirst QHP |
$16.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$14.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.43
|
| Rate for Payer: SOMOS Essential |
$12.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.57
|
|
|
CHG RADIOLOGICAL EXAMINATION SURGICAL SPECIMEN
|
Professional
|
Both
|
$117.74
|
|
|
Service Code
|
HCPCS 76098 TC
|
| Min. Negotiated Rate |
$22.99 |
| Max. Negotiated Rate |
$73.89 |
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.63
|
| Rate for Payer: Healthfirst Commercial |
$32.84
|
| Rate for Payer: Healthfirst Essential Plan |
$73.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.20
|
| Rate for Payer: Healthfirst QHP |
$32.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.63
|
| Rate for Payer: SOMOS Essential |
$24.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.84
|
|
