|
CHG RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I
|
Professional
|
Both
|
$251.44
|
|
|
Service Code
|
HCPCS 75989 TC
|
| Min. Negotiated Rate |
$45.81 |
| Max. Negotiated Rate |
$147.24 |
| Rate for Payer: Cash Price |
$67.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$65.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$58.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$65.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$49.08
|
| Rate for Payer: Healthfirst Commercial |
$65.44
|
| Rate for Payer: Healthfirst Essential Plan |
$147.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.17
|
| Rate for Payer: Healthfirst QHP |
$65.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$65.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$55.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$65.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$49.08
|
| Rate for Payer: SOMOS Essential |
$49.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.44
|
|
|
CHG RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I
|
Professional
|
Both
|
$224.11
|
|
|
Service Code
|
HCPCS 75989 26
|
| Min. Negotiated Rate |
$42.05 |
| Max. Negotiated Rate |
$135.16 |
| Rate for Payer: Cash Price |
$60.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$60.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$54.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$54.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$57.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$60.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$57.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.05
|
| Rate for Payer: Healthfirst Commercial |
$60.07
|
| Rate for Payer: Healthfirst Essential Plan |
$135.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$57.07
|
| Rate for Payer: Healthfirst QHP |
$60.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$42.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$60.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$51.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$42.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$60.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$45.05
|
| Rate for Payer: SOMOS Essential |
$45.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$60.07
|
|
|
CHG RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I
|
Professional
|
Both
|
$475.55
|
|
|
Service Code
|
HCPCS 75989
|
| Min. Negotiated Rate |
$87.86 |
| Max. Negotiated Rate |
$282.40 |
| Rate for Payer: Cash Price |
$128.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$125.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$112.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$112.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$119.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$125.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$119.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$94.13
|
| Rate for Payer: Healthfirst Commercial |
$125.51
|
| Rate for Payer: Healthfirst Essential Plan |
$282.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$119.23
|
| Rate for Payer: Healthfirst QHP |
$125.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$87.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$125.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$106.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$87.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$125.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$94.13
|
| Rate for Payer: SOMOS Essential |
$94.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$125.51
|
|
|
CHG RADIOLOGIC EXAM ABDOMEN 1 VIEW
|
Professional
|
Both
|
$128.63
|
|
|
Service Code
|
HCPCS 74018
|
| Min. Negotiated Rate |
$24.23 |
| Max. Negotiated Rate |
$77.87 |
| Rate for Payer: Cash Price |
$35.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.96
|
| Rate for Payer: Healthfirst Commercial |
$34.61
|
| Rate for Payer: Healthfirst Essential Plan |
$77.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.88
|
| Rate for Payer: Healthfirst QHP |
$34.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.96
|
| Rate for Payer: SOMOS Essential |
$25.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.61
|
|
|
CHG RADIOLOGIC EXAM ABDOMEN 1 VIEW
|
Professional
|
Both
|
$93.31
|
|
|
Service Code
|
HCPCS 74018 TC
|
| Min. Negotiated Rate |
$17.55 |
| Max. Negotiated Rate |
$56.41 |
| Rate for Payer: Cash Price |
$25.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.80
|
| Rate for Payer: Healthfirst Commercial |
$25.07
|
| Rate for Payer: Healthfirst Essential Plan |
$56.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23.82
|
| Rate for Payer: Healthfirst QHP |
$25.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$25.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$21.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18.80
|
| Rate for Payer: SOMOS Essential |
$18.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.07
|
|
|
CHG RADIOLOGIC EXAM ABDOMEN 1 VIEW
|
Professional
|
Both
|
$35.35
|
|
|
Service Code
|
HCPCS 74018 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 RADIOLOGIC EXAM ABDOMEN 2 VIEWS
|
Professional
|
Both
|
$113.44
|
|
|
Service Code
|
HCPCS 74019 TC
|
| Min. Negotiated Rate |
$21.36 |
| Max. Negotiated Rate |
$68.65 |
| Rate for Payer: Cash Price |
$30.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$27.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$28.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$30.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.88
|
| Rate for Payer: Healthfirst Commercial |
$30.51
|
| Rate for Payer: Healthfirst Essential Plan |
$68.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.98
|
| Rate for Payer: Healthfirst QHP |
$30.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$30.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$25.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.88
|
| Rate for Payer: SOMOS Essential |
$22.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.51
|
|
|
CHG RADIOLOGIC EXAM ABDOMEN 2 VIEWS
|
Professional
|
Both
|
$157.92
|
|
|
Service Code
|
HCPCS 74019
|
| Min. Negotiated Rate |
$29.78 |
| Max. Negotiated Rate |
$95.72 |
| Rate for Payer: Cash Price |
$42.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$42.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$42.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$40.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.91
|
| Rate for Payer: Healthfirst Commercial |
$42.54
|
| Rate for Payer: Healthfirst Essential Plan |
$95.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.41
|
| Rate for Payer: Healthfirst QHP |
$42.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$42.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$36.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$42.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31.91
|
| Rate for Payer: SOMOS Essential |
$31.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.54
|
|
|
CHG RADIOLOGIC EXAM ABDOMEN 2 VIEWS
|
Professional
|
Both
|
$44.49
|
|
|
Service Code
|
HCPCS 74019 26
|
| Min. Negotiated Rate |
$8.42 |
| Max. Negotiated Rate |
$27.07 |
| Rate for Payer: Cash Price |
$11.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.02
|
| Rate for Payer: Healthfirst Commercial |
$12.03
|
| Rate for Payer: Healthfirst Essential Plan |
$27.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.43
|
| Rate for Payer: Healthfirst QHP |
$12.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$12.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$10.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.02
|
| Rate for Payer: SOMOS Essential |
$9.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.03
|
|
|
CHG RADIOLOGIC EXAM ABDOMEN 3+ VIEWS
|
Professional
|
Both
|
$50.93
|
|
|
Service Code
|
HCPCS 74021 26
|
| Min. Negotiated Rate |
$9.66 |
| Max. Negotiated Rate |
$31.05 |
| Rate for Payer: Cash Price |
$13.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.35
|
| Rate for Payer: Healthfirst Commercial |
$13.80
|
| Rate for Payer: Healthfirst Essential Plan |
$31.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.11
|
| Rate for Payer: Healthfirst QHP |
$13.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$13.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$11.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$10.35
|
| Rate for Payer: SOMOS Essential |
$10.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.80
|
|
|
CHG RADIOLOGIC EXAM ABDOMEN 3+ VIEWS
|
Professional
|
Both
|
$132.13
|
|
|
Service Code
|
HCPCS 74021 TC
|
| Min. Negotiated Rate |
$24.61 |
| Max. Negotiated Rate |
$79.11 |
| Rate for Payer: Cash Price |
$35.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.37
|
| Rate for Payer: Healthfirst Commercial |
$35.16
|
| Rate for Payer: Healthfirst Essential Plan |
$79.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.40
|
| Rate for Payer: Healthfirst QHP |
$35.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.37
|
| Rate for Payer: SOMOS Essential |
$26.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.16
|
|
|
CHG RADIOLOGIC EXAM ABDOMEN 3+ VIEWS
|
Professional
|
Both
|
$183.05
|
|
|
Service Code
|
HCPCS 74021
|
| Min. Negotiated Rate |
$34.28 |
| Max. Negotiated Rate |
$110.18 |
| Rate for Payer: Cash Price |
$49.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$48.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$44.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$44.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$46.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$48.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$46.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.73
|
| Rate for Payer: Healthfirst Commercial |
$48.97
|
| Rate for Payer: Healthfirst Essential Plan |
$110.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.52
|
| Rate for Payer: Healthfirst QHP |
$48.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$48.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$48.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36.73
|
| Rate for Payer: SOMOS Essential |
$36.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$48.97
|
|
|
CHG RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST
|
Professional
|
Both
|
$137.87
|
|
|
Service Code
|
HCPCS 73565 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 RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST
|
Professional
|
Both
|
$34.27
|
|
|
Service Code
|
HCPCS 73565 26
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$20.79 |
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.93
|
| Rate for Payer: Healthfirst Commercial |
$9.24
|
| Rate for Payer: Healthfirst Essential Plan |
$20.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.78
|
| Rate for Payer: Healthfirst QHP |
$9.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.93
|
| Rate for Payer: SOMOS Essential |
$6.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.24
|
|
|
CHG RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST
|
Professional
|
Both
|
$172.13
|
|
|
Service Code
|
HCPCS 73565
|
| Min. Negotiated Rate |
$32.44 |
| Max. Negotiated Rate |
$104.27 |
| Rate for Payer: Cash Price |
$46.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$44.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$44.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.76
|
| Rate for Payer: Healthfirst Commercial |
$46.34
|
| Rate for Payer: Healthfirst Essential Plan |
$104.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.02
|
| Rate for Payer: Healthfirst QHP |
$46.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$46.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$34.76
|
| Rate for Payer: SOMOS Essential |
$34.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.34
|
|
|
CHG RADIOLOGIC EXAM CHEST 2 VIEWS
|
Professional
|
Both
|
$143.71
|
|
|
Service Code
|
HCPCS 71046
|
| Min. Negotiated Rate |
$27.09 |
| Max. Negotiated Rate |
$87.08 |
| Rate for Payer: Cash Price |
$39.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.02
|
| Rate for Payer: Healthfirst Commercial |
$38.70
|
| Rate for Payer: Healthfirst Essential Plan |
$87.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.77
|
| Rate for Payer: Healthfirst QHP |
$38.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.02
|
| Rate for Payer: SOMOS Essential |
$29.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.70
|
|
|
CHG RADIOLOGIC EXAM CHEST 2 VIEWS
|
Professional
|
Both
|
$41.79
|
|
|
Service Code
|
HCPCS 71046 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 RADIOLOGIC EXAM CHEST 2 VIEWS
|
Professional
|
Both
|
$101.92
|
|
|
Service Code
|
HCPCS 71046 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 RADIOLOGIC EXAM CHEST 3 VIEWS
|
Professional
|
Both
|
$127.79
|
|
|
Service Code
|
HCPCS 71047 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 RADIOLOGIC EXAM CHEST 3 VIEWS
|
Professional
|
Both
|
$180.18
|
|
|
Service Code
|
HCPCS 71047
|
| Min. Negotiated Rate |
$33.73 |
| Max. Negotiated Rate |
$108.43 |
| Rate for Payer: Cash Price |
$49.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$48.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$48.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.14
|
| Rate for Payer: Healthfirst Commercial |
$48.19
|
| Rate for Payer: Healthfirst Essential Plan |
$108.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$45.78
|
| Rate for Payer: Healthfirst QHP |
$48.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$48.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$40.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$48.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36.14
|
| Rate for Payer: SOMOS Essential |
$36.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$48.19
|
|
|
CHG RADIOLOGIC EXAM CHEST 3 VIEWS
|
Professional
|
Both
|
$52.36
|
|
|
Service Code
|
HCPCS 71047 26
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$31.93 |
| Rate for Payer: Cash Price |
$14.36
|
| 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 RADIOLOGIC EXAM CHEST 4+ VIEWS
|
Professional
|
Both
|
$196.67
|
|
|
Service Code
|
HCPCS 71048
|
| Min. Negotiated Rate |
$36.60 |
| Max. Negotiated Rate |
$117.63 |
| Rate for Payer: Cash Price |
$52.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.21
|
| Rate for Payer: Healthfirst Commercial |
$52.28
|
| Rate for Payer: Healthfirst Essential Plan |
$117.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.67
|
| Rate for Payer: Healthfirst QHP |
$52.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.21
|
| Rate for Payer: SOMOS Essential |
$39.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.28
|
|
|
CHG RADIOLOGIC EXAM CHEST 4+ VIEWS
|
Professional
|
Both
|
$137.87
|
|
|
Service Code
|
HCPCS 71048 TC
|
| Min. Negotiated Rate |
$25.43 |
| Max. Negotiated Rate |
$81.74 |
| Rate for Payer: Cash Price |
$37.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$36.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.25
|
| Rate for Payer: Healthfirst Commercial |
$36.33
|
| Rate for Payer: Healthfirst Essential Plan |
$81.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.51
|
| Rate for Payer: Healthfirst QHP |
$36.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$36.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.25
|
| Rate for Payer: SOMOS Essential |
$27.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.33
|
|
|
CHG RADIOLOGIC EXAM CHEST 4+ VIEWS
|
Professional
|
Both
|
$58.80
|
|
|
Service Code
|
HCPCS 71048 26
|
| Min. Negotiated Rate |
$11.17 |
| Max. Negotiated Rate |
$35.91 |
| Rate for Payer: Cash Price |
$15.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.97
|
| Rate for Payer: Healthfirst Commercial |
$15.96
|
| Rate for Payer: Healthfirst Essential Plan |
$35.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.16
|
| Rate for Payer: Healthfirst QHP |
$15.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$15.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$13.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$11.97
|
| Rate for Payer: SOMOS Essential |
$11.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.96
|
|
|
CHG RADIOLOGIC EXAM CHEST SINGLE VIEW
|
Professional
|
Both
|
$111.41
|
|
|
Service Code
|
HCPCS 71045
|
| Min. Negotiated Rate |
$20.96 |
| Max. Negotiated Rate |
$67.39 |
| Rate for Payer: Cash Price |
$29.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$28.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.46
|
| Rate for Payer: Healthfirst Commercial |
$29.95
|
| Rate for Payer: Healthfirst Essential Plan |
$67.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.45
|
| Rate for Payer: Healthfirst QHP |
$29.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$25.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.46
|
| Rate for Payer: SOMOS Essential |
$22.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.95
|
|
