|
CHG RADIOLOGIC EXAM CHEST SINGLE VIEW
|
Professional
|
Both
|
$76.06
|
|
|
Service Code
|
HCPCS 71045 TC
|
| Min. Negotiated Rate |
$14.29 |
| Max. Negotiated Rate |
$45.92 |
| Rate for Payer: Cash Price |
$20.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.31
|
| Rate for Payer: Healthfirst Commercial |
$20.41
|
| Rate for Payer: Healthfirst Essential Plan |
$45.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.39
|
| Rate for Payer: Healthfirst QHP |
$20.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$20.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$17.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$14.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.31
|
| Rate for Payer: SOMOS Essential |
$15.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.41
|
|
|
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
|
|
|
CHG RADIOLOGIC EXAM COLON DOUBLE CONTRAST STUDY
|
Professional
|
Both
|
$714.14
|
|
|
Service Code
|
HCPCS 74280 TC
|
| Min. Negotiated Rate |
$127.48 |
| Max. Negotiated Rate |
$409.77 |
| Rate for Payer: Cash Price |
$189.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$182.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$163.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$163.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$173.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$182.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$173.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$182.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$182.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$136.59
|
| Rate for Payer: Healthfirst Commercial |
$182.12
|
| Rate for Payer: Healthfirst Essential Plan |
$409.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$173.01
|
| Rate for Payer: Healthfirst QHP |
$182.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$127.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$182.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$154.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$127.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$182.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$136.59
|
| Rate for Payer: SOMOS Essential |
$136.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$182.12
|
|
|
CHG RADIOLOGIC EXAM COLON DOUBLE CONTRAST STUDY
|
Professional
|
Both
|
$241.64
|
|
|
Service Code
|
HCPCS 74280 26
|
| Min. Negotiated Rate |
$45.21 |
| Max. Negotiated Rate |
$145.31 |
| Rate for Payer: Cash Price |
$65.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$64.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$58.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$61.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$64.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$61.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.44
|
| Rate for Payer: Healthfirst Commercial |
$64.58
|
| Rate for Payer: Healthfirst Essential Plan |
$145.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.35
|
| Rate for Payer: Healthfirst QHP |
$64.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$64.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$54.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$64.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$48.44
|
| Rate for Payer: SOMOS Essential |
$48.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$64.58
|
|
|
CHG RADIOLOGIC EXAM COLON DOUBLE CONTRAST STUDY
|
Professional
|
Both
|
$955.82
|
|
|
Service Code
|
HCPCS 74280
|
| Min. Negotiated Rate |
$172.69 |
| Max. Negotiated Rate |
$555.08 |
| Rate for Payer: Cash Price |
$255.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$246.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$222.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$222.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$234.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$234.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$246.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$185.03
|
| Rate for Payer: Healthfirst Commercial |
$246.70
|
| Rate for Payer: Healthfirst Essential Plan |
$555.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$234.37
|
| Rate for Payer: Healthfirst QHP |
$246.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$172.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$246.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$209.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$172.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$185.03
|
| Rate for Payer: SOMOS Essential |
$185.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.70
|
|
|
CHG RADIOLOGIC EXAM COLON SINGLE CONTRAST STUDY
|
Professional
|
Both
|
$462.74
|
|
|
Service Code
|
HCPCS 74270 TC
|
| Min. Negotiated Rate |
$83.57 |
| Max. Negotiated Rate |
$268.63 |
| Rate for Payer: Cash Price |
$124.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$119.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$107.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$107.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$119.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$119.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$119.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$89.54
|
| Rate for Payer: Healthfirst Commercial |
$119.39
|
| Rate for Payer: Healthfirst Essential Plan |
$268.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$113.42
|
| Rate for Payer: Healthfirst QHP |
$119.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$83.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$119.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$101.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$83.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$119.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$89.54
|
| Rate for Payer: SOMOS Essential |
$89.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$119.39
|
|
|
CHG RADIOLOGIC EXAM COLON SINGLE CONTRAST STUDY
|
Professional
|
Both
|
$658.56
|
|
|
Service Code
|
HCPCS 74270
|
| Min. Negotiated Rate |
$120.44 |
| Max. Negotiated Rate |
$387.13 |
| Rate for Payer: Cash Price |
$177.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$172.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$154.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$154.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$163.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$172.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$163.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$172.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$172.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$129.04
|
| Rate for Payer: Healthfirst Commercial |
$172.06
|
| Rate for Payer: Healthfirst Essential Plan |
$387.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$163.46
|
| Rate for Payer: Healthfirst QHP |
$172.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$120.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$172.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$146.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$120.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$172.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$129.04
|
| Rate for Payer: SOMOS Essential |
$129.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$172.06
|
|
|
CHG RADIOLOGIC EXAM COLON SINGLE CONTRAST STUDY
|
Professional
|
Both
|
$195.83
|
|
|
Service Code
|
HCPCS 74270 26
|
| Min. Negotiated Rate |
$36.86 |
| Max. Negotiated Rate |
$118.48 |
| Rate for Payer: Cash Price |
$53.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.49
|
| Rate for Payer: Healthfirst Commercial |
$52.66
|
| Rate for Payer: Healthfirst Essential Plan |
$118.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.03
|
| Rate for Payer: Healthfirst QHP |
$52.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.49
|
| Rate for Payer: SOMOS Essential |
$39.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.66
|
|
|
CHG RADIOLOGIC EXAM COMPLETE ACUTE ABDOMEN SERIES
|
Professional
|
Both
|
$150.82
|
|
|
Service Code
|
HCPCS 74022 TC
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$91.35 |
| Rate for Payer: Cash Price |
$41.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$40.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.45
|
| Rate for Payer: Healthfirst Commercial |
$40.60
|
| Rate for Payer: Healthfirst Essential Plan |
$91.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.57
|
| Rate for Payer: Healthfirst QHP |
$40.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$40.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$30.45
|
| Rate for Payer: SOMOS Essential |
$30.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.60
|
|
|
CHG RADIOLOGIC EXAM COMPLETE ACUTE ABDOMEN SERIES
|
Professional
|
Both
|
$62.79
|
|
|
Service Code
|
HCPCS 74022 26
|
| Min. Negotiated Rate |
$11.84 |
| Max. Negotiated Rate |
$38.07 |
| Rate for Payer: Cash Price |
$16.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.69
|
| Rate for Payer: Healthfirst Commercial |
$16.92
|
| Rate for Payer: Healthfirst Essential Plan |
$38.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.07
|
| Rate for Payer: Healthfirst QHP |
$16.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$14.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.69
|
| Rate for Payer: SOMOS Essential |
$12.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.92
|
|
|
CHG RADIOLOGIC EXAM COMPLETE ACUTE ABDOMEN SERIES
|
Professional
|
Both
|
$213.61
|
|
|
Service Code
|
HCPCS 74022
|
| Min. Negotiated Rate |
$40.26 |
| Max. Negotiated Rate |
$129.42 |
| Rate for Payer: Cash Price |
$58.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$57.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$51.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$51.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$54.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$57.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$54.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.14
|
| Rate for Payer: Healthfirst Commercial |
$57.52
|
| Rate for Payer: Healthfirst Essential Plan |
$129.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$54.64
|
| Rate for Payer: Healthfirst QHP |
$57.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$40.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$57.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$48.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$40.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$57.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$43.14
|
| Rate for Payer: SOMOS Essential |
$43.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$57.52
|
|
|
CHG RADIOLOGIC EXAM ESOPHAGUS DOUBLE CONTRAST STUDY
|
Professional
|
Both
|
$476.53
|
|
|
Service Code
|
HCPCS 74221
|
| Min. Negotiated Rate |
$86.70 |
| Max. Negotiated Rate |
$278.69 |
| Rate for Payer: Cash Price |
$127.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$123.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$111.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$111.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$117.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$123.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$117.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$123.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$123.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$92.89
|
| Rate for Payer: Healthfirst Commercial |
$123.86
|
| Rate for Payer: Healthfirst Essential Plan |
$278.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$117.67
|
| Rate for Payer: Healthfirst QHP |
$123.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$86.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$123.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$105.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$86.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$123.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$92.89
|
| Rate for Payer: SOMOS Essential |
$92.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$123.86
|
|
|
CHG RADIOLOGIC EXAM ESOPHAGUS DOUBLE CONTRAST STUDY
|
Professional
|
Both
|
$341.99
|
|
|
Service Code
|
HCPCS 74221 TC
|
| Min. Negotiated Rate |
$61.30 |
| Max. Negotiated Rate |
$197.03 |
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$87.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$78.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$78.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$83.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$87.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$83.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$87.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$87.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$65.68
|
| Rate for Payer: Healthfirst Commercial |
$87.57
|
| Rate for Payer: Healthfirst Essential Plan |
$197.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$83.19
|
| Rate for Payer: Healthfirst QHP |
$87.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$61.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$87.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$74.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$61.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$87.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$65.68
|
| Rate for Payer: SOMOS Essential |
$65.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$87.57
|
|
|
CHG RADIOLOGIC EXAM ESOPHAGUS DOUBLE CONTRAST STUDY
|
Professional
|
Both
|
$134.54
|
|
|
Service Code
|
HCPCS 74221 26
|
| Min. Negotiated Rate |
$25.40 |
| Max. Negotiated Rate |
$81.65 |
| Rate for Payer: Cash Price |
$36.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$36.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.22
|
| Rate for Payer: Healthfirst Commercial |
$36.29
|
| Rate for Payer: Healthfirst Essential Plan |
$81.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.48
|
| Rate for Payer: Healthfirst QHP |
$36.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$36.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.22
|
| Rate for Payer: SOMOS Essential |
$27.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.29
|
|
|
CHG RADIOLOGIC EXAM ESOPHAGUS SINGLE CONTRAST STUDY
|
Professional
|
Both
|
$307.48
|
|
|
Service Code
|
HCPCS 74220 TC
|
| Min. Negotiated Rate |
$55.32 |
| Max. Negotiated Rate |
$177.82 |
| Rate for Payer: Cash Price |
$81.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$79.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$71.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$71.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$75.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$79.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$75.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$79.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$59.27
|
| Rate for Payer: Healthfirst Commercial |
$79.03
|
| Rate for Payer: Healthfirst Essential Plan |
$177.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$75.08
|
| Rate for Payer: Healthfirst QHP |
$79.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$55.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$79.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$67.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$55.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$79.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$59.27
|
| Rate for Payer: SOMOS Essential |
$59.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$79.03
|
|
|
CHG RADIOLOGIC EXAM ESOPHAGUS SINGLE CONTRAST STUDY
|
Professional
|
Both
|
$425.22
|
|
|
Service Code
|
HCPCS 74220
|
| Min. Negotiated Rate |
$77.06 |
| Max. Negotiated Rate |
$247.70 |
| Rate for Payer: Cash Price |
$113.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$110.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$99.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$99.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$104.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$110.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$104.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$110.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$110.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$82.57
|
| Rate for Payer: Healthfirst Commercial |
$110.09
|
| Rate for Payer: Healthfirst Essential Plan |
$247.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$104.59
|
| Rate for Payer: Healthfirst QHP |
$110.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$77.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$110.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$93.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$77.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$110.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$82.57
|
| Rate for Payer: SOMOS Essential |
$82.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$110.09
|
|
|
CHG RADIOLOGIC EXAM ESOPHAGUS SINGLE CONTRAST STUDY
|
Professional
|
Both
|
$117.71
|
|
|
Service Code
|
HCPCS 74220 26
|
| Min. Negotiated Rate |
$21.74 |
| Max. Negotiated Rate |
$69.89 |
| Rate for Payer: Cash Price |
$31.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$27.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.30
|
| Rate for Payer: Healthfirst Commercial |
$31.06
|
| Rate for Payer: Healthfirst Essential Plan |
$69.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.51
|
| Rate for Payer: Healthfirst QHP |
$31.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$31.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.30
|
| Rate for Payer: SOMOS Essential |
$23.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.06
|
|
|
CHG RADIOLOGIC EXAMINATION ANKLE 2 VIEWS
|
Professional
|
Both
|
$107.66
|
|
|
Service Code
|
HCPCS 73600 TC
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$64.28 |
| Rate for Payer: Cash Price |
$29.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.43
|
| Rate for Payer: Healthfirst Commercial |
$28.57
|
| Rate for Payer: Healthfirst Essential Plan |
$64.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.14
|
| Rate for Payer: Healthfirst QHP |
$28.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.43
|
| Rate for Payer: SOMOS Essential |
$21.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.57
|
|
|
CHG RADIOLOGIC EXAMINATION ANKLE 2 VIEWS
|
Professional
|
Both
|
$140.53
|
|
|
Service Code
|
HCPCS 73600
|
| Min. Negotiated Rate |
$25.91 |
| Max. Negotiated Rate |
$83.30 |
| Rate for Payer: Cash Price |
$37.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.77
|
| Rate for Payer: Healthfirst Commercial |
$37.02
|
| Rate for Payer: Healthfirst Essential Plan |
$83.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.17
|
| Rate for Payer: Healthfirst QHP |
$37.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$31.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.77
|
| Rate for Payer: SOMOS Essential |
$27.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.02
|
|
|
CHG RADIOLOGIC EXAMINATION ANKLE 2 VIEWS
|
Professional
|
Both
|
$32.83
|
|
|
Service Code
|
HCPCS 73600 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 RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY
|
Professional
|
Both
|
$140.14
|
|
|
Service Code
|
HCPCS 70030
|
| Min. Negotiated Rate |
$26.67 |
| Max. Negotiated Rate |
$85.72 |
| Rate for Payer: Cash Price |
$38.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.57
|
| Rate for Payer: Healthfirst Commercial |
$38.10
|
| Rate for Payer: Healthfirst Essential Plan |
$85.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.20
|
| Rate for Payer: Healthfirst QHP |
$38.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.57
|
| Rate for Payer: SOMOS Essential |
$28.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.10
|
|
|
CHG RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY
|
Professional
|
Both
|
$104.79
|
|
|
Service Code
|
HCPCS 70030 TC
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$64.28 |
| Rate for Payer: Cash Price |
$28.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.43
|
| Rate for Payer: Healthfirst Commercial |
$28.57
|
| Rate for Payer: Healthfirst Essential Plan |
$64.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.14
|
| Rate for Payer: Healthfirst QHP |
$28.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.43
|
| Rate for Payer: SOMOS Essential |
$21.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.57
|
|
|
CHG RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY
|
Professional
|
Both
|
$35.35
|
|
|
Service Code
|
HCPCS 70030 26
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$21.46 |
| Rate for Payer: Cash Price |
$9.26
|
| 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 EXAMINATION FEMUR 1 VIEW
|
Professional
|
Both
|
$126.14
|
|
|
Service Code
|
HCPCS 73551
|
| Min. Negotiated Rate |
$24.02 |
| Max. Negotiated Rate |
$77.20 |
| Rate for Payer: Cash Price |
$34.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.73
|
| Rate for Payer: Healthfirst Commercial |
$34.31
|
| Rate for Payer: Healthfirst Essential Plan |
$77.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.59
|
| Rate for Payer: Healthfirst QHP |
$34.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.73
|
| Rate for Payer: SOMOS Essential |
$25.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.31
|
|
|
CHG RADIOLOGIC EXAMINATION FEMUR 1 VIEW
|
Professional
|
Both
|
$93.31
|
|
|
Service Code
|
HCPCS 73551 TC
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$57.28 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.09
|
| Rate for Payer: Healthfirst Commercial |
$25.46
|
| Rate for Payer: Healthfirst Essential Plan |
$57.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24.19
|
| Rate for Payer: Healthfirst QHP |
$25.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$25.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$21.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19.09
|
| Rate for Payer: SOMOS Essential |
$19.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.46
|
|
