|
CHG RADIOLOGIC EXAMINATION FEMUR 1 VIEW
|
Professional
|
Both
|
$32.83
|
|
|
Service Code
|
HCPCS 73551 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 RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS
|
Professional
|
Both
|
$117.74
|
|
|
Service Code
|
HCPCS 73552 TC
|
| Min. Negotiated Rate |
$22.17 |
| Max. Negotiated Rate |
$71.26 |
| Rate for Payer: Cash Price |
$32.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.75
|
| Rate for Payer: Healthfirst Commercial |
$31.67
|
| Rate for Payer: Healthfirst Essential Plan |
$71.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.09
|
| Rate for Payer: Healthfirst QHP |
$31.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$31.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.75
|
| Rate for Payer: SOMOS Essential |
$23.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.67
|
|
|
CHG RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS
|
Professional
|
Both
|
$153.09
|
|
|
Service Code
|
HCPCS 73552
|
| Min. Negotiated Rate |
$28.85 |
| Max. Negotiated Rate |
$92.72 |
| Rate for Payer: Cash Price |
$41.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$41.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$39.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.91
|
| Rate for Payer: Healthfirst Commercial |
$41.21
|
| Rate for Payer: Healthfirst Essential Plan |
$92.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.15
|
| Rate for Payer: Healthfirst QHP |
$41.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$41.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$35.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$30.91
|
| Rate for Payer: SOMOS Essential |
$30.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.21
|
|
|
CHG RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS
|
Professional
|
Both
|
$35.35
|
|
|
Service Code
|
HCPCS 73552 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 EXAMINATION FOOT 2 VIEWS
|
Professional
|
Both
|
$91.88
|
|
|
Service Code
|
HCPCS 73620 TC
|
| Min. Negotiated Rate |
$17.28 |
| Max. Negotiated Rate |
$55.53 |
| Rate for Payer: Cash Price |
$25.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.51
|
| Rate for Payer: Healthfirst Commercial |
$24.68
|
| Rate for Payer: Healthfirst Essential Plan |
$55.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23.45
|
| Rate for Payer: Healthfirst QHP |
$24.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$24.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$20.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18.51
|
| Rate for Payer: SOMOS Essential |
$18.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.68
|
|
|
CHG RADIOLOGIC EXAMINATION FOOT 2 VIEWS
|
Professional
|
Both
|
$121.84
|
|
|
Service Code
|
HCPCS 73620
|
| Min. Negotiated Rate |
$22.93 |
| Max. Negotiated Rate |
$73.69 |
| Rate for Payer: Cash Price |
$33.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.56
|
| Rate for Payer: Healthfirst Commercial |
$32.75
|
| Rate for Payer: Healthfirst Essential Plan |
$73.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.11
|
| Rate for Payer: Healthfirst QHP |
$32.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.56
|
| Rate for Payer: SOMOS Essential |
$24.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.75
|
|
|
CHG RADIOLOGIC EXAMINATION FOOT 2 VIEWS
|
Professional
|
Both
|
$29.96
|
|
|
Service Code
|
HCPCS 73620 26
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$18.16 |
| Rate for Payer: Cash Price |
$8.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.05
|
| Rate for Payer: Healthfirst Commercial |
$8.07
|
| Rate for Payer: Healthfirst Essential Plan |
$18.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.67
|
| Rate for Payer: Healthfirst QHP |
$8.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$5.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$6.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$5.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.05
|
| Rate for Payer: SOMOS Essential |
$6.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.07
|
|
|
CHG RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS
|
Professional
|
Both
|
$147.70
|
|
|
Service Code
|
HCPCS 73560
|
| Min. Negotiated Rate |
$27.55 |
| Max. Negotiated Rate |
$88.54 |
| Rate for Payer: Cash Price |
$40.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$39.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.51
|
| Rate for Payer: Healthfirst Commercial |
$39.35
|
| Rate for Payer: Healthfirst Essential Plan |
$88.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.38
|
| Rate for Payer: Healthfirst QHP |
$39.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$39.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.51
|
| Rate for Payer: SOMOS Essential |
$29.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.35
|
|
|
CHG RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS
|
Professional
|
Both
|
$114.87
|
|
|
Service Code
|
HCPCS 73560 TC
|
| Min. Negotiated Rate |
$21.36 |
| Max. Negotiated Rate |
$68.65 |
| Rate for Payer: Cash Price |
$31.27
|
| 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 EXAMINATION KNEE 1/2 VIEWS
|
Professional
|
Both
|
$32.83
|
|
|
Service Code
|
HCPCS 73560 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 RADIOLOGIC EXAMINATION KNEE 3 VIEWS
|
Professional
|
Both
|
$174.65
|
|
|
Service Code
|
HCPCS 73562
|
| Min. Negotiated Rate |
$32.92 |
| Max. Negotiated Rate |
$105.82 |
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$42.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$44.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$44.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.27
|
| Rate for Payer: Healthfirst Commercial |
$47.03
|
| Rate for Payer: Healthfirst Essential Plan |
$105.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.68
|
| Rate for Payer: Healthfirst QHP |
$47.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$47.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35.27
|
| Rate for Payer: SOMOS Essential |
$35.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.03
|
|
|
CHG RADIOLOGIC EXAMINATION KNEE 3 VIEWS
|
Professional
|
Both
|
$36.79
|
|
|
Service Code
|
HCPCS 73562 26
|
| Min. Negotiated Rate |
$6.94 |
| Max. Negotiated Rate |
$22.32 |
| Rate for Payer: Cash Price |
$10.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.44
|
| Rate for Payer: Healthfirst Commercial |
$9.92
|
| Rate for Payer: Healthfirst Essential Plan |
$22.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.42
|
| Rate for Payer: Healthfirst QHP |
$9.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.44
|
| Rate for Payer: SOMOS Essential |
$7.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.92
|
|
|
CHG RADIOLOGIC EXAMINATION KNEE 3 VIEWS
|
Professional
|
Both
|
$137.87
|
|
|
Service Code
|
HCPCS 73562 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 EXAMINATION MANDIPLE PRTL <4 VIEWS
|
Professional
|
Both
|
$130.69
|
|
|
Service Code
|
HCPCS 70100 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 EXAMINATION MANDIPLE PRTL <4 VIEWS
|
Professional
|
Both
|
$35.35
|
|
|
Service Code
|
HCPCS 70100 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 EXAMINATION MANDIPLE PRTL <4 VIEWS
|
Professional
|
Both
|
$166.01
|
|
|
Service Code
|
HCPCS 70100
|
| Min. Negotiated Rate |
$31.29 |
| Max. Negotiated Rate |
$100.58 |
| Rate for Payer: Cash Price |
$45.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$44.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$44.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.52
|
| Rate for Payer: Healthfirst Commercial |
$44.70
|
| Rate for Payer: Healthfirst Essential Plan |
$100.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42.47
|
| Rate for Payer: Healthfirst QHP |
$44.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$44.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$44.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$33.52
|
| Rate for Payer: SOMOS Essential |
$33.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44.70
|
|
|
CHG RADIOLOGIC EXAMINATION NECK SOFT TISSUE
|
Professional
|
Both
|
$135.84
|
|
|
Service Code
|
HCPCS 70360
|
| Min. Negotiated Rate |
$25.31 |
| Max. Negotiated Rate |
$81.36 |
| Rate for Payer: Cash Price |
$36.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$36.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.12
|
| Rate for Payer: Healthfirst Commercial |
$36.16
|
| Rate for Payer: Healthfirst Essential Plan |
$81.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.35
|
| Rate for Payer: Healthfirst QHP |
$36.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$36.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.12
|
| Rate for Payer: SOMOS Essential |
$27.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.16
|
|
|
CHG RADIOLOGIC EXAMINATION NECK SOFT TISSUE
|
Professional
|
Both
|
$100.49
|
|
|
Service Code
|
HCPCS 70360 TC
|
| Min. Negotiated Rate |
$18.63 |
| Max. Negotiated Rate |
$59.90 |
| Rate for Payer: Cash Price |
$26.95
|
| 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 RADIOLOGIC EXAMINATION NECK SOFT TISSUE
|
Professional
|
Both
|
$35.35
|
|
|
Service Code
|
HCPCS 70360 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 EXAMINATION OSSEOUS SURVEY COMPL
|
Professional
|
Both
|
$108.57
|
|
|
Service Code
|
HCPCS 77075 26
|
| Min. Negotiated Rate |
$19.99 |
| Max. Negotiated Rate |
$64.26 |
| Rate for Payer: Cash Price |
$28.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.42
|
| Rate for Payer: Healthfirst Commercial |
$28.56
|
| Rate for Payer: Healthfirst Essential Plan |
$64.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.13
|
| Rate for Payer: Healthfirst QHP |
$28.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.56
|
| 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) |
$19.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.42
|
| Rate for Payer: SOMOS Essential |
$21.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.56
|
|
|
CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY COMPL
|
Professional
|
Both
|
$428.86
|
|
|
Service Code
|
HCPCS 77075
|
| Min. Negotiated Rate |
$79.82 |
| Max. Negotiated Rate |
$256.57 |
| Rate for Payer: Cash Price |
$116.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$114.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$102.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$102.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$108.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$114.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$108.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$114.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$114.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$85.52
|
| Rate for Payer: Healthfirst Commercial |
$114.03
|
| Rate for Payer: Healthfirst Essential Plan |
$256.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$108.33
|
| Rate for Payer: Healthfirst QHP |
$114.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$79.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$114.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$96.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$79.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$114.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$85.52
|
| Rate for Payer: SOMOS Essential |
$85.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$114.03
|
|
|
CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY COMPL
|
Professional
|
Both
|
$320.29
|
|
|
Service Code
|
HCPCS 77075 TC
|
| Min. Negotiated Rate |
$59.83 |
| Max. Negotiated Rate |
$192.31 |
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$85.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$76.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$76.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$81.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$85.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$81.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.10
|
| Rate for Payer: Healthfirst Commercial |
$85.47
|
| Rate for Payer: Healthfirst Essential Plan |
$192.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$81.20
|
| Rate for Payer: Healthfirst QHP |
$85.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$59.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$85.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$72.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$59.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$85.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$64.10
|
| Rate for Payer: SOMOS Essential |
$64.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$85.47
|
|
|
CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY INFANT
|
Professional
|
Both
|
$459.17
|
|
|
Service Code
|
HCPCS 77076
|
| Min. Negotiated Rate |
$86.04 |
| Max. Negotiated Rate |
$276.57 |
| Rate for Payer: Cash Price |
$124.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$122.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$110.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$110.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$116.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$122.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$116.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$122.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$122.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$92.19
|
| Rate for Payer: Healthfirst Commercial |
$122.92
|
| Rate for Payer: Healthfirst Essential Plan |
$276.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$116.77
|
| Rate for Payer: Healthfirst QHP |
$122.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$86.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$122.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$104.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$86.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$122.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$92.19
|
| Rate for Payer: SOMOS Essential |
$92.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$122.92
|
|
|
CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY INFANT
|
Professional
|
Both
|
$136.01
|
|
|
Service Code
|
HCPCS 77076 26
|
| Min. Negotiated Rate |
$25.68 |
| Max. Negotiated Rate |
$82.53 |
| Rate for Payer: Cash Price |
$36.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$36.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.51
|
| Rate for Payer: Healthfirst Commercial |
$36.68
|
| Rate for Payer: Healthfirst Essential Plan |
$82.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.85
|
| Rate for Payer: Healthfirst QHP |
$36.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$36.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$31.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.51
|
| Rate for Payer: SOMOS Essential |
$27.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.68
|
|
|
CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY INFANT
|
Professional
|
Both
|
$323.16
|
|
|
Service Code
|
HCPCS 77076 TC
|
| Min. Negotiated Rate |
$60.37 |
| Max. Negotiated Rate |
$194.04 |
| Rate for Payer: Cash Price |
$88.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$86.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$77.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$77.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$81.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$86.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$81.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.68
|
| Rate for Payer: Healthfirst Commercial |
$86.24
|
| Rate for Payer: Healthfirst Essential Plan |
$194.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$81.93
|
| Rate for Payer: Healthfirst QHP |
$86.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$60.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$86.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$73.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$60.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$86.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$64.68
|
| Rate for Payer: SOMOS Essential |
$64.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$86.24
|
|
