|
CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY LIMITED
|
Professional
|
Both
|
$192.50
|
|
|
Service Code
|
HCPCS 77074 TC
|
| Min. Negotiated Rate |
$36.57 |
| Max. Negotiated Rate |
$117.54 |
| Rate for Payer: Cash Price |
$52.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.18
|
| Rate for Payer: Healthfirst Commercial |
$52.24
|
| Rate for Payer: Healthfirst Essential Plan |
$117.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.63
|
| Rate for Payer: Healthfirst QHP |
$52.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.18
|
| Rate for Payer: SOMOS Essential |
$39.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.24
|
|
|
CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY LIMITED
|
Professional
|
Both
|
$83.58
|
|
|
Service Code
|
HCPCS 77074 26
|
| Min. Negotiated Rate |
$15.82 |
| Max. Negotiated Rate |
$50.85 |
| Rate for Payer: Cash Price |
$22.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.95
|
| Rate for Payer: Healthfirst Commercial |
$22.60
|
| Rate for Payer: Healthfirst Essential Plan |
$50.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.47
|
| Rate for Payer: Healthfirst QHP |
$22.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$15.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$22.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$19.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$16.95
|
| Rate for Payer: SOMOS Essential |
$16.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.60
|
|
|
CHG RADIOLOGIC EXAMINATION OSSEOUS SURVEY LIMITED
|
Professional
|
Both
|
$276.08
|
|
|
Service Code
|
HCPCS 77074
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$168.41 |
| Rate for Payer: Cash Price |
$75.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$74.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$67.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$67.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$71.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$74.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$71.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$74.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$56.14
|
| Rate for Payer: Healthfirst Commercial |
$74.85
|
| Rate for Payer: Healthfirst Essential Plan |
$168.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$71.11
|
| Rate for Payer: Healthfirst QHP |
$74.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$52.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$74.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$63.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$52.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$74.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$56.14
|
| Rate for Payer: SOMOS Essential |
$56.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$74.85
|
|
|
CHG RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS
|
Professional
|
Both
|
$120.19
|
|
|
Service Code
|
HCPCS 72170
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$72.72 |
| Rate for Payer: Cash Price |
$32.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.24
|
| Rate for Payer: Healthfirst Commercial |
$32.32
|
| Rate for Payer: Healthfirst Essential Plan |
$72.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.70
|
| Rate for Payer: Healthfirst QHP |
$32.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.24
|
| Rate for Payer: SOMOS Essential |
$24.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.32
|
|
|
CHG RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS
|
Professional
|
Both
|
$86.10
|
|
|
Service Code
|
HCPCS 72170 TC
|
| Min. Negotiated Rate |
$16.19 |
| Max. Negotiated Rate |
$52.04 |
| Rate for Payer: Cash Price |
$23.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$23.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$23.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.35
|
| Rate for Payer: Healthfirst Commercial |
$23.13
|
| Rate for Payer: Healthfirst Essential Plan |
$52.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.97
|
| Rate for Payer: Healthfirst QHP |
$23.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$16.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$23.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$19.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$16.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$17.35
|
| Rate for Payer: SOMOS Essential |
$17.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.13
|
|
|
CHG RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS
|
Professional
|
Both
|
$34.09
|
|
|
Service Code
|
HCPCS 72170 26
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$20.68 |
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.89
|
| Rate for Payer: Healthfirst Commercial |
$9.19
|
| Rate for Payer: Healthfirst Essential Plan |
$20.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.73
|
| Rate for Payer: Healthfirst QHP |
$9.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.89
|
| Rate for Payer: SOMOS Essential |
$6.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.19
|
|
|
CHG RADIOLOGIC EXAMINATION SACROILIAC JNTS <3 VIEWS
|
Professional
|
Both
|
$141.75
|
|
|
Service Code
|
HCPCS 72200
|
| Min. Negotiated Rate |
$27.24 |
| Max. Negotiated Rate |
$87.57 |
| Rate for Payer: Cash Price |
$39.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.19
|
| Rate for Payer: Healthfirst Commercial |
$38.92
|
| Rate for Payer: Healthfirst Essential Plan |
$87.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.97
|
| Rate for Payer: Healthfirst QHP |
$38.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.19
|
| Rate for Payer: SOMOS Essential |
$29.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.92
|
|
|
CHG RADIOLOGIC EXAMINATION SACROILIAC JNTS <3 VIEWS
|
Professional
|
Both
|
$32.66
|
|
|
Service Code
|
HCPCS 72200 26
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$20.68 |
| Rate for Payer: Cash Price |
$8.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.89
|
| Rate for Payer: Healthfirst Commercial |
$9.19
|
| Rate for Payer: Healthfirst Essential Plan |
$20.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.73
|
| Rate for Payer: Healthfirst QHP |
$9.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.89
|
| Rate for Payer: SOMOS Essential |
$6.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.19
|
|
|
CHG RADIOLOGIC EXAMINATION SACROILIAC JNTS <3 VIEWS
|
Professional
|
Both
|
$109.10
|
|
|
Service Code
|
HCPCS 72200 TC
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$66.89 |
| Rate for Payer: Cash Price |
$30.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$28.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.30
|
| Rate for Payer: Healthfirst Commercial |
$29.73
|
| Rate for Payer: Healthfirst Essential Plan |
$66.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.24
|
| Rate for Payer: Healthfirst QHP |
$29.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$25.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.30
|
| Rate for Payer: SOMOS Essential |
$22.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.73
|
|
|
CHG RADIOLOGIC EXAMINATION SALIVARY GLAND CALCULUS
|
Professional
|
Both
|
$161.88
|
|
|
Service Code
|
HCPCS 70380
|
| Min. Negotiated Rate |
$30.23 |
| Max. Negotiated Rate |
$97.18 |
| Rate for Payer: Cash Price |
$44.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$43.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.39
|
| Rate for Payer: Healthfirst Commercial |
$43.19
|
| Rate for Payer: Healthfirst Essential Plan |
$97.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.03
|
| Rate for Payer: Healthfirst QHP |
$43.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$43.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$36.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.39
|
| Rate for Payer: SOMOS Essential |
$32.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.19
|
|
|
CHG RADIOLOGIC EXAMINATION SALIVARY GLAND CALCULUS
|
Professional
|
Both
|
$129.22
|
|
|
Service Code
|
HCPCS 70380 TC
|
| Min. Negotiated Rate |
$24.07 |
| Max. Negotiated Rate |
$77.38 |
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.79
|
| Rate for Payer: Healthfirst Commercial |
$34.39
|
| Rate for Payer: Healthfirst Essential Plan |
$77.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.67
|
| Rate for Payer: Healthfirst QHP |
$34.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.79
|
| Rate for Payer: SOMOS Essential |
$25.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.39
|
|
|
CHG RADIOLOGIC EXAMINATION SALIVARY GLAND CALCULUS
|
Professional
|
Both
|
$32.66
|
|
|
Service Code
|
HCPCS 70380 26
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$19.80 |
| Rate for Payer: Cash Price |
$8.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.60
|
| Rate for Payer: Healthfirst Commercial |
$8.80
|
| Rate for Payer: Healthfirst Essential Plan |
$19.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.36
|
| Rate for Payer: Healthfirst QHP |
$8.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.60
|
| Rate for Payer: SOMOS Essential |
$6.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.80
|
|
|
CHG RADIOLOGIC EXAMINATION SELLA TURCICA
|
Professional
|
Both
|
$36.61
|
|
|
Service Code
|
HCPCS 70240 26
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$22.23 |
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.41
|
| Rate for Payer: Healthfirst Commercial |
$9.88
|
| Rate for Payer: Healthfirst Essential Plan |
$22.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.39
|
| Rate for Payer: Healthfirst QHP |
$9.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.41
|
| Rate for Payer: SOMOS Essential |
$7.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.88
|
|
|
CHG RADIOLOGIC EXAMINATION SELLA TURCICA
|
Professional
|
Both
|
$104.79
|
|
|
Service Code
|
HCPCS 70240 TC
|
| Min. Negotiated Rate |
$19.45 |
| Max. Negotiated Rate |
$62.53 |
| Rate for Payer: Cash Price |
$28.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.84
|
| Rate for Payer: Healthfirst Commercial |
$27.79
|
| Rate for Payer: Healthfirst Essential Plan |
$62.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.40
|
| Rate for Payer: Healthfirst QHP |
$27.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$27.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.84
|
| Rate for Payer: SOMOS Essential |
$20.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.79
|
|
|
CHG RADIOLOGIC EXAMINATION SELLA TURCICA
|
Professional
|
Both
|
$141.40
|
|
|
Service Code
|
HCPCS 70240
|
| Min. Negotiated Rate |
$26.37 |
| Max. Negotiated Rate |
$84.76 |
| Rate for Payer: Cash Price |
$38.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.25
|
| Rate for Payer: Healthfirst Commercial |
$37.67
|
| Rate for Payer: Healthfirst Essential Plan |
$84.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.79
|
| Rate for Payer: Healthfirst QHP |
$37.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.25
|
| Rate for Payer: SOMOS Essential |
$28.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.67
|
|
|
CHG RADIOLOGIC EXAMINATION SKULL 4< VIEWS
|
Professional
|
Both
|
$35.35
|
|
|
Service Code
|
HCPCS 70250 26
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$21.46 |
| 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 SKULL 4< VIEWS
|
Professional
|
Both
|
$154.53
|
|
|
Service Code
|
HCPCS 70250
|
| Min. Negotiated Rate |
$29.12 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Cash Price |
$42.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$41.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$39.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.20
|
| Rate for Payer: Healthfirst Commercial |
$41.60
|
| Rate for Payer: Healthfirst Essential Plan |
$93.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.52
|
| Rate for Payer: Healthfirst QHP |
$41.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$41.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$35.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31.20
|
| Rate for Payer: SOMOS Essential |
$31.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.60
|
|
|
CHG RADIOLOGIC EXAMINATION SKULL 4< VIEWS
|
Professional
|
Both
|
$119.18
|
|
|
Service Code
|
HCPCS 70250 TC
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$72.14 |
| Rate for Payer: Cash Price |
$32.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.05
|
| Rate for Payer: Healthfirst Commercial |
$32.06
|
| Rate for Payer: Healthfirst Essential Plan |
$72.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.46
|
| Rate for Payer: Healthfirst QHP |
$32.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.05
|
| Rate for Payer: SOMOS Essential |
$24.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.06
|
|
|
CHG RADIOLOGIC EXAMINATION TEETH 1 VIEW
|
Professional
|
Both
|
$56.81
|
|
|
Service Code
|
HCPCS 70300
|
| Min. Negotiated Rate |
$10.88 |
| Max. Negotiated Rate |
$34.99 |
| Rate for Payer: Cash Price |
$15.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.66
|
| Rate for Payer: Healthfirst Commercial |
$15.55
|
| Rate for Payer: Healthfirst Essential Plan |
$34.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.77
|
| Rate for Payer: Healthfirst QHP |
$15.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$10.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$15.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$13.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$11.66
|
| Rate for Payer: SOMOS Essential |
$11.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.55
|
|
|
CHG RADIOLOGIC EXAMINATION TEETH 1 VIEW
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS 70300 26
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$12.64 |
| Rate for Payer: Cash Price |
$5.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.21
|
| Rate for Payer: Healthfirst Commercial |
$5.62
|
| Rate for Payer: Healthfirst Essential Plan |
$12.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.34
|
| Rate for Payer: Healthfirst QHP |
$5.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$5.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$4.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4.21
|
| Rate for Payer: SOMOS Essential |
$4.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.62
|
|
|
CHG RADIOLOGIC EXAMINATION TEETH 1 VIEW
|
Professional
|
Both
|
$35.81
|
|
|
Service Code
|
HCPCS 70300 TC
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$22.34 |
| Rate for Payer: Cash Price |
$9.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.45
|
| Rate for Payer: Healthfirst Commercial |
$9.93
|
| Rate for Payer: Healthfirst Essential Plan |
$22.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.43
|
| Rate for Payer: Healthfirst QHP |
$9.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.45
|
| Rate for Payer: SOMOS Essential |
$7.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.93
|
|
|
CHG RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS
|
Professional
|
Both
|
$104.79
|
|
|
Service Code
|
HCPCS 73590 TC
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$63.41 |
| Rate for Payer: Cash Price |
$28.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.14
|
| Rate for Payer: Healthfirst Commercial |
$28.18
|
| Rate for Payer: Healthfirst Essential Plan |
$63.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.77
|
| Rate for Payer: Healthfirst QHP |
$28.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.14
|
| Rate for Payer: SOMOS Essential |
$21.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.18
|
|
|
CHG RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS
|
Professional
|
Both
|
$31.40
|
|
|
Service Code
|
HCPCS 73590 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 TIBIA & FIBULA 2 VIEWS
|
Professional
|
Both
|
$136.19
|
|
|
Service Code
|
HCPCS 73590
|
| Min. Negotiated Rate |
$25.65 |
| Max. Negotiated Rate |
$82.44 |
| Rate for Payer: Cash Price |
$37.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$36.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.48
|
| Rate for Payer: Healthfirst Commercial |
$36.64
|
| Rate for Payer: Healthfirst Essential Plan |
$82.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.81
|
| Rate for Payer: Healthfirst QHP |
$36.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$36.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$31.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.48
|
| Rate for Payer: SOMOS Essential |
$27.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.64
|
|
|
CHG RADIOLOGIC EXAM KNEE ARTHROGRAPHY RS&I
|
Professional
|
Both
|
$550.17
|
|
|
Service Code
|
HCPCS 73580
|
| Min. Negotiated Rate |
$87.09 |
| Max. Negotiated Rate |
$279.92 |
| Rate for Payer: Cash Price |
$129.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$124.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$111.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$111.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$118.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$124.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$118.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$124.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$124.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$93.31
|
| Rate for Payer: Healthfirst Commercial |
$124.41
|
| Rate for Payer: Healthfirst Essential Plan |
$279.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$118.19
|
| Rate for Payer: Healthfirst QHP |
$124.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$87.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$124.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$105.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$87.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$124.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$93.31
|
| Rate for Payer: SOMOS Essential |
$93.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$124.41
|
|
