|
CHG RADIOLOGIC EXAM KNEE ARTHROGRAPHY RS&I
|
Professional
|
Both
|
$126.25
|
|
|
Service Code
|
HCPCS 73580 26
|
| Min. Negotiated Rate |
$23.89 |
| Max. Negotiated Rate |
$76.79 |
| Rate for Payer: Cash Price |
$34.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.60
|
| Rate for Payer: Healthfirst Commercial |
$34.13
|
| Rate for Payer: Healthfirst Essential Plan |
$76.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.42
|
| Rate for Payer: Healthfirst QHP |
$34.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.60
|
| Rate for Payer: SOMOS Essential |
$25.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.13
|
|
|
CHG RADIOLOGIC EXAM KNEE ARTHROGRAPHY RS&I
|
Professional
|
Both
|
$423.92
|
|
|
Service Code
|
HCPCS 73580 TC
|
| Min. Negotiated Rate |
$63.20 |
| Max. Negotiated Rate |
$203.13 |
| Rate for Payer: Cash Price |
$94.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$90.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$81.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$81.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$85.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$90.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$85.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$90.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67.71
|
| Rate for Payer: Healthfirst Commercial |
$90.28
|
| Rate for Payer: Healthfirst Essential Plan |
$203.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$85.77
|
| Rate for Payer: Healthfirst QHP |
$90.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$63.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$90.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$76.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$63.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$90.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$67.71
|
| Rate for Payer: SOMOS Essential |
$67.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$90.28
|
|
|
CHG RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS
|
Professional
|
Both
|
$44.66
|
|
|
Service Code
|
HCPCS 73564 26
|
| Min. Negotiated Rate |
$8.46 |
| Max. Negotiated Rate |
$27.18 |
| Rate for Payer: Cash Price |
$12.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.06
|
| Rate for Payer: Healthfirst Commercial |
$12.08
|
| Rate for Payer: Healthfirst Essential Plan |
$27.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.48
|
| Rate for Payer: Healthfirst QHP |
$12.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$12.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$10.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.06
|
| Rate for Payer: SOMOS Essential |
$9.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.08
|
|
|
CHG RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS
|
Professional
|
Both
|
$155.12
|
|
|
Service Code
|
HCPCS 73564 TC
|
| Min. Negotiated Rate |
$29.78 |
| Max. Negotiated Rate |
$95.72 |
| Rate for Payer: Cash Price |
$43.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$42.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$42.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$40.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.91
|
| Rate for Payer: Healthfirst Commercial |
$42.54
|
| Rate for Payer: Healthfirst Essential Plan |
$95.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.41
|
| Rate for Payer: Healthfirst QHP |
$42.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$42.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$36.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$42.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31.91
|
| Rate for Payer: SOMOS Essential |
$31.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.54
|
|
|
CHG RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS
|
Professional
|
Both
|
$199.78
|
|
|
Service Code
|
HCPCS 73564
|
| Min. Negotiated Rate |
$38.23 |
| Max. Negotiated Rate |
$122.89 |
| Rate for Payer: Cash Price |
$55.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$54.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$49.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$49.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$51.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$54.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$51.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.97
|
| Rate for Payer: Healthfirst Commercial |
$54.62
|
| Rate for Payer: Healthfirst Essential Plan |
$122.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$51.89
|
| Rate for Payer: Healthfirst QHP |
$54.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$38.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$54.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$46.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$38.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$54.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.97
|
| Rate for Payer: SOMOS Essential |
$40.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.62
|
|
|
CHG RADIOLOGIC EXAM MASTOIDS < 3 VIEWS PER SIDE
|
Professional
|
Both
|
$166.01
|
|
|
Service Code
|
HCPCS 70120
|
| Min. Negotiated Rate |
$31.02 |
| Max. Negotiated Rate |
$99.70 |
| Rate for Payer: Cash Price |
$44.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$44.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$44.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.23
|
| Rate for Payer: Healthfirst Commercial |
$44.31
|
| Rate for Payer: Healthfirst Essential Plan |
$99.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42.09
|
| Rate for Payer: Healthfirst QHP |
$44.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$44.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$44.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$33.23
|
| Rate for Payer: SOMOS Essential |
$33.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44.31
|
|
|
CHG RADIOLOGIC EXAM MASTOIDS < 3 VIEWS PER SIDE
|
Professional
|
Both
|
$130.69
|
|
|
Service Code
|
HCPCS 70120 TC
|
| Min. Negotiated Rate |
$24.35 |
| Max. Negotiated Rate |
$78.25 |
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.09
|
| Rate for Payer: Healthfirst Commercial |
$34.78
|
| Rate for Payer: Healthfirst Essential Plan |
$78.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.04
|
| Rate for Payer: Healthfirst QHP |
$34.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.09
|
| Rate for Payer: SOMOS Essential |
$26.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.78
|
|
|
CHG RADIOLOGIC EXAM MASTOIDS < 3 VIEWS PER SIDE
|
Professional
|
Both
|
$35.35
|
|
|
Service Code
|
HCPCS 70120 26
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$21.46 |
| Rate for Payer: Cash Price |
$9.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.16
|
| Rate for Payer: Healthfirst Commercial |
$9.54
|
| Rate for Payer: Healthfirst Essential Plan |
$21.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.06
|
| Rate for Payer: Healthfirst QHP |
$9.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.16
|
| Rate for Payer: SOMOS Essential |
$7.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.54
|
|
|
CHG RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS
|
Professional
|
Both
|
$132.13
|
|
|
Service Code
|
HCPCS 72190 TC
|
| Min. Negotiated Rate |
$24.61 |
| Max. Negotiated Rate |
$79.11 |
| Rate for Payer: Cash Price |
$35.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.37
|
| Rate for Payer: Healthfirst Commercial |
$35.16
|
| Rate for Payer: Healthfirst Essential Plan |
$79.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.40
|
| Rate for Payer: Healthfirst QHP |
$35.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.37
|
| Rate for Payer: SOMOS Essential |
$26.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.16
|
|
|
CHG RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS
|
Professional
|
Both
|
$180.53
|
|
|
Service Code
|
HCPCS 72190
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$108.63 |
| Rate for Payer: Cash Price |
$49.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$48.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$48.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.21
|
| Rate for Payer: Healthfirst Commercial |
$48.28
|
| Rate for Payer: Healthfirst Essential Plan |
$108.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$45.87
|
| Rate for Payer: Healthfirst QHP |
$48.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$48.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$48.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36.21
|
| Rate for Payer: SOMOS Essential |
$36.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$48.28
|
|
|
CHG RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS
|
Professional
|
Both
|
$48.44
|
|
|
Service Code
|
HCPCS 72190 26
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$29.50 |
| Rate for Payer: Cash Price |
$13.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.83
|
| Rate for Payer: Healthfirst Commercial |
$13.11
|
| Rate for Payer: Healthfirst Essential Plan |
$29.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.45
|
| Rate for Payer: Healthfirst QHP |
$13.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$13.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$11.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.83
|
| Rate for Payer: SOMOS Essential |
$9.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.11
|
|
|
CHG RADIOLOGIC EXAM PHRNX&/CRV ESOPH CONTRAST STUDY
|
Professional
|
Both
|
$115.05
|
|
|
Service Code
|
HCPCS 74210 26
|
| Min. Negotiated Rate |
$21.23 |
| Max. Negotiated Rate |
$68.24 |
| Rate for Payer: Cash Price |
$30.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$27.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$28.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$30.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.75
|
| Rate for Payer: Healthfirst Commercial |
$30.33
|
| Rate for Payer: Healthfirst Essential Plan |
$68.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.81
|
| Rate for Payer: Healthfirst QHP |
$30.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$30.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$25.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.75
|
| Rate for Payer: SOMOS Essential |
$22.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.33
|
|
|
CHG RADIOLOGIC EXAM PHRNX&/CRV ESOPH CONTRAST STUDY
|
Professional
|
Both
|
$300.30
|
|
|
Service Code
|
HCPCS 74210 TC
|
| Min. Negotiated Rate |
$53.14 |
| Max. Negotiated Rate |
$170.82 |
| Rate for Payer: Cash Price |
$79.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$75.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$68.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$68.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$72.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$75.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$72.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$56.94
|
| Rate for Payer: Healthfirst Commercial |
$75.92
|
| Rate for Payer: Healthfirst Essential Plan |
$170.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$72.12
|
| Rate for Payer: Healthfirst QHP |
$75.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$53.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$75.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$64.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$53.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$75.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$56.94
|
| Rate for Payer: SOMOS Essential |
$56.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$75.92
|
|
|
CHG RADIOLOGIC EXAM PHRNX&/CRV ESOPH CONTRAST STUDY
|
Professional
|
Both
|
$415.31
|
|
|
Service Code
|
HCPCS 74210
|
| Min. Negotiated Rate |
$74.38 |
| Max. Negotiated Rate |
$239.06 |
| Rate for Payer: Cash Price |
$109.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$106.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$95.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$95.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$100.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$106.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$100.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$106.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$79.69
|
| Rate for Payer: Healthfirst Commercial |
$106.25
|
| Rate for Payer: Healthfirst Essential Plan |
$239.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$100.94
|
| Rate for Payer: Healthfirst QHP |
$106.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$74.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$106.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$90.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$74.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$106.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$79.69
|
| Rate for Payer: SOMOS Essential |
$79.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$106.25
|
|
|
CHG RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE VIEWS
|
Professional
|
Both
|
$43.05
|
|
|
Service Code
|
HCPCS 72202 26
|
| Min. Negotiated Rate |
$8.15 |
| Max. Negotiated Rate |
$26.21 |
| Rate for Payer: Cash Price |
$11.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.74
|
| Rate for Payer: Healthfirst Commercial |
$11.65
|
| Rate for Payer: Healthfirst Essential Plan |
$26.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.07
|
| Rate for Payer: Healthfirst QHP |
$11.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$11.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$9.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.74
|
| Rate for Payer: SOMOS Essential |
$8.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.65
|
|
|
CHG RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE VIEWS
|
Professional
|
Both
|
$167.97
|
|
|
Service Code
|
HCPCS 72202
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$101.83 |
| Rate for Payer: Cash Price |
$45.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$45.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$45.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.95
|
| Rate for Payer: Healthfirst Commercial |
$45.26
|
| Rate for Payer: Healthfirst Essential Plan |
$101.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43.00
|
| Rate for Payer: Healthfirst QHP |
$45.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$45.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$38.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$33.95
|
| Rate for Payer: SOMOS Essential |
$33.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.26
|
|
|
CHG RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE VIEWS
|
Professional
|
Both
|
$124.92
|
|
|
Service Code
|
HCPCS 72202 TC
|
| Min. Negotiated Rate |
$23.53 |
| Max. Negotiated Rate |
$75.62 |
| Rate for Payer: Cash Price |
$34.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.21
|
| Rate for Payer: Healthfirst Commercial |
$33.61
|
| Rate for Payer: Healthfirst Essential Plan |
$75.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.93
|
| Rate for Payer: Healthfirst QHP |
$33.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$33.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.21
|
| Rate for Payer: SOMOS Essential |
$25.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.61
|
|
|
CHG RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS
|
Professional
|
Both
|
$53.62
|
|
|
Service Code
|
HCPCS 70260 26
|
| Min. Negotiated Rate |
$10.17 |
| Max. Negotiated Rate |
$32.69 |
| Rate for Payer: Cash Price |
$14.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.90
|
| Rate for Payer: Healthfirst Commercial |
$14.53
|
| Rate for Payer: Healthfirst Essential Plan |
$32.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.80
|
| Rate for Payer: Healthfirst QHP |
$14.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$10.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$14.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$12.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$10.90
|
| Rate for Payer: SOMOS Essential |
$10.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.53
|
|
|
CHG RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS
|
Professional
|
Both
|
$190.05
|
|
|
Service Code
|
HCPCS 70260
|
| Min. Negotiated Rate |
$35.88 |
| Max. Negotiated Rate |
$115.31 |
| Rate for Payer: Cash Price |
$51.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$51.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$46.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$46.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$48.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$51.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$48.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.44
|
| Rate for Payer: Healthfirst Commercial |
$51.25
|
| Rate for Payer: Healthfirst Essential Plan |
$115.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$48.69
|
| Rate for Payer: Healthfirst QHP |
$51.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$35.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$51.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$43.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$35.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$51.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$38.44
|
| Rate for Payer: SOMOS Essential |
$38.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$51.25
|
|
|
CHG RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS
|
Professional
|
Both
|
$136.43
|
|
|
Service Code
|
HCPCS 70260 TC
|
| Min. Negotiated Rate |
$25.70 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Cash Price |
$37.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$36.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.54
|
| Rate for Payer: Healthfirst Commercial |
$36.72
|
| Rate for Payer: Healthfirst Essential Plan |
$82.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.88
|
| Rate for Payer: Healthfirst QHP |
$36.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$36.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$31.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.54
|
| Rate for Payer: SOMOS Essential |
$27.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.72
|
|
|
CHG RADIOLOGIC EXAM SMALL INT DOUBLE CONTRAST STUDY
|
Professional
|
Both
|
$224.77
|
|
|
Service Code
|
HCPCS 74251 26
|
| Min. Negotiated Rate |
$41.79 |
| Max. Negotiated Rate |
$134.32 |
| Rate for Payer: Cash Price |
$60.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$59.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$53.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$56.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$59.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$56.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.77
|
| Rate for Payer: Healthfirst Commercial |
$59.70
|
| Rate for Payer: Healthfirst Essential Plan |
$134.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$56.72
|
| Rate for Payer: Healthfirst QHP |
$59.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$41.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$59.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$50.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$41.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$59.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$44.77
|
| Rate for Payer: SOMOS Essential |
$44.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$59.70
|
|
|
CHG RADIOLOGIC EXAM SMALL INT DOUBLE CONTRAST STUDY
|
Professional
|
Both
|
$767.48
|
|
|
Service Code
|
HCPCS 74251 TC
|
| Min. Negotiated Rate |
$240.62 |
| Max. Negotiated Rate |
$773.44 |
| Rate for Payer: Cash Price |
$362.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$343.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$309.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$309.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$326.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$343.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$326.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$343.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$343.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$257.81
|
| Rate for Payer: Healthfirst Commercial |
$343.75
|
| Rate for Payer: Healthfirst Essential Plan |
$773.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$326.56
|
| Rate for Payer: Healthfirst QHP |
$343.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$240.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$343.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$292.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$240.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$343.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$257.81
|
| Rate for Payer: SOMOS Essential |
$257.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$343.75
|
|
|
CHG RADIOLOGIC EXAM SMALL INT DOUBLE CONTRAST STUDY
|
Professional
|
Both
|
$992.25
|
|
|
Service Code
|
HCPCS 74251
|
| Min. Negotiated Rate |
$282.42 |
| Max. Negotiated Rate |
$907.76 |
| Rate for Payer: Cash Price |
$423.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$403.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$363.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$363.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$383.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$403.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$383.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$403.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$403.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$302.59
|
| Rate for Payer: Healthfirst Commercial |
$403.45
|
| Rate for Payer: Healthfirst Essential Plan |
$907.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$383.28
|
| Rate for Payer: Healthfirst QHP |
$403.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$282.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$403.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$342.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$282.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$403.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$302.59
|
| Rate for Payer: SOMOS Essential |
$302.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$403.45
|
|
|
CHG RADIOLOGIC EXAM SMALL INT SINGLE CONTRAST STUDY
|
Professional
|
Both
|
$526.26
|
|
|
Service Code
|
HCPCS 74250
|
| Min. Negotiated Rate |
$96.14 |
| Max. Negotiated Rate |
$309.04 |
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$137.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$123.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$123.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$130.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$137.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$130.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$137.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$137.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$103.01
|
| Rate for Payer: Healthfirst Commercial |
$137.35
|
| Rate for Payer: Healthfirst Essential Plan |
$309.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$130.48
|
| Rate for Payer: Healthfirst QHP |
$137.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$96.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$137.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$116.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$96.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$137.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$103.01
|
| Rate for Payer: SOMOS Essential |
$103.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$137.35
|
|
|
CHG RADIOLOGIC EXAM SMALL INT SINGLE CONTRAST STUDY
|
Professional
|
Both
|
$154.07
|
|
|
Service Code
|
HCPCS 74250 26
|
| Min. Negotiated Rate |
$29.14 |
| Max. Negotiated Rate |
$93.67 |
| Rate for Payer: Cash Price |
$41.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$41.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$39.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.22
|
| Rate for Payer: Healthfirst Commercial |
$41.63
|
| Rate for Payer: Healthfirst Essential Plan |
$93.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.55
|
| Rate for Payer: Healthfirst QHP |
$41.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$41.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$35.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31.22
|
| Rate for Payer: SOMOS Essential |
$31.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.63
|
|
