|
CHG PULMONARY VENTILATION IMAGING
|
Professional
|
$757.72
|
|
|
Service Code
|
HCPCS 78579
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$568.29 |
| Rate for Payer: Cash Price |
$202.14
|
| Rate for Payer: Cash Price |
$202.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$194.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$194.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$205.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$216.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$205.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$216.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$216.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$162.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$205.67
|
| Rate for Payer: Healthfirst QHP |
$216.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$151.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$216.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$184.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$151.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$216.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$568.29
|
| Rate for Payer: SOMOS Essential |
$568.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$216.49
|
|
|
CHG PULMONARY VENTILATION IMAGING
|
Professional
|
$666.44
|
|
|
Service Code
|
HCPCS 78579 TC
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$568.29 |
| Rate for Payer: Cash Price |
$177.52
|
| Rate for Payer: Cash Price |
$177.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$171.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$171.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$180.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$190.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$180.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$190.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$190.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$142.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$180.89
|
| Rate for Payer: Healthfirst QHP |
$190.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$133.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$190.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$161.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$133.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$190.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$499.83
|
| Rate for Payer: SOMOS Essential |
$499.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$190.41
|
|
|
CHG PULMONARY VENTILATION & PERFUSION IMAGING
|
Professional
|
$1,125.01
|
|
|
Service Code
|
HCPCS 78582 TC
|
| Min. Negotiated Rate |
$39.34 |
| Max. Negotiated Rate |
$991.28 |
| Rate for Payer: Cash Price |
$300.97
|
| Rate for Payer: Cash Price |
$300.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$289.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$289.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$305.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$321.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$305.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$321.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$321.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$241.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$305.36
|
| Rate for Payer: Healthfirst QHP |
$321.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$225.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$321.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$273.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$225.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$321.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$843.76
|
| Rate for Payer: SOMOS Essential |
$843.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$321.43
|
|
|
CHG PULMONARY VENTILATION & PERFUSION IMAGING
|
Professional
|
$1,321.71
|
|
|
Service Code
|
HCPCS 78582
|
| Min. Negotiated Rate |
$39.34 |
| Max. Negotiated Rate |
$991.28 |
| Rate for Payer: Cash Price |
$355.16
|
| Rate for Payer: Cash Price |
$355.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$339.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$339.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$358.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$377.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$358.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$377.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$377.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$283.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$358.75
|
| Rate for Payer: Healthfirst QHP |
$377.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$264.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$377.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$320.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$264.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$377.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$991.28
|
| Rate for Payer: SOMOS Essential |
$991.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$377.63
|
|
|
CHG PULMONARY VENTILATION & PERFUSION IMAGING
|
Professional
|
$196.70
|
|
|
Service Code
|
HCPCS 78582 26
|
| Min. Negotiated Rate |
$39.34 |
| Max. Negotiated Rate |
$991.28 |
| Rate for Payer: Cash Price |
$54.19
|
| Rate for Payer: Cash Price |
$54.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$50.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$50.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$53.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$56.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$53.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$53.39
|
| Rate for Payer: Healthfirst QHP |
$56.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$39.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$56.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$47.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$39.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$56.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$147.52
|
| Rate for Payer: SOMOS Essential |
$147.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56.20
|
|
|
CHG QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING
|
Professional
|
$805.84
|
|
|
Service Code
|
HCPCS 78597
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$604.38 |
| Rate for Payer: Cash Price |
$214.59
|
| Rate for Payer: Cash Price |
$214.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$207.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$207.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$218.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$230.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$218.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$230.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$230.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$172.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$218.73
|
| Rate for Payer: Healthfirst QHP |
$230.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$161.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$230.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$195.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$161.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$230.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$604.38
|
| Rate for Payer: SOMOS Essential |
$604.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$230.24
|
|
|
CHG QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING
|
Professional
|
$669.31
|
|
|
Service Code
|
HCPCS 78597 TC
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$604.38 |
| Rate for Payer: Cash Price |
$178.30
|
| Rate for Payer: Cash Price |
$178.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$172.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$172.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$181.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$191.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$181.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$191.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$143.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$181.67
|
| Rate for Payer: Healthfirst QHP |
$191.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$133.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$191.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$162.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$133.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$191.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$501.98
|
| Rate for Payer: SOMOS Essential |
$501.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$191.23
|
|
|
CHG QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING
|
Professional
|
$136.50
|
|
|
Service Code
|
HCPCS 78597 26
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$604.38 |
| Rate for Payer: Cash Price |
$36.28
|
| Rate for Payer: Cash Price |
$36.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$39.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.05
|
| Rate for Payer: Healthfirst QHP |
$39.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$39.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$102.38
|
| Rate for Payer: SOMOS Essential |
$102.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.00
|
|
|
CHG QUANT DIFF PULM PRFUSION & VENTLAJ W/WO IMAGIN
|
Professional
|
$156.21
|
|
|
Service Code
|
HCPCS 78598 26
|
| Min. Negotiated Rate |
$31.24 |
| Max. Negotiated Rate |
$905.94 |
| Rate for Payer: Cash Price |
$41.74
|
| Rate for Payer: Cash Price |
$41.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$44.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42.40
|
| Rate for Payer: Healthfirst QHP |
$44.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$44.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$44.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$117.16
|
| Rate for Payer: SOMOS Essential |
$117.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44.63
|
|
|
CHG QUANT DIFF PULM PRFUSION & VENTLAJ W/WO IMAGIN
|
Professional
|
$1,207.92
|
|
|
Service Code
|
HCPCS 78598
|
| Min. Negotiated Rate |
$31.24 |
| Max. Negotiated Rate |
$905.94 |
| Rate for Payer: Cash Price |
$322.67
|
| Rate for Payer: Cash Price |
$322.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$310.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$310.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$327.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$345.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$327.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$345.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$345.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$258.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$327.86
|
| Rate for Payer: Healthfirst QHP |
$345.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$241.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$345.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$293.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$241.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$345.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$905.94
|
| Rate for Payer: SOMOS Essential |
$905.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$345.12
|
|
|
CHG QUANT DIFF PULM PRFUSION & VENTLAJ W/WO IMAGIN
|
Professional
|
$1,051.68
|
|
|
Service Code
|
HCPCS 78598 TC
|
| Min. Negotiated Rate |
$31.24 |
| Max. Negotiated Rate |
$905.94 |
| Rate for Payer: Cash Price |
$280.93
|
| Rate for Payer: Cash Price |
$280.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$270.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$270.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$285.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$300.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$285.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$300.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$300.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$225.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$285.46
|
| Rate for Payer: Healthfirst QHP |
$300.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$210.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$300.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$255.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$210.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$300.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$788.76
|
| Rate for Payer: SOMOS Essential |
$788.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$300.48
|
|
|
CHG RADEX 1 PLNE BODY SECTION OTH/THN W/UROGRAPY
|
Professional
|
$383.88
|
|
|
Service Code
|
HCPCS 76100
|
| Min. Negotiated Rate |
$23.04 |
| Max. Negotiated Rate |
$287.91 |
| Rate for Payer: Cash Price |
$103.67
|
| Rate for Payer: Cash Price |
$103.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$98.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$98.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$104.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$109.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$104.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$109.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$82.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$104.20
|
| Rate for Payer: Healthfirst QHP |
$109.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$76.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$109.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$93.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$76.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$109.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$287.91
|
| Rate for Payer: SOMOS Essential |
$287.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$109.68
|
|
|
CHG RADEX 1 PLNE BODY SECTION OTH/THN W/UROGRAPY
|
Professional
|
$115.22
|
|
|
Service Code
|
HCPCS 76100 26
|
| Min. Negotiated Rate |
$23.04 |
| Max. Negotiated Rate |
$287.91 |
| Rate for Payer: Cash Price |
$30.35
|
| Rate for Payer: Cash Price |
$30.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.27
|
| Rate for Payer: Healthfirst QHP |
$32.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$86.42
|
| Rate for Payer: SOMOS Essential |
$86.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.92
|
|
|
CHG RADEX 1 PLNE BODY SECTION OTH/THN W/UROGRAPY
|
Professional
|
$268.66
|
|
|
Service Code
|
HCPCS 76100 TC
|
| Min. Negotiated Rate |
$23.04 |
| Max. Negotiated Rate |
$287.91 |
| Rate for Payer: Cash Price |
$73.32
|
| Rate for Payer: Cash Price |
$73.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$69.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$69.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$72.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$76.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$72.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$72.92
|
| Rate for Payer: Healthfirst QHP |
$76.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$53.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$76.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$65.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$53.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$76.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$201.50
|
| Rate for Payer: SOMOS Essential |
$201.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$76.76
|
|
|
CHG RADEX ABSCESS/FISTULA/SINUS TRACT RS&I
|
Professional
|
$255.26
|
|
|
Service Code
|
HCPCS 76080
|
| Min. Negotiated Rate |
$20.31 |
| Max. Negotiated Rate |
$191.44 |
| Rate for Payer: Cash Price |
$69.11
|
| Rate for Payer: Cash Price |
$69.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$65.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$69.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$69.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.28
|
| Rate for Payer: Healthfirst QHP |
$72.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$51.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$72.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$61.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$51.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$191.44
|
| Rate for Payer: SOMOS Essential |
$191.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.93
|
|
|
CHG RADEX ABSCESS/FISTULA/SINUS TRACT RS&I
|
Professional
|
$153.69
|
|
|
Service Code
|
HCPCS 76080 TC
|
| Min. Negotiated Rate |
$20.31 |
| Max. Negotiated Rate |
$191.44 |
| Rate for Payer: Cash Price |
$41.88
|
| Rate for Payer: Cash Price |
$41.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.71
|
| Rate for Payer: Healthfirst QHP |
$43.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$43.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$115.27
|
| Rate for Payer: SOMOS Essential |
$115.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.91
|
|
|
CHG RADEX ABSCESS/FISTULA/SINUS TRACT RS&I
|
Professional
|
$101.57
|
|
|
Service Code
|
HCPCS 76080 26
|
| Min. Negotiated Rate |
$20.31 |
| Max. Negotiated Rate |
$191.44 |
| Rate for Payer: Cash Price |
$27.23
|
| Rate for Payer: Cash Price |
$27.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.57
|
| Rate for Payer: Healthfirst QHP |
$29.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$76.18
|
| Rate for Payer: SOMOS Essential |
$76.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.02
|
|
|
CHG RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ
|
Professional
|
$36.79
|
|
|
Service Code
|
HCPCS 73050 26
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$92.17 |
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.98
|
| Rate for Payer: Healthfirst QHP |
$10.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$7.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$10.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.59
|
| Rate for Payer: SOMOS Essential |
$27.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.51
|
|
|
CHG RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ
|
Professional
|
$86.10
|
|
|
Service Code
|
HCPCS 73050 TC
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$92.17 |
| Rate for Payer: Cash Price |
$23.81
|
| Rate for Payer: Cash Price |
$23.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23.37
|
| Rate for Payer: Healthfirst QHP |
$24.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$24.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$20.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$64.58
|
| Rate for Payer: SOMOS Essential |
$64.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.60
|
|
|
CHG RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ
|
Professional
|
$122.89
|
|
|
Service Code
|
HCPCS 73050
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$92.17 |
| Rate for Payer: Cash Price |
$33.85
|
| Rate for Payer: Cash Price |
$33.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.35
|
| Rate for Payer: Healthfirst QHP |
$35.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$92.17
|
| Rate for Payer: SOMOS Essential |
$92.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.11
|
|
|
CHG RADEX ANKLE ARTHROGRAPHY RS&I
|
Professional
|
$557.13
|
|
|
Service Code
|
HCPCS 73615
|
| Min. Negotiated Rate |
$22.33 |
| Max. Negotiated Rate |
$417.85 |
| Rate for Payer: Cash Price |
$149.43
|
| Rate for Payer: Cash Price |
$149.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$143.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$143.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$151.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$159.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$151.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$159.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$159.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$119.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$151.22
|
| Rate for Payer: Healthfirst QHP |
$159.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$111.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$159.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$135.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$111.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$159.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$417.85
|
| Rate for Payer: SOMOS Essential |
$417.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$159.18
|
|
|
CHG RADEX ANKLE ARTHROGRAPHY RS&I
|
Professional
|
$111.65
|
|
|
Service Code
|
HCPCS 73615 26
|
| Min. Negotiated Rate |
$22.33 |
| Max. Negotiated Rate |
$417.85 |
| Rate for Payer: Cash Price |
$30.14
|
| Rate for Payer: Cash Price |
$30.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.30
|
| Rate for Payer: Healthfirst QHP |
$31.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$31.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$83.74
|
| Rate for Payer: SOMOS Essential |
$83.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.90
|
|
|
CHG RADEX ANKLE ARTHROGRAPHY RS&I
|
Professional
|
$445.48
|
|
|
Service Code
|
HCPCS 73615 TC
|
| Min. Negotiated Rate |
$22.33 |
| Max. Negotiated Rate |
$417.85 |
| Rate for Payer: Cash Price |
$119.29
|
| Rate for Payer: Cash Price |
$119.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$114.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$114.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$120.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$120.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$127.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$95.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$120.92
|
| Rate for Payer: Healthfirst QHP |
$127.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$89.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$127.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$108.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$89.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$334.11
|
| Rate for Payer: SOMOS Essential |
$334.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.28
|
|
|
CHG RADEX ANKLE COMPLETE MINIMUM 3 VIEWS
|
Professional
|
$159.01
|
|
|
Service Code
|
HCPCS 73610
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$119.26 |
| Rate for Payer: Cash Price |
$42.94
|
| Rate for Payer: Cash Price |
$42.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$45.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43.16
|
| Rate for Payer: Healthfirst QHP |
$45.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$45.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$38.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$119.26
|
| Rate for Payer: SOMOS Essential |
$119.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.43
|
|
|
CHG RADEX ANKLE COMPLETE MINIMUM 3 VIEWS
|
Professional
|
$124.92
|
|
|
Service Code
|
HCPCS 73610 TC
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$119.26 |
| Rate for Payer: Cash Price |
$33.63
|
| Rate for Payer: Cash Price |
$33.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.91
|
| Rate for Payer: Healthfirst QHP |
$35.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$93.69
|
| Rate for Payer: SOMOS Essential |
$93.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.69
|
|
