|
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
|
|
|
CHG RADEX CALCANEUS MINIMUM 2 VIEWS
|
Professional
|
$31.40
|
|
|
Service Code
|
HCPCS 73650 26
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$92.45 |
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.52
|
| Rate for Payer: Healthfirst QHP |
$8.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.55
|
| Rate for Payer: SOMOS Essential |
$23.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.97
|
|
|
CHG RADEX CALCANEUS MINIMUM 2 VIEWS
|
Professional
|
$91.88
|
|
|
Service Code
|
HCPCS 73650 TC
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$92.45 |
| Rate for Payer: Cash Price |
$24.99
|
| Rate for Payer: Cash Price |
$24.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24.94
|
| Rate for Payer: Healthfirst QHP |
$26.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$68.91
|
| Rate for Payer: SOMOS Essential |
$68.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.25
|
|
|
CHG RADEX CALCANEUS MINIMUM 2 VIEWS
|
Professional
|
$123.27
|
|
|
Service Code
|
HCPCS 73650
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$92.45 |
| Rate for Payer: Cash Price |
$33.55
|
| Rate for Payer: Cash Price |
$33.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.46
|
| Rate for Payer: Healthfirst QHP |
$35.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$92.45
|
| Rate for Payer: SOMOS Essential |
$92.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.22
|
|
|
CHG RADEX CLAVICLE COMPLETE
|
Professional
|
$32.83
|
|
|
Service Code
|
HCPCS 73000 26
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$104.32 |
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.91
|
| Rate for Payer: Healthfirst QHP |
$9.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.62
|
| Rate for Payer: SOMOS Essential |
$24.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.38
|
|
|
CHG RADEX CLAVICLE COMPLETE
|
Professional
|
$139.09
|
|
|
Service Code
|
HCPCS 73000
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$104.32 |
| Rate for Payer: Cash Price |
$38.27
|
| Rate for Payer: Cash Price |
$38.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$39.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.75
|
| Rate for Payer: Healthfirst QHP |
$39.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$39.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$104.32
|
| Rate for Payer: SOMOS Essential |
$104.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.74
|
|
|
CHG RADEX CLAVICLE COMPLETE
|
Professional
|
$106.23
|
|
|
Service Code
|
HCPCS 73000 TC
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$104.32 |
| Rate for Payer: Cash Price |
$29.31
|
| Rate for Payer: Cash Price |
$29.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$27.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$28.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$30.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.83
|
| Rate for Payer: Healthfirst QHP |
$30.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$30.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$25.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$79.67
|
| Rate for Payer: SOMOS Essential |
$79.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.35
|
|
|
CHG RADEX ELBOW 2 VIEWS
|
Professional
|
$32.83
|
|
|
Service Code
|
HCPCS 73070 26
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$94.60 |
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.91
|
| Rate for Payer: Healthfirst QHP |
$9.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.62
|
| Rate for Payer: SOMOS Essential |
$24.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.38
|
|
|
CHG RADEX ELBOW 2 VIEWS
|
Professional
|
$93.31
|
|
|
Service Code
|
HCPCS 73070 TC
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$94.60 |
| Rate for Payer: Cash Price |
$25.38
|
| Rate for Payer: Cash Price |
$25.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.33
|
| Rate for Payer: Healthfirst QHP |
$26.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.98
|
| Rate for Payer: SOMOS Essential |
$69.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.66
|
|
|
CHG RADEX ELBOW 2 VIEWS
|
Professional
|
$126.14
|
|
|
Service Code
|
HCPCS 73070
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$94.60 |
| Rate for Payer: Cash Price |
$34.34
|
| Rate for Payer: Cash Price |
$34.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.24
|
| Rate for Payer: Healthfirst QHP |
$36.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$36.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$94.60
|
| Rate for Payer: SOMOS Essential |
$94.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.04
|
|
|
CHG RADEX ELBOW ARTHROGRAPHY RS&I
|
Professional
|
$479.50
|
|
|
Service Code
|
HCPCS 73085
|
| Min. Negotiated Rate |
$22.33 |
| Max. Negotiated Rate |
$359.62 |
| Rate for Payer: Cash Price |
$116.42
|
| Rate for Payer: Cash Price |
$116.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$123.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$123.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$130.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$137.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$130.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$137.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$137.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$102.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$130.15
|
| Rate for Payer: Healthfirst QHP |
$137.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$95.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$137.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$116.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$95.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$137.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$359.62
|
| Rate for Payer: SOMOS Essential |
$359.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$137.00
|
|
|
CHG RADEX ELBOW ARTHROGRAPHY RS&I
|
Professional
|
$111.65
|
|
|
Service Code
|
HCPCS 73085 26
|
| Min. Negotiated Rate |
$22.33 |
| Max. Negotiated Rate |
$359.62 |
| Rate for Payer: Cash Price |
$28.17
|
| Rate for Payer: Cash Price |
$28.17
|
| 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 ELBOW ARTHROGRAPHY RS&I
|
Professional
|
$367.85
|
|
|
Service Code
|
HCPCS 73085 TC
|
| Min. Negotiated Rate |
$22.33 |
| Max. Negotiated Rate |
$359.62 |
| Rate for Payer: Cash Price |
$88.25
|
| Rate for Payer: Cash Price |
$88.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$94.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$94.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$99.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$105.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$99.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$78.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$99.84
|
| Rate for Payer: Healthfirst QHP |
$105.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$73.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$105.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$89.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$73.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$105.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$275.89
|
| Rate for Payer: SOMOS Essential |
$275.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$105.10
|
|
|
CHG RADEX ELBOW COMPLETE MINIMUM 3 VIEWS
|
Professional
|
$34.09
|
|
|
Service Code
|
HCPCS 73080 26
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$105.24 |
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.25
|
| Rate for Payer: Healthfirst QHP |
$9.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.57
|
| Rate for Payer: SOMOS Essential |
$25.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.74
|
|
|
CHG RADEX ELBOW COMPLETE MINIMUM 3 VIEWS
|
Professional
|
$140.32
|
|
|
Service Code
|
HCPCS 73080
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$105.24 |
| Rate for Payer: Cash Price |
$38.61
|
| Rate for Payer: Cash Price |
$38.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.09
|
| Rate for Payer: Healthfirst QHP |
$40.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$40.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$105.24
|
| Rate for Payer: SOMOS Essential |
$105.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.09
|
|
|
CHG RADEX ELBOW COMPLETE MINIMUM 3 VIEWS
|
Professional
|
$106.23
|
|
|
Service Code
|
HCPCS 73080 TC
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$105.24 |
| Rate for Payer: Cash Price |
$29.31
|
| Rate for Payer: Cash Price |
$29.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$27.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$28.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$30.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.83
|
| Rate for Payer: Healthfirst QHP |
$30.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$30.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$25.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$79.67
|
| Rate for Payer: SOMOS Essential |
$79.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.35
|
|
|
CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 1 VW
|
Professional
|
$132.13
|
|
|
Service Code
|
HCPCS 72081 TC
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$136.34 |
| Rate for Payer: Cash Price |
$35.99
|
| Rate for Payer: Cash Price |
$35.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.86
|
| Rate for Payer: Healthfirst QHP |
$37.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$99.10
|
| Rate for Payer: SOMOS Essential |
$99.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.75
|
|
|
CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 1 VW
|
Professional
|
$49.67
|
|
|
Service Code
|
HCPCS 72081 26
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$136.34 |
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.48
|
| Rate for Payer: Healthfirst QHP |
$14.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$14.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$12.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$37.25
|
| Rate for Payer: SOMOS Essential |
$37.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.19
|
|
|
CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 1 VW
|
Professional
|
$181.79
|
|
|
Service Code
|
HCPCS 72081
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$136.34 |
| Rate for Payer: Cash Price |
$49.61
|
| Rate for Payer: Cash Price |
$49.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$46.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$46.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$51.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.34
|
| Rate for Payer: Healthfirst QHP |
$51.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$51.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$51.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$136.34
|
| Rate for Payer: SOMOS Essential |
$136.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$51.94
|
|
|
CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 2/3 VW
|
Professional
|
$61.57
|
|
|
Service Code
|
HCPCS 72082 26
|
| Min. Negotiated Rate |
$12.31 |
| Max. Negotiated Rate |
$226.10 |
| Rate for Payer: Cash Price |
$16.78
|
| Rate for Payer: Cash Price |
$16.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.71
|
| Rate for Payer: Healthfirst QHP |
$17.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$12.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$17.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$14.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$12.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$46.18
|
| Rate for Payer: SOMOS Essential |
$46.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.59
|
|
|
CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 2/3 VW
|
Professional
|
$301.46
|
|
|
Service Code
|
HCPCS 72082
|
| Min. Negotiated Rate |
$12.31 |
| Max. Negotiated Rate |
$226.10 |
| Rate for Payer: Cash Price |
$82.24
|
| Rate for Payer: Cash Price |
$82.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$77.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$77.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$81.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$86.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$81.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$81.82
|
| Rate for Payer: Healthfirst QHP |
$86.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$60.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$86.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$73.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$60.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$86.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$226.10
|
| Rate for Payer: SOMOS Essential |
$226.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$86.13
|
|
|
CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 2/3 VW
|
Professional
|
$239.93
|
|
|
Service Code
|
HCPCS 72082 TC
|
| Min. Negotiated Rate |
$12.31 |
| Max. Negotiated Rate |
$226.10 |
| Rate for Payer: Cash Price |
$65.46
|
| Rate for Payer: Cash Price |
$65.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$61.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$65.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$68.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$65.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$68.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$68.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$65.12
|
| Rate for Payer: Healthfirst QHP |
$68.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$47.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$68.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$58.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$47.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$68.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$179.95
|
| Rate for Payer: SOMOS Essential |
$179.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$68.55
|
|
|
CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 4/5 VW
|
Professional
|
$336.81
|
|
|
Service Code
|
HCPCS 72083
|
| Min. Negotiated Rate |
$13.63 |
| Max. Negotiated Rate |
$252.61 |
| Rate for Payer: Cash Price |
$92.44
|
| Rate for Payer: Cash Price |
$92.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$86.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$86.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$91.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$96.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$91.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$96.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$96.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$91.42
|
| Rate for Payer: Healthfirst QHP |
$96.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$67.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$96.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$81.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$67.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$96.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$252.61
|
| Rate for Payer: SOMOS Essential |
$252.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$96.23
|
|
|
CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 4/5 VW
|
Professional
|
$68.15
|
|
|
Service Code
|
HCPCS 72083 26
|
| Min. Negotiated Rate |
$13.63 |
| Max. Negotiated Rate |
$252.61 |
| Rate for Payer: Cash Price |
$18.73
|
| Rate for Payer: Cash Price |
$18.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.50
|
| Rate for Payer: Healthfirst QHP |
$19.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$51.11
|
| Rate for Payer: SOMOS Essential |
$51.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.47
|
|
|
CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 4/5 VW
|
Professional
|
$268.66
|
|
|
Service Code
|
HCPCS 72083 TC
|
| Min. Negotiated Rate |
$13.63 |
| Max. Negotiated Rate |
$252.61 |
| Rate for Payer: Cash Price |
$73.71
|
| Rate for Payer: Cash Price |
$73.71
|
| 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
|
|
