|
CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 6/> VW
|
Professional
|
$81.27
|
|
|
Service Code
|
HCPCS 72084 26
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$319.49 |
| Rate for Payer: Cash Price |
$21.84
|
| Rate for Payer: Cash Price |
$21.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$23.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.06
|
| Rate for Payer: Healthfirst QHP |
$23.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$16.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$23.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$19.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$16.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$60.95
|
| Rate for Payer: SOMOS Essential |
$60.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.22
|
|
|
CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 6/> VW
|
Professional
|
$425.99
|
|
|
Service Code
|
HCPCS 72084
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$319.49 |
| Rate for Payer: Cash Price |
$115.43
|
| Rate for Payer: Cash Price |
$115.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$109.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$109.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$115.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$121.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$115.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$121.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$121.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$91.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$115.62
|
| Rate for Payer: Healthfirst QHP |
$121.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$85.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$121.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$103.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$85.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$121.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$319.49
|
| Rate for Payer: SOMOS Essential |
$319.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$121.71
|
|
|
CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 6/> VW
|
Professional
|
$344.72
|
|
|
Service Code
|
HCPCS 72084 TC
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$319.49 |
| Rate for Payer: Cash Price |
$93.59
|
| Rate for Payer: Cash Price |
$93.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$88.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$88.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$93.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$98.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$93.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$98.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$98.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$93.57
|
| Rate for Payer: Healthfirst QHP |
$98.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$68.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$98.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$83.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$68.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$98.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$258.54
|
| Rate for Payer: SOMOS Essential |
$258.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$98.49
|
|
|
CHG RADEX FACIAL BONES < 3 VIEWS
|
Professional
|
$138.53
|
|
|
Service Code
|
HCPCS 70140
|
| Min. Negotiated Rate |
$7.90 |
| Max. Negotiated Rate |
$103.90 |
| Rate for Payer: Cash Price |
$37.35
|
| Rate for Payer: Cash Price |
$37.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$39.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.60
|
| Rate for Payer: Healthfirst QHP |
$39.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$39.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$103.90
|
| Rate for Payer: SOMOS Essential |
$103.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.58
|
|
|
CHG RADEX FACIAL BONES < 3 VIEWS
|
Professional
|
$99.05
|
|
|
Service Code
|
HCPCS 70140 TC
|
| Min. Negotiated Rate |
$7.90 |
| Max. Negotiated Rate |
$103.90 |
| Rate for Payer: Cash Price |
$26.95
|
| Rate for Payer: Cash Price |
$26.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.88
|
| Rate for Payer: Healthfirst QHP |
$28.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$74.29
|
| Rate for Payer: SOMOS Essential |
$74.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.30
|
|
|
CHG RADEX FACIAL BONES < 3 VIEWS
|
Professional
|
$39.48
|
|
|
Service Code
|
HCPCS 70140 26
|
| Min. Negotiated Rate |
$7.90 |
| Max. Negotiated Rate |
$103.90 |
| Rate for Payer: Cash Price |
$10.39
|
| Rate for Payer: Cash Price |
$10.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.72
|
| Rate for Payer: Healthfirst QHP |
$11.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$7.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$11.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$9.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.61
|
| Rate for Payer: SOMOS Essential |
$29.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.28
|
|
|
CHG RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS
|
Professional
|
$49.67
|
|
|
Service Code
|
HCPCS 70150 26
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$150.36 |
| 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 FACIAL BONES COMPLETE MINIMUM 3 VIEWS
|
Professional
|
$200.48
|
|
|
Service Code
|
HCPCS 70150
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$150.36 |
| Rate for Payer: Cash Price |
$55.11
|
| Rate for Payer: Cash Price |
$55.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$51.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$51.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$54.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$57.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$54.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$54.42
|
| Rate for Payer: Healthfirst QHP |
$57.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$40.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$57.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$48.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$40.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$57.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$150.36
|
| Rate for Payer: SOMOS Essential |
$150.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$57.28
|
|
|
CHG RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS
|
Professional
|
$150.82
|
|
|
Service Code
|
HCPCS 70150 TC
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$150.36 |
| Rate for Payer: Cash Price |
$41.49
|
| Rate for Payer: Cash Price |
$41.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$40.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.94
|
| Rate for Payer: Healthfirst QHP |
$43.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$43.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$36.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$113.12
|
| Rate for Payer: SOMOS Essential |
$113.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.09
|
|
|
CHG RADEX FINGR MINIMUM 2 VIEWS
|
Professional
|
$27.65
|
|
|
Service Code
|
HCPCS 73140 26
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$123.06 |
| Rate for Payer: Cash Price |
$7.52
|
| Rate for Payer: Cash Price |
$7.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.50
|
| Rate for Payer: Healthfirst QHP |
$7.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$5.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$7.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$6.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$5.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.74
|
| Rate for Payer: SOMOS Essential |
$20.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.90
|
|
|
CHG RADEX FINGR MINIMUM 2 VIEWS
|
Professional
|
$136.43
|
|
|
Service Code
|
HCPCS 73140 TC
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$123.06 |
| Rate for Payer: Cash Price |
$37.56
|
| Rate for Payer: Cash Price |
$37.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.03
|
| Rate for Payer: Healthfirst QHP |
$38.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$102.32
|
| Rate for Payer: SOMOS Essential |
$102.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.98
|
|
|
CHG RADEX FINGR MINIMUM 2 VIEWS
|
Professional
|
$164.08
|
|
|
Service Code
|
HCPCS 73140
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$123.06 |
| Rate for Payer: Cash Price |
$45.08
|
| Rate for Payer: Cash Price |
$45.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$42.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$44.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$44.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.54
|
| Rate for Payer: Healthfirst QHP |
$46.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$46.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$123.06
|
| Rate for Payer: SOMOS Essential |
$123.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.88
|
|
|
CHG RADEX FOOT COMPLETE MINIMUM 3 VIEWS
|
Professional
|
$114.87
|
|
|
Service Code
|
HCPCS 73630 TC
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$110.65 |
| Rate for Payer: Cash Price |
$31.27
|
| Rate for Payer: Cash Price |
$31.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.18
|
| Rate for Payer: Healthfirst QHP |
$32.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$86.15
|
| Rate for Payer: SOMOS Essential |
$86.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.82
|
|
|
CHG RADEX FOOT COMPLETE MINIMUM 3 VIEWS
|
Professional
|
$147.53
|
|
|
Service Code
|
HCPCS 73630
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$110.65 |
| Rate for Payer: Cash Price |
$40.19
|
| Rate for Payer: Cash Price |
$40.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$42.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$40.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.04
|
| Rate for Payer: Healthfirst QHP |
$42.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$42.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$35.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$42.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$110.65
|
| Rate for Payer: SOMOS Essential |
$110.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.15
|
|
|
CHG RADEX FOOT COMPLETE MINIMUM 3 VIEWS
|
Professional
|
$32.66
|
|
|
Service Code
|
HCPCS 73630 26
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$110.65 |
| Rate for Payer: Cash Price |
$8.91
|
| Rate for Payer: Cash Price |
$8.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.86
|
| Rate for Payer: Healthfirst QHP |
$9.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.50
|
| Rate for Payer: SOMOS Essential |
$24.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.33
|
|
|
CHG RADEX FOREARM 2 VIEWS
|
Professional
|
$94.75
|
|
|
Service Code
|
HCPCS 73090 TC
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$94.60 |
| Rate for Payer: Cash Price |
$25.77
|
| Rate for Payer: Cash Price |
$25.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.72
|
| Rate for Payer: Healthfirst QHP |
$27.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$27.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$71.06
|
| Rate for Payer: SOMOS Essential |
$71.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.07
|
|
|
CHG RADEX FOREARM 2 VIEWS
|
Professional
|
$126.14
|
|
|
Service Code
|
HCPCS 73090
|
| Min. Negotiated Rate |
$6.28 |
| 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 FOREARM 2 VIEWS
|
Professional
|
$31.40
|
|
|
Service Code
|
HCPCS 73090 26
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$94.60 |
| 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 FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD
|
Professional
|
$35.35
|
|
|
Service Code
|
HCPCS 76010 26
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$96.47 |
| Rate for Payer: Cash Price |
$9.26
|
| Rate for Payer: Cash Price |
$9.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.60
|
| Rate for Payer: Healthfirst QHP |
$10.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$7.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$10.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.51
|
| Rate for Payer: SOMOS Essential |
$26.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.10
|
|
|
CHG RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD
|
Professional
|
$128.63
|
|
|
Service Code
|
HCPCS 76010
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$96.47 |
| Rate for Payer: Cash Price |
$34.25
|
| Rate for Payer: Cash Price |
$34.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.91
|
| Rate for Payer: Healthfirst QHP |
$36.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$36.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$31.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$96.47
|
| Rate for Payer: SOMOS Essential |
$96.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.75
|
|
|
CHG RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD
|
Professional
|
$93.31
|
|
|
Service Code
|
HCPCS 76010 TC
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$96.47 |
| Rate for Payer: Cash Price |
$24.99
|
| Rate for Payer: Cash Price |
$24.99
|
| 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 HAND 2 VIEWS
|
Professional
|
$32.83
|
|
|
Service Code
|
HCPCS 73120 26
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$101.06 |
| 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 HAND 2 VIEWS
|
Professional
|
$134.75
|
|
|
Service Code
|
HCPCS 73120
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$101.06 |
| Rate for Payer: Cash Price |
$37.09
|
| Rate for Payer: Cash Price |
$37.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.58
|
| Rate for Payer: Healthfirst QHP |
$38.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$101.06
|
| Rate for Payer: SOMOS Essential |
$101.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.50
|
|
|
CHG RADEX HAND 2 VIEWS
|
Professional
|
$101.92
|
|
|
Service Code
|
HCPCS 73120 TC
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$101.06 |
| Rate for Payer: Cash Price |
$28.13
|
| Rate for Payer: Cash Price |
$28.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.66
|
| Rate for Payer: Healthfirst QHP |
$29.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$76.44
|
| Rate for Payer: SOMOS Essential |
$76.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.12
|
|
|
CHG RADEX HAND MINIMUM 3 VIEWS
|
Professional
|
$159.01
|
|
|
Service Code
|
HCPCS 73130
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$119.26 |
| Rate for Payer: Cash Price |
$43.72
|
| Rate for Payer: Cash Price |
$43.72
|
| 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
|
|
