|
CHG RADEX HAND MINIMUM 3 VIEWS
|
Professional
|
$124.92
|
|
|
Service Code
|
HCPCS 73130 TC
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$119.26 |
| Rate for Payer: Cash Price |
$34.42
|
| Rate for Payer: Cash Price |
$34.42
|
| 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 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
|
|
|
CHG RADEX HIP ARTHROGRAPHY RS&I
|
Professional
|
$114.52
|
|
|
Service Code
|
HCPCS 73525 26
|
| Min. Negotiated Rate |
$22.90 |
| Max. Negotiated Rate |
$421.08 |
| Rate for Payer: Cash Price |
$31.78
|
| Rate for Payer: Cash Price |
$31.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.08
|
| Rate for Payer: Healthfirst QHP |
$32.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$85.89
|
| Rate for Payer: SOMOS Essential |
$85.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.72
|
|
|
CHG RADEX HIP ARTHROGRAPHY RS&I
|
Professional
|
$446.92
|
|
|
Service Code
|
HCPCS 73525 TC
|
| Min. Negotiated Rate |
$22.90 |
| Max. Negotiated Rate |
$421.08 |
| Rate for Payer: Cash Price |
$119.29
|
| Rate for Payer: Cash Price |
$119.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$114.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$114.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$121.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$121.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$127.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$95.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$121.31
|
| Rate for Payer: Healthfirst QHP |
$127.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$89.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$127.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$108.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$89.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$335.19
|
| Rate for Payer: SOMOS Essential |
$335.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.69
|
|
|
CHG RADEX HIP ARTHROGRAPHY RS&I
|
Professional
|
$561.44
|
|
|
Service Code
|
HCPCS 73525
|
| Min. Negotiated Rate |
$22.90 |
| Max. Negotiated Rate |
$421.08 |
| Rate for Payer: Cash Price |
$151.07
|
| Rate for Payer: Cash Price |
$151.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$144.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$144.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$152.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$160.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$152.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$160.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$160.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$120.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$152.39
|
| Rate for Payer: Healthfirst QHP |
$160.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$112.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$160.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$136.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$112.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$160.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$421.08
|
| Rate for Payer: SOMOS Essential |
$421.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$160.41
|
|
|
CHG RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS
|
Professional
|
$176.79
|
|
|
Service Code
|
HCPCS 73521
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$132.59 |
| Rate for Payer: Cash Price |
$48.22
|
| Rate for Payer: Cash Price |
$48.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$45.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$45.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$47.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$50.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$47.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$37.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.98
|
| Rate for Payer: Healthfirst QHP |
$50.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$35.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$50.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$42.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$35.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$50.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$132.59
|
| Rate for Payer: SOMOS Essential |
$132.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.51
|
|
|
CHG RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS
|
Professional
|
$133.56
|
|
|
Service Code
|
HCPCS 73521 TC
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$132.59 |
| Rate for Payer: Cash Price |
$36.38
|
| Rate for Payer: Cash Price |
$36.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.25
|
| Rate for Payer: Healthfirst QHP |
$38.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$100.17
|
| Rate for Payer: SOMOS Essential |
$100.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.16
|
|
|
CHG RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS
|
Professional
|
$43.23
|
|
|
Service Code
|
HCPCS 73521 26
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$132.59 |
| Rate for Payer: Cash Price |
$11.83
|
| Rate for Payer: Cash Price |
$11.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.73
|
| Rate for Payer: Healthfirst QHP |
$12.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$12.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$10.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.42
|
| Rate for Payer: SOMOS Essential |
$32.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.35
|
|
|
CHG RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS
|
Professional
|
$172.38
|
|
|
Service Code
|
HCPCS 73522 TC
|
| Min. Negotiated Rate |
$11.26 |
| Max. Negotiated Rate |
$171.50 |
| Rate for Payer: Cash Price |
$47.38
|
| Rate for Payer: Cash Price |
$47.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$44.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$44.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$46.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$49.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$46.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.79
|
| Rate for Payer: Healthfirst QHP |
$49.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$49.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$49.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$129.28
|
| Rate for Payer: SOMOS Essential |
$129.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$49.25
|
|
|
CHG RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS
|
Professional
|
$228.66
|
|
|
Service Code
|
HCPCS 73522
|
| Min. Negotiated Rate |
$11.26 |
| Max. Negotiated Rate |
$171.50 |
| Rate for Payer: Cash Price |
$62.84
|
| Rate for Payer: Cash Price |
$62.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$58.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$65.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$49.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.06
|
| Rate for Payer: Healthfirst QHP |
$65.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$65.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$55.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$65.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$171.50
|
| Rate for Payer: SOMOS Essential |
$171.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.33
|
|
|
CHG RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS
|
Professional
|
$56.32
|
|
|
Service Code
|
HCPCS 73522 26
|
| Min. Negotiated Rate |
$11.26 |
| Max. Negotiated Rate |
$171.50 |
| Rate for Payer: Cash Price |
$15.45
|
| Rate for Payer: Cash Price |
$15.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.29
|
| Rate for Payer: Healthfirst QHP |
$16.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$13.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$42.24
|
| Rate for Payer: SOMOS Essential |
$42.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.09
|
|
|
CHG RADEX HIPS BILATERAL WITH PELVIS MINIMUM 5 VIEWS
|
Professional
|
$203.98
|
|
|
Service Code
|
HCPCS 73523 TC
|
| Min. Negotiated Rate |
$12.31 |
| Max. Negotiated Rate |
$199.16 |
| Rate for Payer: Cash Price |
$55.64
|
| Rate for Payer: Cash Price |
$55.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$52.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$52.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$55.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$58.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$55.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$58.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$58.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$55.37
|
| Rate for Payer: Healthfirst QHP |
$58.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$40.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$58.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$49.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$40.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$58.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$152.98
|
| Rate for Payer: SOMOS Essential |
$152.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$58.28
|
|
|
CHG RADEX HIPS BILATERAL WITH PELVIS MINIMUM 5 VIEWS
|
Professional
|
$61.57
|
|
|
Service Code
|
HCPCS 73523 26
|
| Min. Negotiated Rate |
$12.31 |
| Max. Negotiated Rate |
$199.16 |
| 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 HIPS BILATERAL WITH PELVIS MINIMUM 5 VIEWS
|
Professional
|
$265.55
|
|
|
Service Code
|
HCPCS 73523
|
| Min. Negotiated Rate |
$12.31 |
| Max. Negotiated Rate |
$199.16 |
| Rate for Payer: Cash Price |
$72.41
|
| Rate for Payer: Cash Price |
$72.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$68.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$68.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$72.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$75.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$72.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$56.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$72.08
|
| Rate for Payer: Healthfirst QHP |
$75.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$53.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$75.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$64.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$53.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$75.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$199.16
|
| Rate for Payer: SOMOS Essential |
$199.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$75.87
|
|
|
CHG RADEX HIP UNILATERAL WITH PELVIS 1 VIEW
|
Professional
|
$36.79
|
|
|
Service Code
|
HCPCS 73501 26
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$106.18 |
| Rate for Payer: Cash Price |
$10.05
|
| Rate for Payer: Cash Price |
$10.05
|
| 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 HIP UNILATERAL WITH PELVIS 1 VIEW
|
Professional
|
$104.79
|
|
|
Service Code
|
HCPCS 73501 TC
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$106.18 |
| Rate for Payer: Cash Price |
$28.52
|
| Rate for Payer: Cash Price |
$28.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$28.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.44
|
| Rate for Payer: Healthfirst QHP |
$29.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$25.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$78.59
|
| Rate for Payer: SOMOS Essential |
$78.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.94
|
|
|
CHG RADEX HIP UNILATERAL WITH PELVIS 1 VIEW
|
Professional
|
$141.58
|
|
|
Service Code
|
HCPCS 73501
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$106.18 |
| Rate for Payer: Cash Price |
$38.57
|
| Rate for Payer: Cash Price |
$38.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.43
|
| Rate for Payer: Healthfirst QHP |
$40.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$40.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$106.18
|
| Rate for Payer: SOMOS Essential |
$106.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.45
|
|
|
CHG RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS
|
Professional
|
$201.22
|
|
|
Service Code
|
HCPCS 73502
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$150.92 |
| Rate for Payer: Cash Price |
$55.68
|
| Rate for Payer: Cash Price |
$55.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$51.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$51.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$54.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$57.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$54.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$54.62
|
| Rate for Payer: Healthfirst QHP |
$57.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$40.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$57.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$48.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$40.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$57.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$150.92
|
| Rate for Payer: SOMOS Essential |
$150.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$57.49
|
|
|
CHG RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS
|
Professional
|
$43.23
|
|
|
Service Code
|
HCPCS 73502 26
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$150.92 |
| Rate for Payer: Cash Price |
$11.83
|
| Rate for Payer: Cash Price |
$11.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.73
|
| Rate for Payer: Healthfirst QHP |
$12.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$12.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$10.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.42
|
| Rate for Payer: SOMOS Essential |
$32.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.35
|
|
|
CHG RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS
|
Professional
|
$157.99
|
|
|
Service Code
|
HCPCS 73502 TC
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$150.92 |
| Rate for Payer: Cash Price |
$43.85
|
| Rate for Payer: Cash Price |
$43.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$45.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42.88
|
| Rate for Payer: Healthfirst QHP |
$45.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$45.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$38.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$118.49
|
| Rate for Payer: SOMOS Essential |
$118.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.14
|
|
|
CHG RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS
|
Professional
|
$201.11
|
|
|
Service Code
|
HCPCS 73503 TC
|
| Min. Negotiated Rate |
$10.47 |
| Max. Negotiated Rate |
$190.10 |
| Rate for Payer: Cash Price |
$55.64
|
| Rate for Payer: Cash Price |
$55.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$51.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$51.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$54.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$57.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$54.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$54.59
|
| Rate for Payer: Healthfirst QHP |
$57.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$40.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$57.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$48.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$40.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$57.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$150.83
|
| Rate for Payer: SOMOS Essential |
$150.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$57.46
|
|
|
CHG RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS
|
Professional
|
$52.36
|
|
|
Service Code
|
HCPCS 73503 26
|
| Min. Negotiated Rate |
$10.47 |
| Max. Negotiated Rate |
$190.10 |
| Rate for Payer: Cash Price |
$14.36
|
| Rate for Payer: Cash Price |
$14.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.21
|
| Rate for Payer: Healthfirst QHP |
$14.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$10.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$14.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$12.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.27
|
| Rate for Payer: SOMOS Essential |
$39.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.96
|
|
|
CHG RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS
|
Professional
|
$253.47
|
|
|
Service Code
|
HCPCS 73503
|
| Min. Negotiated Rate |
$10.47 |
| Max. Negotiated Rate |
$190.10 |
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$65.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$68.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$68.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$68.80
|
| Rate for Payer: Healthfirst QHP |
$72.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$50.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$72.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$61.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$50.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$190.10
|
| Rate for Payer: SOMOS Essential |
$190.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.42
|
|
|
CHG RADEX HUMERUS MINIMUM 2 VIEWS
|
Professional
|
$139.09
|
|
|
Service Code
|
HCPCS 73060
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$104.32 |
| Rate for Payer: Cash Price |
$37.48
|
| Rate for Payer: Cash Price |
$37.48
|
| 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 HUMERUS MINIMUM 2 VIEWS
|
Professional
|
$106.23
|
|
|
Service Code
|
HCPCS 73060 TC
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$104.32 |
| Rate for Payer: Cash Price |
$28.92
|
| Rate for Payer: Cash Price |
$28.92
|
| 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
|
|
